{
  "abstract": "Background: The exposome framework has expanded understanding of how cumulative environmental exposures influence cardiometabolic health. Although air pollution, green space, and socioeconomic factors are increasingly recognized within this framework, the food environment remains less consistently conceptualized as a structural cardiometabolic exposure.\n\nMethods: This narrative review synthesizes current literature on food environment determinants, including availability, accessibility, affordability, and food insecurity, alongside common approaches used to operationalize food environments in research. We also review mechanistic and epidemiologic evidence linking unhealthy food environments, particularly those characterized by high exposure to ultra-processed foods, with cardiometabolic outcomes. Finally, we discuss interactions with walkability, air pollution, climate stressors, socioeconomic vulnerability, and emerging exposures such as microplastics.\n\nResults: Food environments shape dietary behaviors through structural constraints that influence food choice, purchasing, and consumption. Unhealthy food environments may promote higher intake of ultra-processed foods and lower intake of minimally processed foods, contributing to obesity, insulin resistance, type 2 diabetes, cardiovascular disease, and chronic kidney disease through interconnected metabolic, inflammatory, and vascular pathways. These effects frequently cluster with other adverse neighborhood conditions, amplifying persistent and cumulative cardiometabolic risk contributing to health inequities. Current research is limited by heterogeneous exposure definitions, cross-sectional designs, residual confounding, and underrepresentation of low- and middle-income settings.\n\nConclusions: The food environment should be considered a major structural component of the cardiometabolic exposome. Improving its measurement and prioritizing longitudinal, equity-focused, and policy-relevant research will be essential to inform interventions that reduce cardiometabolic disease burden and disparities.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Medicine, NYC Health + Hospitals/Elmhurst, Icahn School of Medicine at Mt. Sinai, Queens, NY, United States",
    "Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States",
    "Department of Cardiology, NYC Health + Hospitals/Elmhurst, Icahn School of Medicine at Mt. Sinai, Queens, NY, United States",
    "Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, United States",
    "Center for Cardiovascular Computational and Precision Health (C3PH), Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States",
    "Center for Health & Nature, Houston, TX, United States",
    "Cardiovascular Research Institute, Case Western Reserve University School of Medicine, Cleveland, OH, United States",
    "School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom",
    "Surgical Services, Louis Stokes Cleveland, Cleveland, OH, United States"
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 12,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Pedro Rafael Vieira de Oliveira Salerno"
    },
    {
      "affs": [
        1
      ],
      "name": "Jiada Zhan"
    },
    {
      "affs": [
        0
      ],
      "name": "Ricardo J. Estrada-Mendizabal"
    },
    {
      "affs": [
        0
      ],
      "name": "Omar Aboukhatwa"
    },
    {
      "affs": [
        0
      ],
      "name": "Avery Hum"
    },
    {
      "affs": [
        0
      ],
      "name": "Mohamed Bassiony"
    },
    {
      "affs": [
        0
      ],
      "name": "Leonel Al Dakar"
    },
    {
      "affs": [
        2
      ],
      "name": "Gayatri Setia"
    },
    {
      "affs": [
        3
      ],
      "name": "Darcy Freedman"
    },
    {
      "affs": [
        4,
        5
      ],
      "name": "Sadeer Al-Kindi"
    },
    {
      "affs": [
        6,
        7,
        8
      ],
      "name": "Salil V. Deo"
    },
    {
      "affs": [
        4,
        5
      ],
      "name": "Weichuan Dong"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/3nbvjrcssdhm4.bib",
  "cited_by": 0,
  "doi": "10.3389/fnut.2026.1851911",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13736084/",
  "id": "3nbvjrcssdhm4",
  "issns": [
    "2296-861X"
  ],
  "landing_url": "https://doi.org/10.3389/fnut.2026.1851911",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Review"
    ],
    [
      "openalex",
      "2307|Health, Environment, Cognitive Aging"
    ]
  ],
  "openalex": "W7223177696",
  "pdf_url": "https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2026.1851911/pdf",
  "pmcid": "PMC13736084",
  "pmid": "42991535",
  "published": "2026-10-22",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/3nbvjrcssdhm4.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T12:21:37Z",
      "native_id": "PMC13736084",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fnut.2026.1851911"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2307|Health, Environment, Cognitive Aging",
      "subfield": "pharmacology-toxicology"
    }
  ],
  "title": "The food environment as a cardiometabolic exposure: mechanisms, inequities, and interacting environmental risk",
  "title_text": "The food environment as a cardiometabolic exposure: mechanisms, inequities, and interacting environmental risk",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T12:21:37Z",
  "url": "https://research.draconitic.com/paper/3nbvjrcssdhm4",
  "venue": "Frontiers in Nutrition",
  "versions": []
}