Does Adherence to Mediterranean Diet Mediate the Association Between Food Environment and Obesity Among Non-Hispanic Black and White Older US Adults? A Path Analysis. Issue 6 (July 2020)

• Record Type: Journal Article
• Authors: Chen, Meifang; Howard, Virginia; Harrington, Kathy F.; Creger, Thomas; Judd, Suzanne E.; Fontaine, Kevin R.
• Is Part Of: American journal of health promotion. Volume 34:Issue 6(2020)
• Page Start: 652
• Page End: 658
• Publication Date: 2020-07
• Subjects: obesity -- BMI -- dietary pattern -- Mediterranean diet -- food environment -- built environment -- path analysis -- population health -- health disparities -- epidemiology; Health promotion -- Periodicals; Health Promotion; Health promotion; Periodicals; Periodicals; 613.05
• DOI: 10.1177/0890117120905240
• Languages: English
• ISSNs: 0890-1171

Abstract

Purpose: This study aims to test the hypothesis that in addition to a direct effect of food environment on obesity, food environment is indirectly associated with obesity through consuming Mediterranean diet (MD). Design: Cross-sectional secondary data analysis. Setting: Nationwide community-dwelling residency. Sample: A total of 20 897 non-Hispanic black and white adults aged ≥45 years who participated in the REasons for Geographic and Racial Differences in Stroke study and completed baseline assessment during January 2003 and October 2007. Measures: The Modified Retail Food Environment Index (mRFEI; 0-100) was used as food environment indicator. The MD score (0-9) was calculated to indicate the dietary pattern adherence. Body mass index (BMI; kg/m 2 ) was used to estimate obesity. Analysis: Path analysis was used to quantify the pathways between food environment, MD adherence, and obesity. Proper data transformation was made using Box–Cox power transformation to meet certain analysis assumptions. Results: The participants were from 49 states of the United States, with the majority (64.42%) residing in the South. Most of the participants were retired, female, white, married, having less than college graduate education, having annual household income ≤75 000, and having health insurance. The means of mRFEI was 10.92 (standard deviation [SD] = 10.19), MD score was 4.36 (SD = 1.70), and the BMI was 28.96 kg/m 2 (SD = 5.90). Access to healthy food outlets (β = .04, P < .0001) and MD adherence (β = .08, P < .0001) had significant and inverse relationships with BMI, respectively. Mediterranean diet adherence mediated the relationship between food environment and obesity among a subpopulation who had an annual household income of <$75 000 (β = −.02, P = .0391). Conclusion: Population-tailored interventions/policies to modify food environment and promote MD consumption are needed in order to combat the obesity crisis in the United States.