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Areas with a high density of fast food outlets are associated with a greater prevalence of type 1 diabetes but not type 2 diabetes, according to new research.
These findings come from an analysis of emergency claims data for 5 million adults and 1.6 million children in New York who visited an emergency department at least once during 2009-2013. Researchers also looked at sociodemographic data for the area from community surveys and used local authorities’ inspection data to characterize local restaurant and retail food environments.
But when the analysis was adjusted to account for a range of factors, including age, sex, ethnicity, household income, and employment rates, the association between fast food swamps and diabetes was significant for pediatric type 1 diabetes only.
“Given the rising prevalence of type 1 diabetes, there has been increasing belief that certain environmental influences are contributing sharply to these increases,” wrote David C. Lee, MD, New York University Langone Health, and his coauthors. “There is some emerging literature which suggests that pregnant women in adverse food environments may have a higher likelihood of gestational diabetes, which some believe may affect health outcomes in their offspring.”
The study also failed to find an influence of retail food swamps – areas with more bodegas or small convenience stores within a 1-mile radius – on the prevalence of either type 1 or type 2 diabetes, in either adults or children. When researchers extended this to a 2-mile radius, they did find a significantly higher prevalence of pediatric type 1 diabetes associated with retail food swamps but a significantly lower prevalence of adult type 1 diabetes.
“This result may suggest that the retail food environment does not have a strong association with local diabetes prevalence or may be due to how we measured the retail food environment,” they wrote.
In general, the study found that the prevalence of adult and pediatric type 1 diabetes was significantly lower in most black neighborhoods, while the prevalence of adult type 1 diabetes was significantly lower in most Hispanic neighborhoods. Higher-income neighborhoods showed a significantly higher prevalence of pediatric type 1 diabetes.
The prevalence of type 2 diabetes in adults was significantly higher in low-income neighborhoods and those with more elderly residents, while the highest rates of pediatric type 2 diabetes were found in black neighborhoods.
The authors commented that they were surprised that their data did not show a higher prevalence of adult type 2 diabetes in black neighborhoods.
“In our multivariate analysis, older age and lower income were the only demographic or socioeconomic factors associated with higher adult type 2 diabetes prevalence,” they wrote.
Their use of ED surveillance data may have skewed the findings toward individuals more likely to visit those departments, namely Medicaid patients. But they suggested this would be balanced by the fact that the analysis was based on small geographic areas.
“Overall, our results may suggest that the physical food environment may not play as strong a role in characterizing the risk of type 2 diabetes among children and that other factors such as genetics, health behaviors, environmental exposures, or family influences may play more important roles.”
The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the Juvenile Diabetes Research Foundation. No conflicts of interest were declared.
SOURCE: Lee DC et al. J Endocr Soc. 2018. Apr 17. doi: 10.1210/js.2018-00001.
Areas with a high density of fast food outlets are associated with a greater prevalence of type 1 diabetes but not type 2 diabetes, according to new research.
These findings come from an analysis of emergency claims data for 5 million adults and 1.6 million children in New York who visited an emergency department at least once during 2009-2013. Researchers also looked at sociodemographic data for the area from community surveys and used local authorities’ inspection data to characterize local restaurant and retail food environments.
But when the analysis was adjusted to account for a range of factors, including age, sex, ethnicity, household income, and employment rates, the association between fast food swamps and diabetes was significant for pediatric type 1 diabetes only.
“Given the rising prevalence of type 1 diabetes, there has been increasing belief that certain environmental influences are contributing sharply to these increases,” wrote David C. Lee, MD, New York University Langone Health, and his coauthors. “There is some emerging literature which suggests that pregnant women in adverse food environments may have a higher likelihood of gestational diabetes, which some believe may affect health outcomes in their offspring.”
The study also failed to find an influence of retail food swamps – areas with more bodegas or small convenience stores within a 1-mile radius – on the prevalence of either type 1 or type 2 diabetes, in either adults or children. When researchers extended this to a 2-mile radius, they did find a significantly higher prevalence of pediatric type 1 diabetes associated with retail food swamps but a significantly lower prevalence of adult type 1 diabetes.
“This result may suggest that the retail food environment does not have a strong association with local diabetes prevalence or may be due to how we measured the retail food environment,” they wrote.
In general, the study found that the prevalence of adult and pediatric type 1 diabetes was significantly lower in most black neighborhoods, while the prevalence of adult type 1 diabetes was significantly lower in most Hispanic neighborhoods. Higher-income neighborhoods showed a significantly higher prevalence of pediatric type 1 diabetes.
