- A big research of veterans in the United States found significant links between the availability of food in the neighborhood and the prevalence of type 2 diabetes.
- Veterans residing in rural, suburban, and high- and low-density urban areas were evaluated.
- They discovered a relationship between a larger number of fast-food businesses and an increase in type 2 diabetes in all sorts of communities.
- In suburban and rural towns, a higher density of supermarkets compared to other food outlets was linked to lower levels of type 2 diabetes.
Scientists from New York University (NYU) used the Veterans Health Administration’s resources to investigate people’s risk of getting type 2 diabetes based on their local food environment. In the Journal of the American Medical Association Network Open, first author Rania Kanchi, MPH, and her colleagues described their work.
Prior research had found that greater community resources, such as access to nutritious food and exercise, were linked to a lower incidence of diabetes. These research, however, were constrained to geographically comparable, urban-only settings.
In this one-of-a-kind study, principal investigator Dr. Lorna E. Thorpe, MPH, Ph.D., and her NYU colleagues used a different approach.
They studied 4,100,650 adults from the Veterans Administration Diabetes Risk cohort, a group of veterans who did not have diabetes. The researchers next used data from the US Census Bureau to assess food environments and divide communities into rural, suburban, high-density, and low-density urban regions.
Dr. Thorpe, director of the Division of Epidemiology and vice-chair of strategy and planning in NYU’s Grossman School of Medicine’s Department of Population Health, told Medical News Today:
“Only a few longitudinal studies have tracked the emergence of diabetes among people who live in certain environments and rigorously assessed the role of those environments on diabetes risk. Ours is among the largest, harnessing electronic health records of veterans. [A] key strength is that we were able to assess how these relationships differed across the urban and rural spectrum.”
How the study was carried out by the researchers
First, researchers compared the number of fast-food businesses in veterans’ areas to all eateries across a five-year period. Then, throughout the same time period, they tracked the fraction of food shops that were supermarkets.
Researchers took into account confounders, or variables that might have an impact on the study’s conclusion, such as educational attainment, unemployment rate, low income, need for public assistance, and absence of a car. Age, sex, race, ethnicity, and handicap were all factors taken into account by the researchers.
The participants in the research were mostly white non-Hispanic men (92.2%). (76.3 percent ). Furthermore, more than 70% of the veterans surveyed had a disability (34.8%) or were living on a low income (37.9 percent ).
Over a five-year period, scientists watched the veterans. They discovered that 539,369 veterans (13.2%) had diabetes, with those aged 60–79 (17%) having the highest prevalence, followed by those aged 40–59. (14.9 percent ).
There were clear divisions between ethnic and minority groups. Non-Hispanic Black adults, for example, had the greatest rate of type 2 diabetes (16.9%), followed by non-Hispanic Native Hawaiian and Pacific Islanders (15%) and non-Hispanic American Indian and Alaskan Native participants (both 15%). (14.2 percent ).
Non-Hispanic white (12.9 percent), non-Hispanic Asian (12.8 percent), and Hispanic (12.8 percent) veterans were more likely to develop type 2 diabetes. Males were more likely than women to get type 2 diabetes, with 13.6 percent of men developing the disease compared to just 8.2 percent of women. Finally, veterans with disabilities and poor income had a higher risk of developing type 2 diabetes.
Cause and effect?
The proportion of supermarkets to retail food establishments was about similar across all community categories, at around 10%. The percentage of fast-food restaurants to other eateries, on the other hand, was as follows:
- 26% in high-density urban communities
- 31% in low-density urban communities
- 32% in suburban communities
- 29% in rural communities
In all four towns, an increase in the presence of fast-food restaurants relative to all restaurants was linked to an increased incidence of type 2 diabetes.
The research found that a 10% increase in the number of fast-food restaurants compared to other eateries resulted in:
- a 1% increase in type 2 diabetes risk in rural, high-density, and low-density urban areas
- a 2% increase in type 2 diabetes risk in suburban communities
Type 2 diabetes was more common in those who lived in high-density metropolitan regions (14.3 percent ). Low-density urban inhabitants (13.1 percent) and rural dwellers came in second and third, respectively (13.2 percent ). Veterans from the suburbs had the lowest rate of type 2 diabetes (12.6 percent ).
In suburban and rural towns, higher supermarket density compared to other food shops was linked to a decreased risk of type 2 diabetes, but not in urban areas.
Dr. Thorpe explained to MNT, “The relative mix of food outlets in one’s community does increase or decrease [the] risk for diabetes over time — above and beyond an individual’s risk profile, and that is in general modifiable through programs and policy.” She continued, “
“High proportions of restaurants being fast food led to a greater risk of diabetes, irrespective of how rural or urban [an area one lives in], and supermarkets seemed to play a particularly strong preventive role in suburban and rural areas.”
Individual and policy initiatives
In summarizing the study’s difficulties, the authors conclude that their findings show that fast-food restaurant-specific health policies might be helpful. “Opportunities exist to either change the sorts of food accessible in fast-food restaurants or, more harder, change zoning rules to restrict the availability of fast-food restaurants to minimize [diabetes] risk,” Dr. Thorpe explained. She went on to say:
“In non-urban settings, because the relative availability of supermarkets reduces diabetes risk, it may be important to:
- improve the mix of healthy vs. unhealthy foods at supermarkets
- improve transportation options
- increase supermarket availability
- or introduce a combination of [the above].”
Dr. Thorpe also talked to MNT on how people might lower their risk of having type 2 diabetes in their neighborhood:
“For individual residents: Play close attention to how [the] availability of food outlets affects your day-to-day choices, and build practices to take advantage of healthy options in your communities.”
The capacity of the authors to watch veterans and their dietary surroundings over a lengthy period of time is cited as a strength of this study. However, the investigators were unable to analyze the veterans’ diets, physical activity, or comorbid conditions due to restrictions. In addition, the researchers were unable to ascertain how frequently veterans visited stores in their communities.
The researchers believe that banning fast-food outlets in all neighborhoods and increasing rural and suburban supermarkets are two ways to lower type 2 diabetes in the United States.