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

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Abstract

Background

The 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.

Methods

We 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).

Results

From 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; I ² = 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; I ² = 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; I ² = 95%). No convincing evidence was found of an association between food environment with T2DM risk/prevalence.

Conclusions

An 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 material

The 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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Most cited references 108

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Quantity and Quality of Sleep and Incidence of Type 2 Diabetes

Francesco Cappuccio, Lanfranco D'Elia, Pasquale Strazzullo … (2009)

OBJECTIVE To assess the relationship between habitual sleep disturbances and the incidence of type 2 diabetes and to obtain an estimate of the risk. RESEARCH DESIGN AND METHODS We conducted a systematic search of publications using MEDLINE (1955–April 2009), EMBASE, and the Cochrane Library and manual searches without language restrictions. We included studies if they were prospective with follow-up >3 years and had an assessment of sleep disturbances at baseline and incidence of type 2 diabetes. We recorded several characteristics for each study. We extracted quantity and quality of sleep, how they were assessed, and incident cases defined with different validated methods. We extracted relative risks (RRs) and 95% CI and pooled them using random-effects models. We performed sensitivity analysis and assessed heterogeneity and publication bias. RESULTS We included 10 studies (13 independent cohort samples; 107,756 male and female participants, follow-up range 4.2–32 years, and 3,586 incident cases of type 2 diabetes). In pooled analyses, quantity and quality of sleep predicted the risk of development of type 2 diabetes. For short duration of sleep (≤5–6 h/night), the RR was 1.28 (95% CI 1.03–1.60, P = 0.024, heterogeneity P = 0.015); for long duration of sleep (>8–9 h/night), the RR was 1.48 (1.13–1.96, P = 0.005); for difficulty in initiating sleep, the RR was 1.57 (1.25–1.97, P < 0.0001); and for difficulty in maintaining sleep, the RR was 1.84 (1.39–2.43, P < 0.0001). CONCLUSIONS Quantity and quality of sleep consistently and significantly predict the risk of the development of type 2 diabetes. The mechanisms underlying this relation may differ between short and long sleepers.

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Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies.

J Danesh, R. Collins, P Appleby … (1998)

A large number of epidemiologic studies have reported on associations between various "inflammatory" factors and coronary heart disease (CHD). To assess the associations of blood levels of fibrinogen, C-reactive protein (CRP), and albumin and leukocyte count with the subsequent risk of CHD. Meta-analyses of any long-term prospective studies of CHD published before 1998 on any of these 4 factors. Studies were identified by MEDLINE searches, scanning of relevant reference lists, hand searching of cardiology, epidemiology, and other relevant journals, and discussions with authors of relevant reports. All relevant studies identified were included. The following information was abstracted from published reports (supplemented, in several cases, by the authors): size and type of cohort, mean age, mean duration of follow-up, assay methods, degree of adjustment for confounders, and relationship of CHD risk to the baseline assay results. For fibrinogen, with 4018 CHD cases in 18 studies, comparison of individuals in the top third with those in the bottom third of the baseline measurements yielded a combined risk ratio of 1.8 (95% confidence interval [CI], 1.6-2.0) associated with a difference in long-term usual mean fibrinogen levels of 2.9 pmol/L (0.1 g/dL) between the top and bottom thirds (10.3 vs 7.4 pmol/L [0.35 vs 0.25 g/dL]). For CRP, with 1053 CHD cases in 7 studies, the combined risk ratio of 1.7 (95% CI, 1.4-2.1) was associated with a difference of 1.4 mg/L (2.4 vs 1.0 mg/L). For albumin, with 3770 CHD cases in 8 studies, the combined risk ratio of 1.5 (95% CI, 1.3-1.7) was associated with a difference of 4 g/L (38 vs 42 g/L, ie, an inverse association). For leukocyte count, with 5337 CHD cases in the 7 largest studies, the combined risk ratio of 1.4 (95% CI, 1.3-1.5) was associated with a difference of 2.8 x 10(9)/L (8.4 vs 5.6 x 10(9)/L). Each of these overall results was highly significant (P<.0001). The published results from these prospective studies are remarkably consistent for each factor, indicating moderate but highly statistically significant associations with CHD. Hence, even though mechanisms that might account for these associations are not clear, further study of the relevance of these factors to the causation of CHD is warranted.

