Abstract
Diabetes is a major health concern and is influenced by lifestyle, which can be affected by the neighbourhood environment. Specifically, a fast-food environment can influence eating behaviours and thus diabetes prevalence. Therefore, our aim was to assess the relationship between fast-food environment and diabetes prevalence for urban and rural environments in the Netherlands, using multiple indicators and buffer sizes. In this cross-sectional study, data on a nationwide sample of adults older than 19 years in the Netherlands were taken from the 2012 Dutch national health survey (from Public Health Monitor), in which participants were surveyed on topics related to health and lifestyle behaviour. Fast-food outlet exposures were determined within street-network buffers of 100 m, 400 m, 1000 m, and 1500 m around residential addresses. For each of these buffers, three indicators were calculated: presence (yes or no) of fast-food outlets, fast-food outlet density, and ratio. Logistic regression analyses were carried out to assess associations of these indicators with diabetes, adjusting for potential confounders and stratifying into urban and rural areas. 387 195 adults were surveyed, 284 793 of whom were included in the study. 22 951 (8%) reported having diabetes. Fast-food outlet exposures were positively associated with diabetes prevalence. We did not observe large differences between urban and rural areas. The effect estimates were small for all indicators. For example, in the 400 m buffer in the urban environment, the odds ratio (OR) for having diabetes among people with a fast-food outlet present compared with those without, was 1·006 (95% CI 1·003-1·009) using the presence indicator. The presence indicator showed higher effect estimates and the most consistent results across buffer sizes (ranging from OR 1·005 [95% CI 1·000-1·010] with the 1000 m buffer to 1·016 [1·005-1·028] with the 1500 m buffer in urban areas and from 1·002 [0·998-1·005] with the 1500 m buffer to 1·009 [1·006-1·018] with the 100 m buffer in rural areas) compared with the density and ratio indicators. The results confirm the evidence that the fast-food outlet environment is a diabetes risk factor. All data included were at the individual level and the variability was ensured by the spatial distribution and number of participants. In this study, we only accounted for residential exposure because we were unable to account for exposure outside the residential environment. The findings of this study encourage local governments to consider the potential adverse effects of fast-food exposures and aim at minimising unhealthy food access. Global Geo Health Data Centre, Utrecht University, Netherlands.
Highlights
Diabetes is one of the main global health threats in the 21st century.[1,2,3] Globally, one in ten adults aged 20–79 years had diabetes in 2021.4 The prevalence of diabetes is estimated to increase even further, from 2·8% in 2000 to 4·4% in 2030.5 in the Netherlands, the proportion of people prescribed diabetes medication increased from 3·8 % in 2006 to 4·6% in 2012.6 There are two main types of diabetes that can affect the general population: type 1 diabetes and type 2 diabetes
From the literature search we found only four studies that have examined the association between the fast-food environment and diabetes at an individual level, diabetes is a major global health threat
We aimed to investigate the associations between fast-food environment exposures and diabetes prevalence by using various exposure indicators and buffer sizes, for rural and urban subpopulations separately
Summary
Diabetes is one of the main global health threats in the 21st century.[1,2,3] Globally, one in ten adults aged 20–79 years had diabetes in 2021.4 The prevalence of diabetes is estimated to increase even further, from 2·8% in 2000 to 4·4% in 2030.5 in the Netherlands, the proportion of people prescribed diabetes medication increased from 3·8 % in 2006 to 4·6% in 2012.6 There are two main types of diabetes that can affect the general population: type 1 diabetes and type 2 diabetes. Type 1 diabetes is almost exclusively determined by genetics and represents less than 10% of the total diabetes cases.[7] By contrast, type 2 diabetes is highly determined by modifiable, mainly lifestyle-related factors, such as physical inactivity, poor diet, smoking, and alcohol consumption.[1,3]. In the Netherlands, the number of food outlets has increased by 8% from 2008 to 2012.17 Given that most fast-food is energy dense and nutrient poor, its consumption might cause an increased body-mass index and type 2 diabetes.[18,19]
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