PC1166: The Association Between Neighborhood Quality and Cardiovascular Risk Factors Among Children with Obesity

Background: Socioeconomic and neighborhood factors are associated with disparities in health including physical activity, body mass index (BMI), and cardiovascular fitness among pediatric populations. We aim to further characterize these associations in a population of children with obesity so future interventions can target children at increased risk for poorer cardiovascular health.

Methods: This study uses baseline data from the Hearts & Parks randomized controlled trial. Participants aged 5-17 were enrolled if they had a BMI >= 95th percentile for age and sex and if they lived within a 20-mile radius of Duke Children’s Healthy Lifestyles pediatric weight management clinic. Patient addresses were collected and linked to the Child Opportunity Index (COI) at the census tract level. The composite COI is the primary exposure and is comprised of 29 indicators of neighborhood resources and conditions that impact children. Secondary exposure variables included specific indicator variables: walkability, greenspace, access to healthy foods and commute duration. Outcomes included body mass index relative to 95th percentile for age (BMI95p), submaximal exertion heart rate after the YMCA bench step score (HR), and systolic and diastolic blood pressure percentiles (SBP/DBP). Crude and adjusted generalized linear regressions were used to examine associations between the COI and patient outcomes.

Results: The sample (n=248) was 52.4% female, 17.3% non-Hispanic White, 38.7% non-Hispanic Black, and 37.5% Hispanic. 60%.7 of the sample had Class 1 obesity, and 39.3% had Class 2 or 3 (severe) obesity. Nationally normed COI scores for the sample was distributed as follows: Very Low (21.8%), Low (16.5%), Moderate (26.6%), High (20.6%), Very High (14.5%), where the categories are defined by quintiles of COI score percentiles. No significant associations were observed between the composite COI score and any of the outcome variables (BMI95p, HR, SBP, DBP). Additionally, there was no association between any of the secondary indicators (walkability, greenspace, access to healthy food, commute duration) and outcomes.

Conclusion: While environmental factors are known to predict development of obesity; among a sample of diverse children who have already developed obesity or severe obesity, environment is not independently associated with degree of obesity or cardiovascular outcomes Treatment of childhood obesity and related conditions should encompass strategies beyond prevention and lifestyle modification as interventions that are more intensive may be necessary to improve child health.