Geospatial analysis of food environment demonstrates associations with gestational diabetes

Abstract

Background Gestational diabetes mellitus (GDM) is one of most common complications of pregnancy, with incidence rates varying by maternal age, race/ethnicity, obesity, parity, and family history. Given its increasing prevalence in recent decades, co-variant environmental and sociodemographic factors may be additional determinants of GDM occurrence. Objectives We hypothesized that environmental risk factors, in particular measures of the food environment, may be a diabetes contributor. We employed geospatial modeling in a populous U.S. county to characterize the association of the relative availability of fast food restaurants and supermarkets to GDM. Study Design Utilizing a perinatal database with over 4900 encoded antenatal and outcome variables inclusive of zip code data, 8912 consecutive pregnancies were analyzed for correlations between GDM and food environment based on county-wide food permit registration data. Linkage between pregnancies and food environment was achieved on the basis of validated 5 digit zip code data. The prevalence of supermarkets and fast food restaurants per 100,000 inhabitants for each zip code were gathered from publicly available food permit sources. In order to independently authenticate our findings with objective data, we measured hemoglobin A1c (HbA1c) levels as a function of geospatial distribution of food environment in a matched subset (n=80). Results Residence in neighborhoods with a high prevalence of fast food restaurants (fourth quartile) was significantly associated with an increased risk of developing GDM (relative to first quartile, aOR: 1.63 [95% CI 1.21–2.19]). In multivariate analysis, this association held true after controlling for potential confounders (p=0.002). Measurement of HbA1c levels in a matched subset were significantly increased in association with residence in a zip code with a higher fast food/supermarket ratio (n=80, r=0.251 p<0.05). Conclusions As demonstrated by geospatial analysis, a relationship of food environment and risk for gestational diabetes was identified.

Preterm birth and its associations with residence and ambient vehicular traffic exposure

“…The majority of our subjects had no high school degree (58.1%), earned less than $34,999 per year (95.2%), and had a median gravidity of 3 (range, 2–4) while being, on average, overweight in the first trimester (median, 27.31 kg/m 2 [23.7–31.62]). Similar to other national estimates, 14–17,24–27 10.1% of all births were preterm, with 6.8% of those were late PTB, and 3.3% were early PTB. Table 2 summarizes additional clinical information on our patients.…”

“…as previously published. 24 Clinical data that were extracted for this study comprise the patient history (including smoking status, nicotine and substance use, and familial obstetrical history and prenatal care clinics and providers), socioeconomic status (education, income, immigration status), and residential and workplace data (each trimester of pregnancy residence and workplace 5-digit zip code). Not all 4900 potential Peri-Bank variables were used in this analysis.…”

Pre-Pregnancy Fast Food Consumption Is Associated with Gestational Diabetes Mellitus among Tehranian Women

“…This global increase may be partly attributed to changes in dietary habits and nutritional transitions from traditional to Western-style fast food intake (high-energy and low nutrient density) which is steadily increasing and is a major factor in the development of metabolic disorders [4,5,6]. Although the undesirable effects of fast food consumption on obesity, insulin resistance and diabetes have been extensively studied [4,7,8,9], epidemiologic studies regarding the effects of fast food consumption in relation to GDM are scarce [10,11,12,13] and are mostly from Western populations that may not be generalizable to other populations because of cultural and social differences [14]. …”

Transforming Life: A Broad View of the Developmental Origins of Health and Disease Concept from an Ecological Justice Perspective

“…Media exposure can place children in front of celebrity endorsements for high-calorie, low-nutrient foods and beverages [326]. From a DOHaD perspective, the conversation concerning the built environment and drivers of behaviour is imperative; availability of convenience stores is associated with obesity in SES disadvantaged preschool children and higher presence of fast-food outlets with gestational diabetes [327,328]. …”