Neighborhood food environment density and cardiometabolic health in iranian adults: a cross-sectional study

Food environment (FE) density may influence cardiometabolic indices (CI), but findings remain inconsistent across anthropometric indices, lipid profiles, blood pressure, and glucose levels, while evidence from low- and middle-income countries remains limited. Therefore, this study aimed to examine the association between neighborhood FE density and cardiometabolic health in Iranian adults using a cross-sectional design. This cross-sectional study included 1127 adults (mean age: 56.39 ± 9.01 years) from the reassessment phase (2021–2024) of the Shahrekord Cohort Study. All eligible participants from the reassessment phase who resided in Shahrekord city and had complete data of the study variables were included. Data on demographic, socioeconomic, and lifestyle characteristics, as well as health outcomes including anthropometric indices, lipid profiles, blood pressure, and glucose levels, were collected. FE densities were assessed using geographic information system software. Multiple regression models were applied to examine the associations after adjusting for age and sex, as well as additional potential confounders selected based on bivariate analyses ( p < 0.25). The density of food outlets (including greengrocers, fast-food outlets, restaurants, pastry shops, butcher shops, and poultry and fish markets) was not significantly associated with body mass index (BMI), waist-to-height ratio, lipid parameters, blood pressure, or glucose levels (all p-values > 0.05). These null associations remained unchanged after adjustment for potential confounders. However, significant interactions were observed between sex and the densities of both fast-food outlets (P-interaction = 0.023) and pastry shops (P-interaction = 0.012) on glucose levels. Sex-stratified analyses revealed a divergence in the direction of the effect, showing a positive association with glucose in women and an inverse pattern in men, though stratum-specific associations did not reach statistical significance. Our findings suggest that neighborhood FE density alone may not be a sufficient determinant of CI among adults in Shahrekord, Iran. Instead, cardiometabolic outcomes are likely influenced by the complex interplay of social determinants of health (SDH), including socioeconomic conditions, lifestyle behaviors, and individual characteristics. Future longitudinal and multilevel studies are warranted to clarify these complex pathways and to inform evidence-based policies for the prevention of non-communicable diseases.