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Supermarkets, other food stores, and obesity: the atherosclerosis risk in communities study.

Kimberly Morland, Ana V. Diez Roux, Steve Wing (2006)

Obesity is a leading public health concern, and although environmental factors have been hypothesized to play a role in the prevention of obesity, little empirical data exist to document their effects. The purpose of this study was to examine whether characteristics of the local food environment are associated with the prevalence of cardiovascular disease risk factors. A cross-sectional study of men and women participating in the third visit (1993-1995) of the Atherosclerosis Risk in Communities (ARIC) Study was conducted in 2004. The analyses included 10,763 ARIC participants residing in one of the 207 eligible census tracts located in the four ARIC-defined geographic areas. Names and addresses of food stores located in Mississippi, North Carolina, Maryland, and Minnesota were obtained from departments of agriculture. Multilevel modeling was used to calculate prevalence ratios of the associations between the presence of specific types of food stores and cardiovascular disease risk factors. The presence of supermarkets was associated with a lower prevalence of obesity and overweight (obesity prevalence ratio [PR] = 0.83, 95% confidence interval [CI] = 0.75-0.92; overweight PR = 0.94, 95% CI = 0.90-0.98), and the presence of convenience stores was associated with a higher prevalence of obesity and overweight (obesity PR = 1.16, 95% CI = 1.05-1.27; overweight PR = 1.06, 95% CI = 1.02-1.10). Associations for diabetes, high serum cholesterol, and hypertension were not consistently observed. Results from this study suggest that characteristics of local food environments may play a role in the prevention of overweight and obesity.

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Author and article information

Contributors

N. R. den Braver: 020-4443080 , n.denbraver@vumc.nl

Journal

Journal ID (nlm-ta): BMC Med

Journal ID (iso-abbrev): BMC Med

Title: BMC Medicine

Publisher: BioMed Central (London )

ISSN (Electronic): 1741-7015

Publication date (Electronic): 31 January 2018

Publication date PMC-release: 31 January 2018

Publication date Collection: 2018

Volume: 16

Electronic Location Identifier: 12

Affiliations

[1 ]ISNI 0000 0004 0435 165X, GRID grid.16872.3a, Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, ; De Boelelaan 1089a, 1081HV Amsterdam, The Netherlands

[2 ]ISNI 0000 0004 1754 9227, GRID grid.12380.38, University Library, VU, ; Amsterdam, The Netherlands

[3 ]ISNI 0000000084992262, GRID grid.7177.6, Amsterdam School for Communication Research, University of Amsterdam, ; Amsterdam, The Netherlands

[4 ]ISNI 0000000090126352, GRID grid.7692.a, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, ; Utrecht, The Netherlands

Article

Publisher ID: 997

DOI: 10.1186/s12916-017-0997-z

PMC ID: 5791730

PubMed ID: 29382337

SO-VID: ac4dbef3-f32b-439b-9785-1368d50bc102

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 31 July 2017

Date accepted : 15 December 2017

Custom metadata

ScienceOpen disciplines: Medicine

Keywords: built environment,type 2 diabetes mellitus,lifestyle behaviour,prevention,urbanisation

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ScienceOpen disciplines: Medicine

Keywords: built environment, type 2 diabetes mellitus, lifestyle behaviour, prevention, urbanisation

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

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Tobacco Prevention & Cessation

Most cited references 108

Quantity and Quality of Sleep and Incidence of Type 2 Diabetes

Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies.

Supermarkets, other food stores, and obesity: the atherosclerosis risk in communities study.

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