Effects of urbanization on metabolic syndrome via dietary intake and physical activity in Chinese adults: Multilevel mediation analysis with latent centering

Factors Associated With Diabetes Self-Care Performance in Indonesians With Type 2 Diabetes: A Cross-Sectional Study

BACKGROUND

In Indonesia, the number of Type 2 diabetes cases is increasing rapidly, making it the third leading cause of death and among the leading noncommunicable disease healthcare expenditures in the country. Thus, there is a critical need for Indonesians with Type 2 diabetes to perform better self-care to optimize their health and prevent the onset of comorbidities.

PURPOSE

This study was designed to investigate the influence of knowledge, depression, and perceived barriers on Type 2 diabetes self-care performance in Indonesia.

METHODS

A cross-sectional study was conducted on 185 patients with Type 2 diabetes, with demographic, diabetes history, obesity status, diabetes knowledge, depression, perceived barriers, and self-care performance data collected. The Indonesian version of the Revised Diabetes Knowledge Test, Depression Anxiety Stress Scale, Perceived Barrier Questionnaire and Self-Care Inventory-Revised were used. Descriptive, bivariate, and multiple linear regression analyses were performed.

RESULTS

Study participants were found to have moderate diabetes self-care performance scores. Annual eye checks, blood glucose self-monitoring, healthy diet selection, and regular exercise were the least common self-management techniques performed and were consistent with the perceived difficulties of the participants. Being illiterate or having an elementary school education (β = 4.59, p = .002), having a junior or senior high school education (β = 3.01, p = .006), having moderate depression (β = -0.92, p = .04), diabetes knowledge (β = 0.09, p = .006), and perceived barriers (β = 0.31, p < .001) were found to explain 40% of the variance in self-care performance. Educational level, depression, and perceived barriers were the strongest factors that impacted Type 2 diabetes self-care performance in this study.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Nurses should not only provide diabetes education but also identify barriers to diabetes self-care early, screen for the signs and symptoms of depression, and target patients with lower levels of education.

Urban densification over 9 years and change in the metabolic syndrome: A nationwide investigation from the ORISCAV-LUX cohort study

A growing body of evidence suggests that urban densification may be protective against obesity, type 2 diabetes, and cardiometabolic diseases, yet studies on how built environmental features relate to metabolic syndrome (MetS) and its components are scarce. This longitudinal study examines the associations of baseline urban density and densification over 9 years with MetS and MetS components, among 510 participants enrolled in both waves of the ORISCAV-LUX study (2007-2017) in Luxembourg. A continuous MetS score (siMS) was calculated for each participant. Six features of residential built environments were computed around participants' home address: street connectivity, population density, density of amenities, street network distance to the nearest bus station, density of public transport stations, and land use mix. A composite index of urban densification (UDI) was calculated by averaging the six standardized built environment variables. Using adjusted generalized estimating equation (GEE) models, one-SD increase in UDI was associated with a worsening of the siMS score (β = 0.07, 95% CI: 0.02, 0.13), higher triglyceride levels (β = 0.05, 95% CI: 0.02, 0.09), and lower HDL-c levels (β = -1.29, 95% CI: -2.20, -0.38). The detrimental effect of UDI on lipid levels was significant only for participants living in dense areas at baseline. Higher baseline UDI, as well as increased UDI over time among movers, were also associated with greater waist circumference. There were no associations between UDI, fasting plasma glucose and systolic blood pressure. Sex and neighborhood socio-economic status did not moderate the associations between UDI and the cardiometabolic outcomes. Overall, we found limited evidence for an effect of urban densification on MetS and its components. Understanding urban dynamics remains a challenge, and more research investigating the independent and joint health effect of built environment features is needed to support urban planning and design that promote cardiometabolic health.

