1
|
Fang X, Xie Y, Cao S, Liu J, Shi Y, Yu L, Zheng T, Liu H, Li Y, Xu S, Xia W. Associations between maternal urinary rare earth elements during pregnancy and birth weight-for-gestational age: Roles of cord blood vitamin D levels. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 912:169222. [PMID: 38081430 DOI: 10.1016/j.scitotenv.2023.169222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/25/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
Prenatal exposure to rare earth elements (REEs) may contribute to adverse birth outcomes in previous studies. Cord blood vitamin D has been suggested to modify or mediate the effects of environmental exposures. However, none has investigated these roles of cord blood vitamin D in the associations of prenatal exposure to REEs with fetal growth. Maternal trimester-specific urinary concentrations of 13 REEs, cord blood total 25-hydroxyvitamin D at delivery, and birth weight (BW)-for-gestational age (GA) were determined in 710 mother-newborn pairs from Wuhan, China. Higher maternal average urinary concentrations of europium (Eu), gadolinium (Gd), dysprosium (Dy), holmium (Ho), erbium (Er), and ytterbium (Yb) across three trimesters, either individually or jointly, were significantly associated with lower BW-for-GA Z-scores and higher odds of small for gestational age (SGA) [β = -0.092; 95 % confidence interval (CI): -0.149, -0.035 for BW-for-GA Z-scores, and odds ratio = 1.60; 95 % CI: 1.14, 2.24 for SGA involved in each unit increase in weighted quantile sum index of REEs mixture]. When stratified by cord blood vitamin D levels, the associations mentioned above persisted in participants with relatively low vitamin D levels (<13.94 μg/L, the first tertile of distribution), but not among those with relatively high levels (≥13.94 μg/L) (all p-values for interaction < 0.05). The mediation analyses taking account of exposure-mediator interaction showed that the relationships between REEs (as individual and mixture) exposure and lower BW-for-GA were partly mediated through decreasing cord blood vitamin D levels. The proportions mediated by cord blood vitamin D levels were 24.48 % for BW-for-GA Z-scores and 29.05 % for SGA corresponding to the REEs mixture exposure. Conclusively, our study revealed that prenatal exposures to Eu, Gd, Dy, Ho, Er, and Yb were related to fetal growth restriction. Cord blood vitamin D might alleviate toxic effects of these REEs and its reduction might partly mediate REE-induced fetal growth restriction.
Collapse
Affiliation(s)
- Xingjie Fang
- Key Laboratory of Environment and Health, Ministry of Education, Ministry of Environmental Protection, State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ya Xie
- Key Laboratory of Environment and Health, Ministry of Education, Ministry of Environmental Protection, State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shuting Cao
- Key Laboratory of Environment and Health, Ministry of Education, Ministry of Environmental Protection, State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiangtao Liu
- Key Laboratory of Environment and Health, Ministry of Education, Ministry of Environmental Protection, State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yujie Shi
- Key Laboratory of Environment and Health, Ministry of Education, Ministry of Environmental Protection, State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ling Yu
- Key Laboratory of Environment and Health, Ministry of Education, Ministry of Environmental Protection, State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tongzhang Zheng
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02912, United States
| | - Hongxiu Liu
- Key Laboratory of Environment and Health, Ministry of Education, Ministry of Environmental Protection, State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuanyuan Li
- Key Laboratory of Environment and Health, Ministry of Education, Ministry of Environmental Protection, State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shunqing Xu
- Key Laboratory of Environment and Health, Ministry of Education, Ministry of Environmental Protection, State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wei Xia
- Key Laboratory of Environment and Health, Ministry of Education, Ministry of Environmental Protection, State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| |
Collapse
|
2
|
