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Zhu Y, Hu C, Lin L, Wang S, Lin H, Huo Y, Wan Q, Qin Y, Hu R, Shi L, Su Q, Yu X, Yan L, Qin G, Tang X, Chen G, Xu M, Xu Y, Wang T, Zhao Z, Gao Z, Wang G, Shen F, Luo Z, Chen L, Li Q, Ye Z, Zhang Y, Liu C, Wang Y, Wu S, Yang T, Deng H, Chen L, Zeng T, Zhao J, Mu Y, Wang W, Ning G, Bi Y, Chen Y, Lu J. Obesity mediates the opposite association of education and diabetes in Chinese men and women: Results from the REACTION study. J Diabetes 2022; 14:739-748. [PMID: 36217863 PMCID: PMC9705800 DOI: 10.1111/1753-0407.13325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/06/2022] [Accepted: 09/17/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Evidence regarding the impact of education on diabetes risk is scarce in developing countries. We aimed to explore the association between education and diabetes within a large population in China and to identify the possible mediators between them. METHODS Information on educational level and lifestyle factors was collected through questionnaires. Diabetes was diagnosed from self-report and biochemical measurements. A structural equation model was constructed to quantify the mediation effect of each mediator. RESULTS Compared with their least educated counterparts, men with college education had a higher risk of diabetes (odds ratio [OR] 1.19; 95% confidence interval [CI], 1.12-1.27), while college-educated women were less likely to have diabetes (OR 0.77; 95% CI, 0.73-0.82). Obesity was the strongest mediator in both genders (proportion of mediation: 11.6% in men and 23.9% in women), and its association with education was positive in men (β[SE] 0.0387 [0.0037]) and negative in women (β[SE] -0.0824 [0.0030]). Taken together, all behavioral factors explained 12.4% of the excess risk of diabetes in men and 33.3% in women. CONCLUSIONS In a general Chinese population, the association between education level and diabetes was positive in men but negative in women. Obesity was the major mediator underlying the education disparities of diabetes risk, with a stronger mediation effect among women.
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Affiliation(s)
- Yuanyue Zhu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Chunyan Hu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Lin Lin
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Shuangyuan Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Hong Lin
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yanan Huo
- Jiangxi Provincial People's Hospital Affiliated to Nanchang UniversityNanchangChina
| | - Qin Wan
- The Affiliated Hospital of Luzhou Medical CollegeLuzhouChina
| | - Yingfen Qin
- The First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Ruying Hu
- Zhejiang Provincial Center for Disease Control and PreventionHangzhouChina
| | - Lixin Shi
- Affiliated Hospital of Guiyang Medical UniversityGuiyangChina
| | - Qing Su
- Xinhua Hospital Affiliated to Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Xuefeng Yu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Li Yan
- Sun Yat‐sen Memorial Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Guijun Qin
- The First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Xulei Tang
- The First Hospital of Lanzhou UniversityLanzhouChina
| | - Gang Chen
- Fujian Provincial Hospital, Fujian Medical UniversityFuzhouChina
| | - Min Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yu Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Tiange Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Zhiyun Zhao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Zhengnan Gao
- Dalian Municipal Central Hospital Affiliated of Dalian Medical UniversityDalianChina
| | - Guixia Wang
- The First Hospital of Jilin UniversityChangchunChina
| | - Feixia Shen
- The First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Zuojie Luo
- The First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Li Chen
- Qilu Hospital of Shandong UniversityJinanChina
| | - Qiang Li
- The Second Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Zhen Ye
- Zhejiang Provincial Center for Disease Control and PreventionHangzhouChina
| | - Yinfei Zhang
- Central Hospital of Shanghai Jiading DistrictShanghaiChina
| | - Chao Liu
- Jiangsu Province Hospital on Integration of Chinese and Western MedicineNanjingChina
| | - Youmin Wang
- The First Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Shengli Wu
- Karamay Municipal People's HospitalXinjiangChina
| | - Tao Yang
- The First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Huacong Deng
- The First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Lulu Chen
- Union HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Tianshu Zeng
- Union HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Jiajun Zhao
- Shandong Provincial Hospital affiliated to Shandong UniversityJinanChina
| | - Yiming Mu
- Chinese People's Liberation Army General HospitalBeijingChina
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Guang Ning
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yufang Bi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yuhong Chen
