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The relationship of the built and food environments with the metabolic syndrome in the Athens metropolitan area: a sex-stratified spatial analysis in the context of the ATTICA epidemiological study

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Abstract

Purpose

The built and food environments are widely acknowledged to play an important role in defining human health by influencing, among others, behaviors such as nutrition habits and physical activities. The aim of this study was to identify the spatial variability of the sex-specific prevalence of the metabolic syndrome (MetS) and its environmental determinants in the Athens metropolitan area.

Methods

Data on the prevalence of the MetS were provided by the ATTICA epidemiological study for 2749 participants, with complete data for geographical identification (1375 women [44 years old {SD = 14 years}] and 1374 men [45 years old {SD = 13 years}]), while socioeconomic, demographic, and environmental characteristics were provided by official national and international databases.

Results

Approximately 20% of the people residing in the study area were diagnosed with MetS, with its prevalence being almost two times higher in men compared to women. Areas more extensively covered by green urban spaces and sports facilities were shown to have a lower prevalence of MetS, while greater density and availability of supermarkets and street markets were inversely related to MetS prevalence in both sexes. In addition, the present analysis revealed that the beneficial role of the built environment’s characteristics on MetS prevalence was significantly stronger in the male population, while the preventive effect of the food environment’s characteristics was almost 1.5 times stronger in the female population

Conclusion

Although individualized prevention and treatment approaches are necessary to decrease the burden of MetS, environmental modifications that promote healthy behaviors represent an essential health approach.

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Data availability

The data are available upon request. For expression of interest, please contact Prof. Demosthenes Panagiotakos (dbpanag@hua.gr).

Code availability

Not applicable.

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Acknowledgements

The authors would like to thank the ATTICA study group of investigators: Christina Chrysohoou, Yannis Skoumas, Natasa Katinioti, Labros Papadimitriou, Constantina Masoura, Spiros Vellas, Yannis Lentzas, Manolis Kambaxis, Konstanitna Paliou, Vassiliki Metaxa, Ekavi Georgousopoulou, Agathi Ntzouvani, Dimitris Mpougatas, Nikolaos Skourlis, Christina Papanikolaou, Aikaterini Kalogeropoulou, Evangelia Pitaraki, Alexandros Laskaris, Mihail Hatzigeorgiou, Athanasios Grekas, and Eleni Kokkou for assistance in the initial physical examination and/or the follow-up evaluation; Efi Tsetsekou for her assistance in psychological evaluation and follow-up evaluation; and the laboratory team, Carmen Vassiliadou and George Dedousis (genetic analysis), Marina Toutouza-Giotsa, Constantina Tselika, and Sia Poulopoulou (biochemical analysis), and Maria Toutouza for database management. We would also like to thank all the individuals who participated in the ATTICA study.

Funding

The ATTICA study is supported by research grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003].

Author information

Authors and Affiliations

  1. Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El. Venizelou Ave., 17671, Athens, Kallithea, Greece

    Thomas Tsiampalis & Demosthenes B. Panagiotakos

  2. Department of Geography, School of Environment, Geography and Applied Economics, Harokopio University, Athens, Greece

    Antigoni Faka & Christos Chalkias

  3. Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece

    Theodora Psaltopoulou

  4. School of Medicine, University of Athens, Athens, Greece

    Christos Pitsavos

  5. Faculty of Health, University of Canberra, Canberra, Australia

    Demosthenes B. Panagiotakos

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  1. Thomas Tsiampalis
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  4. Christos Pitsavos
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  6. Demosthenes B. Panagiotakos
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Contributions

TT wrote the manuscript (interpretation of the results and discussion) and performed the statistical analysis. AF, TP, CC, and CP contributed to the interpretation of the results and discussion. DBP and CP were responsible for the study’s design and implementation and critically reviewed the manuscript.

Corresponding author

Correspondence to Demosthenes B. Panagiotakos.

Ethics declarations

Ethics approval and consent to participate

ATTICA study was approved by the bioethics committee of the Athens Medical School. The study was carried out in accordance with the Declaration of Helsinki (1989) of the World Medical Association.

Informed consent

All participants were informed about the study aims and procedures, and written informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare no competing interests.

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Tsiampalis, T., Faka, A., Psaltopoulou, T. et al. The relationship of the built and food environments with the metabolic syndrome in the Athens metropolitan area: a sex-stratified spatial analysis in the context of the ATTICA epidemiological study. Hormones 20, 723–734 (2021). https://doi.org/10.1007/s42000-021-00293-3

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