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

> **NIH NIH R01** · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · 2021 · $709,318

## Abstract

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.

## Key facts

- **NIH application ID:** 10135951
- **Project number:** 5R01DK124400-02
- **Recipient organization:** NEW YORK UNIVERSITY SCHOOL OF MEDICINE
- **Principal Investigator:** David C Lee
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $709,318
- **Award type:** 5
- **Project period:** 2020-07-01 → 2025-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10135951

## Citation

> US National Institutes of Health, RePORTER application 10135951, The Impact of the Food Environment and Other Environmental Exposures on the Risk of Diabetes in Rural Settings (5R01DK124400-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10135951. Licensed CC0.

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