Individuals living in neighborhoods conducive to physical activity and providing access to healthy foods may have a lower risk of developing type 2 diabetes in a five-year period, according to a report in the October 12 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
"The worldwide epidemic of type 2 diabetes mellitus is largely driven by the combined rise in obesity, intake of energy-dense or nutrient-poor foods and physical inactivity," the authors write as background information in the article. Interventions to reduce risk on the individual level-including surgery, medication and behavior change-have had mixed results. Large-scale behavior change may be necessary to reverse the diabetes epidemic, but such a change is difficult to achieve and may be unsustainable if the surrounding environment is not supportive.
Amy H. Auchincloss, Ph.D., M.P.H., of Drexel University School of Public Health, Philadelphia, and colleagues studied 2,285 adults age 45 to 84 who were initially examined between 2000 and 2002. Study participants were from three of the sites in the Multi-Ethnic Study of Atherosclerosis (MESA) for which neighborhood level data were obtained: Baltimore; Forsyth County, N.C.; and New York City/Bronx. Blood glucose levels were obtained from study participants at baseline and at three follow-up examinations, during which other individual characteristics also were assessed (including diet, body mass index [BMI] and physical activity levels).
Measures of neighborhood resources were obtained from a separate assessment, the Community Survey, in which other residents of the same neighborhoods (defined as the area within a 20-minute walk or a mile from their homes) rated the suitability of their environment for physical activity and access to healthy foods. For instance, they were asked if it was pleasant or easy to walk in their neighborhood, and whether a large, high-quality selection of fruits, vegetables and other low-fat foods was available. Scores for physical activity and healthy foods were calculated for each neighborhood on scales of one to five (with five representing the healthiest areas).
Over a median (midpoint) of five years of follow-up, 233 of the 2,285 participants (10.2 percent) developed diabetes. Average neighborhood scores were 3.68 for physical activity and 3.36 for healthy foods.