Is the neighborhood food environment associated with dietary patterns in middle income countries? Data Analyzes from ELSA-Brasil Study

Background: Perceived measures of availability / accessibility of healthy food in neighborhood have been pointed up as consistently related to multiple healthy dietary outcomes in developed countries. The food environment and... [ view full abstract ]

Background: Perceived measures of availability / accessibility of healthy food in neighborhood have been pointed up as consistently related to multiple healthy dietary outcomes in developed countries. The food environment and it’s relationship with diet and health are scarcely studied in low and middle income countries.
Objective: To analyze the association between the perception of availability of healthy food in neighborhood and dietary patterns of Brazilian workers and to investigate if this association is different across urbanization level of the city.
Methods: We evaluated 11,462 participants at the baseline (2008-2010) of the Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort of civil servants between 35 and 74 years old conducted in six capitals in Brazil. The neighborhood average perception of healthy food availability was calculated using an adapted self-reported scale answered by participants who lived in the same neighborhood. The neighborhoods were created using spatial aggregation based on SKATER (‘Spatial Kluster Analysis by Tree Edge Removal’). Three food patterns were identified using principal components analyses and a standardized individual score was estimated for “Fruits and Vegetables” and “Traditional and refined foods” patterns. Linear Models were estimated using R.
Results: After age, sex, education, income and marital status adjustment, a direct association was observed between availability of healthy food and fruit and vegetable dietary pattern, and it was stronger in the more urban (β=0.046; p-value: 0.003) versus less urban cities (β=0.020; p-value: 0.128). An inverse association was detected between the healthiest food environment and “Traditional and refined foods” pattern but there is no difference across the cities.
Conclusion: These results suggest some similarities with previous results found in developed countries and suggest some effect modification by urbanization level in a middle income country.