Should we use absolute or relative measures when assessing foodscape exposure in relation to fruit and vegetable intake? Evidence from a wide-scale Canadian study

Clary, Christelle; Ramos, Yuddy; Shareck, Martine; Kestens, Yan

doi:10.1016/j.ypmed.2014.11.023

Cited by 68 publications

(99 citation statements)

References 33 publications

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“…Changes of sign across the study area when absolute measures are used may therefore partly result from not controlling for the alternate exposure. This finding suggests that greater consideration of relative measures of exposure is required, consistent with mounting evidence of association between relative measures of exposure and various health outcomes in the United States (e.g., using the Retail Food Environment Index (51-53)), Australia (32), and Canada (31,54,55).…”

Section: A) B)supporting

confidence: 55%

“…To address this gap, in the present study, we used GWR models alongside "classical" global models to predict fruit and vegetable intake in relation to the residential food environment. Recent literature has suggested that relative measures (accounting simultaneously for both healthy and unhealthy exposures) may be better correlates of diet than the traditional absolute measures (accounting for either healthy or unhealthy outlets alone) (31,32). Therefore, residential exposure was assessed both as absolute densities of healthy and unhealthy outlets (taken separately) and as a relative measure, as the proportion of total outlets classified as healthy.…”

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confidence: 99%

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The Local Food Environment and Fruit and Vegetable Intake: A Geographically Weighted Regression Approach in the ORiEL Study

Clary¹,

Lewis²,

Flint³

et al. 2016

Am. J. Epidemiol.

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Studies that explore associations between the local food environment and diet routinely use global regression models, which assume that relationships are invariant across space, yet such stationarity assumptions have been little tested. We used global and geographically weighted regression models to explore associations between the residential food environment and fruit and vegetable intake. Analyses were performed in 4 boroughs of London, United Kingdom, using data collected between April 2012 and July 2012 from 969 adults in the Olympic Regeneration in East London Study. Exposures were assessed both as absolute densities of healthy and unhealthy outlets, taken separately, and as a relative measure (proportion of total outlets classified as healthy). Overall, local models performed better than global models (lower Akaike information criterion). Locally estimated coefficients varied across space, regardless of the type of exposure measure, although changes of sign were observed only when absolute measures were used. Despite findings from global models showing significant associations between the relative measure and fruit and vegetable intake (β = 0.022; P < 0.01) only, geographically weighted regression models using absolute measures outperformed models using relative measures. This study suggests that greater attention should be given to nonstationary relationships between the food environment and diet. It further challenges the idea that a single measure of exposure, whether relative or absolute, can reflect the many ways the food environment may shape health behaviors. absolute exposure; fruit and vegetable intake; geographically weighted regression; local food environment; nonstationarity; relative exposure Abbreviations: AICc, corrected Akaike information criterion; GWR, geographically weighted regression; ORiEL, Olympic Regeneration in East London.Over the last decade, an extensive body of research has investigated how the local food environment may be related to dietary behaviors (1). A large majority of studies have used global regression to model the association between exposure to either healthy or unhealthy food environments and diet-related outcomes (2, 3). However, reviews have highlighted the lack of consistency in findings (2, 3), with associations for the same type of relationship being positive (4-10), negative (11), or nonexistent (12-18).By using global regression models, researchers have implicitly relied on the assumption of a stationary relationship; that is, parameter estimates describe what is assumed to be an invariant relationship across space. However, public health researchers have begun to challenge the stationarity assumption. Using spatial regression modeling, such as geographically weighted regression (GWR), a technique that allows for spatial variations in parameter estimates (19,20), investigators have highlighted variations in associations across space between a range of environmental exposures and outcomes such as diet (21), obesity (22-27), active transportation (28), and bi...

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Section: A) B)supporting

confidence: 55%

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confidence: 99%

The Local Food Environment and Fruit and Vegetable Intake: A Geographically Weighted Regression Approach in the ORiEL Study

Clary¹,

Lewis²,

Flint³

et al. 2016

Am. J. Epidemiol.

