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Food environment and diabetes mellitus in South Asia: A geospatial analysis of health outcome data

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Title: Food environment and diabetes mellitus in South Asia: A geospatial analysis of health outcome data
Authors: Kusuma, D
Atanasova, P
Pineda, E
Anjana, RM
De Silva, L
Hanif, AA
Hasan, M
Hossain, MM
Indrawansa, S
Jayamanne, D
Jha, S
Kasturiratne, A
Katulanda, P
Khawaja, KI
Kumarendran, B
Mridha, MK
Rajakaruna, V
Chambers, JC
Frost, G
Sassi, F
Miraldo, M
Item Type: Journal Article
Abstract: BACKGROUND: The global epidemic of type 2 diabetes mellitus (T2DM) renders its prevention a major public health priority. A key risk factor of diabetes is obesity and poor diets. Food environments have been found to influence people's diets and obesity, positing they may play a role in the prevalence of diabetes. Yet, there is scant evidence on the role they may play in the context of low- and middle-income countries (LMICs). We examined the associations of food environments on T2DM among adults and its heterogeneity by income and sex. METHODS AND FINDINGS: We linked individual health outcome data of 12,167 individuals from a network of health surveillance sites (the South Asia Biobank) to the density and proximity of food outlets geolocated around their homes from environment mapping survey data collected between 2018 and 2020 in Bangladesh and Sri Lanka. Density was defined as share of food outlets within 300 m from study participant's home, and proximity was defined as having at least 1 outlet within 100 m from home. The outcome variables include fasting blood glucose level, high blood glucose, and self-reported diagnosed diabetes. Control variables included demographics, socioeconomic status (SES), health status, healthcare utilization, and physical activities. Data were analyzed in ArcMap 10.3 and STATA 15.1. A higher share of fast-food restaurants (FFR) was associated with a 9.21 mg/dl blood glucose increase (95% CI: 0.17, 18.24; p < 0.05). Having at least 1 FFR in the proximity was associated with 2.14 mg/dl blood glucose increase (CI: 0.55, 3.72; p < 0.01). A 1% increase in the share of FFR near an individual's home was associated with 8% increase in the probability of being clinically diagnosed as a diabetic (average marginal effects (AMEs): 0.08; CI: 0.02, 0.14; p < 0.05). Having at least 1 FFR near home was associated with 16% (odds ratio [OR]: 1.16; CI: 1.01, 1.33; p < 0.05) and 19% (OR: 1.19; CI: 1.03, 1.38; p < 0.05) increases in the odds of higher blood glucose levels and diagnosed diabetes, respectively. The positive association between FFR density and blood glucose level was stronger among women than men, but the association between FFR proximity and blood glucose level was stronger among men as well as among those with higher incomes. One of the study's key limitations is that we measured exposure to food environments around residency geolocation; however, participants may source their meals elsewhere. CONCLUSIONS: Our results suggest that the exposure to fast-food outlets may have a detrimental impact on the risk of T2DM, especially among females and higher-income earners. Policies should target changes in the food environments to promote better diets and prevent T2DM.
Issue Date: 26-Apr-2022
Date of Acceptance: 18-Mar-2022
URI: http://hdl.handle.net/10044/1/96060
DOI: 10.1371/journal.pmed.1003970
ISSN: 1549-1277
Publisher: Public Library of Science (PLoS)
Journal / Book Title: PLoS Medicine
Volume: 19
Issue: 4
Replaces: 10044/1/95384
http://hdl.handle.net/10044/1/95384
Copyright Statement: © 2022 Kusuma et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Sponsor/Funder: National Institute for Health Research
National Institute for Health Research
Funder's Grant Number: 16/136/68
NIHR132960
Keywords: Adult
Blood Glucose
Diabetes Mellitus, Type 2
Female
Humans
Male
Obesity
Outcome Assessment, Health Care
Residence Characteristics
Sri Lanka
Humans
Diabetes Mellitus, Type 2
Obesity
Blood Glucose
Residence Characteristics
Adult
Sri Lanka
Female
Male
Outcome Assessment, Health Care
Adult
Blood Glucose
Diabetes Mellitus, Type 2
Female
Humans
Male
Obesity
Outcome Assessment, Health Care
Residence Characteristics
Sri Lanka
General & Internal Medicine
11 Medical and Health Sciences
Publication Status: Published
Conference Place: United States
Open Access location: https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1003970#discussedHeader
Article Number: ARTN e1003970
Appears in Collections:Imperial College Business School
Department of Metabolism, Digestion and Reproduction
Faculty of Medicine



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