Ahmadabad AD, Jahangiry L, Gilani N, Farhangi MA, Mohammadi E, Ponnet K. Lifestyle patterns, nutritional, and metabolic syndrome determinants in a sample of the older Iranian population. BMC Geriatr 2024; 24:36. [PMID: 38191298 PMCID: PMC10775447 DOI: 10.1186/s12877-024-04659-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 01/02/2024] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Chronic diseases and metabolic disorders are prevalent health concerns that often escalate with increasing age and thus affect older individuals. The proportion of the elderly population in Iran increased from 7.22% in 2006 to 12.0% in 2023. The current study aimed to evaluate lifestyle patterns and lifestyle risk factors among patients with metabolic syndrome (MetS) based on dietary, physical activity, and smoking, as well as MetS components. METHODS This cross-sectional study included 582 older people with MetS living in Yazd, Iran. Latent class analysis (LCA) was used to determine the lifestyle behaviors of diet patterns, smoking, and physical activity. Dietary intake was measured using a validated food frequency questionnaire, and dietary patterns were identified using principal component analysis (PCA). Clinical measurements of MetS components were examined using relevant guidelines. RESULTS The mean age of the participants was 72.71 years (SD = 5.57). Using PCA, two dietary patterns were identified: traditional patterns (e.g., fruits, fish, poultry, vegetables, meats, salt, and sugar sweetened beverages) and high-fat patterns (e.g., high-fat dairy). Applying LCA identified two classes of lifestyle patterns. About 35% (n = 204) of the participants were categorized in a low-risk class (I) and characterized by physical activity (0.93%, n = 190), a traditional pattern for diet (61%, n = 122), and zero probability of smoking. About 65% (n = 378) of the patients were categorized in high-risk class (II) and characterized by low physical activity levels (69%, n = 261), cigarette smoking (71.6%, n = 271), and a high-fat dietary pattern (56.9%, n = 215). CONCLUSION The results of our study indicated two distinct classes within the patients. In class I, aging patients with MetS exhibited characteristics such as engagement in physical activity and having a traditional pattern for diet. Class II, with a higher prevalence of lifestyle risk factors, included individuals who engaged in cigarette smoking, displayed low physical activity (69%), and having a high-fat diet. The combination of these lifestyle factors exposed them to a heightened risk of developing MetS. The findings could guide healthcare professionals to be aware of the associations between different lifestyle risk factors and to focus on multiple behaviors at the same time.
Collapse
Affiliation(s)
- Ali Dehghani Ahmadabad
- Department of Geriatric Health, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Jahangiry
- Department of Health education and promotion, Faculty of health, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Neda Gilani
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Eesa Mohammadi
- Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Koen Ponnet
- Faculty of Social Sciences, Imec-Mict-Ghent University, Ghent, Belgium
| |
Collapse
|
3
|
Dietrich JW, Abood A, Dasgupta R, Anoop S, Jebasingh FK, Spurgeon R, Thomas N, Boehm BO. A novel simple disposition index (SPINA-DI) from fasting insulin and glucose concentration as a robust measure of carbohydrate homeostasis. J Diabetes 2024. [PMID: 38169110 DOI: 10.1111/1753-0407.13525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/17/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
AIMS The widely used dynamic disposition index, derived from oral glucose tolerance testing, is an integrative measure of the homeostatic performance of the insulin-glucose feedback control. Its collection is, however, time consuming and expensive. We, therefore, pursued the question if such a measure can be calculated at baseline/fasting conditions using plasma concentrations of insulin and glucose. METHODS A new fasting-based disposition index (structure parameter inference approach-disposition index [SPINA-DI]) was calculated as the product of the reconstructed insulin receptor gain (SPINA-GR) times the secretory capacity of pancreatic beta cells (SPINA-GBeta). The novel index was evaluated in computer simulations and in three independent, multiethnic cohorts. The objectives were distribution in various populations, diagnostic performance, reliability and correlation to established physiological biomarkers of carbohydrate metabolism. RESULTS Mathematical and in-silico analysis demonstrated SPINA-DI to mirror the hyperbolic relationship between insulin sensitivity and beta-cell function and to represent an optimum of the homeostatic control. It significantly correlates to the oral glucose tolerance test based disposition index and other important physiological parameters. Furthermore, it revealed higher discriminatory power for the diagnosis of (pre)diabetes and superior retest reliability than other static and dynamic function tests of glucose homeostasis. CONCLUSIONS SPINA-DI is a novel simple reliable and inexpensive marker of insulin-glucose homeostasis suitable for screening purposes and a wider clinical application.
