The Urban-Rural Continuum and Child Health: Influence of Residential Location on Ultra-Processed Food Consumption, Physical Activity, and Metabolic Biomarkers.

OBJECTIVE

This study aimed to investigate the association between residential location-urban area and urban expansion area and sociodemographic characteristics, health behaviors, and clinical-metabolic outcomes among schoolchildren aged 6 to 9 years in the municipality of Rio das Ostras, Brazil.

METHODS

This was a cross-sectional study involving 420 students from public municipal schools. Sociodemographic and behavioral data were collected using validated questionnaires (QUADA-3 and QUAFDA). Anthropometric measurements, blood pressure, and biochemical analyses were conducted. Associations were assessed using Pearson's chi-square or Fisher's exact tests and logistic regression models, both crude and adjusted for age, sex, maternal and paternal education, and household income.were estimated with 95% confidence intervals (CI).

FINDINGS: Children living in urban expansion areas had lower paternal education levels (p = 0.021) and were less likely to engage in active commuting to school (2.4% vs. 42.6%; p < 0.001). No significant differences were observed in excess weight, physical activity scores, or ultra-processed food consumption between the two groups. However, children from urban expansion areas showed a higher prevalence of prediabetes (OR = 0.133; 95% CI = 0.045-0.358; p < 0.001), elevated total cholesterol (OR = 0.423; p = 0.007), low HDL-c (OR = 0.324; p < 0.001), elevated LDL-c (OR = 0.304; p < 0.001), and elevated triglycerides (OR = 0.484; p = 0.029).

CONCLUSIONS

Residing in urban expansion areas was associated with worse clinical-metabolic outcomes among schoolchildren, independent of nutritional status, physical activity, and ultra-processed food consumption. These findings highlight the need for intersectoral and place-based policies to promote healthier environments for children in territories undergoing urbanization.