The Retail Food Environment Index and its association with dietary patterns, body mass index, and socioeconomic position: A multilevel assessment in Mexico

In Mexico, 75% of the population are affected by overweight or obesity, and the availability and affordability of high-calorie-dense foods and beverages are high. This study tested the association between the retail food environment index (RFEI), dietary patterns, body mass index (BMI), and socioeconomic position (SEP) in Mexico. Cross-sectional diet, health, and sociodemographic population-based secondary data analyses were conducted. The RFEI was calculated by dividing the total number of fast-food outlets and convenience stores by the total number of supermarkets and fruit and vegetable stores per census tract area. Associations between BMI, dietary patterns, SEP and the RFEI were tested using multilevel linear regression, including interactions of the RFEI with SEP, gender, and age. Living in neighbourhoods with a higher RFEI was associated with a 0.01kg/m2 higher BMI (β = 0.01, 95%CI: 0.0005, 0.02, p = 0.04), equivalent to a mean 0.046 weight gain for a 1.60m tall person per 10% higher RFEI. Unhealthy dietary patterns were more likely in neighbourhoods with a higher RFEI (β = 0.100, 95%CI: 0.03, 0.12, p = 0.001). Multilevel linear regression showed that lower SEP households had a higher RFEI compared to higher SEP households (β = 0.020, 95% CI: -0.006 to 0.04, p = 0.10). Generalised structural equation models revealed a graded relationship between RFEI and SEP, showing that lower SEP households were exposed to a higher RFEI (β = 0.060, 95% CI: 0.05 to 0.07, p