The influence of geographic life environments on cardiometabolic risk factors: a systematic review, a methodological assessment and a research agenda

Recent environmental changes play a role in the dramatic increase in the prevalence of cardiometabolic risk factors (CMRFs) such as obesity, hypertension, type 2 diabetes, dyslipidemias and the metabolic syndrome in industrialized countries. Therefore, identifying environmental characteristics that are associated with risk factors is critical to develop more effective public health interventions. We conducted a systematic review of the literature investigating relationships between characteristics of geographic life environments and CMRFs (131 articles). Most studies were published after 2006, relied on cross‐sectional designs, and examined whether sociodemographic and physical environmental characteristics, and more recently service environment characteristics, were associated with obesity or, to a lesser extent, hypertension. Only 14 longitudinal studies were retrieved; diabetes, dyslipidemias and the metabolic syndrome were rarely analysed; and aspects of social interactions in the neighbourhood were critically underinvestigated. Environmental characteristics that were consistently associated with either obesity or hypertension include low area socioeconomic position; low urbanization degree; low street intersection, service availability and residential density; high noise pollution; low accessibility to supermarkets and high density of convenience stores; and low social cohesion. Intermediate mechanisms between environmental characteristics and CMRFs have received little attention. We propose a research agenda based on the assessment of underinvestigated areas of research and methodological limitations of current literature.