Top

Published in:

01-12-2021 | Original Article

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

Authors: Thomas Tsiampalis, Antigoni Faka, Theodora Psaltopoulou, Christos Pitsavos, Christos Chalkias, Demosthenes B. Panagiotakos

Published in: Hormones | Issue 4/2021

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.

Panagiotakos DB, Pitsavos C, Skoumas Y, Stefanadis C (2007) The association between food patterns and the metabolic syndrome using principal components analysis: the ATTICA Study. J Am Diet Assoc 107(6):979–997. https://doi.org/10.1016/j.jada.2007.03.006CrossRefPubMed

Saklayen MG (2018) The global epidemic of the metabolic syndrome. Curr Hypertens Rep 20(2):12. https://doi.org/10.1007/s11906-018-0812-zCrossRefPubMedPubMedCentral

Qi L, Cho YA (2008) Gene-environment interaction and obesity. Nutr Rev 66(12):684–694. https://doi.org/10.1111/j.1753-4887.2008.00128.xCrossRefPubMed

Kastorini CM, Milionis HJ, Esposito K, Giugliano D, Goudevenos JA, Panagiotakos DB (2011) The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol 57(11):1299–1313. https://doi.org/10.1016/j.jacc.2010.09.073CrossRefPubMed

Faka A, Chalkias C, Georgousopoulou EN, Tripitsidis A, Pitsavos C, Panagiotakos DB (2019) Identifying determinants of obesity in Athens, Greece through global and local statistical models. Spat Spatio-Temporal Epidemiol 29:31–41. https://doi.org/10.1016/j.sste.2019.02.002CrossRef

Thompson Coon J, Boddy K, Stein K, Whear R, Barton J, Depledge MH (2011) Does participating in physical activity in outdoor natural environments have a greater effect on physical and mental wellbeing than physical activity indoors? A systematic review. Environ Sci Technol 45(5):1761–1772. https://doi.org/10.1021/es102947tCrossRefPubMed

Gong Y, Palmer S, Gallacher J, Marsden T, Fone D (2016) A systematic review of the relationship between objective measurements of the urban environment and psychological distress. Environ Int 96:48–57. https://doi.org/10.1016/j.envint.2016.08.019CrossRefPubMed

Markevych I, Schoierer J, Hartig T, Chudnovsky A, Hystad P, Dzhambov AM, de Vries S, Triguero-Mas M, Brauer M, Nieuwenhuijsen MJ, Lupp G, Richardson EA, Astell-Burt T, Dimitrova D, Feng X, Sadeh M, Standl M, Heinrich J, Fuertes E (2017) Exploring pathways linking greenspace to health: theoretical and methodological guidance. Environ Res 158:301–317. https://doi.org/10.1016/j.envres.2017.06.028CrossRefPubMed

Kotzeva M, Brandmüller T, Lupa I, Önnerfors A, Corselli-Nordblad L, Coyette C, Johansson A, Strandell H, Pascal W (2016) Urban Europe—statistics on cities, towns, and suburbs [WWW Document]. https://doi.org/10.2785/91120

10.

Matthiessen C, Lucht S, Hennigh F, Ohlwein S, Jakobs H, Jöckel KH, Moebus S, Hoffmann B, Heinz Nixdorf Recall Study Investigative Group (2018) Long-term exposure to airborne particulate matter and NO2 and prevalent and incident metabolic syndrome—results from the Heinz Nixdorf Recall Study. Environ Int 116:74–82. https://doi.org/10.1016/j.envint.2018.02.035CrossRefPubMed

11.

Faka A, Chalkias C, Montano D, Georgousopoulou EN, Tripitsidis A, Koloverou E, Tousoulis D, Pitsavos C, Panagiotakos DB (2018) Association of socio-environmental determinants with diabetes prevalence in the Athens metropolitan area, Greece: a spatial analysis. Rev Diabet Stud 14(4):381–389. https://doi.org/10.1900/RDS.2017.14.381CrossRefPubMedPubMedCentral

12.