The prevalence of type 2 diabetes in adults was significantly higher in low-income neighborhoods and those with more elderly residents, while the highest rates of pediatric type 2 diabetes were found in black neighborhoods.
The authors commented that they were surprised that their data did not show a higher prevalence of adult type 2 diabetes in black neighborhoods.
“In our multivariate analysis, older age and lower income were the only demographic or socioeconomic factors associated with higher adult type 2 diabetes prevalence,” they wrote.
Their use of ED surveillance data may have skewed the findings toward individuals more likely to visit those departments, namely Medicaid patients. But they suggested this would be balanced by the fact that the analysis was based on small geographic areas.
“Overall, our results may suggest that the physical food environment may not play as strong a role in characterizing the risk of type 2 diabetes among children and that other factors such as genetics, health behaviors, environmental exposures, or family influences may play more important roles.”
The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the Juvenile Diabetes Research Foundation. No conflicts of interest were declared.
SOURCE: Lee DC et al. J Endocr Soc. 2018. Apr 17. doi: 10.1210/js.2018-00001.
Areas with a high density of fast food outlets are associated with a greater prevalence of type 1 diabetes but not type 2 diabetes, according to new research.
These findings come from an analysis of emergency claims data for 5 million adults and 1.6 million children in New York who visited an emergency department at least once during 2009-2013. Researchers also looked at sociodemographic data for the area from community surveys and used local authorities’ inspection data to characterize local restaurant and retail food environments.
But when the analysis was adjusted to account for a range of factors, including age, sex, ethnicity, household income, and employment rates, the association between fast food swamps and diabetes was significant for pediatric type 1 diabetes only.
“Given the rising prevalence of type 1 diabetes, there has been increasing belief that certain environmental influences are contributing sharply to these increases,” wrote David C. Lee, MD, New York University Langone Health, and his coauthors. “There is some emerging literature which suggests that pregnant women in adverse food environments may have a higher likelihood of gestational diabetes, which some believe may affect health outcomes in their offspring.”
The study also failed to find an influence of retail food swamps – areas with more bodegas or small convenience stores within a 1-mile radius – on the prevalence of either type 1 or type 2 diabetes, in either adults or children. When researchers extended this to a 2-mile radius, they did find a significantly higher prevalence of pediatric type 1 diabetes associated with retail food swamps but a significantly lower prevalence of adult type 1 diabetes.
“This result may suggest that the retail food environment does not have a strong association with local diabetes prevalence or may be due to how we measured the retail food environment,” they wrote.
In general, the study found that the prevalence of adult and pediatric type 1 diabetes was significantly lower in most black neighborhoods, while the prevalence of adult type 1 diabetes was significantly lower in most Hispanic neighborhoods. Higher-income neighborhoods showed a significantly higher prevalence of pediatric type 1 diabetes.
The prevalence of type 2 diabetes in adults was significantly higher in low-income neighborhoods and those with more elderly residents, while the highest rates of pediatric type 2 diabetes were found in black neighborhoods.
The authors commented that they were surprised that their data did not show a higher prevalence of adult type 2 diabetes in black neighborhoods.
“In our multivariate analysis, older age and lower income were the only demographic or socioeconomic factors associated with higher adult type 2 diabetes prevalence,” they wrote.
Their use of ED surveillance data may have skewed the findings toward individuals more likely to visit those departments, namely Medicaid patients. But they suggested this would be balanced by the fact that the analysis was based on small geographic areas.
“Overall, our results may suggest that the physical food environment may not play as strong a role in characterizing the risk of type 2 diabetes among children and that other factors such as genetics, health behaviors, environmental exposures, or family influences may play more important roles.”
The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the Juvenile Diabetes Research Foundation. No conflicts of interest were declared.
SOURCE: Lee DC et al. J Endocr Soc. 2018. Apr 17. doi: 10.1210/js.2018-00001.
FROM JOURNAL OF THE ENDOCRINE SOCIETY
Key clinical point: Neighborhoods with higher numbers of fast food restaurants are linked to a higher prevalence of type 1, not type 2, diabetes.
Major finding: Fast food swamps are associated with a higher prevalence of pediatric type 1 diabetes.
Study details: Retrospective analysis of emergency claims data for 5 million adults and 1.6 million children.
Disclosures: The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the Juvenile Diabetes Research Foundation. No conflicts of interest were declared.
Source: Lee DC et al. J Endocr Soc. 2018. Apr 17. doi: 10.1210/js.2018-00001.