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“…A growing number of recent reports indicate that relative measures, such as the ratio or proportion of various types of food retail outlets, may be more useful than absolute measures for understanding associations with dietary behaviours and related health outcomes, because they better reflect the balance of available resources. 11,12,14 A recent study from Ontario found a strong relationship between the concentration of fast-food relative to other types of restaurants and obesity in areas with high volumes of fast-food retailers. 11 In light of these findings, the primary aim of this study was to assess whether this exposure accelerates the risk of diabetes.…”

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confidence: 99%

Relative and absolute availability of fast-food restaurants in relation to the development of diabetes: A population-based cohort study

Polsky

Moineddin

Glazier

et al. 2016

Can J Public Health

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OBJECTIVES:To determine whether residents living in areas with a high proportion of fast-food restaurants (FFR) relative to all restaurants are more likely to develop diabetes and whether the risk varies according to the volume of FFR. METHODS:The study cohort consisted of adult respondents (20-84 years) to the Canadian Community Health Survey (cycles 2005, 2007/2008, 2009/2010) who resided within walking distance (720 m) of at least one restaurant in Toronto, Brampton, Mississauga or Hamilton, ON. The development of diabetes was established by linking participants to the Ontario Diabetes Database. Cox proportional hazards models were used to estimate hazard ratios (HRs) of incident diabetes associated with relative and absolute measures of restaurant availability.RESULTS: During a median follow-up of 5 years, 347 of 7,079 participants (4.6%) developed diabetes. Among younger adults (20-65 years, n = 5,806), a greater proportion of fast-food relative to all restaurants was significantly associated with incident diabetes after adjustment for a range of individual and area-level covariates, but only in areas with high volumes of fast-food retailers (3+ outlets) (HR = 1.79, 95% confidence interval: 1.03-3.12, across the interquartile range). Adjusting for body mass index rendered this association non-significant. No significant associations were observed in areas with low volumes of FFR or among older adults (65-84 years, n = 1,273). Absolute availability (number) of fast-food and other restaurants was generally unrelated to incident diabetes. CONCLUSION:Areas with the double burden of a high volume of FFR and few dining alternatives may represent an adverse environment for the development of diabetes.KEY WORDS: Diabetes mellitus; fast food; restaurants; body mass index; cohort studies La traduction du résumé se trouve à la fin de l'article.

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“…Furthermore, because "healthy" and "unhealthy" sources are often spatially correlated in urban areas, relative measures of exposure may be more adapted to tease out effects. 12 A small but growing number of studies have used such metrics to estimate associations with dietrelated outcomes. 8,12,13 Inconsistent findings might also be linked to variations in the dose-response relationship.…”

mentioning

confidence: 99%

“…12 A small but growing number of studies have used such metrics to estimate associations with dietrelated outcomes. 8,12,13 Inconsistent findings might also be linked to variations in the dose-response relationship. Ecological models have long recognized dynamic and complex interactions between individuals and their environments.…”

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confidence: 99%

The food environment and diet quality of urban-dwelling older women and men: Assessing the moderating role of diet knowledge

Mercille

Richard

Gauvin

et al. 2016

Can J Public Health

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OBJECTIVES:The relationships between local food environments and dietary patterns are important for older adults and could be different in men and women. We examined associations between exposure to neighbourhood food sources and food consumption and the moderating role of diet knowledge separately among older women and men living in Montreal in 2003-2005 (n = 722). METHODS:The proportion of fast-food outlets relative to all restaurants (%FFO) and the proportion of healthy food stores relative to all stores (%HFS) were estimated for 500 m buffers around participants' homes. Two dietary patterns, designated "Western" and "prudent", reflecting lower-and higher-quality diets respectively, were identified from food frequency questionnaire data. The unique and interactive effects of diet knowledge and food-source exposure on diet scores were tested with separate linear regression models for women and men. RESULTS:For men, greater %FFO exposure was related to lower prudent diet scores (β = −0.18, p = 0.02), but no effect of %HFS exposure was observed and no interactions were statistically significant. For women, an inverse relationship between %FFO and prudent diet scores was strongest among those with low diet knowledge (β = −0.22, p < 0.01). No other associations were statistically significant.CONCLUSION: Older men's diet patterns may reflect unhealthy cues associated with fast-food outlets. Among women, diet knowledge potentiated both negative and positive relationships with the food environment. In the absence of consistent main effects of the food environment on diet scores, subgroup analysis is a promising avenue for research.KEY WORDS: Diet; older adults; urban population; food supply; effect modifier La traduction du résumé se trouve à la fin de l'article.

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Should we use absolute or relative measures when assessing foodscape exposure in relation to fruit and vegetable intake? Evidence from a wide-scale Canadian study

Cited by 68 publications

References 33 publications

The Local Food Environment and Fruit and Vegetable Intake: A Geographically Weighted Regression Approach in the ORiEL Study

The Local Food Environment and Fruit and Vegetable Intake: A Geographically Weighted Regression Approach in the ORiEL Study

Relative and absolute availability of fast-food restaurants in relation to the development of diabetes: A population-based cohort study

The food environment and diet quality of urban-dwelling older women and men: Assessing the moderating role of diet knowledge

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