Association between neighbourhood walkability and metabolic risk factors influenced by physical activity: a cross-sectional study of adults in Toronto, Canada

Loo, Caitlin; Greiver, Michelle; Aliarzadeh, Babak; Lewis, Daniel

doi:10.1136/bmjopen-2016-013889

Cited by 49 publications

(33 citation statements)

References 50 publications

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“…Ten studies investigated the association between neighbourhood walkability and T2DM risk/prevalence. Six studies received a strong quality rating [ 20 , 48 , 57 , 58 , 62 , 65 ]. Six studies observed that highly walkable neighbourhoods were associated with a lower T2DM risk/prevalence [ 19 – 22 , 45 , 54 , 65 ].…”

Section: Resultsmentioning

confidence: 99%

Built environmental characteristics and diabetes: a systematic review and meta-analysis

Braver

Lakerveld

Rutters

et al. 2018

BMC Med

172

103

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BackgroundThe built environment influences behaviour, like physical activity, diet and sleep, which affects the risk of type 2 diabetes mellitus (T2DM). This study systematically reviewed and meta-analysed evidence on the association between built environmental characteristics related to lifestyle behaviour and T2DM risk/prevalence, worldwide.MethodsWe systematically searched PubMed, EMBASE.com and Web of Science from their inception to 6 June 2017. Studies were included with adult populations (>18 years), T2DM or glycaemic markers as outcomes, and physical activity and/or food environment and/or residential noise as independent variables. We excluded studies of specific subsamples of the population, that focused on built environmental characteristics that directly affect the cardiovascular system, that performed prediction analyses and that do not report original research. Data appraisal and extraction were based on published reports (PROSPERO-ID: CRD42016035663).ResultsFrom 11,279 studies, 109 were eligible and 40 were meta-analysed. Living in an urban residence was associated with higher T2DM risk/prevalence (n = 19, odds ratio (OR) = 1.40; 95% CI, 1.2–1.6; I2 = 83%) compared to living in a rural residence. Higher neighbourhood walkability was associated with lower T2DM risk/prevalence (n = 8, OR = 0.79; 95% CI, 0.7–0.9; I2 = 92%) and more green space tended to be associated with lower T2DM risk/prevalence (n = 6, OR = 0.90; 95% CI, 0.8–1.0; I2 = 95%). No convincing evidence was found of an association between food environment with T2DM risk/prevalence.ConclusionsAn important strength of the study was the comprehensive overview of the literature, but our study was limited by the conclusion of mainly cross-sectional studies. In addition to other positive consequences of walkability and access to green space, these environmental characteristics may also contribute to T2DM prevention. These results may be relevant for infrastructure planning.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0997-z) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Built environmental characteristics and diabetes: a systematic review and meta-analysis

Braver

Lakerveld

Rutters

et al. 2018

BMC Med

172

103

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“…Previous studies have established Walk Score as a validated measure of neighborhood walkability that is associated with cardiometabolic risk factors (such as physical activity, obesity and blood pressure) in a variety of settings, including Toronto 21–24. In the current study, Walk Score was indeed associated with total physical activity in the year prior to pregnancy.…”

Section: Discussionsupporting

confidence: 48%

“…It should be recognized that our data do not rule out any impact of walkability on risk of GDM (however small), particularly since neighborhood design will affect the entire population where even a modest effect can be beneficial for society. Accordingly, these data certainly do not argue against city planning as a societal approach to the T2DM epidemic (as enhanced walkability has been linked to cardiometabolic benefits outside of pregnancy) 2–5 21–24. However, our inability to detect any discernible impact of neighborhood walkability on insulin sensitivity, beta-cell function and glycemia in 1318 pregnant women suggests that the overall effect of urban design on the incidence of GDM may be relatively modest (as compared with its benefits outside of pregnancy).…”

Section: Discussionmentioning

confidence: 81%

“…The walkability of each woman’s residential neighborhood was assessed using Walk Score, which is an established index that reflects the walkability of an address using an algorithm that considers its distance to 13 amenities (grocery stores, coffee shops, restaurants, bars, movie theaters, schools, parks, libraries, bookstores, fitness centers, drugstores, hardware stores, clothing/music stores) and aspects of pedestrian friendliness (such as population density, block length, and intersection density). Walk Score is a validated measure18–20 that has been associated with cardiometabolic risk factors such as physical activity, weight and blood pressure,21–24 including previous studies in Toronto 21 22. It yields a numerical score that ranges from 0 to 100, from which categories of walkability have been previously established,21 23 24 ranging from ‘car-dependent’ (Walk Score <50) to ‘somewhat walkable’ (Walk Score 50–69 inclusive) to ‘very walkable’ (Walk Score 70–89 inclusive) to ‘walker’s paradise’ (Walk Score 90–100 inclusive).…”

