Short ReportFood environment, walkability, and public open spaces are associated with incident development of cardio-metabolic risk factors in a biomedical cohort
Introduction
A number of studies have now reported on the associations between built environmental attributes, such as urban form and access to healthful food and physical activity resources, and risk factors for cardio-metabolic diseases (Leal and Chaix, 2011, Feng et al., 2010). This body of research has been criticised on the basis of substantial heterogeneity across studies in the way built environmental features are operationalised, focusing on a single environmental attribute in isolation from other potentially correlated features, and the lack of longitudinal evidence (Leal and Chaix, 2011, Feng et al., 2010, Daniel et al., 2008). In addition, the majority of studies have focused on body mass index (BMI) or obesity as a sole marker of cardio-metabolic risk (Leal and Chaix, 2011). Although cardio-metabolic risk factors such as (central) obesity, impaired glycaemia, hypertension and dyslipidaemia tend to cluster and collectively define the metabolic syndrome, they represent distinct risk components under the control of convergent but distinct biological pathways and vary in their ability to predict the onset of type 2 diabetes and cardiovascular diseases (Sattar et al., 2008). These risk components also respond differentially to behavioural interventions, most likely reflecting behavioural specificity of biological conditioning, such as that demonstrated for physical activity (Boulé et al., 2001). It is therefore possible that these distinct risk components are differentially influenced by specific built environmental features that would theoretically promote either physical activity or healthful eating. The aim of the present study was to test this hypothesis by investigating whether residential built environment attributes related to food, public open space (POS), and walkability differed in their capacity to predict incident development of a range of cardio-metabolic risk factors.
Section snippets
Methods
This study is part of the Place and Metabolic Syndrome project which investigates associations between built environment attributes and cardio-metabolic risk factors. The study draws on the first two waves of data collection of the North West Adelaide Health Study (NWAHS), a longitudinal biomedical cohort with three waves of data collected over ten years. Adults aged 18 years and over from the northern and western metropolitan regions of Adelaide, South Australia, were randomly selected at
Results
A total of 3145 participants had a complete geo-referenced record, covariate information and clinical data at baseline and follow-up. The mean follow up period was 3.5 years (SD: 1.1). Socio-demographic and clinical baseline characteristics of the sample are presented in Table 1, Table 2 Incidence rates were 24.7% for pre-diabetes/diabetes, 24.7% for hypertension, 21.7% dyslipidaemia, and 26.4% for abdominal obesity.
Incident abdominal obesity was associated with the relative unhealthfulness of
Discussion
Results suggest that built environmental attributes promoting an active lifestyle or hindering a healthful diet are differentially related to the incidence of cardio-metabolic risk factors such as impaired glucose metabolism and central obesity. These results likely indicate different mechanisms linking environmental attributes to risk components. POS size and walkability, both theoretically promoting physically active lifestyles, protected against the development of impaired glycaemic
Funding
This research forms part of larger partnership between the Spatial Epidemiology and Evaluation Research Group (SEERG) at the University of South Australia and the South Australian Department for Health and Ageing that aims to link information on cardio-metabolic health with a range of local community characteristics such as availability and accessibility of public transport, fruit and vegetable stores or green space, or poor quality housing, fast food, and crime. This research initiative,
Acknowledgements
This manuscript has been reviewed for scientific content and consistency of data interpretation by Chief Investigators of the North West Adelaide Health Study (NWAHS). We are grateful for the interest and commitment of cohort participants. We appreciate the contributions of research support staff involved in recruitment and clinical follow up.
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