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Association between neighbourhood walkability and metabolic risk factors influenced by physical activity: a cross-sectional study of adults in Toronto, Canada
  1. C K Jennifer Loo1,
  2. Michelle Greiver2,3,
  3. Babak Aliarzadeh2,3,
  4. Daniel Lewis4
  1. 1Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  2. 2Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3North York General Hospital, Toronto, Ontario, Canada
  4. 4Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Dr C K Jennifer Loo; jennifer.loo{at}


Objective To determine whether neighbourhood walkability is associated with clinical measures of obesity, hypertension, diabetes and dyslipidaemia in an urban adult population.

Design Observational cross-sectional study.

Setting Urban primary care patients.

Participants 78 023 Toronto residents, aged 18 years and over, who were formally rostered or had at least 2 visits between 2012 and 2014 with a primary care physician participating in the University of Toronto Practice Based Research Network (UTOPIAN), within the Canadian Primary Care Sentinel Surveillance Network (CPCSSN).

Main outcome measures Differences in average body mass index (BMI), systolic and diastolic blood pressure, fasting blood glucose, haemoglobin A1c (HbA1C), total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein and triglyceride between residents in the highest versus the lowest quartile of neighbourhood walkability, as estimated using multivariable linear regression models and stratified by age. Outcomes were objectively measured and were retrieved from primary care electronic medical records. Models adjusted for age, sex, smoking, medications, medical comorbidities and indices of neighbourhood safety and marginalisation.

Results Compared with those in the lowest walkability quartile, individuals in the highest quartile had lower mean BMI (−2.64 kg/m2, 95% CI −2.98 to −2.30; p<0.001), systolic blood pressure (−1.35 mm Hg, 95% CI −2.01 to −0.70; p<0.001), diastolic blood pressure (−0.60 mm Hg, 95% CI 1.06 to −0.14; p=0.010) and HbA1c (−0.063%, 95% CI −0.11 to −0.021; p=0.003) and higher mean HDL (0.052 mmol/L, 95% CI 0.029 to 0.075; p<0.001). In age-stratified analyses, differences in the mean BMI were consistently observed for adults aged 18 to under 40 (−4.44 kg/m2, 95% CI −5.09 to −3.79; p<0.001), adults aged 40–65 (−2.74 kg/m2, 95% CI −3.24 to −2.23; p<0.001) and adults aged over 65 (−0.87 kg/m2, 95% CI −1.48 to −0.26; p=0.005).

Conclusions There was a clinically meaningful association between living in the most walkable neighbourhoods and having lower BMI in adults of all ages.

  • built environment
  • active transportation
  • obesity
  • neighbourhood walkability
  • utilitarian walking
  • metabolic risk

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors CKJL conceptualised the study. CKJL and DL designed the analyses in consultation with MG and BA. CKJL cleaned and analysed the data, and drafted the manuscript. All authors contributed to revising the paper.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval This study was reviewed and approved by the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) Research, Privacy and Ethics Officer and by the London School of Hygiene and Tropical Medicine MSc Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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