title: Associations of built food environment with body mass index and waist circumference among youth with diabetes.
abstract: BACKGROUND
  Youth with diabetes are at increased risk for obesity and cardiovascular disease complications. However, less is known about the influence of built food environment on health outcomes in this population. The aim of this study was to explore the associations of accessibility and availability of supermarkets and fast food outlets with Body Mass Index (BMI) z-score and waist circumference among youth with diabetes.
  
  
  METHODS
  Information on residential location and adiposity measures (BMI z-score and waist circumference) for 845 youths with diabetes residing in South Carolina was obtained from the South Carolina site of the SEARCH for Diabetes in Youth study. Food outlets data obtained from the South Carolina Department of Health and Environmental Control and InfoUSA were merged based on names and addresses of the outlets. The comprehensive data on franchised supermarket and fast food outlets was then used to construct three accessibility and availability measures around each youth's residence.
  
  
  RESULTS
  Increased number and density of chain supermarkets around residence location were associated with lower BMI z-score and waist circumference among youth with diabetes. For instance, for a female child of 10 years of age with height of 54.2 inches and weight of 70.4 pounds, lower supermarket density around residence location was associated with about 2.8-3.2 pounds higher weight, when compared to female child of same age, height and weight with highest supermarket density around residence location. Similarly, lower supermarket density around residence location was associated with a 3.5-3.7 centimeter higher waist circumference, when compared to residence location with the highest supermarket density. The associations of number and density of chain fast food outlets with adiposity measures, however, were not significant. No significant associations were observed between distance to the nearest supermarket and adiposity measures. However, contrary to our expectation, increased distance to the nearest fast food outlet was associated with higher BMI z-score, but not with waist circumference.
  
  
  CONCLUSIONS
  Food environments conducive to healthy eating may significantly influence health behaviors and outcomes. Efforts to increase the availability of supermarkets providing options/selections for health-promoting foods may significantly improve the dietary intake and reduce adiposity among youth with diabetes.
authors: Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA.
authors: Archana P
authors: AP
authors: Lamichhane
authors: Robin
authors: R
authors: Puett
authors: Dwayne E
authors: DE
authors: Porter
authors: Matteo
authors: M
authors: Bottai
authors: Elizabeth J
authors: EJ
authors: Mayer-Davis
authors: Angela D
authors: AD
authors: Liese
mesh_terms: D050154:Adiposity; D000293:Adolescent; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D003132:Commerce; D048909:Diabetes Complications; D003920:Diabetes Mellitus; D004032:Diet; D004777:Environment; D004779:Environment Design; D057140:Fast Foods; D005260:Female; D005523:Food Supply; D006801:Humans; D008297:Male; D009765:Obesity / Q000209:etiology* / Q000517:prevention & control; D012111:Residence Characteristics; D013022:South Carolina; D055105:Waist Circumference