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. 2024 Nov 1;178(11):1172-1182.
doi: 10.1001/jamapediatrics.2024.3459.

Neighborhood Food Access in Early Life and Trajectories of Child Body Mass Index and Obesity

Izzuddin M Aris  1 , Allison J Wu  2 , Pi-I D Lin  1 , Mingyu Zhang  3 , Huma Farid  3 , Monique M Hedderson  4 , Yeyi Zhu  4 , Assiamira Ferrara  4 , Rana F Chehab  4 , Emily S Barrett  5 , Susan Carnell  6 , Carlos A Camargo Jr  7   8   9 , Su H Chu  8 , Hooman Mirzakhani  8 , Rachel S Kelly  8 , Sarah S Comstock  10 , Rita S Strakovsky  11 , Thomas G O'Connor  12 , Jody M Ganiban  13 , Anne L Dunlop  14 , Dana Dabelea  15   16   17 , Carrie V Breton  18 , Theresa M Bastain  18 , Shohreh F Farzan  18 , Christine C Call  19 , Tina Hartert  20   21 , Brittney Snyder  20 , Sara Santarossa  22   23 , Andrea E Cassidy-Bushrow  23   24   25 , T Michael O'Shea  26 , Lacey A McCormack  27   28 , Margaret R Karagas  29 , Cindy T McEvoy  30 , Akram Alshawabkeh  31 , Emily Zimmerman  32 , Rosalind J Wright  33 , Mariel McCann  33 , Robert O Wright  33 , Brent Coull  34 , Ndidiamaka Amutah-Onukagha  35 , Michele R Hacker  3   7 , Tamarra James-Todd  36 , Emily Oken  1 ; ECHO Cohort Consortium
Collaborators, Affiliations

Neighborhood Food Access in Early Life and Trajectories of Child Body Mass Index and Obesity

Izzuddin M Aris et al. JAMA Pediatr. .

Abstract

Importance: Limited access to healthy foods, resulting from residence in neighborhoods with low food access, is a public health concern. The contribution of this exposure in early life to child obesity remains uncertain.

Objective: To examine associations of neighborhood food access during pregnancy or early childhood with child body mass index (BMI) and obesity risk.

Design, setting, and participants: Data from cohorts participating in the US nationwide Environmental Influences on Child Health Outcomes consortium between January 1, 1994, and March 31, 2023, were used. Participant inclusion required a geocoded residential address in pregnancy (mean 32.4 gestational weeks) or early childhood (mean 4.3 years) and information on child BMI.

Exposures: Residence in low-income, low-food access neighborhoods, defined as low-income neighborhoods where the nearest supermarket is more than 0.5 miles for urban areas or more than 10 miles for rural areas.

Main outcomes and measures: BMI z score, obesity (age- and sex-specific BMI ≥95th percentile), and severe obesity (age- and sex-specific BMI ≥120% of the 95th percentile) from age 0 to 15 years.

Results: Of 28 359 children (55 cohorts; 14 657 [51.7%] male and 13 702 [48.3%] female; 590 [2.2%] American Indian, Alaska Native, Native Hawaiian, or Other Pacific Islander; 1430 [5.4%] Asian; 4034 [15.3%] Black; 17 730 [67.2%] White; and 2592 [9.8%] other [unspecified] or more than 1 race; 5754 [20.9%] Hispanic and 21 838 [79.1%] non-Hispanic) with neighborhood food access data, 23.2% resided in low-income, low-food access neighborhoods in pregnancy and 24.4% in early childhood. After adjusting for individual sociodemographic characteristics, residence in low-income, low-food access (vs non-low-income, low-food access) neighborhoods in pregnancy was associated with higher BMI z scores at ages 5 years (β, 0.07; 95% CI, 0.03-0.11), 10 years (β, 0.11; 95% CI, 0.06-0.17), and 15 years (β, 0.16; 95% CI, 0.07-0.24); higher obesity risk at 5 years (risk ratio [RR], 1.37; 95% CI, 1.21-1.55), 10 years (RR, 1.71; 95% CI, 1.37-2.12), and 15 years (RR, 2.08; 95% CI, 1.53-2.83); and higher severe obesity risk at 5 years (RR, 1.21; 95% CI, 0.95-1.53), 10 years (RR, 1.54; 95% CI, 1.20-1.99), and 15 years (RR, 1.92; 95% CI, 1.32-2.80). Findings were similar for residence in low-income, low-food access neighborhoods in early childhood. These associations were robust to alternative definitions of low income and low food access and additional adjustment for prenatal characteristics associated with child obesity.

