Researchers have long known or suspected that a person’s diet may play a role in their risk for type 2 diabetes — along with other factors like older age, being overweight or obese, and a family history of diabetes. But since there are so many different foods and ingredients that might influence a person’s diabetes risk, it can be difficult to study the effect of diet on this risk. What’s more, even studies that look at dietary factors usually rely on participants to self-report their food intake, which can be problematic because people might not accurately remember what they’ve eaten. For the latest study, researchers aimed to avoid these problems by taking a step back from actual food intake and looking instead at aspects of a person’s food environment — whether they had easy access to fast food restaurants, other restaurants, and supermarkets.
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The study participants were over 4.1 million U.S. military veterans who didn’t have type 2 diabetes when the period of analysis began between 2008 and 2016, with follow-up lasting through 2018 for a median period of 5.5 years per person. During this period, the onset of type 2 diabetes was assessed through interactions with the Veterans Affairs health care system, as shown by records of A1C levels (a measure of long-term blood glucose control), prescriptions for diabetes medications, and more. The average age of participants was 59.4 years at the beginning of the study, and 92% were men. Non-Hispanic white people made up 76% of study participants.
Higher density of fast food restaurants linked to higher risk of type 2 diabetes
The researchers calculated the average number of fast food restaurants, supermarkets, and other food sources (like other restaurants) within walking distance of each participant’s home over a five-year period. They then calculated the density of both fast food restaurants and supermarkets compared with other food sources. For any type of community that participants lived in — high-density or low-density urban areas, suburban areas, or rural areas — the researchers found that a higher relative density of fast food restaurants was linked to a slightly higher risk of developing type 2 diabetes. For high-density urban, low-density urban, and rural areas this risk level was 1% higher, and for suburban areas it was 2% higher. A higher relative density of supermarkets, on the other hand, was linked to a slightly lower risk of developing type 2 diabetes only in suburban (3% lower) and rural (1% lower) areas. Each of these risk levels was calculated after adjusting for other factors known to affect the risk of developing type 2 diabetes.
“These findings suggest that neighborhood food environment measures are associated with type 2 diabetes among U.S. veterans in multiple community types,” the researchers wrote, “and that food environments are potential avenues for action to address the burden of diabetes.” In particular, policies that increase the availability of supermarkets in suburban and rural areas could help prevent type 2 diabetes, while restricting the availability of fast food restaurants in all types of communities could have a similar effect, according to the study authors. More research is needed to find out if similar effects are seen in adults who aren’t U.S. military veterans, and in populations that include larger numbers of women.