The food environment as a cardiometabolic exposure: mechanisms, inequities, and interacting environmental risk
9 affiliations
- 1Department of Medicine, NYC Health + Hospitals/Elmhurst, Icahn School of Medicine at Mt. Sinai, Queens, NY, United States
- 2Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
- 3Department of Cardiology, NYC Health + Hospitals/Elmhurst, Icahn School of Medicine at Mt. Sinai, Queens, NY, United States
- 4Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, United States
- 5Center for Cardiovascular Computational and Precision Health (C3PH), Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States
- 6Center for Health & Nature, Houston, TX, United States
- 7Cardiovascular Research Institute, Case Western Reserve University School of Medicine, Cleveland, OH, United States
- 8School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- 9Surgical Services, Louis Stokes Cleveland, Cleveland, OH, United States
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.
Methods: 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.
Results: 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.
Conclusions: 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.
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BibTeX
@article{salerno2026food,
title = {{The food environment as a cardiometabolic exposure: mechanisms, inequities, and interacting environmental risk}},
author = {Pedro Rafael Vieira de Oliveira Salerno and Jiada Zhan and Ricardo J. Estrada-Mendizabal and Omar Aboukhatwa and Avery Hum and Mohamed Bassiony and Leonel Al Dakar and Gayatri Setia and Darcy Freedman and Sadeer Al-Kindi and Salil V. Deo and Weichuan Dong},
journal = {Frontiers in Nutrition},
year = {2026},
month = oct,
doi = {10.3389/fnut.2026.1851911},
url = {https://doi.org/10.3389/fnut.2026.1851911},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The food environment as a cardiometabolic exposure: mechanisms, inequities, and interacting environmental risk
AU - Pedro Rafael Vieira de Oliveira Salerno
AU - Jiada Zhan
AU - Ricardo J. Estrada-Mendizabal
AU - Omar Aboukhatwa
AU - Avery Hum
AU - Mohamed Bassiony
AU - Leonel Al Dakar
AU - Gayatri Setia
AU - Darcy Freedman
AU - Sadeer Al-Kindi
AU - Salil V. Deo
AU - Weichuan Dong
PY - 2026
DA - 2026/10/22
JO - Frontiers in Nutrition
DO - 10.3389/fnut.2026.1851911
UR - https://doi.org/10.3389/fnut.2026.1851911
AB - 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. Methods: 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. Results: 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. Conclusions: 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.
SN - 2296-861X
ER -