Urbanization and residents' health: from the perspective of environmental pollution

The development of urbanization has important implications for the environment and the human health. However, it is still lacking a comprehensive analysis between urbanization, environmental pollution, and residents' health based on a unified research system. In this study, we assessed the integrated level of urbanization by the entropy method based on the representative indicators. It has been found that there is a significant progress in the urbanization level in the provinces from 2005 to 2020. The impact of urbanization development on environmental pollution was analyzed using the system GMM (Generalized Method of Moments), and the results show an inverted U-shaped relationship between urbanization and environmental pollution. Fixed effect regression model analysis infers that urbanization has a dual impact on population health. Urbanization promotes residents' health by improving medical conditions, but the environmental pollution caused by urbanization is harmful to residents' health. This paper integrated urbanization, environmental pollution, and residents' health into a research system to analyze the impact of urbanization on environmental pollution and residents' health. Some policy recommendations have been proposed based on the research results for promoting high-quality development of urbanization, reducing environmental pollution, and improving residents' health.

Assessing the diet quality, environmental impact, and monetary costs of the dietary transition in China (1997–2011): Impact of urbanization

Background

Increased urbanization has been linked to transitions in dietary patterns. However, evidence on the impacts of urbanization on diet quality, and environmental impact, and diet cost is limited. The aim of this study was to investigate the time trends of these three dietary sustainability in China over the period 1997–2011 and to examine their associations with urbanization.

Methods

Food consumption of 8,330 participants (18–64y) of the China Health and Nutrition Survey cohort (1997, 2000, 2004, 2006, 2009, and 2011) were examined and diet quality was assessed using the Chinese Healthy Eating Index 2016 (CHEI2016). Dietary related environmental impacts on Greenhouse Gas Emissions (GHGE), Total Water Use (TWU), and Land Use (LU) were estimated using the Chinese Food Life Cycle Assessment Database. Monetary cost of diet was calculated using the community market prices of food items. Multilevel mixed-effects models were used to estimate associations between the time trend of dietary sustainability indicators and degree of urbanization.

Results

From 1997 to 2011, the CHEI2016 score increased by 10.6%, GHGE by 23.8%, LU by 29.1%, and the inflation-corrected cost of diet by 80%. Urbanization was positively associated with these time trends, which remained after adjustment for sociodemographic and lifestyle factors (all P &lt; 0·05).

Conclusion

The rapid urbanization in China over the past two decades has been followed by an improvement in the overall dietary quality, but this has been accompanied by an increase in the environmental impacts and higher cost of the diet, especially in communities with lower urbanization index.

Associations of dietary patterns with obesity and weight change for adults aged 18-65 years: Evidence from the China Health and Nutrition Survey (CHNS)

BACKGROUND

Obesity has become a significant public health problem within China. By observing dietary patterns, an individual's actual dietary habit of nutrients or foods in combination can be identified. We aimed to examine dietary patterns in relation to the risk of obesity (body mass index (BMI) ≥ 25 kg/m2) and weight change (average weight change per five years) within a Chinese cohort.

METHODS

We analyzed the data from 6,677 adults aged 18-65 years in the China Health and Nutrition Survey 1997-2015. Westernized, traditional Chinese, and high-starch plant-based dietary patterns were identified by principal components analysis. We estimated relative risks (RRs) and least-squares means (LS-means) with 95% confidence intervals (CIs) using the Cox proportional hazards models and the generalized linear models, respectively.

RESULTS

High adherence to the Westernized dietary pattern was associated with increased risks of obesity and weight gain. Comparing top with bottom quintiles, RR (95% CI) for obesity (BMI ≥ 25 kg/m2) was 1.57 (1.26-1.95; P for trend < 0.001). LS-means of weight change (kg/5 years) were 1.73 (0.98-2.47) and 1.13 (0.39-1.87; P for trend = 0.036) in the top and bottom quintiles, respectively. Increased weight gain among those following the Westernized dietary pattern was stronger in the Southern region than the Northern region. There was a slight hint of an inverse association between the traditional Chinese dietary pattern and obesity. We did not find any significant association for the high-starch plant-based dietary pattern.