Collapse
Affiliation(s)
- Johannes W Dietrich
- Diabetes, Endocrinology and Metabolism Section, Department of Internal Medicine I, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
- Diabetes Centre Bochum/Hattingen, St. Elisabeth-Hospital Blankenstein, Hattingen, Germany
- Centre for Rare Endocrine Diseases, Ruhr Centre for Rare Diseases (CeSER), Ruhr University Bochum and Witten/Herdecke University, Bochum, Germany
- Centre for Diabetes Technology, Catholic Hospitals Bochum, Bochum, Germany
| | - Assjana Abood
- Diabetes, Endocrinology and Metabolism Section, Department of Internal Medicine I, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
- Diabetes Centre Bochum/Hattingen, St. Elisabeth-Hospital Blankenstein, Hattingen, Germany
- Centre for Rare Endocrine Diseases, Ruhr Centre for Rare Diseases (CeSER), Ruhr University Bochum and Witten/Herdecke University, Bochum, Germany
- Centre for Diabetes Technology, Catholic Hospitals Bochum, Bochum, Germany
| | - Riddhi Dasgupta
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Shajith Anoop
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Felix K Jebasingh
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - R Spurgeon
- Department of Endocrinology, Bangalore Baptist Hospital, Bangalore, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Bernhard O Boehm
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- King's College London, School of Life Course & Population Sciences, London, UK
| |
Collapse
|
4
|
Miao R, Yu R, Zhou H, Liu L, Peng T, Wang J. Novel use of structural equation modelling to examine diet and metabolic traits associated with microvascular endothelial dysfunction in middle-aged Chinese males: a cross-sectional study. BMJ Open 2023; 13:e073357. [PMID: 37709331 PMCID: PMC10921913 DOI: 10.1136/bmjopen-2023-073357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/21/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND The present study aims to use structural equation modelling (SEM) with multiple regression pathways to examine direct and indirect links from diet and metabolic traits to microvascular endothelial dysfunction (ED) among middle-aged Chinese males. METHODS The study was conducted in middle-aged Chinese males, who underwent a health check-up between 2018 and 2019. Data on lifestyle behaviour factors (physical activity, diet pattern, sleep quality and diet data underwent factor analysis in advance) and metabolic risk factors referring to metabolic traits were introduced into the SEM to examine inter-relationship among these factors and their association with ED, as evaluated by the reactive hyperaemia index (RHI). RESULTS Both exploratory factor analysis and confirmatory factor analysis identified two major dietary patterns: 'prudent pattern' and 'western pattern'. The univariate test suggested that only triglycerides (TGs) and prudent dietary pattern were directly associated with RHI. Furthermore, prudent dietary pattern had an indirect association with RHI via TG (prudent diet→TG: β=-0.15, p<0.05; TG→RHI: β=-0.17, p<0.001). As to confirming the hypothesised association between variables apart, physical activity frequency was correlated to the decrease in TG (β=-0.29, p<0.001), but had no direct correlation to RHI. CONCLUSION The network of direct and indirect associations among diet pattern and cardiometabolic risk factors with RHI measured ED among middle-aged males. The most significant modifiable factors identified were TG and prudent diet pattern, which needs to be targeted as preventive strategies for early microvascular impairment.