Faka A, Chalkias C, Magriplis E, Georgousopoulou EN, Tripitsidis A, Pitsavos C, Panagiotakos DB (2020) The influence of socio-environmental determinants on hypertension. A spatial analysis in Athens metropolitan area, Greece. J Prevent Med Hyg 61(1):E76–E84. https://doi.org/10.15167/jpmh2020.21.1.988CrossRef

13.

Alter DA, Eny K (2005) The relationship between the supply of fast-food chains and cardiovascular outcomes. Can J Public Health 96(3):173–177. https://doi.org/10.1007/BF03403684CrossRefPubMedPubMedCentral

14.

Tsiampalis T, Faka A, Kouvari M, Psaltopoulou T, Pitsavos C, Chalkias C, Panagiotakos DB (2020) The impact of socioeconomic and environmental determinants on Mediterranean diet adherence: a municipal-level spatial analysis in Athens metropolitan area, Greece. Int J Food Sci Nutr 1–12. Advance online publication. https://doi.org/10.1080/09637486.2020.1791057

15.

Panagiotakos DB, Georgousopoulou EN, Pitsavos C, Chrysohoou C, Metaxa V, Georgiopoulos GA, Kalogeropoulou K, Tousoulis D, Stefanadis C, ATTICA Study group (2015) Ten-year (2002–2012) cardiovascular disease incidence and all-cause mortality, in urban Greek population: the ATTICA Study. Int J Cardiol 180:178–184. https://doi.org/10.1016/j.ijcard.2014.11.206CrossRefPubMed

16.

Panagiotakos D, Pitsavos C, Chrysohoou C, Skoumas I, Stefanadis C, ATTICA Study (2008) Five-year incidence of cardiovascular disease and its predictors in Greece: the ATTICA study. Vasc Med 13(2):113–121. https://doi.org/10.1177/1358863x07087731CrossRefPubMed

17.

Pitsavos C, Panagiotakos DB, Chrysohoou C, Stefanadis C (2003) Epidemiology of cardiovascular risk factors in Greece: aims, design and baseline characteristics of the ATTICA study. BMC Public Health 3:32. https://doi.org/10.1186/1471-2458-3-32CrossRefPubMedPubMedCentral

18.

Tsiampalis T, Panagiotakos DB (2020) Missing-data analysis: socio-demographic, clinical and lifestyle determinants of low response rate on self-reported psychological and nutrition related multi-item instruments in the context of the ATTICA epidemiological study. BMC Med Res Methodol 20(1):148. Published 2020 Jun 8. https://doi.org/10.1186/s12874-020-01038-3

19.

United Nations Educational Scientific and Cultural Organization Institute for Statistics: International Standard Classification of Education ISCED (2011) Montréal, 2012

20.

Prastacos P, Chrysoulakis N, Kochilakis G (2011) Urban Atlas, land use modelling and spatial metric techniques. Barcelona: Proceedings of the 51st European Congress of the Regional Science Association International, 30 August–2 September 2011

21.

Brewer CA, Pickle L (2002) Evaluation of methods for classifying epidemiological data on choropleth maps in series. Ann Assoc Am Geogr 92(4):662–681CrossRef

22.

Lisabeth LD, Diez Roux AV, Escobar JD, Smith MA, Morgenstern LB (2007) Neighborhood environment and risk of ischemic stroke: the brain attack surveillance in Corpus Christi (BASIC) Project. Am J Epidemiol 165(3):279–287CrossRef

23.

Roux AVD, Merkin SS, Arnett D, Chambless L, Massing M, Nieto FJ, Watson RL (2001) Neighborhood of residence and incidence of coronary heart disease. N Engl J Med 345(2):99–106CrossRef

24.

Krishnan S, Cozier YC, Rosenberg L, Palmer JR (2010) Socioeconomic status and incidence of type 2 diabetes: results from the Black Women's Health Study. Am J Epidemiol 171(5):564–570CrossRef

25.

