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02-10-2022 | Type 2 diabetes | News

Fast-food restaurant access does not impact socioeconomic link to diabetes risk

Author: Laura Cowen

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medwireNews: The risk for type 2 diabetes increases with worsening neighborhood-level socioeconomic conditions but the link between the two is not mediated by access to fast-food restaurants, US study findings indicate.

This suggests that interventions such as restricting fast-food restaurants, targeting availability of supermarkets, and taxing sugar sweetened beverages “would not necessarily mitigate the role of poor NSEE [neighborhood socioeconomic environment]” on type 2 diabetes risk, say Lorna Thorpe (New York University Grossman School of Medicine) and co-investigators.

Thorpe and collaborators from the Diabetes Location, Environmental Attributes, and Disparities Network measured NSEE by creating an index that included census data on education level, unemployment rates, household income, and whether households were in poverty, received public assistance, and owned a car.

They then assessed its impact on diabetes risk in three large, geographically distinct study samples that were each divided into four levels of community type ranging from rural to higher-density urban areas.

The researchers report in Diabetes Care that, in all three samples, worse NSEE was associated with a significantly increased risk for diabetes in lower-density urban, suburban/small town, and rural areas, while in higher-density urban communities there was either no association or a nonsignificant inverse association.

The next step was to investigate whether the association was mediated by access to fast-food restaurants and supermarkets and found that the results varied in each of the three study samples.

In the Veterans Administration Diabetes Risk cohort, which includes over 4.1 million diabetes-free veterans, diabetes risk increased significantly with greater exposure to fast-food restaurants and decreased significantly with greater access to supermarkets across all community types.

In the Reasons for Geographic and Racial Differences in Stroke epidemiologic cohort (n=11,208) there were nonsignificant positive associations between exposure to fast-food restaurants and diabetes risk in urban and lower-density urban areas but no associations in suburban/small town and rural areas.

There were also no significant associations between diabetes risk and supermarket access in either this cohort or in the Geisinger/Johns Hopkins University case–control study of 15,888 people with new-onset type 2 diabetes and 79,435 matched controls from Pennsylvania.

However, the investigators found that risk for type 2 diabetes in the Geisinger/Johns Hopkins University group decreased with increasing access to fast-food outlets in all but the rural communities.

Thorpe and team say that this “finding could suggest true geographic variation in the influence of food environments on [type 2 diabetes] risk (due either to actual variation in the types of fast-food restaurants present in this area of Pennsylvania or in how residents use restaurants),” but also highlights “the challenges of multilevel causal inference and the implicit assumptions of population-average associations in multilevel models.”

Finally, the researchers showed that, across the three study samples, the relationship between NSEE and diabetes onset was “not mediated through the relative availability of fast-food restaurants.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group

Diabetes Care 2022; doi:10.2337/dc21-1693

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