Section: Methodsmentioning

confidence: 99%

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Neighborhood walkability and risk of gestational diabetes

Kew

Mehmood

et al. 2020

BMJ Open Diab Res Care

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ObjectiveHigher neighborhood walkability has been associated with a lower risk of type 2 diabetes mellitus (T2DM) by promoting greater physical activity (thereby reducing weight and lowering insulin resistance). However, it is not known if walkability may similarly reduce maternal risk of gestational diabetes mellitus (GDM), which arises in the setting of the severe physiologic insulin resistance of pregnancy. Indeed, the insulin resistance of pregnancy is primarily driven by placental hormones and not maternal weight gain. Thus, we sought to evaluate the impact of neighborhood walkability on maternal risk of GDM and the pathophysiologic determinants thereof (insulin sensitivity and pancreatic beta-cell function).MethodsIn this study, 1318 women reported their pregravid physical activity (Baecke questionnaire) while undergoing an oral glucose tolerance test (OGTT) at mean 29.3 weeks’ gestation. The OGTT identified 290 women with GDM and enabled assessment of insulin sensitivity and beta-cell function. Based on their residential Walk Score, the women were stratified into the following four established categories of neighborhood walkability: car dependent (n=328), somewhat walkable (n=315), very walkable (n=406), and walker’s paradise (n=269).ResultsThere was a progressive increase in pregravid total physical activity (p=0.002), non-sport leisure-time activity (p=0.009) and sport activity (p=0.01) across the walkability groups (from car dependent to somewhat walkable to very walkable to walker’s paradise), coupled with a concomitant decline in pre-pregnancy body mass index (p=0.007). However, in pregnancy, the groups did not differ in gestational weight gain (p=0.80). Moreover, the walkability groups also did not differ in mean adjusted insulin sensitivity, beta-cell function, or glycemia on the antepartum OGTT. On logistic regression analysis, Walk Score did not predict GDM (OR=1.001, 95% CI 0.995 to 1.007).ConclusionNeighborhood walkability is not a significant determinant of maternal risk of GDM. Thus, in contrast to T2DM, the effect of neighborhood design on incidence of GDM will be comparatively modest.

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“…This could potentially underline obstacles that may be introduced by the build environment. As previous studies have shown an association between living in the most walkable neighborhoods [32] and having a lower BMI in adults of all ages, it see could be interesting to study what may pose barriers to active transportation and to study the effect of those barriers on healthy habits.…”

Section: Discussionmentioning

confidence: 99%

Lifestyle and Health Habits of a Canadian University Community

Busque¹,

Yao²,

Miquelon³

et al. 2017

JPAR

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In 2014, World Health Organization reported that more than 1.9 billion people were obese (World Health Organization, 2014). This epidemic is thought to cost $2 trillion globally every year (Dobbs et al., 2014). With the increase of the prevalence of obesity, there is a continuous search for effective obesity-prevention and health promotion strategies. In a Canadian university, Perusse-Lachance and colleagues (2010) showed that 22.9% of students and 37.3% of staff members were either overweight or obese. The purpose of this study was to examine the prevalence of obesity, healthy lifestyle habits, and healthy environments among students and employees of a Canadian university. Respondents were students and employees during the 2016 fall semester (October). A web based-survey assessing lifestyle habits, such as physical activity and nutrition, was sent by email to all students (n = 15,000) and employees (n = 1,500). In total, 1,989 students (12.1%) and 484 employees (33.6%) completed the questionnaire. All data were analyzed using SPSS. Results showed that 32.7% of students and 44.5% of employees were overweight. Results also revealed that 55.2% of students and 44.9 % of employees were considered physically inactive. Regarding vegetables and fruit, 81.2% of students and 79.4% of employees did not meet the Canadian recommendations. The herein results suggest that overweight and obesity can be important concerns in a welleducated sample and they can be associated with various health-related behaviors.

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Association between neighbourhood walkability and metabolic risk factors influenced by physical activity: a cross-sectional study of adults in Toronto, Canada

Cited by 49 publications

References 50 publications

Built environmental characteristics and diabetes: a systematic review and meta-analysis

Built environmental characteristics and diabetes: a systematic review and meta-analysis

Neighborhood walkability and risk of gestational diabetes

Lifestyle and Health Habits of a Canadian University Community

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