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Deprecated: Implicit conversion from float 269.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Epidemiology 2015 ; 26 (3): 344-52 Nephropedia Template TP
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Does food vendor density mediate the association between neighborhood deprivation and BMI? A G-computation mediation analysis #MMPMID25741628
Epidemiology 2015[May]; 26 (3): 344-52 PMID25741628show ga
Background: In previous research, neighborhood deprivation was positively associated with body mass index (BMI) among adults with diabetes. We assessed whether the association between neighborhood deprivation and BMI is attributable, in part, to geographic variation in the availability of healthful and unhealthful food vendors. Methods: Subjects were 16,634 participants of the Diabetes Study of Northern California (DISTANCE), a multiethnic cohort of adults living with diabetes. Neighborhood deprivation and healthful (supermarket and produce) and unhealthful (fast food outlets and convenience stores) food vendor kernel density were calculated at each participant's residential block centroid. We estimated the total effect, controlled direct effect, natural direct effect, and natural indirect effect of neighborhood deprivation on BMI. Mediation effects were estimated using G-computation, a maximum likelihood substitution estimator of the G-formula that allows for complex data relationships such as multiple mediators and sequential causal pathways. Results: We estimated that if neighborhood deprivation were reduced from the most deprived to the least deprived quartile, average BMI would change by ?0.73 units (95% CI ?1.05, ?0.32); however, we did not detect evidence of mediation by food vendor density. In contrast to previous findings, a simulated reduction in neighborhood deprivation from the most deprived to the least deprived quartile was associated with dramatic declines in both healthful and unhealthful food vendor density.