CONCLUSIONS

The Westernized dietary pattern increased the risk of obesity among Chinese adults. Weight gain associated with Western dietary pattern was more pronounced in the Southern region than in the Northern region. Our study will provide helpful data in developing dietary guidelines for the prevention of obesity specific to different regions in China.

Metabolic syndrome in people with HIV from Guatemala: analysis of components and risk factors

BACKGROUND

People with HIV (PWH) in Latin America are at a greater risk of developing comorbidities due to the increasing burden of obesity and metabolic syndrome in the region. We explored the associations between social, cardiovascular and HIV-related risk factors with metabolic syndrome in PWH from Guatemala.

METHODS

Cross-sectional study analyzing demographic, clinical and laboratory data from PWH. Metabolic syndrome diagnosis and components are defined by the harmonized Joint Scientific Statement criteria. Data were collected from July 2019 to March 2020 and analyzed using correlations and logistic regression.

RESULTS

Median age was 39 years [IQR 31-48], 56.8% of participants were male and 31.5% (n = 266, 95% CI 0.28-0.34) had metabolic syndrome. Age (adjusted odds ratio (aOR): 1.03, 95% CI 1.02-1.05, p <0.001), urban dweller (aOR: 1.48, 95% CI 1.00-2.18, p = 0.049), low physical activity (aOR: 1.45, 95% CI 1.01-2.08, p = 0.046), hyperuricemia (aOR: 3.31, 95% CI 1.93-5.67, p <0.001), current CD4⁺ T cell count < 200 cells/mm³ (aOR: 1.96, 95% CI 1.19-3.23, p = 0.009), 6 months of efavirenz (aOR: 1.89, 95% CI 1.29-2.77, p = 0.001), and obesity (aOR: 37.0, 95% CI 7.70-178.2, p < 0.001) were independently associated with metabolic syndrome.

CONCLUSIONS

Prevalence of metabolic syndrome in this study was high and driven mainly by social and cardiovascular risk factors such as age, urban dwelling, obesity, hyperuricemia and low physical activity. Efavirenz use and CD4 count were the only HIV-related factors associated with metabolic syndrome.

Trends for the Association between Body Mass Index and Risk of Cardiovascular Disease among the Japanese Population: The Circulatory Risk in Communities Study (CIRCS)

AIM

This study aimed to investigate whether the impact of body mass index (BMI) on the risk of cardiovascular disease (CVD) has changed among the 1960s, 1970s, 1980s, 1990s, and early 2000s in Japan.

METHODS

The study population consisted of residents in Japan aged 40-69 years who had no history of CVD. The baseline surveys have been conducted every year since 1963. We defined the first, second, third, fourth, and fifth cohorts as 1963-1969 (n=4,248), 1970-1979 (n=6,742), 1980-1989 (n=12,789), 1990-1999 (n=12,537), and 2000-2005 (n=9,140) respectively. The participants were followed up for a median of 15 years for each cohort to determine the incidence of CVD. We classified them into four categories (BMI ＜21.0, 21.0-＜23.0, 23.0-＜25.0, and ≥ 25.0 kg/m ²).

RESULTS

From 1963-1969 to 2000-2005, the prevalence of BMI ≥ 25.0 increased over time. Compared with BMI 23.0-＜25.0, the age-, sex- and community-adjusted hazard ratios (95% confidence interval [CIs]) of CVD for BMI ≥ 25.0 were 1.10 (0.77-1.57), 0.89 (0.68-1.18), 1.03 (0.85-1.26), 1.28 (1.04-1.58), and 1.36 (1.04-1.78)in the first, second, third, fourth, and fifth cohorts, respectively. The corresponding population attributable fractions were 2.0% (nonsignificant), -2.6% (nonsignificant), 0.9% (nonsignificant), 7.6%, and 10.9%. Further adjustment for systolic blood pressure and antihypertensive medication use in the fourth and fifth cohorts attenuated the associations, which may reflect that blood pressure may mediate the BMI-CVD association.

CONCLUSION

The proportion of CVD attributable to overweight/obesity has increased during the periods between 1963-1969 and 2000-2005. The significant associations between overweight/obesity and risk of CVD after the 1990s were mediated by blood pressure levels.

