Food environment and diabetes mellitus in South Asia: a geospatial analysis of health outcome data
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 prevalenc...
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Science::Medicine Diabetes Mellitus Food Environment Kusuma, Dian Atanasova, Petya Pineda, Elisa Anjana, Ranjit Mohan De Silva, Laksara Hanif, Abu Am Hasan, Mehedi Hossain, Md. Mokbul Indrawansa, Susantha Jayamanne, Deepal Jha, Sujeet Kasturiratne, Anuradhani Katulanda, Prasad Khawaja, Khadija I. Kumarendran, Balachandran Mridha, Malay K. Rajakaruna, Vindya Chambers, John Campbell Frost, Gary Sassi, Franco Miraldo, Marisa Food environment and diabetes mellitus in South Asia: a geospatial analysis of health outcome data |
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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. |
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Lee Kong Chian School of Medicine (LKCMedicine) |
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Lee Kong Chian School of Medicine (LKCMedicine) Kusuma, Dian Atanasova, Petya Pineda, Elisa Anjana, Ranjit Mohan De Silva, Laksara Hanif, Abu Am Hasan, Mehedi Hossain, Md. Mokbul Indrawansa, Susantha Jayamanne, Deepal Jha, Sujeet Kasturiratne, Anuradhani Katulanda, Prasad Khawaja, Khadija I. Kumarendran, Balachandran Mridha, Malay K. Rajakaruna, Vindya Chambers, John Campbell Frost, Gary Sassi, Franco Miraldo, Marisa |
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Article |
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Kusuma, Dian Atanasova, Petya Pineda, Elisa Anjana, Ranjit Mohan De Silva, Laksara Hanif, Abu Am Hasan, Mehedi Hossain, Md. Mokbul Indrawansa, Susantha Jayamanne, Deepal Jha, Sujeet Kasturiratne, Anuradhani Katulanda, Prasad Khawaja, Khadija I. Kumarendran, Balachandran Mridha, Malay K. Rajakaruna, Vindya Chambers, John Campbell Frost, Gary Sassi, Franco Miraldo, Marisa |
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Kusuma, Dian |
title |
Food environment and diabetes mellitus in South Asia: a geospatial analysis of health outcome data |
title_short |
Food environment and diabetes mellitus in South Asia: a geospatial analysis of health outcome data |
title_full |
Food environment and diabetes mellitus in South Asia: a geospatial analysis of health outcome data |
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Food environment and diabetes mellitus in South Asia: a geospatial analysis of health outcome data |
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Food environment and diabetes mellitus in South Asia: a geospatial analysis of health outcome data |
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food environment and diabetes mellitus in south asia: a geospatial analysis of health outcome data |
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2022 |
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https://hdl.handle.net/10356/161377 |
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sg-ntu-dr.10356-1613772023-03-05T16:50:54Z Food environment and diabetes mellitus in South Asia: a geospatial analysis of health outcome data Kusuma, Dian Atanasova, Petya Pineda, Elisa Anjana, Ranjit Mohan De Silva, Laksara Hanif, Abu Am Hasan, Mehedi Hossain, Md. Mokbul Indrawansa, Susantha Jayamanne, Deepal Jha, Sujeet Kasturiratne, Anuradhani Katulanda, Prasad Khawaja, Khadija I. Kumarendran, Balachandran Mridha, Malay K. Rajakaruna, Vindya Chambers, John Campbell Frost, Gary Sassi, Franco Miraldo, Marisa Lee Kong Chian School of Medicine (LKCMedicine) Science::Medicine Diabetes Mellitus Food Environment 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. Published version This article was funded by the National Institute for Health Research (NIHR) (16/136/68) using UK aid from the UK Government to support global health research (JCC) and the LISS DTP funded by the Economic & Social Research Council (ESRC) (ES/P000703/1). 2022-08-30T05:06:40Z 2022-08-30T05:06:40Z 2022 Journal Article Kusuma, D., Atanasova, P., Pineda, E., Anjana, R. M., De Silva, L., Hanif, A. A., Hasan, M., Hossain, M. M., Indrawansa, S., Jayamanne, D., Jha, S., Kasturiratne, A., Katulanda, P., Khawaja, K. I., Kumarendran, B., Mridha, M. K., Rajakaruna, V., Chambers, J. C., Frost, G., ...Miraldo, M. (2022). Food environment and diabetes mellitus in South Asia: a geospatial analysis of health outcome data. PLoS Medicine, 19(4), e1003970-. https://dx.doi.org/10.1371/journal.pmed.1003970 1549-1277 https://hdl.handle.net/10356/161377 10.1371/journal.pmed.1003970 35472059 2-s2.0-85128961368 4 19 e1003970 en PLoS medicine © 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. application/pdf |