Background and objectives: Over the past two decades, food environment has changed, and the obesity and overweight rates have increased dramatically in China. Previous studies have suggested an association between food environment and obesity, while most studies were based on the data from developed countries, and few were conducted in developing countries.
Methods and study design: The current study evaluated the influence of food establishments (distance to and types of grocery store, free market, restaurant, and food stall) on body mass index (BMI) in 348 children aged 6-17 years, surveyed in the 2009 and 2011 China Health and Nutrition Survey in nine provinces. Food establishments were assessed using geographic information system (GIS) data. Weight and height of children were directly measured.
Results: Our longitudinal analysis suggested boys in the 2nd quartile of the proximity to the nearest grocery store had higher BMI (by 1.6 kg/m2, 95% CI, 0.07 to 3.24) as compared to those in the 1st quartile, while girls in higher quartiles had lower BMI (-1.78 kg/m2, 95% CI: -3.38 to - 0.18, 2nd quartile; -1.62 kg/m2, 95%: -3.22 to -0.01, 3rd quartile) as compared to those in the 1st quartile. Boys and girls in the 2nd quartile of the proximity to the nearest Chinese restaurant had lower BMI (-1.69 kg/m2, 95% CI: - 3.27 to -0.12; -1.76 kg/m2, 95% CI: -3.26, -0.27, respectively) as compared to those in the 1st quartile.
Conclusions: Food environment may affect children's BMI in China, while the association is inconsistent with previous studies. Further research is needed.
背景与目的：近二十年来，中国居民的食物环境发生了巨大变化，超重和肥 胖率也显著上升。既往研究提示肥胖率上升与食物环境变化之间可能存在一定 的关联，但此类研究多数在发达国家开展，很少在发展中国家开展。方法与 研究设计：本文从队列研究“中国健康与营养调查”中选取了348 名6-17 岁的 儿童青少年作为研究对象，利用2009 年和2011 年两轮调查的身体测量指标及 其他相关社会经济学指标，结合地理信息系统（geographic information system, GIS）采集的儿童青少年所居住家庭至最近的食物购买地点或餐馆的直线距离 数据（包括便利店、自由市场、中式餐馆、及流动食品摊），分析评价了食物 环境变化对中国儿童青少年体质指数的影响。结果：两轮数据的纵向分析结 果显示，与第一分位相比，居住在与最近的便利店距离为第二分位的男生 BMI 显著升高（平均升高1.6 kg/m2，95% CI：0.07, 3.24），而居住在更高分 位的女孩BMI 则显著降低（第二分位降低1.78 kg/m2，95% CI：-3.38, -0.18； 第三分位降低1.62 kg/m2，95%：-3.22, -0.01）。与第一分位相比，居住在与 最近中式餐馆距离为第二分位的男生女生BMI 均显著降低（男生降低1.69 kg/m2，95% CI：-3.27, -0.12; 女生降低1.76 kg/m2，95% CI：-3.26, -0.27）。 结论：食物环境可能影响中国儿童青少年的体质指数，但该作用的具体方向 仍需进一步探究。.