Urbanization, ambient air pollution, and prevalence of chronic kidney disease: A nationwide cross-sectional study

An increasing number of studies have linked ambient air pollution to chronic kidney disease (CKD) prevalence. However, its potential effect modification by urbanization has not been investigated. Based on data of 47,204 adults from the China National Survey of Chronic Kidney Disease (CKSCKD) dataset, night light satellite remote sensing data and high-resolution air pollution inversion products, the present cross-sectional study investigated the association between fine particulate matter <2.5 mm in diameter (PM_2.5), nitrogen dioxide (NO₂), night light index (NLI) and CKD prevalence in China, and the effect modification by urbanization characterized by administrative classification and NLI on the pollutant-health associations. Our results showed that a 10-μg/m³ increase in PM_2.5 at 3-year moving average, a 10-μg/m³ increase in NO₂ at 5-year moving average, and a 10-U increase in NLI at 5-year moving average were significantly associated with increased odds of CKD prevalence [OR = 1.24 (95 %CI:1.14, 1.35); OR = 1.12 (95 %CI:1.09, 1.15); OR = 1.05 (95 %CI:1.02, 1.07)]. Meanwhile, the pollutant-health associations were more apparent in medium-urbanized areas compared to low- and high-urbanized areas. For instance, a 10-μg/m³ increase in PM_2.5 concentration at 2-year moving average was associated with increased odds of CKD in the areas with NLI level in the second [OR = 2.78 (95 %CI:1.77, 4.36)] and third quartiles [OR = 1.49 (95 %CI:1.14, 1.95)], compared to the lowest [OR = 0.96 (95% CI: 0.73, 1.26)] and highest [OR = 0.63 (95% CI: 0.39-1.02)] quartiles. PM_2.5 and NO₂ were associated with increased odds of CKD prevalence, especially in areas with medium NLI levels, suggesting the necessity of strengthening environmental management in medium-urbanized regions.

Longitudinal measurement invariance in urbanization index of Chinese communities across 2000 and 2015: a Bayesian approximate measurement invariance approach

BACKGROUND

The Urbanicity Scale was developed based on the China Health and Nutrition Survey (CHNS) to measure the urbanization index of communities according to 12 components. The present study was designed to systematically investigate the factorial validity, reliability, and longitudinal measurement invariance (LMI) of the Urbanicity Scale.

METHODS

Six waves of CHNS data from 2000 to 2015 were adopted. The factor structure and reliability of the Urbanicity Scale for 301 communities were examined using Bayesian exploratory factor analysis. Metric and scalar LMIs were evaluated using both the conventional exact and a novel approximate LMI approach via Bayesian structural equation modeling across various timeframes.

RESULTS

The findings verified the one-factor structure for the Urbanicity Scale, with adequate reliability. LMI was established for the Urbanicity Scale only over a shorter timeframe from 2006 to 2009 but not over a longer timeframe from 2000 to 2015. Partial LMI was found in the factor loadings and item intercepts for the Urbanicity Scale over the 2004 to 2011 period.

CONCLUSION

Interpretation of the temporal change in urbanicity was supported only for a shorter (2006 to 2009) but not a longer timeframe (2000 to 2015). Adjustments addressing the partial non-invariance of the measurement parameters are needed for the analysis of temporal changes in urbanicity between 2004 and 2011.

