Disentangling the Multifactorial Influences on Diabetes Risk Among Rural Communities: Food Environment, Diet Quality, and Dietary Chemical Exposures

AIMS: Rural communities experience a higher prevalence of type 2 diabetes and diabetes-related mortality than urban populations. This study sought to disaggregate the influences of demographic and socioeconomic factors, food environment, diet quality, and dietary chemical exposures on diabetes risk in rural areas. MATERIALS AND METHODS: We enrolled participants from rural Sullivan County in an observational cohort study involving surveys and biospecimen collection measuring bisphenols and phthalates. We measured these endocrine disrupting chemicals found in food packaging, as rural residents generally consume canned foods and other shelf-stable foods more frequently than their urban counterparts. We used LASSO regression to compare the relative influence of these factors had on rural diabetes risk. RESULTS: Based on values for LASSO regression coefficients among 276 participants, the strongest risk factors for diagnosed diabetes included: older age (+0.486), lower household income (+0.172), Hispanic ethnicity (+0.124), red meat intake (+0.093), proportion of fast food restaurants among nearby restaurants (+0.071), and two phthalates (+0.149 and + 0.107). Among study participants without a history of diabetes, high HbA1c levels were associated with older age (+0.106), being non-Hispanic Black (+0.064), more trans-fat and red meat intake (+0.044 and +0.028), higher BMI (+0.014), higher levels of total bisphenols (+0.005), and higher levels of high-molecular weight phthalates (+0.002). CONCLUSIONS: Demographic and socioeconomic factors were the strongest predictors of rural diabetes risk; however, diet quality, food environment, and dietary chemical exposures also each played a key role. Our study identified modifiable risk factors, which could help reduce the burden of rural diabetes.