The influence of geographic life environments on cardiometabolic risk factors: a systematic review, a methodological assessment and a research agenda.
Recent environmental changes play a role in the dramatic increase in the prevalence of cardiometabolic risk factors (CMRFs) such as obesity, hypertension, type 2 diabetes, dyslipidemias and the metabolic syndrome in industrialized countries. Therefore, identifying environmental characteristics that are associated with risk factors is critical to develop more effective public health interventions. We conducted a systematic review of the literature investigating relationships between characteristics of geographic life environments and CMRFs (131 articles). Most studies were published after 2006, relied on cross-sectional designs, and examined whether sociodemographic and physical environmental characteristics, and more recently service environment characteristics, were associated with obesity or, to a lesser extent, hypertension. Only 14 longitudinal studies were retrieved; diabetes, dyslipidemias and the metabolic syndrome were rarely analysed; and aspects of social interactions in the neighbourhood were critically underinvestigated. Environmental characteristics that were consistently associated with either obesity or hypertension include low area socioeconomic position; low urbanization degree; low street intersection, service availability and residential density; high noise pollution; low accessibility to supermarkets and high density of convenience stores; and low social cohesion. Intermediate mechanisms between environmental characteristics and CMRFs have received little attention. We propose a research agenda based on the assessment of underinvestigated areas of research and methodological limitations of current literature.
Leal
C
C
Inserm, U707, Research Unit in Epidemiology, Information Systems, and Modeling, Paris, France. leal@u707.jussieu.fr
Chaix
B
B
D015444:Exercise / Q000502:physiology*; D006331:Heart Diseases / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008659:Metabolic Diseases / Q000453:epidemiology* / Q000209:etiology; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000209:etiology; D009765:Obesity / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D012307:Risk Factors; D012931:Social Environment