Diabetes Risk Mediates the Relationship Between an Unhealthy Food Environment and Pronociceptive Mechanisms: Findings from The Oklahoma Study of Native American Pain Risk (OK-SNAP)

Diabetes impacts millions of Americans and can lead to peripheral neuropathy and chronic pain. Given that Native Americans (NAs) are at a high risk for diabetes, this could contribute to NA pain inequities. A healthy diet is a common method to manage diabetes risk; however, access to healthy foods is a significant barrier for many Americans. Mailing addresses of healthy, chronic pain-free participants from OK-SNAP (96 NAs, 110 Non-Hispanic Whites) were geocoded and linked to the Modified Retail Food Environment Index, which measures the percentage of healthy food retailers in a census tract. Diabetes risk was calculated by summing the number of known risk factors based on age, BMI, physical activity, blood pressure, smoking status, and family history of diabetes. Mediation analyses revealed that living in unhealthier food environments was related to higher diabetes risk scores that were related to greater spinal sensitization (increased temporal summation of the nociceptive flexion reflex [TS-NFR; marker of spinal nociception]) and impaired endogenous inhibition of NFR (reduced conditioned pain modulation of NFR). TS-pain and CPM of pain experience were not associated with food environment or diabetes risk. Ethnicity did not moderate any relationship. These findings support a relationship between structural inequalities and poorer health and extends this to include associations with pronociceptive processes. These effects can be detected in healthy individuals, before disease onset, and may operate outside of awareness since they were not associated with pain experience. This highlights the need for interventions focused on increasing access to healthy food. This research was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number R01MD007807, and by the University of Tulsa Office of Research and Sponsored Programs. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the University of Tulsa.