Greater access to fast-food outlets is associated with poorer bone health in young children
- 933 Downloads
A healthy diet positively influences childhood bone health, but how the food environment relates to bone development is unknown. Greater neighbourhood access to fast-food outlets was associated with lower bone mass among infants, while greater access to healthy speciality stores was associated with higher bone mass at 4 years.
Identifying factors that contribute to optimal childhood bone development could help pinpoint strategies to improve long-term bone health. A healthy diet positively influences bone health from before birth and during childhood. This study addressed a gap in the literature by examining the relationship between residential neighbourhood food environment and bone mass in infants and children.
One thousand one hundred and seven children participating in the Southampton Women’s Survey, UK, underwent measurement of bone mineral density (BMD) and bone mineral content (BMC) at birth and 4 and/or 6 years by dual-energy X-ray absorptiometry (DXA). Cross-sectional observational data describing food outlets within the boundary of each participant’s neighbourhood were used to derive three measures of the food environment: the counts of fast-food outlets, healthy speciality stores and supermarkets.
Neighbourhood exposure to fast-food outlets was associated with lower BMD in infancy (β = −0.23 (z-score): 95 % CI −0.38, −0.08) and lower BMC after adjustment for bone area and confounding variables (β = −0.17 (z-score): 95 % CI −0.32, −0.02). Increasing neighbourhood exposure to healthy speciality stores was associated with higher BMD at 4 and 6 years (β = 0.16(z-score): 95 % CI 0.00, 0.32 and β = 0.13(z-score): 95 % CI −0.01, 0.26 respectively). The relationship with BMC after adjustment for bone area and confounding variables was statistically significant at 4 years, but not at 6 years.
The neighbourhood food environment that pregnant mothers and young children are exposed may affect bone development during early childhood. If confirmed in future studies, action to reduce access to fast-food outlets could have benefits for childhood development and long-term bone health.
KeywordsDevelopmental modelling DXA Epidemiology General population studies Nutrition
We thank the mothers who gave us their time and the team of dedicated research nurses and ancillary staff for their assistance. We also thank Miss Jamie Lawrence for her assistance ground-truthing the neighbourhood food environment. This work was supported by grants from the Medical Research Council, British Heart Foundation, Arthritis Research UK, Dunhill Medical Trust, Food Standards Agency, National Osteoporosis Society, International Osteoporosis Foundation, NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust and the European Union’s Seventh Framework Programme (FP7/2007-2013), project EarlyNutrition under grant agreement no289346. Christina Vogel was supported by a UK National Institute for Health Research (NIHR) Doctoral Research Fellowship. The views in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health or other funders.
Conflicts of interest
Christina Vogel, Camille Parsons, Sian Robinson and Hazel Inskip have no conflicts of interests to declare. Janis Baird has received grant research support from Danone Nutricia Early Life Nutrition; however, the study in this manuscript is not related to this relationship. Keith Godfrey has received reimbursement for speaking at conferences sponsored by companies selling nutritional products and is part of an academic consortium that has received research funding from Abbott Nutrition, Nestec and Danone. Nicholas Harvey has received consultancy, lecture fees and honoraria from Alliance for Better Bone Health, AMGEN, MSD, Eli Lilly, Servier, Shire, Consilient Healthcare and Internis Pharma. Cyrus Cooper has received consultancy, lecture fees and honoraria from AMGEN, GSK, Alliance for Better Bone Health, MSD, Eli Lilly, Pfizer, Novartis, Servier, Medtronic and Roche.
- 6.Department of Health UK (2010) Healthy lives, healthy people: our strategy for public health in England. LondonGoogle Scholar
- 7.Department of Health UK (2013) Reducing obesity and improving diet. https://www.gov.uk/government/policies/reducing-obesity-and-improving-diet. Accessed 10 June 2013
- 8.US National Institutes of Health (2011) Strategic Plan for NIH Obesity Research. Washington DCGoogle Scholar
- 11.World Health Organisation (2003) Diet, Nutrition and the Prevention of Chronic Disease: Report of a joint WHO/FAO Expert Consultation. WHO Technical Report Series. GenevaGoogle Scholar
- 12.World Health Organisation European Ministerial Conference (2013) Vienna Declaration on Nutrition and Noncommunicable Diseases in the Context of Health 2020. Regional Office for EuropeGoogle Scholar
- 15.Cole ZA, Gale CR, Javaid MK, Robinson SM, Law C, Boucher BJ, Crozier SR, Godfrey KM, Dennison EM, Cooper C (2009) Maternal dietary patterns during pregnancy and childhood bone mass: a longitudinal study. J Bone Mineral Res: Off J Am Soc Bone Mineral Res 24(4):663–668. doi: 10.1359/jbmr.081212 CrossRefGoogle Scholar
- 24.Harvey NC, Mahon PA, Kim M, Cole ZA, Robinson SM, Javaid K, Inskip HM, Godfrey KM, Dennison EM, Cooper C (2012) Intrauterine growth and postnatal skeletal development: findings from the Southampton Women’s Survey. Paediatr Perinat Epidemiol 26(1):34–44. doi: 10.1111/j.1365-3016.2011.01237.x CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Noble M, McLennan D, Wilkinson K, Whitworth A, Barnes H, Dibben C (2008) English indices of deprivation 2007. LondonGoogle Scholar
- 27.Statacorp (2013) Stata statistical software: release 13. 11 edn. College Station, TexasGoogle Scholar
- 30.Skidmore P, Welch A, van Sluijs E, Jones A, Harvey I, Harrison F, Griffin S, Cassidy A (2010) Impact of neighbourhood food environment on food consumption in children aged 9–10 years in the UK SPEEDY (sport, physical activity and eating behaviour: environmental determinants in young people) study. Public Health Nutr 13(7):1022–1030. doi: 10.1017/S1368980009992035 CrossRefPubMedGoogle Scholar
- 38.Public Health England (2013) Obesity and the environment: regulating the growth of fast food outlets. LondonGoogle Scholar
- 40.Ni Mhurchu C, Vandevijvere S, Waterlander W, Thornton LE, Kelly B, Cameron AJ, Snowdon W, Swinburn B (2013) Monitoring the availability of healthy and unhealthy foods and non-alcoholic beverages in community and consumer retail food environments globally. Obes Rev 14(Suppl 1):108–119. doi: 10.1111/obr.12080 CrossRefPubMedGoogle Scholar