Neighborhood greenspace and risk of type 2 diabetes in a prospective cohort: the Multi-Ethncity Study of Atherosclerosis

Abstract Background Neighborhood greenspaces provide opportunities for increased physical activity and social interaction, and thus may reduce the risk of Type 2 diabetes. However, there is little robust research on greenspace and diabetes. In this study, we examine the longitudinal association between neighborhood greenspace and incident diabetes in the Multi-Ethnic Study of Atherosclerosis. Methods A prospective cohort study (N = 6814; 2000-2018) was conducted to examine the association between greenspace, measured as annual and high vegetation season median greenness determined by satellite (Normalized Difference Vegetation Index) within 1000 m of participant homes, and incident diabetes assessed at clinician visits, defined as a fasting glucose level of at least 126 mg/dL, use of insulin or use of hypoglycemic medication, controlling for covariates in stages. Five thousand five hundred seventy-four participants free of prevalent diabetes at baseline were included in our analysis. Results Over the study period, 886 (15.9%) participants developed diabetes. Adjusting for individual characteristics, individual and neighborhood-scale SES, additional neighborhood factors, and diabetes risk factors, we found a 21% decrease in the risk of developing diabetes per IQR increase in greenspace (HR: 0.79; 95% CI: 0.63, 0.99). Conclusions Overall, neighborhood greenspace provides a protective influence in the development of diabetes, suggesting that neighborhood-level urban planning that supports access to greenspace--along with healthy behaviors--may aid in diabetes prevention. Additional research is needed to better understand how an area’s greenness influences diabetes risk, how to better characterize greenspace exposure and usage, and future studies should focus on robust adjustment for neighborhood-level confounders.

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The Effect of Surrounding Greenness on Type 2 Diabetes Mellitus: A Nationwide Population-Based Cohort in Taiwan

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18010267 ◽

2020 ◽

Vol 18 (1) ◽

pp. 267

Author(s):

Hui-Ju Tsai ◽

Chia-Ying Li ◽

Wen-Chi Pan ◽

Tsung-Chieh Yao ◽

Huey-Jen Su ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Vegetation Index ◽

Normalized Difference Vegetation Index ◽

Population Based ◽

Research Database ◽

Individual Level ◽

The Relationship

This study determines whether surrounding greenness is associated with the incidence of type 2 diabetes Mellitus (T2DM) in Taiwan. A retrospective cohort study determines the relationship between surrounding greenness and the incidence of T2DM during the study period of 2001–2012 using data from the National Health Insurance Research Database. The satellite-derived normalized difference vegetation index (NDVI) from the global MODIS database in the NASA Earth Observing System is used to assess greenness. Cox proportional hazard models are used to determine the relationship between exposure to surrounding greenness and the incidence of T2DM, with adjustment for potential confounders. A total of 429,504 subjects, including 40,479 subjects who developed T2DM, were identified during the study period. There is an inverse relationship between exposure to surrounding greenness and the incidence of T2DM after adjustment for individual-level covariates, comorbidities, and the region-level covariates (adjusted HR = 0.81, 95% CI: 0.79–0.82). For the general population of Taiwan, greater exposure to surrounding greenness is associated with a lower incidence of T2DM.

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Association of Lifecourse Socioeconomic Status with Chronic Inflammation and Type 2 Diabetes Risk: The Whitehall II Prospective Cohort Study

PLoS Medicine ◽

10.1371/journal.pmed.1001479 ◽

2013 ◽

Vol 10 (7) ◽

pp. e1001479 ◽

Cited By ~ 111

Author(s):

Silvia Stringhini ◽

G. David Batty ◽

Pascal Bovet ◽

Martin J. Shipley ◽

Michael G. Marmot ◽

...

