Auchincloss Amy H, Diez Roux Ana V, Brown Daniel G, Erdmann Christine A, Bertoni Alain G
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan 48109-2029, USA.
Epidemiology. 2008 Jan;19(1):146-57. doi: 10.1097/EDE.0b013e31815c480.
: Little is known about the influence of the built environment, and in particular neighborhood resources, on health. We hypothesized that neighborhood resources for physical activity and healthy foods are associated with insulin resistance.
: Person-level data (n = 2026) came from 3 sites of The Multi-Ethnic Study of Atherosclerosis, a study of adults aged 45-84 years. Area-level data were derived from a population-based residential survey. The homeostasis model assessment index was used as an insulin resistance measure among persons not treated for diabetes. We used linear regression to estimate associations between area features and insulin resistance.
: Greater neighborhood physical activity resources consistently were associated with lower insulin resistance. Adjusted for age, sex, family history of diabetes, race/ethnicity, income and education, insulin resistance was reduced by 17% (95% confidence interval = -31% to -1%) for an increase from the 10th to 90th percentiles of resources. Greater healthy food resources were also inversely related to insulin resistance, although the association was not robust to adjustment for race/ethnicity. Analyses including diet, physical activity, and body mass index suggested that these variables partly mediated observed associations. Results were similar when impaired fasting glucose/diabetes was considered as the outcome variable.
: Diabetes prevention efforts may need to consider features of residential environment.
关于建筑环境，尤其是邻里资源对健康的影响，人们了解甚少。我们假设，邻里的体育活动资源和健康食品与胰岛素抵抗有关。
个体层面的数据（n = 2026）来自动脉粥样硬化多民族研究的3个地点，该研究对象为45 - 84岁的成年人。区域层面的数据来自一项基于人群的居住调查。稳态模型评估指数被用作未接受糖尿病治疗人群的胰岛素抵抗指标。我们使用线性回归来估计区域特征与胰岛素抵抗之间的关联。
邻里体育活动资源越丰富，胰岛素抵抗水平持续越低。在调整年龄、性别、糖尿病家族史、种族/民族、收入和教育因素后，资源从第10百分位数增加到第90百分位数时，胰岛素抵抗降低了17%（95%置信区间 = -31%至-1%）。更丰富的健康食品资源也与胰岛素抵抗呈负相关，尽管在调整种族/民族因素后，这种关联并不稳健。纳入饮食、体育活动和体重指数的分析表明，这些变量部分介导了观察到的关联。将空腹血糖受损/糖尿病作为结果变量时，结果相似。
糖尿病预防工作可能需要考虑居住环境的特征。
