American Journal of Epidemiology Advance Access published online on February 27, 2008
American Journal of Epidemiology, doi:10.1093/aje/kwm394
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Original Contribution |
Associations of the Local Food Environment with Diet Quality—A Comparison of Assessments based on Surveys and Geographic Information Systems
The Multi-Ethnic Study of Atherosclerosis
1 Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
2 Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
Correspondence to Dr. Ana V. Diez Roux, Department of Epidemiology, School of Public Health, University of Michigan, 1214 South University Avenue, 2nd floor, Ann Arbor, MI 48103 (e-mail: adiezrou{at}umich.edu).
Received for publication August 3, 2007. Accepted for publication December 13, 2007.
There is growing interest in understanding how food environments affect diet, but characterizing the food environment is challenging. The authors investigated the relation between global diet measures (an empirically derived "fats and processed meats" (FPM) dietary pattern and the Alternate Healthy Eating Index (AHEI)) and three complementary measures of the local food environment: 1) supermarket density, 2) participant-reported assessments, and 3) aggregated survey responses of independent informants. Data were derived from the baseline examination (2000–2002) of the Multi-Ethnic Study of Atherosclerosis, a US study of adults aged 45–84 years. A healthy diet was defined as scoring in the top or bottom quintile of AHEI or FPM, respectively. The probability of having a healthy diet was modeled by each environment measure using binomial regression. Participants with no supermarkets near their homes were 25–46% less likely to have a healthy diet than those with the most stores, after adjustment for age, sex, race/ethnicity, and socioeconomic indicators: The relative probability of a healthy diet for the lowest store density category versus the highest was 0.75 (95% confidence interval: 0.59, 0.95) for the AHEI and 0.54 (95% confidence interval: 0.42, 0.70) for FPM. Similarly, participants living in areas with the worst-ranked food environments (by participants or informants) were 22–35% less likely to have a healthy diet than those in the best-ranked food environments. Efforts to improve diet may benefit from combining individual and environmental approaches.
diet; food; residence characteristics; social class
Abbreviations: AHEI, Alternate Healthy Eating Index; CI, confidence interval; FPM, fats and processed meats; MESA, Multi-Ethnic Study of Atherosclerosis