Collapse
Affiliation(s)
- Rujia Miao
- Health Management Center, Central South University Third Xiangya Hospital, Changsha, China
| | - Renhe Yu
- Department of Epidemiology and Health Statistics, Central South University, Changsha, China
| | - Hui Zhou
- Health Management Center, Central South University Third Xiangya Hospital, Changsha, China
| | - Lei Liu
- Health Management Center, Central South University Third Xiangya Hospital, Changsha, China
| | - Ting Peng
- Health Management Center, Central South University Third Xiangya Hospital, Changsha, China
| | - Jiangang Wang
- Health Management Center, Central South University Third Xiangya Hospital, Changsha, China
| |
Collapse
|
5
|
Najafi F, Moradinazar M, Rezayan S, Azarpazhooh R, Jamshidi P. Identifying factors associated with of blood pressure using Structural Equation Modeling: evidence from a large Kurdish cohort study in Iran. BMC Endocr Disord 2022; 22:334. [PMID: 36581825 PMCID: PMC9801602 DOI: 10.1186/s12902-022-01244-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/08/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Identifying the risk factors leading to hypertension can help explain why some populations are at a greater risk for developing hypertension than others. The present study seeks to identify the association between the risk factors of hypertension in 35- to 65-year-old participants in western Iran. METHODS This cross-sectional study was conducted on 9705 adults from baseline data of Ravansar Non-Communicable Disease (RaNCD) cohort study, in the west region of Iran. Each of the latent variables were confirmed by confirmatory factor analysis. Using Structural Equation Modeling (SEM), we assessed the direct and indirect effects of factors associated with blood pressure. RESULTS Socioeconomic status (SES), physical activity, mean of serum lipids, obesity, diabetes and family history of hypertension had a diverse impact on the blood pressure, directly and (or) indirectly. The standardized total effect of SES, physical activity, mean of serum lipids, and obesity were -0.09 vs. -0.14, -0.04 vs. -0.04, 0.13 vs. 0.13 and 0.24 vs. 0.15 in men and women, respectively. Diabetes had a direct relationship with the blood pressure in women (0.03). CONCLUSION With regard to control of high blood pressure, public health interventions must target obesity, lifestyle and other risk related to nutritional status such as hyperlipidemia and hyperglycemia in Iranian population and among those with higher SES.
Collapse
Affiliation(s)
- Farid Najafi
- Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehdi Moradinazar
- Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahab Rezayan
- Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Azarpazhooh
- Stroke Prevention and Atherosclerosis Research Center, Robarts Research Institute, Western University, London, ON Canada
| | - Parastoo Jamshidi
- School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
6
|
Kontochristopoulou AM, Karatzi K, Karaglani E, Cardon G, Kivelä J, Wikström K, Iotova V, Tsochev K, Tankova T, Rurik I, Radone AS, Liatis S, Makrilakis K, Moreno LA, Manios Y. Sociodemographic, anthropometric, and lifestyle correlates of prediabetes and type 2 diabetes in europe: The Feel4Diabetes study. Nutr Metab Cardiovasc Dis 2022; 32:1851-1862. [PMID: 35610084 DOI: 10.1016/j.numecd.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/18/2022] [Accepted: 03/25/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS The current work aimed to identify the predominant correlates of prediabetes and T2DM among a variety of socio-demographic, anthropometric and lifestyle indices, in a large sample of adults from families at high risk for T2DM. METHODS AND RESULTS In this cross-sectional study, 2816 adults were recruited from low-socioeconomic areas in high-income countries (HICs) (Belgium-Finland), HICs under austerity measures (Greece-Spain), and low/middle-income countries (LMICs) (Bulgaria-Hungary). A positive association between the male sex (OR, 95% C.I.2.77 (1.69-4.54)) and prediabetes was revealed compared to females, while there was a negative association between younger age (<45 years) (OR, 95% C.I. 0.58 (0.37-0.92)), and low/medium levels of waist circumference (OR, 95% C.I. 0.44 (0.22-0.89)) with prediabetes compared to older age and high levels of waist circumference, respectively. Concerning T2DM, 0-0.5 cups/day of fruits and berries (OR, 95% C.I.2. 13 (1.16-3.91)) and 150-300 g fish/week (OR, 95% C.I. 2.55 (1.01-6.41)) have a positive association compared to higher consumptions, respectively. Conversely, <1 cup/week legumes (OR, 95% C.I. 0.55 (0.31-0.99) as well as 0-0.5 servings (OR, 95% C.I. 0.34 (0.12-0.95) and 0.5-1 servings (OR, 95% C.I. 0.37 (0.19-0.71) of full-fat dairy/day have a negative association compared to higher consumptions, respectively. CONCLUSION These findings indicate the need for diabetes prevention measures targeting young adults and especially men, above 45 years of age, with central obesity and poor dietary habits and prioritize vulnerable groups and populations living in LMICs. NATIONAL CLINICAL TRIAL NUMBER NCT02393872.