Conclusions: Residence in low-income, low-food access neighborhoods in early life was associated with higher subsequent child BMI and higher risk of obesity and severe obesity. We encourage future studies to examine whether investments in neighborhood resources to improve food access in early life would prevent child obesity.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Carnell reported grants from Eli Lilly outside the submitted work. Dr Dunlop reported grants from Emory University (to institution) during the conduct of the study. Dr Hartert reported personal fees from American Thoracic Society (co-chair vaccine and immunization initiative), UpToDate Asthma (content author), Parker B. Francis Board of Scientific Advisors (grant review), the National Heart, Lung, and Blood Institute (council member), and Pfizer (data safety monitoring board member) outside the submitted work. Dr Cassidy-Bushrow reported grants from the National Institutes of Health outside the submitted work. Dr Coull reported grants from Apple outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Location of Participating Study Cohorts and Flow Diagram of Analytic Sample
BMI indicates body mass index; ECHO, Environmental Influences on Child Health Outcomes cohort.
Figure 2.
Figure 2.. Child Body Mass Index (BMI) z Score and Probability of BMI ≥95th Percentile by Neighborhood
A, n = 24 957. B, n = 20 175. Adjusted for mother’s age, educational level, and insurance during pregnancy; number of individuals in household; prenatal cigarette smoking; prenatal secondhand smoke exposure; parity; and child’s birth year. LILA indicates low-income, low–food access.
Figure 3.
Figure 3.. Probability of Severe Obesity by Neighborhood
A, n = 24 957. B, n = 20 175. Adjusted for mother’s age, educational level, and insurance during pregnancy; number of individuals in household; prenatal cigarette smoking; prenatal secondhand smoke exposure; parity; and child’s birth year. LILA indicates low-income, low–food access.
Figure 4.
Figure 4.. Child Body Mass Index (BMI) z Score, Probability of BMI ≥95th Percentile, and Severe Obesity by Changes in Residence
In this figure, n = 17 780; 53 cohorts. Adjusted for mother’s age, educational level, and insurance during pregnancy; number of individuals in household; prenatal cigarette smoking; prenatal secondhand smoke exposure; parity; and child’s birth year. LILA indicates low-income, low–food access.
See this image and copyright information in PMC

References

    1. Odoms-Young A, Brown AGM, Agurs-Collins T, Glanz K. Food insecurity, neighborhood food environment, and health disparities: state of the science, research gaps and opportunities. Am J Clin Nutr. 2024;119(3):850-861. doi: 10.1016/j.ajcnut.2023.12.019 - DOI - PMC - PubMed
    1. Wolfson JA, Leung CW. Food insecurity in the COVID-19 era: a national wake-up call to strengthen SNAP policy. Ann Intern Med. 2024;177(2):255-256. doi: 10.7326/M23-3363 - DOI - PubMed
    1. US Department of Agriculture Economic Research Service . Key statistics & graphics. Published 2021. Accessed March 1st, 2023. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-...
    1. Jenssen BP, Kelly MK, Powell M, Bouchelle Z, Mayne SL, Fiks AG. COVID-19 and changes in child obesity. Pediatrics. 2021;147(5):e2021050123. doi: 10.1542/peds.2021-050123 - DOI - PubMed
    1. Wu AJ, Aris IM, Hivert MF, et al. Association of changes in obesity prevalence with the COVID-19 pandemic in youth in Massachusetts. JAMA Pediatr. 2022;176(2):198-201. doi: 10.1001/jamapediatrics.2021.5095 - DOI - PMC - PubMed