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Greater access to fast-food outlets is associated with poorer bone health in young children



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.

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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.

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Correspondence to C. Vogel.

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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.

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Vogel, C., Parsons, C., Godfrey, K. et al. Greater access to fast-food outlets is associated with poorer bone health in young children. Osteoporos Int 27, 1011–1019 (2016).

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  • Developmental modelling
  • DXA
  • Epidemiology
  • General population studies
  • Nutrition