Collapse
Affiliation(s)
| | - Kalliopi Karatzi
- Laboratory of Dietetics and Quality of Life, Department of Food Science & Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 75 Iera Odos, Athens, 11855, Greece
| | - Eva Karaglani
- Department of Nutrition and Dietetics, Harokopio University, 70 El Venizelou Avenue, Kallithea, Athens, 17671, Greece
| | - Greet Cardon
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Jemina Kivelä
- Finnish Institute for Health and Welfare, Population Health Unit Helsinki, Finland
| | - Katja Wikström
- Finnish Institute for Health and Welfare, Population Health Unit Helsinki, Finland
| | - Violeta Iotova
- Department of Pediatrics, Medical University Varna, Varna, Bulgaria
| | - Kaloyan Tsochev
- Department of Pediatrics, Medical University Varna, Varna, Bulgaria
| | - Tsvetalina Tankova
- Clinical Center of Endocrinology and Gerontology, Medical University of Sofia, Sofia, Bulgaria
| | - Imre Rurik
- Department of Family and Occupational Medicine, University of Debrecen, Debrecen, Hungary
| | - Anett S Radone
- Department of Family and Occupational Medicine, University of Debrecen, Debrecen, Hungary
| | - Stavros Liatis
- First Department of Propaedeutic Medicine, National and Kapodistrian University of Athens Medical School, Laiko General Hospital, Athens, Greece
| | - Konstantinos Makrilakis
- First Department of Propaedeutic Medicine, National and Kapodistrian University of Athens Medical School, Laiko General Hospital, Athens, Greece
| | - Luis A Moreno
- Growth, Exercise, Nutrition and Development Research Group, University of Zaragoza, School of Health Science (EUCS), Zaragoza, Spain
| | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University, 70 El Venizelou Avenue, Kallithea, Athens, 17671, Greece.
| |
Collapse
|
7
|
Duan MJ, Dekker LH, Carrero JJ, Navis G. Using Structural Equation Modeling to Untangle Pathways of Risk Factors Associated with Incident Type 2 Diabetes: the Lifelines Cohort Study. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:1090-1100. [PMID: 35230614 PMCID: PMC9489566 DOI: 10.1007/s11121-022-01357-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/30/2022]
Abstract
Risk factors for type 2 diabetes are multifaceted and interrelated. Unraveling the complex pathways of modifiable risk factors related to incident type 2 diabetes will help prioritize prevention targets. The current analysis extended a previously proposed conceptual model by Bardenheier et al. (Diabetes Care, 36(9), 2655–2662, 2013) on prediabetes with a cross-sectional design. The model described the pathways of four aspects of modifiable risk factors in relation to incident type 2 diabetes, including socioeconomic status (income and education); lifestyle behaviors (diet quality, physical activity, TV watching, smoking, risk drinking, and unhealthy sleep duration); clinical markers (HDL-cholesterol, triglycerides, BMI, and waist circumference); and blood pressure. We performed structural equation modeling to test this conceptual model using a prospective population-based sample of 68,649 participants (35–80 years) from the Lifelines cohort study. During a median follow-up of 41 months, 1124 new cases of type 2 diabetes were identified (incidence 1.6%). The best-fitting model indicated that among all modifiable risk factors included, waist circumference had the biggest direct effect on type 2 diabetes (standardized β-coefficient 0.214), followed by HDL-cholesterol (standardized β-coefficient − 0.134). Less TV watching and more physical activity were found to play an important role in improving clinical markers that were directly associated with type 2 diabetes. Education had the biggest positive effects on all lifestyle behaviors except for unhealthy sleep duration. Our analysis provides evidence to support that structural equation modeling enables a holistic assessment of the interplay of type 2 diabetes risk factors, which not only allows the estimation of their total effects but also prioritization of prevention targets. Regarding the current guideline for diabetes prevention, waist management in addition to BMI control (clinical level), as well as less TV watching in addition to more physical activity (behavioral level), may provide additional public health benefits. Better education would be the main societal goal for the prevention of type 2 diabetes.
