Walkability and its association with prevalent and incident diabetes among adults in different regions of Germany: results of pooled data from five German cohorts

Nadja Kartschmit,Mark Patrick Sheldon,Corinna Köhnke,Neeltje Van Den Berg,Saskia Hartwig,Kathrin Wolf,Annette Peters,Karin Halina Greiser,Werner Maier,Detlef Thürkow,Gavin Rudge,Susanne Moebus,Ulrike Stentzel,Robynne Sutcliffe,Alexander Kluttig,Andreas Wienke,Salman Ahmed,Rafael Mikolajczyk

doi:10.1186/s12902-019-0485-x

Abstract

BackgroundHighly walkable neighbourhoods may increase transport-related and leisure-time physical activity and thus decrease the risk for obesity and obesity-related diseases, such as type 2 diabetes (T2D).MethodsWe investigated the association between walkability and prevalent/incident T2D in a pooled sample from five German cohorts. Three walkability measures were assigned to participant’s addresses: number of transit stations, points of interest, and impedance (restrictions to walking due to absence of intersections and physical barriers) within 640 m. We estimated associations between walkability and prevalent/incident T2D with modified Poisson regressions and adjusted for education, sex, age at baseline, and cohort.ResultsOf the baseline 16,008 participants, 1256 participants had prevalent T2D. Participants free from T2D at baseline were followed over a mean of 9.2 years (SD: 3.5, minimum: 1.6, maximum: 14.8 years). Of these, 1032 participants developed T2D. The three walkability measures were not associated with T2D. The estimates pointed toward a zero effect or were within 7% relative risk increase per 1 standard deviation with 95% confidence intervals including 1.ConclusionIn the studied German settings, walkability differences might not explain differences in T2D.

Highlights

Walkable neighbourhoods may increase transport-related and leisure-time physical activity and decrease the risk for obesity and obesity-related diseases, such as type 2 diabetes (T2D)
Study population Data from five population-based cohort studies from different German areas were included: The Heinz Nixdorf Recall Study (HNR), the Dortmund Health Study (DHS), both conducted in Western Germany, the Cooperative Health Research in the Region of Augsburg (KORA) S4 Survey from the South of Germany, The Cardiovascular Disease Living and Ageing in the city of Halle (CARLA) Study, and the Study of Health in Pomerania (SHIP), the latter two from the Eastern area of Germany
We examined the association between walkability measures and T2D incidence in a sub-sample excluding all participants aged less than 30 years at baseline in order to exclude potential type 1 diabetes cases from the analysis

Summary

Introduction

Walkable neighbourhoods may increase transport-related and leisure-time physical activity and decrease the risk for obesity and obesity-related diseases, such as type 2 diabetes (T2D). Walkability may be associated with a reduced risk of obesity and T2D via increased transport-related and leisure-time physical activity [5,6,7,8,9,10,11,12]. Existing research showing a positive relationship between higher walkability and lower risk of incident and prevalent T2D comes mainly from Australia and North America [12, 13]. Since the built environment in Europe differs from Australia and North America [14, 15], it is not clear whether this association exists in European countries. Our previous pooled analysis of data from five German cohorts indicated a weak association between higher walkability and lower body mass index (BMI) [17]

Objectives

Methods

Results

Conclusion