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Center for a Livable Future


Type and Cost of Foods Sold in Baltimore Neighborhoods: Impact on Dietary Intake and Cardiovascular Risk

Manuel Franco, MD, Doctoral candidate, Department of Epidemiology, JHSPH
Co-investigators: Ana Diez-Roux, MD, PhD; Frederick Brancati, MD; Thomas Glass, PhD; Benjamin Caballero, MD, PhD
Innovation Grant, 2005

Project Summary

The main objective of this project is to map the type and cost of food offered in 489 food stores of 121 neighborhoods of Baltimore, 79 in the City and 42 in the County (see Table 2). Then we will investigate the association of food availability and food prices with dietary intake of 983 Baltimore residents. As secondary objectives, we will investigate the relative contribution of animal and plant sources to the dietary profile, and correlate these data with cardiovascular risk factors such as diet, diabetes, hypertension and obesity.
The results of the study will help direct interventions and policies in non-communicable diseases prevention at the environment level by identifying food availability and food prices as important antecedents and determinants of behaviors and other cardiovascular risk factors(2). The proposed measuring instrument will help to identify populations lacking healthy food choices or unable to afford them. Measuring food availability and price with the proposed validated instrument could be implemented in future epidemiologic studies.


We investigated the association between the availability of healthy foods, diet quality and body mass index (BMI). A cross-sectional study of 759 participants at the Baltimore site of the Multi-Ethnic Study of Atherosclerosis (MESA) was conducted. A Healthy Food Availability Index (HFAI) was measured for each participant based on the availability of healthy foods in all food stores within the participant’s neighborhood of residence. To assess diet quality, two dietary patterns were used, reflecting low- and high-diet quality. BMI was directly measured.

We found that residents of neighborhoods with low food availability tend to eat lower quality diets and consequently had a higher body weight. 

After adjustment for age, sex, income and education, adults living in neighborhoods with low availability of healthy foods scored higher on the low-quality dietary pattern (P = 0.04) compared to adults in neighborhoods with high availability of healthy food. Large race/ethnicity disparities were observed: 24 percent of black participants lived in neighborhoods with low healthy-food-availability, compared to 5 percent % of white participants (P <0.0001). Compared to white participants, black participants scored lower on the high-quality dietary pattern (P <0.0001) and higher on the low-quality dietary pattern (P <0.0001).

Adjusted for age, sex, income, education, physical activity and caloric intake, mean differences of BMI comparing low- to high-availability measures (SE) were: 1.75 kg/m2 (0.62) for neighborhood availability, 1.24 kg/m2 (0.50) for closest store availability and 1.08 kg/m2 (0.53) for all stores within 1 mile, (p values < 0.005)

Improvements in the distribution of locally produced fruits and vegetables may result in higher availability of healthy foods in Baltimore neighborhoods. Such sustainable food store improvements will encourage individual behavior change in Baltimore residents towards higher quality diets and weight gain prevention.