The retail food environment and the cardiometabolic health of Canadians

Diet is among the most important modifiable risk factors for morbidity and mortality worldwide, primarily through the development of cardiometabolic disease. Most Canadians have a suboptimal diet, which poses a considerable health burden on the population, given the importance of dietary quality to disease prevention and management. Poor diet at the population-level likely reflects responses to the food environment that individuals are exposed to. The retail food environment is a component of the built environment that can be modified to contribute to improvements in the health of Canadians at the population level. The overarching hypothesis of the thesis is that less favourable neighbourhood retail food environments will be associated higher prevalence of overweight and obesity (as measured by Body Mass Index or BMI higher body weight), larger waist circumferences (WC) and higher rates of hypertension in the Canadian adult population. Less favourable neighbourhood food environments are characterized by an overabundance of less healthy food stores or a scarcity of healthier food stores. Work to address the overarching hypothesis unfolded over five thesis objectives:1)To systematically review the Canadian literature on associations between neighbourhood food environments, diet and BMI;2)To develop and validate the first pan-Canadian dataset (Can-FED) of neighbourhood food environment measures that are publicly shareable and made using the Statistics Canada Business Register;3)To investigate population-level associations between Can-FED measures, measured BMI and WC of adult participants from the Canadian Health Measures Survey (CHMS);4)To investigate population-level associations between Can-FED measures and hypertension of adult participants from the Canadian Health Measures Survey (CHMS);5)To systematically observe and describe how local food environments have changed in Montreal over the course of the thesis The systematic review (chapter 4) found little evidence of a food environment–diet quality relationship and modest evidence of a food environment–BMI relationship. Chapter 5 was devoted to the development and validation of two versions of Can-FED using a gold standard database of businesses – the Statistics Canada Business Register. These datasets are the first publicly shareable pan-Canadian measures of neighbourhood food environments. Agreement between Can-FED food environment measures and those derived from a proprietary dataset and a municipal health inspection list ranged from rs=0.28 for convenience store density and rs=0.53 for restaurant density. Using the Can-FED measures, I demonstrated that a one standard deviation (SD) increase in the percentage of restaurants that are fast-food was positively associated with BMI and WC for men (BMI: β= 1.49%, 95% CI, 0.37% to 2.61%; WC: β =0.85%, 95% CI, 0.14% to 1.56%) in fully adjusted models, but associations did not reach statistical significance for women. I also demonstrated that a one SD increase in the proportion of fast-food outlets relative to the sum of fast-food outlets and restaurants was associated with higher odds of measured hypertension in the full sample (OR=1.17, 95% CI 1.05 to 1.31) and in sex-specific models (women: OR=1.14, 95% CI 1.01 to 1.29; and men: OR=1.21, 95% CI 1.03 to 1.43). In Montreal, there was wide variation in the characteristics of the retail food environments across five neighbourhoods; however, there was no clear patterning in the characteristics of the food environment by neighbourhood marginalization. I also showed that measures of the food environment are relatively stable over a three-year year period

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