Collapse
Affiliation(s)
- Ming-Jie Duan
- Department of Internal Medicine, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30 001, 9700RB, Groningen, The Netherlands.
| | - Louise H Dekker
- Department of Internal Medicine, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30 001, 9700RB, Groningen, The Netherlands.,National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gerjan Navis
- Department of Internal Medicine, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30 001, 9700RB, Groningen, The Netherlands
| |
Collapse
|
8
|
Farhadipour M, Fallahzadeh H, Ghadiri-Anari A, Mirzaei M. Evaluation of the Risk Factors for Type 2 Diabetes Using the Generalized Structure Equation Modeling in Iranian Adults based on Shahedieh Cohort Study. J Diabetes Metab Disord 2022; 21:919-930. [PMID: 35673503 PMCID: PMC9167270 DOI: 10.1007/s40200-021-00940-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/17/2021] [Indexed: 12/14/2022]
Abstract
Objective Diabetes mellitus (DM) is an important global health risk factor in the twenty-first century and one of the 10 major causes of mortality world wide. The generalized structural equation model (GSEM) is a family of statistical techniques in the analysis of multivariate data, classified and sequential, which measures the hidden variables and the relationships between them. Finding risk factors for type 2 diabetes and providing a model for lifestyle changes is the aim of the study.. Methods This exploratory, cross-sectional study was performed to evaluate the risk factors in a cohort of Iranian diabetic patients aged over 35 years (N = 9975). Among 9975 people over 35 years old participating in the first phase of the Yazd cohort study, 1736 people (17.95%) with diabetes and people who were unaware of their diabetes status and pregnant women were excluded and finally we selected 7431 non-diabetics who had FBG test. By presenting the model of initial generalized structural equations using stata software (version 15), we investigated the risk factors affecting type 2 diabetes. Results The risk factors of BMI (Impact coefficients0.010), triglyceride (0.005), hypertension (0.086), and high cholesterol level (0.005) directly affected the DM status (P < 0.001). Meanwhile, BMI and triglyceride played a mediating role in this regard, and the factors of high-density lipoprotein cholesterol, physical activity (-0.23), and diet (0.001) indirectly affected the DM status. Conclusion Using a large sample, this study provides a clear and direct model of the risk factors for diabetes. The main finding is that the risk factors for diabetes 2 that directly affect Iranians in this study are high blood pressure, BMI, triglycerides and cholesterol.
