ACCESS TO HEALTHY FOOD AND ADULT OBESITY: A SECONDARY SYNTHESIS OF EVIDENCE WITH CLINICAL IMPLICATIONS FOR ENDOCRINOLOGY

Marko Kimi  Milić; Šćepan Sinanović; Dejan Kostić; Branislav Ralić; Altan Gegić

Marko Kimi Milić VIsoka medicinska škola strukovnih studija "Milutin Milanković", Beograd, Srbija https://orcid.org/0009-0007-1308-7220
Šćepan Sinanović VIsoka medicinska škola strukovnih studija "Milutin Milanković", Beograd, Srbija https://orcid.org/0000-0002-8125-7873
Dejan Kostić Univerzitet odbrane u Beogradu, Medicinski fakultet Vojnomedicinske akademije; Instutut za radiologiju, Vojnomedicinska akademija, Beograd, Srbija https://orcid.org/0000-0002-4420-6348
Branislav Ralić Kliničko bolnički centar "Zvezdara", Beograd, Srbija https://orcid.org/0000-0002-9603-5827
Altan Gegić Dom zdravlja Tutin, Srbija

Ključne reči: gojaznost; okruženje hrane; proksimitet; gustina; supermarketi; brza hrana; endokrinologija; javno zdravlje.

Sažetak

Pozadina: Gojaznost je visoko prevalentna I determinisana, pored individualnih faktora, I karakteristikama okruženja hrane. Razumevanje kako dostupnost zdrave hrane utiče na rizik gojaznosti važno je za endokrinološku praksu.

Cilj: Sumarno prikazati odnos između pristupa zdravoj hrani I gojaznosti odraslih te istaknuti kliničke I javnozdravstvene implikacije.

Metode: Fokusirana sekundarna sinteza zasnovana na savremenoj sistematskoj recenziji I meta-analizi, dopunjena reprezentativnim opservacionim studijama. Ekspozicije su operativizovane kao proksimitet, gustina I kompozitni indeksi (npr. RFEI). Ekstrahovani su objedinjeni odnosi izgleda (OR) sa 95% intervalima poverenja; nije rađena nova re-meta-analiza. Kvalitet I pristrasnost razmatrani su u okvirima PRISMA I domena ROBINS-I.

Rezultati: Dosledno se uočava da je bliža dostupnost brze hrane povezana sa višim izgledima za gojaznost (≈OR 1,15), dok su proksimitet supermarketima I veća gustina prodavnica svežih namirnica povezani sa nižim izgledima (≈OR 0,90 I ≈OR 0,93). Kompozitni indeksi su češće bliski neutralnom efektu. Heterogenost zavisi od definicije zone izlaganja (signal jasniji u širim baferima, npr. 1,5–3 km) i od socioekonomskih uslova. Iako su efekti umereni na nivou pojedinca, populaciono mogu biti klinički značajni.

Zaključak: Prostorna dostupnost zdrave hrane merljivo je povezana sa rizikom gojaznosti. Endokrinološka praksa treba da objedini individualno savetovanje sa „mapiranjem“ lokalnih izvora svežih namirnica I upućivanjem na realno dostupne resurse. Javne politike koje smanjuju dominaciju nezdrave ponude I podstiču otvaranje/održivost prodajnih mesta sa zdravijom hranom imaju potencijal za značajan populacioni benefit. Potrebna je standardizacija metrika izlaganja I evaluacija intervencija u realnom okruženju.

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PRISTUP ZDRAVOJ HRANI I GOJAZNOST ODRASLIH: SEKUNDARNA SINTEZA DOKAZA SA KLINIČKIM IMPLIKACIJAMA ZA ENDOKRINOLOGIJU

Sažetak

Reference