The Impact of the Food Environment and Other Environmental Exposures on the Risk of Diabetes in Rural Settings

项目总结 尽管糖尿病的患病率在全国范围内有所上升，但地理差异随着更高的 农村地区糖尿病相关死亡率高于城市地区。有证据表明，不健康的食物 环境会增加城市地区患糖尿病的风险，但对食物环境的粗略衡量可能不会 捕捉农村糖尿病的风险。因此，对食物环境和农村糖尿病的有力分析必须 在正确的地理范围内测量暴露量，并量化某些食品的购买量如何增加 糖尿病风险。食品环境的危害不仅包括大量营养素的不健康失衡， 还包括饮食中的化学物质暴露，如双酚和邻苯二甲酸盐。这些化学物质现在已被认识到 作为内分泌干扰物，可能会促进胰岛素抵抗和糖尿病。尽管之前对糖尿病的研究 风险已经探索了糟糕的饮食质量和饮食污染物相互隔离，这项研究试图 比较这两种危害对农村居民糖尿病风险的综合影响。为了实现这一目标， 这项研究将通过食物频率问卷和食物收据获得详细的饮食数据 购买，测量估计的每日摄入量和尿中双酚和邻苯二甲酸盐的水平，并使用 关注HbA1c检测，以确定与农村糖尿病相关的关键风险因素。研究的背景将是沙利文 纽约县，一个农村县，健康排名和过早死亡率在纽约排名倒数第二 纽约州，也是糖尿病的沉重负担。虽然不能代表所有农村地区，但 沙利文县以白人为主的贫困农村人口是一个研究不足的群体，面临着 糖尿病预后不佳。因此，这项研究的具体目的将是：1)确定饮食是否 农村居民的素质受到他们的地理位置和当地食物特点的影响 环境，2)根据食物消耗量计算双酚和邻苯二甲酸酯的估计日摄入量 农村居民的模式，并将结果与这些化学物质的尿液水平进行比较，以及3)使用护理点 糖化血红蛋白测试以确定糟糕的饮食质量和饮食污染物如何影响农村地区的血糖控制 未事先诊断为糖尿病的居民。

PROJECT SUMMARY Though diabetes prevalence has increased nationally, geographic disparities have widened with higher diabetes-related mortality in rural regions than in urban areas. Evidence suggests that an unhealthy food environment increases diabetes risk in urban areas, but crude measures of the food environment may not capture the risk of rural diabetes. Therefore, robust analyses of the food environment and rural diabetes must measure exposures at the correct geographic scale and quantify how certain food purchases can increase diabetes risk. The hazards of the food environment not only include an unhealthy imbalance of macronutrients, but also dietary chemical exposures such as bisphenols and phthalates. These chemicals are now recognized as endocrine disruptors that may promote insulin resistance and diabetes. Though previous studies of diabetes risk have explored poor diet quality and dietary contaminants in isolation of each other, this study seeks to compare the combined impact of both hazards on diabetes risk among rural residents. To accomplish this goal, the study will obtain detailed dietary data through food frequency questionnaires and receipts of food purchases, measure estimated daily intake and urinary levels of bisphenols and phthalates, and use point-of- care HbA1c testing to identify key risk factors associated with rural diabetes. The study setting will be Sullivan County, New York, a rural county with the second-to-worst health ranking and rate of premature death in New York State, and also a high burden of diabetes. Though not representative of all rural regions, the impoverished, predominately White rural population of Sullivan County is an understudied group at high risk for poor diabetic outcomes. Therefore, the specific aims of this study will be to: 1) determine whether the diet quality of rural residents is influenced by their geographic locations and characteristics of their local food environment, 2) calculate estimated daily intake of bisphenols and phthalates based on the food consumption patterns of rural residents and compare results to urinary levels of these chemicals, and 3) use point-of-care HbA1c tests to identify how poor diet quality and dietary contaminants affect glycemic control among rural residents without a prior diagnosis of diabetes.