Neighborhood Environment May Affect Type 2 Diabetes Risk

Neighborhood resources to support physical activity and, to a lesser extent, healthy diets are linked to a lower incidence of type 2 diabetes.

Residential environments with more resources that support increased physical activity and, to a lesser extent, healthy diets are associated with a lower incidence of type 2 diabetes, according to data published in JAMA Internal Medicine.

Evidence supports the fact that modifying certain risk factors, including obesity, dietary patterns and lack of physical activity can reduce the odds of developing type 2 diabetes — an important cause of death and disability worldwide. Environment, the researchers, may therefore play a significant role in preventing development of the disease.

“A growing body of research linking health behaviors and risk factors for chronic disease to environmental features has suggested that altering environments may foster behavioral changes. Neighborhood physical environments, including access to healthy food and physical activity resources, may influence individual diet and exercise levels,” the researchers wrote.

For the study, Paul J. Christine, MPH, of the University of Michigan in Ann Arbor, and colleagues sought to assess the effect of long-term exposure to neighborhood physical and social environments, including the availability of healthy foods, physical activity resources and levels of social cohesion and safety, were linked to type 2 diabetes development.

The researchers evaluated data from 5,124 participants in the Multi-Ethnic Study of Atherosclerosis. Participants did not have type 2 diabetes at baseline and underwent follow-up examinations from 2000 to 2012.

Information on neighborhood healthy food and physical activity resources were gathered using:

  • Geographic information system-based measures of access to food stores more likely to sell healthier foods, such as supermarkets and fruit and vegetable markets, and access to recreational facilities
  • Survey information about the availability of healthy foods, the walking environment and the social environment for safety and social cohesion.

Median follow-up was 8.9 years (37,394 person-years). During this time, 616 participants (12%) developed type 2 diabetes, with a crude incidence rate of 16.47 per 1,000 person-years (95% CI, 15.22-17.83).

New cases of type 2 diabetes were more likely to be found in those who were black or Hispanic and those who had lower income, fewer years of education, less healthy diets, lower levels of moderate and vigorous physical activity, higher BMI and family history of type 2 diabetes.

After accounting for various patient-related factors, the researchers found that a lower risk for developing type 2 diabetes was linked to greater cumulative exposure to neighborhood physical activity resources (21%; HR per interquartile range increase in summary score, 0.79; 95% CI, 0.71-0.88) and healthy food (12%; HR per interquartile range increase in summary score, 0.88; 95% CI, 0.79-0.98).

Survey measures were the primary driver behind these associations, according to the data.

“Our results suggest that modifying specific features of neighborhood environments, including increasing the availability of healthy foods and [physical activity] resources, may help to mitigate the risk for [type 2 diabetes], although additional intervention studies with measures of multiple neighborhood features are needed. Such approaches may be especially important for addressing disparities in [type 2 diabetes] given the concentration of low-income and minority populations in neighborhoods with fewer health-promoting resources,” the researchers wrote.

In an invited commentary, Nancy E. Adler, PhD, and Aric A. Prather, PhD, of the University of California, San Francisco, placed the findings in context.

“The findings by Christine et al point to the impact of perceived neighborhood resources. Having markets and recreational facilities located nearby may be necessary but not sufficient to enable healthy behaviors. Building more facilities in neighborhoods that lack them is a component of an overall strategy to address the national rise in obesity, but this strategy needs to be informed by an understanding of when such facilities are actually used and the characteristics of the individuals who use them,” they wrote.

“In brief, the risk for [type 2 diabetes] is a combination of both person and place, and our national strategies need to understand and intervene across these levels.”


  1. Christine PJ et al. JAMA Intern Med. 2015;doi:10.1001/jamainternmed.2015.2691.
  2. Adler NE, Prather AA. JAMA Intern Med. 2015;doi:10.1001/jamainternmed.2015.2701.