Keyword(s):

Type 2 Diabetes ◽

Socioeconomic Status ◽

Cohort Study ◽

Chronic Inflammation ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Diabetes Risk

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Dietary glycaemic index and glycaemic load in relation to the risk of type 2 diabetes: a meta-analysis of prospective cohort studies

British Journal Of Nutrition ◽

10.1017/s000711451100540x ◽

2011 ◽

Vol 106 (11) ◽

pp. 1649-1654 ◽

Cited By ~ 77

Author(s):

Jia-Yi Dong ◽

Lijun Zhang ◽

Yong-Hong Zhang ◽

Li-Qiang Qin

Keyword(s):

Type 2 Diabetes ◽

Cohort Studies ◽

Prospective Cohort ◽

Meta Analysis ◽

Glycaemic Index ◽

Diabetes Risk ◽

Prospective Cohort Studies ◽

Glycaemic Load ◽

Pubmed Database

Epidemiological studies of dietary glycaemic index (GI) and glycaemic load (GL) in relation to diabetes risk have yielded inconsistent results. We aimed to examine the associations between dietary GI and GL and the risk of type 2 diabetes by conducting a meta-analysis of prospective cohort studies. Relevant studies were identified by a PubMed database search up to February 2011. Reference lists from retrieved articles were also reviewed. We included prospective cohort studies that reported risk estimates with 95 % CI for the associations between dietary GI and GL and the risk of type 2 diabetes. Either a fixed- or random-effects model was used to compute the summary relative risk (RR). We identified thirteen prospective cohort studies of dietary GI or GL related to diabetes risk. The summary RR of type 2 diabetes for the highest category of the GI compared with the lowest was 1·16 (95 % CI 1·06, 1·26;n12), with moderate evidence of heterogeneity (P = 0·02,I2 = 50·8 %). For the GL, the summary RR was 1·20 (95 % CI 1·11, 1·30;n12), with little evidence of heterogeneity (P = 0·10,I2 = 34·8 %). No evidence of publication bias was observed. In addition, the associations persisted and remained statistically significant in the sensitivity analyses. In conclusion, the present meta-analysis provides further evidence in support of significantly positive associations between dietary GI and GL and the risk of type 2 diabetes. Reducing the intake of high-GI foods may bring benefits in diabetes prevention.

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Metabolically healthy obesity, transition to unhealthy phenotypes and type 2 diabetes in 0.5 million Chinese adults: The China Kadoorie Biobank

Acta Endocrinologica ◽

10.1530/eje-21-0743 ◽

2021 ◽

Author(s):

Zimin Song ◽

Meng Gao ◽

Jun Lv ◽

Canqing Yu ◽

Yu Guo ◽

...

Keyword(s):

Type 2 Diabetes ◽

Health Status ◽

Normal Weight ◽

Metabolic Health ◽

Diabetes Risk ◽

Incident Diabetes ◽

Metabolically Healthy Obese ◽

Healthy Obese ◽

Metabolically Healthy

Objectives: To prospectively assess the association of metabolic health status and its transition with incident diabetes risk across body mass index (BMI) categories. Design: Cohort study based on the China Kadoorie Biobank (CKB) Methods: The CKB study enrolled 512,715 adults aged 30-79 years from 10 diverse areas in China during 2004-2008. After exclusion, 432,763 participants were cross-classified by BMI categories and the metabolic status during followed-up for incident diabetes disease. The changes in BMI and metabolic health status were defined from baseline to the second resurvey. Results: Type 2 diabetes risk is higher for metabolically healthy obese (MHO) subjects than metabolically healthy normal weight (MHN) individuals (HR: 3.97, 95% CI: 3.64-3.66), and it is highest for those affected by metabolically healthy obese (MUO) (HR: 6.47, 95% CI: 6.17-6.79). About 15.26% of participants with MHN converted to metabolically healthy overweight or obesity (MHOO), whereas 48.40% of MHOO remained unconverted throughout the follow-up. In obese or overweight people, the conversion from metabolically healthy to unhealthy might increase the chances of developing diabetes as compared to those with a stable metabolic healthy state (HR: 3.70, 95% CI: 2.99-4.59), while those with persistent metabolic disorders are most likely to have diabetes (HR: 8.32, 95% CI: 7.08-9.78). Conclusions: Metabolic healthy is a transient state, and individuals converted from metabolically healthy status to unhealthy phenotypes across all BMI categories might raise the risk of diabetes.

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Vitamin D Supplementation for Prevention of Type 2 Diabetes Mellitus: To D or Not to D?

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa594 ◽

2020 ◽

Vol 105 (12) ◽

pp. 3721-3733 ◽

Cited By ~ 1

Author(s):

Anastassios G Pittas ◽

Rolf Jorde ◽

Tetsuya Kawahara ◽

Bess Dawson-Hughes

Keyword(s):

Type 2 Diabetes ◽

Vitamin D ◽

Risk Reduction ◽

Observational Studies ◽

Evidence Synthesis ◽

Vitamin D Supplementation ◽

Diabetes Risk ◽

Incident Diabetes ◽

Longitudinal Observational Studies

Abstract Context Over the last decade, vitamin D has emerged as a risk determinant for type 2 diabetes and vitamin D supplementation has been hypothesized as a potential intervention to lower diabetes risk. Recently, several trials have reported on the effect of vitamin D supplementation on diabetes prevention in people with prediabetes. Evidence Acquisition A comprehensive literature review was performed using PubMed, Embase, and ClinicalTrials.gov to identify: (1) recent meta-analyses of longitudinal observational studies that report on the association between blood 25-hydroxyvitamin D (25[OH]D) level and incident diabetes, and (2) clinical trials of adults with prediabetes that have reported on the effect of vitamin D supplementation on incident diabetes. Evidence Synthesis Longitudinal observational studies report highly consistent associations between higher blood 25(OH)D levels and a lower risk of incident diabetes in diverse populations, including populations with prediabetes. Trials in persons with prediabetes show risk reduction in incident diabetes with vitamin D supplementation. In the 3 large trials that were specifically designed and conducted for the prevention of diabetes, vitamin D supplementation, when compared with placebo, reduced the risk of developing diabetes by 10% to 13% in persons with prediabetes not selected for vitamin D deficiency. Conclusions Results from recent trials are congruent with a large body of evidence from observational studies indicating that vitamin D has a role in modulating diabetes risk. Participant-level meta-analysis of the 3 largest trials should provide a more refined estimate of risk reduction and identify patient populations that are likely to benefit the most from vitamin D supplementation.

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Association of Greenness with Blood Pressure among Individuals with Type 2 Diabetes across Rural to Urban Community Types in Pennsylvania, USA

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020614 ◽

2021 ◽

Vol 18 (2) ◽

pp. 614 ◽

Cited By ~ 1

Author(s):

Melissa N. Poulsen ◽

Brian S. Schwartz ◽

Cara Nordberg ◽

Joseph DeWalle ◽

Jonathan Pollak ◽

...

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Vegetation Index ◽

Normalized Difference Vegetation Index ◽

Disease Risk ◽

Spatial Clustering ◽

Blood Pressure Measurement ◽

Cardiovascular Disease Risk ◽

Diabetes Diagnosis

Greenness may impact blood pressure (BP), though evidence is limited among individuals with type 2 diabetes (T2D), for whom BP management is critical. We evaluated associations of residential greenness with BP among individuals with T2D in geographically diverse communities in Pennsylvania. To address variation in greenness type, we evaluated modification of associations by percent forest. We obtained systolic (SBP) and diastolic (DBP) BP measurements from medical records of 9593 individuals following diabetes diagnosis. Proximate greenness was estimated within 1250-m buffers surrounding individuals’ residences using the normalized difference vegetation index (NDVI) prior to blood pressure measurement. Percent forest was calculated using the U.S. National Land Cover Database. Linear mixed models with robust standard errors accounted for spatial clustering; models were stratified by community type (townships/boroughs/cities). In townships, the greenest communities, an interquartile range increase in NDVI was associated with reductions in SBP of 0.87 mmHg (95% CI: −1.43, −0.30) and in DBP of 0.41 mmHg (95% CI: −0.78, −0.05). No significant associations were observed in boroughs or cities. Evidence for modification by percent forest was weak. Findings suggest a threshold effect whereby high greenness may be necessary to influence BP in this population and support a slight beneficial impact of greenness on cardiovascular disease risk.

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