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

The design was cross-sectional, so it cannot show that living in an urban expansion area caused the metabolic differences. The sample came from one municipality in southeastern Brazil, so the results may not apply to other regions. Diet and physical activity were reported by caregivers and children on previous-day questionnaires, which can involve recall bias and social desirability bias. Several outcomes were analysed in smaller subsets than the 420 consented children, including 223 biochemical tests and 168 guardian questionnaires. Income and parental education were self-reported and had missing data, which may reduce power and introduce information bias. The study did not measure objective environmental factors such as school distance, street quality, or public infrastructure.

Do not conclude that living in an urban expansion area caused prediabetes or abnormal lipids. This was a cross-sectional study, and the measured ultra-processed food consumption and overall physical activity did not differ between areas.