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. 2019 Feb 4;18(1):3.
doi: 10.1186/s12942-019-0167-y.

The association between population density and blood lipid levels in Dutch blood donors

Rosa de Groot  1   2 , Jody C Hoenink  3 , Joreintje D Mackenbach  3 , Nicole R den Braver  3 , Maria G M Pinho  3 , Darshan Brassinga  4 , Femmeke J Prinsze  4 , Tiffany C Timmer  4   5   6 , Wim L A M de Kort  4   6 , Johannes Brug  7 , Katja van den Hurk  4 , Jeroen Lakerveld  3   8   9
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The association between population density and blood lipid levels in Dutch blood donors

Rosa de Groot et al. Int J Health Geogr. .

Abstract

Background: In low and middle-income countries (LMIC), the total and LDL cholesterol and triglyceride levels of residents of urban areas are reported to be higher than those of rural areas. This may be due to differences in lifestyle behaviors between residents of urban areas and rural areas in LMIC. In this study, our aims were to (1) examine whether or not LDL cholesterol, total/HDL ratios and triglyceride levels of individuals in densely populated areas are higher than those of individuals living in less-densely populated areas in a high-income country (HIC) and (2) investigate the potential mediating roles of physical activity and sedentary behavior.

Methods: We used cross-sectional data from 2547 Dutch blood donors that participated in Donor InSight-III. Linear regression was used to analyze the association between population density and LDL cholesterol, total/HDL cholesterol ratio and HDL cholesterol. The mediating roles of moderate-to-vigorous physical activity (MVPA) and sedentary behavior were investigated in a subsample (n = 740) for which objectively measured MVPA/sedentary behavior data was available. Multiple mediation with linear regression analyses were performed and the product-of-coefficients method was used to calculate direct and indirect effects.

Results: Mean LDL cholesterol and median total cholesterol/HDL cholesterol ratio and triglyceride levels were 2.89, 3.43 and 1.29 mmol/L, respectively. Population density was not associated with LDL cholesterol [β 0.00 (- 0.01; 0.01)], log transformed total/HDL cholesterol ratio [β 1.00 (1.00; 1.00)] and triglyceride levels [β 1.00 (0.99; 1.00)]. No statistically significant direct or indirect effects were found.

Conclusion: Contrary to previous findings in LMIC, no evidence was found that population density is associated with blood lipid levels in blood donors in the Netherlands or that MVPA and sedentary behavior mediate this association. This may be the result of socioeconomic differences and, in part, may be due to the good health of the study population and the relatively high population density in the Netherlands. Also, compared to LMIC, differences in physical activity levels in more versus less populated areas may be less pronounced in HIC.

Keywords: Adults; Blood lipid levels; Physical activity; Population density; Sedentary behavior.

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Figures

Fig. 1
Fig. 1
Flow chart of total study population and subsample with accelerometer data
Fig. 2
Fig. 2
Mediation analysis framework. c path total effect of population density on blood lipid levels, c′ path direct effect of population density on blood lipids adjusted for mediating variable, a-path effect of population density on mediator, b-path effect of mediator on blood lipids, a-path × b-path indirect effect of population density on blood lipid levels through mediating variables
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