Article

Neighborhood resources for physical activity and healthy foods and incidence of type 2 diabetes mellitus: the Multi-Ethnic study of Atherosclerosis. Arch Intern Med, 169, 1698-1704

Department of Epidemiology and Biostatistics, School of Public Health, Drexel University, Philadelphia, PA 19102, USA.
Archives of internal medicine (Impact Factor: 17.33). 10/2009; 169(18):1698-704. DOI: 10.1001/archinternmed.2009.302
Source: PubMed

ABSTRACT

Despite increasing interest in the extent to which features of residential environments contribute to incidence of type 2 diabetes mellitus, no multisite prospective studies have investigated this question. We hypothesized that neighborhood resources supporting physical activity and healthy diets are associated with a lower incidence of type 2 diabetes.
Person-level data came from 3 sites of the Multi-Ethnic Study of Atherosclerosis, a population-based, prospective study of adults aged 45 to 84 years at baseline. Neighborhood data were derived from a population-based residential survey. Type 2 diabetes was defined as a fasting glucose level of 126 mg/dL or higher (> or =7 mmol/L) or taking insulin or oral hypoglycemic agents. We estimated the hazard ratio of type 2 diabetes incidence associated with neighborhood (US Census tract) resources.
Among 2285 participants, 233 new type 2 diabetes cases occurred during a median of 5 follow-up years. Better neighborhood resources, determined by a combined score for physical activity and healthy foods, were associated with a 38% lower incidence of type 2 diabetes (hazard ratio corresponding to a difference between the 90th and 10th percentiles for resource distribution, 0.62; 95% confidence interval, 0.43-0.88 adjusted for age, sex, family history of diabetes, race/ethnicity, income, assets, educational level, alcohol use, and smoking status). The association remained statistically significant after further adjustment for individual dietary factors, physical activity level, and body mass index.
Better neighborhood resources were associated with lower incidence of type 2 diabetes, which suggests that improving environmental features may be a viable population-level strategy for addressing this disease.

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    • "Significant health consequences arise from not meeting the recommended levels of activity, including higher relative risk (adjusted for known confounders) of coronary heart disease, type 2 diabetes, breast cancer, colon cancer and allcause mortality (Lee et al., 2012). However if the recommended guidelines for physical activity are met, then the population can expect a lower average body mass index (BMI), a reduced incidence of lifestyle diseases related to obesity, such as type 2 diabetes mellitus and high blood pressure, and lower associated healthcare costs (Frank et al., 2009; Auchincloss et al., 2009; Ogilvie et al., 2007). Walking is the most common form of moderate-intensity physical activity among adults (Siegel et al., 1995; Eyler et al., 2003; Ogilvie et al., 2007; Sport N.I., 2010), is widely accessible and especially appealing to obese people, who are less likely to perform vigorous-intensity physical activity (Erlichman et al., 2002). "
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    • "All rights reserved. study area (Auchincloss et al., 2009). Addressing causality issues would also require a longitudinal design with repeated measurements of both exposure and outcome, and that a considerable proportion of study individuals change their exposure (typically by moving to another residential area) during follow-up. "
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    • "All rights reserved. study area (Auchincloss et al., 2009). Addressing causality issues would also require a longitudinal design with repeated measurements of both exposure and outcome, and that a considerable proportion of study individuals change their exposure (typically by moving to another residential area) during follow-up. "
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    ABSTRACT: Green neighbourhood environments have been associated with physical and psychological wellbeing in adults. Access to greenness is potentially more important in vulnerable subgroups. In this study based on longitudinal survey data from southern Sweden the cohort was divided into prognostic groups for good self-reported general (n=8891) and mental (n=9444) health. We used independent survey data to assess perceived neighbourhood greenness in 1km(2) areas, and estimated effects of changing exposure longitudinally stratified by prognostic group. The overall effect on health was small and statistically uncertain (for general health OR 1.04, 95% CI 0.98-1.10, for mental health OR 1.07, 95% CI 1.00-1.14). A more beneficial effect of increased greenness was indicated among subjects with lowest prognostic of good general health (OR 1.24, 95% CI 1.01-1.52). The study provided only weak evidence for beneficial effects of increased neighbourhood greenness triggered by changing residence. It seems that altered life circumstances, e.g. changed civil or socioeconomic status that often trigger a decision to move, are also the key determinants of the health consequences of changing residence. Copyright © 2015 Elsevier Ltd. All rights reserved.
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