Chaix B, Bean K, Leal C, Thomas F, Havard S, Evans D, Pannier B (2010) Individual/neighborhood social factors and blood pressure in the RECORD Cohort Study: which risk factors explain the associations? Hypertension 55(3):769–775CrossRef

26.

Leal C, Bean K, Thomas F, Chaix B (2011). Are associations between neighborhood socioeconomic characteristics and body mass index or waist circumference based on model extrapolations? Epidemiology 694–703

27.

Hickman C (2013) “To brighten the aspect of our streets and increase the health and enjoyment of our city”: The National Health Society and urban green space in late-nineteenth century London. Landsc Urban Plan 118:112–119CrossRef

28.

World Health Organisation (2016) European healthy cities network 2016. Available: 〈http://www.euro.who.int/en/health-topics/environment-and-health/urban-health/activities/healthy-cities/who-european-healthy-cities-network/what-is-a-healthycity〉.

29.

Yang BY, Hu LW, Jalaludin B, et al (2020) Association Between Residential Greenness, Cardiometabolic Disorders, and Cardiovascular Disease Among Adults in China. JAMA Netw Open 3(9):e2017507. Published 2020 Sep 1. https://doi.org/10.1001/jamanetworkopen.2020.17507

30.

Wang K, Lombard J, Rundek T et al (2019) Relationship of neighborhood greenness to heart disease in 249 405 US Medicare Beneficiaries. J Am Heart Assoc 8(6):e010258. https://doi.org/10.1161/JAHA.118.010258CrossRefPubMedPubMedCentral

31.

Astell-Burt T, Feng X, Kolt GS (2014) Greener neighborhoods, slimmer people? Evidence from 246,920 Australians. Int J Obes 38:156–159. https://doi.org/10.1038/ijo.2013.64CrossRef

32.

Dalton AM, Jones AP, Sharp SJ, Cooper AJ, Griffin S, Wareham NJ (2016) Residential neighbourhood greenspace is associated with reduced risk of incident diabetes in older people: a prospective cohort study. BMC Public Health 16(1):1171. Published 2016 Nov 18. https://doi.org/10.1186/s12889-016-3833-z

33.

Brown SC, Lombard J, Wang K et al (2016) Neighborhood greenness and chronic health conditions in medicare beneficiaries. Am J Prev Med 51(1):78–89. https://doi.org/10.1016/j.amepre.2016.02.008CrossRefPubMed

34.

Loo CJ, Greiver M, Aliarzadeh B, Lewis D (2017) Association between neighbourhood walkability and metabolic risk factors influenced by physical activity: a cross-sectional study of adults in Toronto. Canada BMJ open 7(4):e013889CrossRef

35.

Chandrabose M, Cerin E, Mavoa S, Dunstan D, Carver A, Turrell G, Sugiyama T (2019) Neighborhood walkability and 12-year changes in cardio-metabolic risk: the mediating role of physical activity. Int J Behav Nutr Phys Act 16(1):1–11CrossRef

36.

Cohen DA, McKenzie TL, Sehgal A, Williamson S, Golinelli D, Lurie N (2007) Contribution of public parks to physical activity. Am J Public Health 97. https://doi.org/10.2105/AJPH.2005.072447

37.

Moore LV, Diez Roux AV, Nettleton JA, Jacobs DR Jr (2008) Associations of the local food environment with diet quality—a comparison of assessments based on surveys and geographic information systems: the multi-ethnic study of atherosclerosis. Am J Epidemiol 167(8):917–924CrossRef

38.

Bodor JN, Rice JC, Farley TA, Swalm CM, Rose D (2010) The association between obesity and urban food environment. J Urban Health 87(5):771–781CrossRef

39.

Giang T, Karpyn A, Laurison H, Hillier A, Burton M, Perry D (2008) Closing the grocery gap in underserved communities: the creation of the Pennsylvania Fresh Food Financing Initiative. J Public Health Manag Pract 14(3):272–279CrossRef

40.

Rose D, Richards R (2004) Food store access and household fruit and vegetable use among participants in the US Food Stamp Program. Public Health Nutr 7(8):1081–1088CrossRef

41.