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jieli Lu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
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Brand C, Martins CMDL, Lemes VB, Pessoa MLF, Dias AF, Cadore EL, Mota J, Gaya ACA, Gaya AR. Effects and prevalence of responders after a multicomponent intervention on cardiometabolic risk factors in children and adolescents with overweight/obesity: Action for health study. J Sports Sci 2020; 38:682-691. [PMID: 32050850 DOI: 10.1080/02640414.2020.1725384] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This study aimed to verify the effect of a multicomponent intervention on cardiometabolic risk factors (CMRF), and to determine the prevalence of responders on CMRF among children and adolescents with overweight/obesity. This is a quasi-experimental study, developed with 35 children and adolescents with overweight/obesity (control group (CG) = 18; intervention group (IG) = 17), aged between 7 and 13 years. Participants in IG underwent a multicomponent intervention for 12 weeks. The following variables were evaluated: anthropometric measures, maturational stages and CMRF (body fatness, HOMA-IR, triglycerides, high-density and low-density lipoprotein) (HDL-C, LDL-C), total cholesterol (TC), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and AST/ALT ratio. Mixed analysis of variance and the prevalence of responders were used for statistical analysis. There was a significant time x group interaction on body fatness (p < 0.001), HOMA-IR (p = 0.01), HDL-C (p < 0.001), LDL-C (p = 0.009) and TC (p < 0.001). The prevalence of responders for CMRF in IG and CG was respectively: body fatness (47%; 0%; p = 0.04), HOMA-IR (58.8%; 16.6%; p = 0.04); triglycerides (17.6%; 5.5%; p = 0.31); HDL-C (76.4%; 5.5%; p = 0.01), LDL-C (35.3%; 5%; p = 0.08), TC (64.7%; 5%; p = 0.01), AST (5.8%; 0%; p = 0.87), ALT (29.4%; 11.1%; p = 0.24) and AST/ALT ratio (24.4%; 22.2%; p = 0.67). Multicomponent intervention induced positive changes on CMRF along with a higher prevalence of positive adaptations in IG than the CG in some of the cardiometabolic outcomes assessed.
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Affiliation(s)
- Caroline Brand
- Projeto Esporte Brasil (PROESP-Br). School of Physical Education, Physiotherapy and Dance, Post-graduation Program in Human Movement Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Vanilson Batista Lemes
- Projeto Esporte Brasil (PROESP-Br). School of Physical Education, Physiotherapy and Dance, Post-graduation Program in Human Movement Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Luisa Félix Pessoa
- Research Center on Physical Activity, Health and Leisure, Federal University of Paraiba, João Pessoa, Brazil.,Health Science Centre, Federal University of Paraíba, João Pessoa, Brazil
| | - Arieli Fernandes Dias
- Projeto Esporte Brasil (PROESP-Br). School of Physical Education, Physiotherapy and Dance, Post-graduation Program in Human Movement Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Eduardo Lusa Cadore
- School of Physical Education, Physiotherapy and Dance, Post-graduation Program in Human Movement Sciences, Federal University of Rio Grande Do Sul, Porto Alegre, Brazil
| | - Jorge Mota
- Research Center on Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
| | - Adroaldo Cezar Araujo Gaya
- Projeto Esporte Brasil (PROESP-Br). School of Physical Education, Physiotherapy and Dance, Post-graduation Program in Human Movement Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Anelise Reis Gaya
- Projeto Esporte Brasil (PROESP-Br). School of Physical Education, Physiotherapy and Dance, Post-graduation Program in Human Movement Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Jensen SM, Hauger H, Ritz C. Mediation analysis for logistic regression with interactions: Application of a surrogate marker in ophthalmology. PLoS One 2018; 13:e0192857. [PMID: 29432493 PMCID: PMC5809055 DOI: 10.1371/journal.pone.0192857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 01/31/2018] [Indexed: 11/25/2022] Open
Abstract
Mediation analysis is often based on fitting two models, one including and another excluding a potential mediator, and subsequently quantify the mediated effects by combining parameter estimates from these two models. Standard errors of such derived parameters may be approximated using the delta method. For a study evaluating a treatment effect on visual acuity, a binary outcome, we demonstrate how mediation analysis may conveniently be carried out by means of marginally fitted logistic regression models in combination with the delta method. Several metrics of mediation are estimated and results are compared to findings using existing methods.
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Affiliation(s)
- Signe M. Jensen
- Department of Plant and Environmental Sciences, University of Copenhagen, Højbakkegård Allé 13, DK-2630 Taastrup, Denmark
- * E-mail:
| | - Hanne Hauger
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 26, DK-1958 Frederiksberg C, Denmark
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 26, DK-1958 Frederiksberg C, Denmark
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