An estimated 19 million people in the United States live in so-called food deserts, which have less access to healthy, nutritious food. More than 32 million people live below the poverty line – limiting their choices to the cheapest food regardless of their proximity to potentially healthy options. Meanwhile, several studies have pointed to the role of diet in early mortality and the development of chronic diseases such as heart disease, type 2 diabetes, and cancer.
Researchers are just beginning to understand how the complex interaction between individual and societal characteristics affects diet and health. A multidisciplinary team of researchers from the University of Washington and Stanford University recently completed the largest nationwide study to date conducted in the United States on the relationship between food environment, demographics and nutritional health with the help of the popular smartphone-based food diary application. The results of this five-year effort were published on January 18 in Nature Communications, should give scientists, health care practitioners, and policy makers plenty of food to think about.
“Our findings suggest that greater access to groceries, lower access to fast food, and higher income and college education are independently associated with higher consumption of fresh fruits and vegetables, lower consumption of fast food and soft drinks, and a reduced likelihood of being classified as overweight. Or suffer of obesity,” explained lead author Tim Altoff, associate professor at the University of Washington in the Paul G. Allen School of Computer Science and Engineering.
“While these results may not have come as a surprise,” Althoff continued, “our ability to measure the relationship between environment, socioeconomic factors and diet has been challenged by small sample sizes, individual sites, and non-standardized design across studies.” Different from traditional epidemiological studies, our quasi-experimental methodology enabled us to explore the effect on a national scale and to identify the factors that matter most. “
The study, which began when Althoff was a doctoral student at Stanford University, analyzed data from more than 1.1 million users of the MyFitnessPal app — covering nearly 2.3 billion food entries and including more than 9,800 US postal codes — to gain insight into how factors such as access to Grocery stores, fast food, household income level, educational attainment in people’s food consumption and general nutritional health.
The team measured the association of these variables, from data available by zip code, with each of the four self-reported dietary outcomes reported between 2010 and 2016: consumption of fresh fruit and vegetables, consumption of fast food, consumption of soft drinks, and incidence of being overweight or obese. . Classified by body mass index.
To understand how each variable positively or negatively correlated with those outcomes, the researchers used a matching-based approach in which they divided the available ZIP codes into treatment and control groups, and divided by the median length for each entry. This enabled them to compare app users’ records in zip codes that were statistically above average — for example, those with more than 20.3% of the population living within half a mile of the nearest grocery store — with those that were below average.
Of the four inputs the team examined, above-average educational attainment, defined as 29.8% or more of the population with a college degree, was the largest positive predictor of a healthy diet and body mass index. All four inputs contributed positively to diet outcomes, with one exception: Higher household income, defined as income of $70,241 or more, was associated with a marginally higher percentage of people with an increased BMI eligible for increased Weight or obesity. But upon further investigation, these findings only scratch the surface of what is a complex issue that varies from community to community.
“When we dig deeper into the data, we discovered that population-level findings mask significant differences in how food environment and socioeconomic factors align with nutritional health across subpopulations,” said co-author Hamid Nilforoshan, a doctoral student at Stanford.
For example, Nillforshan cited a significantly higher association between above-average grocery store access and increased fruit and vegetable consumption in ZIP codes with the majority of the black population, at a difference of 10.2%, and with the majority of the Hispanic population, at a difference of 7.4%, compared to the ZIP Codes. postal mail with a majority of the non-Hispanic white population, with researchers finding only a 1.7% difference in the association between increased fruit and vegetable consumption and access to grocery stores.
“People are assuming that if we remove food deserts, it will automatically lead to healthy eating, and that higher incomes and a higher score lead to a higher quality diet. These assumptions are already corroborated by population-wide data,” said co-author Jenna Hua, a former colleague of the Post-doctoral at Stanford University School of Medicine and founder and CEO of Million Marker Wellness, Inc.” But if you slice the data, you’ll notice that the effects can vary greatly depending on the community’s diet—a complex issue!”
“While policies aimed at improving food access, economic opportunities and education can support healthy eating, our findings strongly suggest that we need to tailor interventions to communities rather than a one-size-fits-all approach,” Hua continued.
Altov said the team’s approach and findings could guide future research on this complex topic that has implications for both individuals and entire societies.
“We hope that this study will influence public health and epidemiological research methods as well as policy research,” said Altov, who is also director of the Behavioral Data Science Group. “With regard to the former, we have shown that the growing and diverse volume of consumer-reported health data available due to mobile devices and applications can be leveraged in public health research at an unprecedented scale and detail. For the latter, we see many opportunities for future research to investigate the mechanisms driving relationships Divergent dietary intake across subpopulations in the United States.
Gore Leskovic, assistant professor at Stanford University, is the first author of this paper.
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Tim Altoff, Widespread Diet Tracking Data Revealing Contrasting Associations Between Food Environment and Diet, Nature Communications (2022). DOI: 10.1038/s41467-021-27522-y. www.nature.com/articles/s41467-021-27522-y
Presented by the University of Washington
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