Examining the associations between the food environment and dietary intake in British Columbia: A cross-sectional study

Abstract This study aimed to characterize neighbourhood food environments in British Columbia (BC) and to determine if food environment characteristics were associated with fruits and vegetables (FV) intake. A cross-sectional study was conducted using geospatial food environment (Can-FED) and neighbourhood environment measures from the BC Generations Project, a cohort of males and females aged 35-69. Food environment measures (chain grocery stores, fast food outlets, convenience stores, and two relative measures of food outlets) were categorized according to density: class 0 (no presence) to class 4 (highest density). Multivariable mixed-effect models adjusted for sociodemographics and neighbourhood characteristics were constructed to assess the associations between food environments and FV intakes as a continuous variable and as <5 or ≥ 5 servings of FV/day. Approximately 50% of participants lived in neighbourhoods without chain grocery stores, fast food outlets or convenience stores within walking distance. An inverse association between neighbourhoods with the highest density of fast-food restaurants and FV consumption was observed (Odds ratio (OR) =0.89, 95% CI: 0.80, 0.98). Associations between chain grocery stores, convenience stores and FV consumption were attenuated with adjustment for neighbourhood characteristics: walkability, material and social deprivation. The findings suggest the presence of food deserts across urban areas in BC. Participants living in neighbourhoods with greater density of fast-food restaurants were less likely to consume ≥5 servings of FV per day. Further studies are needed to understand the lack of associations between other characteristics of the food environment and dietary intake. Competing Interest Statement I have read the journal's policy and the authors of this manuscript have the following competing interest: RAM is a consultant for Pharmavite for work unrelated to the manuscript. All other authors report no conflict of interest. Funding Statement The author(s) received no specific funding for this work. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics approval was granted by the University of British Columbia, BC Cancer Research Ethics Board (H23-02251). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable Data Availability Statement Software code is available from researchers upon reasonable request. Code used to derive variables is returned to the BCGP as per data access requirements. The datasets analyzed in this study were made available by the BCGP and are available on reasonable request and with approval from the BCGP.