Neighborhood environments can influence a child's risk of developing type 2 diabetes

Type 2 diabetes (T2D), once considered an adult-onset disease, is increasing at alarming rates in children and adolescents. Before the mid-1990s, just 1% to 2% of youth with diabetes had T2D. Today, that number has skyrocketed to between 24% and 45%, with the average age of diagnosis hovering around 13 years old.

This troubling trend closely tracks with the ongoing rise in childhood obesity. While genetics, diet and physical activity all play roles in T2D risk, new research from Florida Atlantic University's Charles E. Schmidt College of Medicine highlights another key factor in T2D risk: where a child lives.

Researchers conducted a large-scale study to explore how T2D is emerging in the youngest children. Using data from the National Survey of Children's Health spanning 2016 to 2020, the team focused on a subgroup of children from birth to age 5 – a rarely studied demographic in T2D research.

The study analyzed responses from caregivers of more than 174,000 children nationwide, including nearly 50,000 in the early childhood group. Researchers examined not only diet and physical activity but also broader influences like neighborhood conditions, caregiver health, food security, and participation in government assistance programs. Their goal: to better understand how early life experiences and environments might shape the risk of developing T2D.

The results, published in the journal Pediatric Research, found that while the overall prevalence of T2D in children under age 5 remained low and relatively stable over the five-year period, the disease's development appears to be tied more to social and environmental factors than to individual behaviors alone.

Certain neighborhood and household characteristics stood out. For example, in both 2016 and 2020, having a library nearby was significantly associated with childhood T2D diagnoses. This association is thought to reflect broader neighborhood and behavioral patterns that encourage sedentary, indoor activities rather than outdoor physical engagement. Libraries tend to reflect more urban environments compared to areas with high neighborhood walkability and green space.

Research has shown that neighborhood environments – such as the presence of sidewalks, parks or other green spaces – can directly influence a child's ability to engage in physical activity, and in turn, affect their risk of developing chronic diseases like type 2 diabetes."

Lea Sacca, Ph.D., senior author and an assistant professor of population health in the Schmidt College of Medicine

Caregivers also increasingly reported neighborhood issues like litter and vandalism. These environmental concerns grew steadily between 2016 and 2020 and were evident across both the overall sample and the youngest age group. Other notable associations emerged in early childhood include receiving help from neighbors in 2016 and neighborhood walkability in 2019.

Study findings also showed that in 2017, access to free or reduced-cost meals showed a similar link to neighborhood and household characteristics. From 2019 to 2020, there was a marked increase in the use of government assistance programs such as food stamps, free meal plans and cash support. While these programs may help address food insecurity, their impact on nutrition quality is more complicated.

Participation in programs like SNAP and school meals has been linked to increased intake of processed, energy-dense foods high in sugar and fat, which may contribute to the risk of T2D.

"While this finding could suggest improved access to food, previous research shows that relying on food assistance doesn't always equate to better nutrition," said Sacca. "For instance, children in food-insecure households tend to have poorer blood sugar control and higher hospitalization rates. Some research even suggests that participants in programs like SNAP may have worse diet quality than non-participants from similarly low-income households."

The researchers say effective T2D prevention and early detection efforts must consider both environmental factors and food quality – particularly neighborhood design and access to nutritious options – for lasting and widespread impact.

Nonetheless, obesity remains the strongest and most common risk factor for TD2 in children. Children who are significantly overweight are four times more likely to develop the disease by age 25 than those with a healthy weight.

"With obesity rates continuing to rise, especially among young children, prevention efforts are critical," said Sacca.

One particularly urgent target is reducing consumption of sugar-sweetened beverages, which are closely linked to both obesity and diabetes risk. Notably, nearly 70% of children aged 2 to 5 consume sugar-sweetened beverages daily. While some school-based policies like vending machine restrictions and small beverage taxes have led to slight decreases in consumption on school grounds, overall intake remains high.

The researchers suggest that more assertive policies, including full bans in schools and larger taxes, may be needed. At the same time, evidence from successful school-based programs shows that improving dietary habits and increasing physical activity among children is achievable with the right support.

"The rise in early-onset type 2 diabetes is a growing public health concern," said Sacca. "Addressing it requires a comprehensive strategy. That includes improving access to nutritious foods, creating healthier neighborhood environments, and investing in policies that promote long-term wellness from the very start of life."

Study co-authors are FAU medical students Ayden Dunn, Paige Brinzo, Sahar Kaleem, Austin Lent, Madison Etzel, Jennifer Mendonca, Vama Jhumkhawala and Milad Khoury, M.D., a clinical affiliate assistant professor of endocrinology in FAU's Department of Medicine.