Robinson PL, Dominguez F, Teklehaimanot S, Lee M, Brown A, Goodchild M (2013) Does distance decay modelling of supermarket accessibility predict fruit and vegetable intake by individuals in a large metropolitan area. J Health Care Poor Underserved 24:172–185CrossRef

42.

Larson NI, Story MT, Nelson MC (2009) Neighborhood environments: disparities in access to healthy foods in the U.S. Am J Prevent Med 36(1):74-81. 14CrossRef

43.

Powell LM, Auld C, Chaloupka FJ, O’Malley PM, Johnston LD (2007) Associations between access to food stores and adolescent body mass index. Am J Prev Med 33(4S):S301–S307CrossRef

44.

Treuhaft S, Karpyn A (2010) The grocery gap: who has access to healthy food and why it matters. The Food Trust

45.

He D, Xi B, Xue J, Huai P, Zhang M, Li J (2014) Association between leisure time physical activity and metabolic syndrome: a meta-analysis of prospective cohort studies. Endocrine 46(2):231–240. https://doi.org/10.1007/s12020-013-0110-0CrossRefPubMed

46.

Gong Y, Gallacher J, Palmer S, Fone D (2014) Neighbourhood green space, physical function and participation in physical activities among elderly men: the Caerphilly Prospective study. Int J Behav Nutr Phys Act 11(1):40. Published 2014 Mar 19. https://doi.org/10.1186/1479-5868-11-40

47.

Eze IC, Schaffner E, Foraster M, et al (2015) Long-term exposure to ambient air pollution and metabolic syndrome in adults. PLoS One 10(6):e0130337. Published 2015 Jun 23. https://doi.org/10.1371/journal.pone.0130337

48.

Bergmann N, Gyntelberg F, Faber J (2014) The appraisal of chronic stress and the development of the metabolic syndrome: a systematic review of prospective cohort studies. Endocr Connect 3(2):R55–R80. https://doi.org/10.1530/EC-14-0031CrossRefPubMedPubMedCentral

49.

Rook GA (2013) Regulation of the immune system by biodiversity from the natural environment: an ecosystem service essential to health. Proc Natl Acad Sci USA 110:18360–18367CrossRef

50.

Lee M, Lim M, Kim J (2019) Fruit and vegetable consumption and the metabolic syndrome: a systematic review and dose-response meta-analysis. Br J Nutr 122(7):723–733. https://doi.org/10.1017/S000711451900165XCrossRefPubMed

51.

Zhang Y, Zhang DZ (2018) Associations of vegetable and fruit consumption with metabolic syndrome. A meta-analysis of observational studies. Public Health Nutr 21(9):1693–1703. https://doi.org/10.1017/S1368980018000381CrossRefPubMed

Title: 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
Authors: Thomas Tsiampalis
Antigoni Faka
Theodora Psaltopoulou
Christos Pitsavos
Christos Chalkias
Demosthenes B. Panagiotakos
Publication date: 01-12-2021
Publisher: Springer International Publishing
Published in: Hormones / Issue 4/2021
Print ISSN: 1109-3099
Electronic ISSN: 2520-8721
DOI: https://doi.org/10.1007/s42000-021-00293-3

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2021

Impaired vagal adaptation to an exercise task in women with gestational diabetes mellitus versus women with uncomplicated pregnancies

Hashimoto’s thyroiditis, iron, and vitamin D deficiency among Egyptian female patients: associations and possible causalities

Hypoglycemia due to PI3K/AKT/mTOR signaling pathway defects: two novel cases and review of the literature

The ancient Greek poet Sappho and the first case report of the fight-or-flight response

Outcomes of transsphenoidal surgery in dopamine agonist-resistant prolactinomas: a retrospective study

Novel presentation of the c.1856A > G (p.Asp619Gly) TSHR gene-activating variant: relapsing hyperthyroidism in three subsequent generations manifesting in early childhood and an in vitro functional study

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials