Geospatial analysis of food environment demonstrates associations with gestational diabetes

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• 作者：Maike K. Kahr ; MD^a ; Melissa A. Suter ; PhD^a ; Jerasimos Ballas ; MD ; MPH^a ; Susan M. Ramin ; MD^a ; Manju Monga ; MD^a ; Wesley Lee ; MD^a ; Min Hu ; MD^a ; Cindy D. Shope ; MS^a ; Arina Chesnokova ; MPH^a ; Laura Krannich ; BSc^a ; Emily N. Griffin ; BSc^a ; Joan Mastrobattista ; MD^a ; Gary A. Dildy ; MD^a ; Stacy L. Strehlow ; MD^a ; Ryan Ramphul ; MSCRP^b ; Winifred J. Hamilton ; PhD ; SM^b ; Kjersti M. Aagaard ; MD ; PhD^a ; ^{aagaardt@bcm.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：food environment ; geospatial analysis ; gestational diabetes ; neighborhood ; pregnancy outcome
• 刊名：American Journal of Obstetrics and Gynecology
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：214
• 期：1
• 页码：110.e1-110.e9
• 全文大小：718 K

文摘

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, covariant environmental and sociodemographic factors may be additional determinants of GDM occurrence.

c_2">Objective

para0015">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 US county to characterize the association of the relative availability of fast food restaurants and supermarkets to GDM.

c_3">Study Design

para0020">Utilizing a perinatal database with >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 countywide 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. To independently authenticate our findings with objective data, we measured hemoglobin A1c levels as a function of geospatial distribution of food environment in a matched subset (n = 80).

c_4">Results

para0025">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: adjusted odds ratio, 1.63; 95% confidence interval, 1.21–2.19). In multivariate analysis, this association held true after controlling for potential confounders (P = .002). Measurement of hemoglobin A1c 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 < .05).

c_5">Conclusion

para0030">As demonstrated by geospatial analysis, a relationship of food environment and risk for gestational diabetes was identified.