Living in vicinity of fast food outlets tied to higher risk of developing diabetes: JAMA

Living in neighborhoods with higher availability of fast-food outlets across all regions of the United States is associated with higher subsequent risk of developing type 2 diabetes.

Neighbourhood food environment variables are related with type 2 diabetes in different community types among US veterans, indicating that food environments are viable routes for intervention to alleviate the diabetes burden.

The findings of this study were published in the Journal of American Medical Association on 29th October, 2021.

Diabetes is a major cause of morbidity and death among people in the United States, yet its prevalence varies across the country, indicating that neighborhood characteristics are connected with regional differences in diabetes.

The study was conducted by Rania Kanchi and team with the objective to look at the relationship between neighborhood food environment and the risk of incident type 2 diabetes in four community types (high-density urban, low-density urban, suburban, and rural). 

This is a nationwide cohort study involving 4 100 650 US veterans who do not have type 2 diabetes. Participants were enrolled in the cohort between 2008 and 2016, and they were followed up on till 2018. The median (interquartile range) duration of follow-up was 5.5 person-years. Data were gathered from electronic health records maintained by the Veterans Administration. Incident type 2 diabetes was defined as two type 2 diabetes International Classification of Diseases, Ninth or Tenth Revision codes, a prescription for diabetic medication other than metformin or acarbose alone, or one type 2 diabetes encounter. Codes from the International Classification of Diseases, Ninth or Tenth Revision, and two cases of high hemoglobin A1c (6.5%).

Fast-food restaurant availability was related with a greater risk of type 2 diabetes in all community categories, but supermarkets were associated with a reduced risk of type 2 diabetes in suburban and rural areas. This study's models found no significant link between supermarket availability and type 2 diabetes incidence in metropolitan neighborhoods. The connection of food environment with type 2 diabetes incidence varied by level of urbanicity but did not differ further by area, according to this study. The relationship between the relative presence of fast-food outlets and the incidence of type 2 diabetes was comparable across all community categories. According to the sensitivity analysis, the relationship between the absolute availability of fast-food outlets and type 2 diabetes incidence was stronger in suburban and rural regions than in LDU towns, but it was nil in HDU communities.

Finally, tailored measures aimed at increasing the availability of supermarkets may be more suitable in suburban and rural areas than in urban communities, although limits on fast-food outlets may be beneficial in all community types. These steps, together with raising knowledge of the risk of type 2 diabetes and the need of a balanced diet, may be related with a reduction in the prevalence of type 2 diabetes among people in the United States.

Reference:

Kanchi R, Lopez P, Rummo PE, et al. Longitudinal Analysis of Neighborhood Food Environment and Diabetes Risk in the Veterans Administration Diabetes Risk Cohort. JAMA Netw Open. 2021;4(10):e2130789. doi:10.1001/jamanetworkopen.2021.30789