Abstract
BackgroundThe food environment has been implicated as an underlying contributor to the global obesity epidemic. However, few studies have evaluated the relationship between the food environment, dietary intake, and overweight/obesity in low- and middle-income countries (LMICs). The aim of this study was to assess the association of full service and fast food restaurant density with dietary intake and overweight/obesity in Delhi, India.MethodsData are from a cross-sectional, population-based study conducted in Delhi. Using multilevel cluster random sampling, 5364 participants were selected from 134 census enumeration blocks (CEBs). Geographic information system data were available for 131 CEBs (n = 5264) from a field survey conducted using hand-held global positioning system devices. The number of full service and fast food restaurants within a 1-km buffer of CEBs was recorded by trained staff using ArcGIS software, and participants were assigned to tertiles of full service and fast food restaurant density based on their resident CEB. Height and weight were measured using standardized procedures and overweight/obesity was defined as a BMI ≥25 kg/m2.ResultsThe most common full service and fast food restaurants were Indian savory restaurants (57.2%) and Indian sweet shops (25.8%). Only 14.1% of full service and fast food restaurants were Western style. After adjustment for age, household income, education, and tobacco and alcohol use, participants in the highest tertile of full service and fast food restaurant density were less likely to consume fruit and more likely to consume refined grains compared to participants in the lowest tertile (both p < 0.05). In unadjusted logistic regression models, participants in the highest versus lowest tertile of full service and fast food restaurant density were significantly more likely to be overweight/obese: odds ratio (95% confidence interval), 1.44 (1.24, 1.67). After adjustment for age, household income, and education, the effect was attenuated: 1.08 (0.92, 1.26). Results were consistent with further adjustment for tobacco and alcohol use, moderate physical activity, and owning a bicycle or motorized vehicle.ConclusionsMost full service and fast food restaurants were Indian, suggesting that the nutrition transition in this megacity may be better characterized by the large number of unhealthy Indian food outlets rather than the Western food outlets. Full service and fast food restaurant density in the residence area of adults in Delhi, India, was associated with poor dietary intake. It was also positively associated with overweight/obesity, but this was largely explained by socioeconomic status. Further research is needed exploring these associations prospectively and in other LMICs.
Highlights
The food environment has been implicated as an underlying contributor to the global obesity epidemic
The median household wealth index was calculated for each Census enumeration block (CEB) and CEBs were categorized into tertiles based on these values. In addition to this Chi-square test, we present descriptive statistics for the mean (SD) body mass index (BMI) of participants in each cell of the 3 × 3 table of CEB full service and fast food restaurant density tertile by CEB median household wealth index tertile
Together with the observation that these participants consumed refined grains more frequently, these results suggest that higher full service and fast food restaurant density may be associated with poor dietary intake in Delhi
Summary
The food environment has been implicated as an underlying contributor to the global obesity epidemic. Few studies have evaluated the relationship between the food environment, dietary intake, and overweight/ obesity in low- and middle-income countries (LMICs). The aim of this study was to assess the association of full service and fast food restaurant density with dietary intake and overweight/obesity in Delhi, India. The presence of full service and fast food restaurants (the latter including both self-service and carry-out venues) may lead to weight gain [7, 8] by providing large portions of high-energy foods with low nutrient density [9, 10]. Few studies have quantified the association between the presence of restaurants and dietary intake in low- and middle-income countries (LMICs). No studies in LMICs have evaluated restaurant density in association with more comprehensive measures of dietary intake
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.