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

Abstract

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.

Are exposures to ready-to-eat food environments associated with type 2 diabetes? A cross-sectional study of 347 551 UK Biobank adult participants

“…13,14 Sedentary lifestyles and consumption of energydense and processed food that is rich in fats and sugars both constitute major risk factors of type 2 diabetes. 15 Un healthy diet has emerged as one of the primary causes in the develop ment of chronic disease, particularly type 2 diabetes. 16 Exposure to the local food environment has been shown to be associated with dietary behaviour and the quality of dietary intake 17 and implicated in the prevalence and sociospatial distribution of obes ity, 18 gestational diabetes, 19,20 and type 2 diabetes.…”

“…16 Exposure to the local food environment has been shown to be associated with dietary behaviour and the quality of dietary intake 17 and implicated in the prevalence and sociospatial distribution of obes ity, 18 gestational diabetes, 19,20 and type 2 diabetes. 15 Previous studies 21 have relied on geographical information system (GIS)-based measures of accessibility to food environments, expressed in terms of objective measures of proximity and density and as the proportion of unhealthy food environments to the total food supply environments within geographically defined neighbourhoods. Un healthy food-supply environments generally comprise retail outlets that sell high-calorie and processed foods, soft drinks, alcohol, and other beverages-ie, products rich in saturated fat, salt, sugar, and other ingredients that are harmful to health.…”

The Next Generation of Diabetes Translation: A Path to Health Equity

“…Jones and colleagues (68) analyzed North Carolina, New York, and Maryland census data and found an increased likelihood of availability of recreational facilities and parks in predominantly non-Hispanic white neighborhoods compared with ethnic minority neighborhoods (i.e., predominantly black and Hispanic neighborhoods). Den Braver and colleagues (40) reported that living in an urban residence was associated with higher T2DM risk or prevalence compared with living in a rural residence; higher neighborhood walkability and more green space tended to be associated with lower T2DM risk or prevalence. Several other reviews noted the role of adequate housing in overall health and well-being (23,130,131); one reported that housing instability and unmet material needs were associated with increased risk of diabetes and poorer outcomes among diabetes patients (14).…”

Neighbourhood drivability: environmental and individual characteristics associated with car use across Europe

“…For example, a recent meta-analysis of observational studies indicated that highly walkable neighbourhoodsi.e. neighbourhoods featuring characteristics that promote walkingare associated with lower risk of type 2 diabetes [6]. Gaining insight into characteristics related to car driving can help inform transport-policies, and thereby improve health and outcomes such as traffic safety, air quality, congestion and climate change.…”