Changes in the Retail Food Environment in Mexican Cities and Their Association with Blood Pressure Outcomes.

Marina Armendariz,Gina S Lovasi,Usama Bilal,Ana Basto-Abreu,Carolina Pérez-Ferrer,Tonatiuh Barrientos-Gutiérrez

doi:10.3390/ijerph19031353

Abstract

Shifting food environments in Latin America have potentially contributed to an increase in the consumption of ultra-processed foods and sugar-sweetened beverages, along with decreases in healthy foods, such as fruits and vegetables. Yet, little is known about the impact that such changes in the food environment have on blood pressure in low- and middle-income countries, including Mexico. We utilized individual-level systolic and diastolic blood pressure (SBP and DBP) measures from the 2016 Mexican Health and Nutrition Survey (ENSANUT, n = 2798 adults). Using an inventory of food stores based on the economic census for 2010 and 2016, we calculated the change in the density of fruit and vegetable stores, convenience stores, and supermarkets. Multilevel regression was used to estimate the association between the 2010–2016 food environment neighborhood-level changes with individual-level blood pressure measured in 2016. Declines in neighborhood-level density of fruit and vegetable stores were associated with higher individual SBP (2.67 mmHg, 95% CI: 0.1, 5.2) in unadjusted models, and marginally associated after controlling for individual-level and area-level covariates. Increases in the density of supermarkets were associated with higher blood pressure outcomes among adults with undiagnosed hypertension. Structural interventions targeting the retail food environment could potentially contribute to better nutrition-related health outcomes in Latin American cities.

Highlights

Unhealthy diets have been linked to many chronic health conditions, cardiometabolic diseases such as obesity, diabetes, and cardiovascular disease (CVD) [1].In recent decades, CVD mortality has declined in high-income countries, whereas CVD mortality has increased in low- and middle-income Latin American countries [2]
The following key findings were identified: (1) density declines in fruit and vegetable shops are associated with higher systolic blood pressure (SBP), though the association was attenuated after controlling for area-level covariates; (2) in adjusted models, neighborhood density increases in large supermarkets was associated with higher blood pressure among adults with undiagnosed hypertension
We point to the changing food environment as a potential populationlevel determinant of health, for individuals living in urban neighborhoods

Summary

Introduction

Unhealthy diets have been linked to many chronic health conditions, cardiometabolic diseases such as obesity, diabetes, and cardiovascular disease (CVD) [1].In recent decades, CVD mortality has declined in high-income countries, whereas CVD mortality has increased in low- and middle-income Latin American countries [2]. High blood pressure (hypertension) is one of the most important risk factors for CVD [3], and almost half a million new hypertension diagnoses occur among adults in Mexico every year [4]. 40% of adults with hypertension remain undiagnosed, and 87% of diagnosed cases have uncontrolled blood pressure [4]. Increased prevalence of hypertension has been partially attributed to life-style factors, such as unhealthy diets, physical inactivity, heavy alcohol consumption, and tobacco use [2]. These behavioral factors, in turn, are shaped by the environments in which people live. As the built and food environments in low- and middle-income countries change as a result of globalization and economic development, research shows an increase in major diet-related health problems [2,5]

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Conclusion