'Food Desert' Dwellers Have Worse Heart-Disease Risk Profiles

Marlene Busko

April 05, 2016

CHICAGO, IL — In a study of residents of Atlanta, GA, those living in "food deserts"—defined as low-income communities without easy access to healthy, affordable food—had worse cardiovascular-disease risk profiles than others living in wealthier neighborhoods with nearby nutritious food sources[1].

Specifically, Atlantans living in disadvantaged areas where the nearest supermarket was a mile or more away were more likely to have hypertension or hyperlipidemia, smoke, be obese, and have higher levels of systemic inflammatory markers and stiffer arteries.

Thus, "neighborhood characteristics that affect availability of healthy foods contribute to an increased risk of cardiovascular disease beyond their effects on traditional risk factors," Dr Heval Mohamed Kelli (Emory University, Atlanta, GA) and colleagues report, in a study presented in a poster at the American College of Cardiology (ACC) 2016 Scientific Sessions.

Tools such as the Framingham risk score do not include low income, low education, or access to healthy food as risk factors, Kelli pointed out to heartwire from Medscape, yet these socioeconomic factors affect heart health. Moreover, "we know that these patients from inner-city areas are prevalent in hospital admissions and have a higher risk of mortality outcomes," he added. Perhaps clinicians "can't change income or food access, but we can empower patients to be more engaged in their health—it's been shown that works," he stressed. Physicians and patients can make more use of mobile phones as an educational tool and to track patient progress, he suggested.

Invited to comment, Dr Socrates Kakoulides (Mount Sinai School of Medicine, New York, NY) agreed that this study reminds clinicians to be more aware of patient circumstances. "Patients in certain neighborhoods with certain educational backgrounds are at higher risk, and we should be more mindful when we come across those patients. Sometimes we make recommendations to our patients that they're going to have a very hard time actually fulfilling."

Scarcity in a Land of Plenty

The United States Department of Agriculture (USDA) estimates that 23.5 million Americans live in food deserts, the researchers report. Not having access to healthy food is tied to obesity and diabetes, and living in a disadvantaged neighborhood is tied to risk of coronary artery disease, they note.

The researchers investigated the impact of living in a food desert on CVD risk factors in 1421 adults living in the Atlanta metropolitan area: 712 community-dwelling participants in the META-Health study and 709 university employees who participated in the Predictive Health study.

The participants replied to questionnaires about demographic information and had blood tests to determine metabolic parameters as well as applanation tonometry (Sphygmocor) to determine arterial stiffness.

The researchers used the Economic Research Service USDA Food Access Research Atlas online map tool to determine whether participants lived in a food desert. This tool allows anyone to enter the name of their city into the search field and zoom in on a map showing which counties have food deserts, Kelli explained. The website also has a map of the entire country, which shows that a surprisingly large number of the more than 3000 counties are classed as food deserts.

The USDA website also explains that making nutritious, affordable food more readily accessible in local grocery stores in disadvantaged communities where residents may not have a car is part of the Let's Move! initiative, launched by Michel Obama, which is dedicated to stopping childhood obesity within a generation, and the Healthy Food Financing Initiative, launched by the Obama administration, provides financing for developing and equipping grocery stores, small retailers, corner stores, and farmers' markets selling healthy food in underserved areas.

Difficult Access to Healthy Foods, Greater CVD Risk Factors

Close to one in 10 study participants (187) lived in a food desert, and the rest did not. Participants in both groups had a mean age of 49, and 39% were male.

Compared with the other participants, individuals who lived in food deserts were more likely to be African American (52% vs 34%, P<0.001) with an annual income below $25,000, and they were less likely to be a college graduate (44% vs 71%, P<0.001). They also had a greater cardiovascular risk factor burden and more indications of subclinical vascular disease: higher levels of hs-CRP (indicating inflammation), lower levels of glutathione (indicating oxidative stress), and a higher augmentation index or pulse-wave reflection (indicating arterial stiffness).

CVD Risk Profile, Living in a Food Desert vs Living Elsewhere

Factor Living in food desert (n=187) Not living in food desert (n=1324) P
Hypertension (%) 47.6 32.4 <0.001
Smoking (%) 21.9 12.4 <0.001
Mean BMI (kg/m2) 30.6 28.6 <0.001
Mean plasma glucose (mg/dL) 94.8 91.2 0.04
Mean atherosclerotic cardiovascular disease (ASCVD) score 4.07 2.83 0.007
Median hs-CRP (mg/L) 0.95 0.41 0.022
Median central augmentation index 22.7 17.8 0.009

After multivariate adjustments for age, gender, race, hypertension, diabetes, and heart disease, living in a food desert remained independently associated with higher levels of hs-CRP (P=0.032) and augmentation index (P=0.034) and lower levels of glutathione (P=0.021).

"The increased prevalence of subclinical vascular disease and vascular disease in food deserts may predispose these subjects to cardiovascular disease," Kelli and colleagues conclude. However, "whether lack of access to healthy foods, low income, or low education is driving these processes needs to be further studied, [and] further investigation and validation in separate cohorts is needed to determine the underlying factors driving this association."

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