TY - JOUR
T1 - Socioeconomic inequalities in the food environment and body composition among school-aged children
T2 - a fixed-effects analysis
AU - Mölenberg, Famke J. M.
AU - Mackenbach, Joreintje D.
AU - Poelman, Maartje P.
AU - Santos, Susana
AU - Burdorf, Alex
AU - van Lenthe, Frank J.
N1 - Funding Information: The Generation R Study was made possible by financial support from the Erasmus Medical Centre, Erasmus University Rotterdam and The Netherlands Organisation for Health Research and Development, The Netherlands Organisation for Scientific Research, the Ministry of Health, Welfare and Sport and the Ministry of Youth and Families. JDM is funded by an NWO VENI grant on ‘Making the healthy choice easier —role of the local food environment’ (Grant Number 451-17-032). SS is supported by the European Union’s Horizon 2020 research and innovation programme under grant agreement 733206 (LifeCycle Project) and 874583 (ATHLETE Project). Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Background: There is limited evidence regarding socioeconomic inequalities of exposure to the food environment and its contribution to childhood obesity. Methods: We used data from 4235 children from the Generation R Study, a large birth-cohort conducted in the city of Rotterdam, The Netherlands. We included 11,277 person-observations of body mass index (BMI) and 6240 person-observations of DXA-derived fat mass index (FMI) and fat-free mass index (FFMI) when children were between 4 and 14 years. We applied linear regression models to evaluate changes in the relative and absolute exposure of fast-food outlets, and the healthiness of the food environment within 400 m from home by maternal education. Furthermore, we used individual-level fixed-effects models to study changes in the food environment to changes in BMI, FMI and FFMI. Results: Children from lower educated mothers were exposed to more fast-food outlets at any time-point between the age of 4 and 14 years. Over a median period of 7.1 years, the absolute (0.6 fast-food outlet (95% CI: 0.4–0.8)) and relative (2.0%-point (95% CI: 0.7–3.4)) amount of fast-food outlets increased more for children from lower as compared to higher educated mothers. The food environment became more unhealthy over time, but no differences in trends were seen by maternal education level. Changes in the food environment were not associated with subsequent changes in BMI, FMI and FFMI. For children from lower educated mothers not exposed to fast-food at first, we found some evidence that the introduction of fast-food was associated with small increases in BMI. Conclusions: Our findings provide evidence of widening inequalities in exposure to fast-food in an already poor food environment. Access to more fast-food outlets does not seem to have an additional impact on BMI in contemporary contexts with ubiquitous fast-food outlets.
AB - Background: There is limited evidence regarding socioeconomic inequalities of exposure to the food environment and its contribution to childhood obesity. Methods: We used data from 4235 children from the Generation R Study, a large birth-cohort conducted in the city of Rotterdam, The Netherlands. We included 11,277 person-observations of body mass index (BMI) and 6240 person-observations of DXA-derived fat mass index (FMI) and fat-free mass index (FFMI) when children were between 4 and 14 years. We applied linear regression models to evaluate changes in the relative and absolute exposure of fast-food outlets, and the healthiness of the food environment within 400 m from home by maternal education. Furthermore, we used individual-level fixed-effects models to study changes in the food environment to changes in BMI, FMI and FFMI. Results: Children from lower educated mothers were exposed to more fast-food outlets at any time-point between the age of 4 and 14 years. Over a median period of 7.1 years, the absolute (0.6 fast-food outlet (95% CI: 0.4–0.8)) and relative (2.0%-point (95% CI: 0.7–3.4)) amount of fast-food outlets increased more for children from lower as compared to higher educated mothers. The food environment became more unhealthy over time, but no differences in trends were seen by maternal education level. Changes in the food environment were not associated with subsequent changes in BMI, FMI and FFMI. For children from lower educated mothers not exposed to fast-food at first, we found some evidence that the introduction of fast-food was associated with small increases in BMI. Conclusions: Our findings provide evidence of widening inequalities in exposure to fast-food in an already poor food environment. Access to more fast-food outlets does not seem to have an additional impact on BMI in contemporary contexts with ubiquitous fast-food outlets.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85112727770&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/34389801
UR - http://www.scopus.com/inward/record.url?scp=85112727770&partnerID=8YFLogxK
U2 - https://doi.org/10.1038/s41366-021-00934-y
DO - https://doi.org/10.1038/s41366-021-00934-y
M3 - Article
C2 - 34389801
SN - 0307-0565
VL - 45
SP - 2554
EP - 2561
JO - International journal of obesity (2005)
JF - International journal of obesity (2005)
IS - 12
ER -