Dietary patterns and metabolic syndrome among urbanized Tibetans: A cross-sectional study

The prevalence of metabolic syndrome (MetS) and the major dietary patterns among urbanized Tibetans are unclear. The present study aimed to investigate the prevalence of MetS among Jiarong Tibetans in Aba Plateau, identify the major dietary patterns, and evaluate their association with the risk of MetS. In this cross-sectional study on 476 subjects, 18-80-years-old, dietary intakes were evaluated using a simplified food frequency questionnaire (SFFQ). MetS was defined according to the International Diabetes Federation (IDF) guidelines. Principal component analysis was performed to assess the major dietary patterns. Multivariate logistic regression analysis examined the associations between dietary patterns and the risk of MetS. The prevalence of Mets in the population was 37.6%. Herein, three major dietary patterns were extracted: traditional Tibetan, urbanized, and healthy dietary patterns. After adjusting for potential confounders (Model 1: adjusted for sex and age; Model 2: adjusted for sex, age, smoking status, drinking situation, physical activity level and total energy intake), subjects in the highest tertile of the healthy dietary had a lower risk of MetS compared to those from the lowest tertile. Also, no significant statistical association was established between the risk of MetS and the traditional Tibetan and urbanized diet.

Dietary calcium, magnesium, and phosphorus intakes and risk of stroke in Chinese adults

Controversial results have been reported about the association of calcium, magnesium, and phosphorus and stroke risk, but none in China. To investigate the association between dietary calcium, magnesium, phosphorus, and stroke incidence in Chinese adults, we collected data from the China Health and Nutrition Survey (CHNS) from 2004 to 2011, including 6411 participants aged 45-79 years and free of stroke at baseline. Diet was assessed by interviews combining 3-d 24-h food recalls and household food inventory weighing at each survey round. The stroke incident was identified based on the validated self-report. Multivariate Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). For 32,024 person-years of follow-up, 179 stroke cases were documented. After adjustment for major lifestyle and dietary risk factors, calcium intake was positively associated with reduced stroke risk, and the HR of stroke comparing extreme quartiles was 0.53 (95% CI 0.29-0.96, P_trend = 0.03). In further stratified analyses, significant heterogeneity across sex strata was found (P_interaction = 0.03). Dietary calcium intake among men was more inversely related to stroke, with HRs being 0.33 (95% CI 0.15-0.76, P _trend = 0.02), compared to 1.24 (95% CI 0.46-3.35, P_trend = 0.89) among women. However, no significant association between stroke and magnesium or phosphorus was revealed. Our findings suggest that higher dietary calcium intake was associated with a lower risk of stroke in Chinese adults, particularly in men.

Accessibility of Rural Life Space on the Jianghan Plain, China: The Role of Livelihood

This article aims to contribute to the relationship between accessibility of rural life space and rural livelihood capital and transitions in rural central China. Employing data produced from a household survey, we developed a composite index for accessibility of rural life space incorporating spatial and temporal attributes of a household’s daily activities and then explored the mediation effect of rural livelihood capital and transitions on accessibility. Results revealed a pattern of diversification in terms of life space accessibility undertaken for daily activities across households. Both livelihood capital and transitions had significant mediation effects on the relationship between socio-economic characteristics of rural households and accessibility of rural life space. The effects of livelihood capital on livelihood transitions also influenced the path on rural households’ accessibility of rural life space. One of the implications of this article is to link rural transformation to the context of urbanization and rural access issues from a perspective of daily activity, and then to figure out the best method for rural development policy and service planning.

The Rise of ST-Elevation Myocardial Infarction in Women of Northeast China

The women of China's Liaoning province display some morbidities in ways that defy medical explanation. Women have higher rates of hypertension, hypercholesterolemia, and metabolic syndrome than men, an anomaly for all three conditions. Most of these patients also suffer from Type 2 Diabetes Mellitus (T2DM) while there was a negative association between being female and T2DM for the rest of China. Each of these conditions can exist independently, but the increase in both their rates and congruence is a recent phenomenon. Stranger still is that Liaoning women are now presenting in hospital emergency departments with ST-Elevation Myocardial Infarction (STEMI), while diabetics predominantly suffer more benign Non-STEMI (NSTEMI) events. Confounding factors in any attempt to study this phenomenon include trace metals like manganese that have been shown to reduce systolic blood pressure in Asian men and raise it in Asian women. Some of the phenomenon may also be associated with the gene for Apolipoprotein 5, but its recent nature suggests other factors besides lipid profiles. Trace metals in the air, water, and diet of Liaoning province, or any urban environment, could play a role.