Collapse
Affiliation(s)
- Marzieh Farhadipour
- grid.412505.70000 0004 0612 5912Department of Biostatistics and Epidemiology, School of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossien Fallahzadeh
- grid.412505.70000 0004 0612 5912Research Center of Prevention & Epidemiology of Non-Communicable Disease, Department of Biostatistics and Epidemiology, School of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Akram Ghadiri-Anari
- grid.412505.70000 0004 0612 5912Department of Internal Medicine, Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Masoud Mirzaei
- grid.412505.70000 0004 0612 5912Research Center of Prevention & Epidemiology of Non-Communicable Disease, Department of Biostatistics and Epidemiology, School of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| |
Collapse
|
9
|
Li R, Hou J, Tu R, Liu X, Zuo T, Dong X, Pan M, Yin S, Hu K, Mao Z, Huo W, Li S, Guo Y, Chen G, Wang C. Associations of mixture of air pollutants with estimated 10-year atherosclerotic cardiovascular disease risk modified by socio-economic status: The Henan Rural Cohort Study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 793:148542. [PMID: 34174609 DOI: 10.1016/j.scitotenv.2021.148542] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/05/2021] [Accepted: 06/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Low socio-economic status (SES) and exposure to single-air pollutant relate to increased prevalent atherosclerotic cardiovascular diseases (ASCVD), however, interactive effect between SES and exposure to single- or multiple-air pollutants on high 10-year ASCVD risk remains unclear. METHODS A total of 31,162 individuals were derived from the Henan Rural Cohort Study. Concentrations of air pollutants (particulate matter with an aerodynamic diameter ≤ 1.0 μm (PM1), ≤2.5 μm (PM2.5) or ≤10 μm (PM10), nitrogen dioxide (NO2)) were assessed using a spatiotemporal model based on satellites data. Independent and joint associations of SES, single- and multiple- air pollutants with high 10-year ASCVD risk were evaluated using logistic regression models, quantile g-computation and structural equation models. The interactive effects of SES and exposure to single- or multiple air pollutants on high 10-year ASCVD risk were visualized by using Interaction plots. RESULTS Exposure to single air pollutant (PM1, PM2.5, PM10 or NO2) related to increased high 10-year ASCVD risk among individuals with low education level or personal average monthly income, compared to the ones with high education level or personal average monthly income. Furthermore, similar results of exposure to mixture of air pollutants with high 10-year ASCVD risk were observed. Positive interactive effects between low SES and exposure to high single air pollutant or the mixture of air pollutants on high 10-year ASCVD risk were observed. CONCLUSION Positive association of low SES with high 10-year ASCVD risk was amplified by exposure to high levels of single air pollutant or a mixture of air pollutants, implying that individuals with low SES may more susceptible to air pollution-related adverse health effect.
Collapse
Affiliation(s)
- Ruiying Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Jian Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Runqi Tu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Tantan Zuo
- Department of Orthopedics, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, PR China
| | - Xiaokang Dong
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Mingming Pan
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Shanshan Yin
- Department of health policy research, Henan Academy of Medical Sciences, Zhengzhou, PR China
| | - Kai Hu
- Department of health policy research, Henan Academy of Medical Sciences, Zhengzhou, PR China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Wenqian Huo
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yuming Guo
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Gongbo Chen
- Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, PR China.
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China.
| |
Collapse
|
10
|
The structure of health in Europe: The relationships between morbidity, functional limitation, and subjective health. SSM Popul Health 2021; 16:100911. [PMID: 34660874 PMCID: PMC8502770 DOI: 10.1016/j.ssmph.2021.100911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 11/21/2022] Open
Abstract
The main objective of this study is to explore the relationships between the three commonly used proxies of health, morbidity, functional limitation, and subjective health, using the most recent data from 18 European countries. The existing studies on the topic are outdated, limited to the United States and to elderly population. Data on 32,679 respondents of the European Social Survey (2014) were analyzed using structural equation modeling. The results suggest that (a) morbidity and functional limitation lead to poorer self-rated health, and (b) morbidity increases the probability of reporting functional limitation(s). Moreover, functional limitation mediates the relationship between morbidity and self-rated health. The model as a whole holds across both genders and all age groups. However, specific tests (SEM multi-group analyses, t-tests) show differences in the health structure between all seven subsamples compared with each other. When both gender and age are taken into account the differences in the structure of health seem to diminish, apart from the elderly, suggesting that the health structure of the elderly differs from others. It is recommended for policy planners to acknowledge the group differences when shaping the policies and health services. First study to test a structure of health model on Europeans of all adult ages. Morbidity affects functional limitation and subjective health. Functional limitation has a negative effect on subjective health. Morbidity also affects subjective health indirectly via functional limitation. The model is stable across the groups despite some differences in the effect magnitudes.
Collapse
|
11
|
Ho YCL, Lee VSY, Ho MHR, Lin GJ, Thumboo J. Towards a Parsimonious Pathway Model of Modifiable and Mediating Risk Factors Leading to Diabetes Risk. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010907. [PMID: 34682644 PMCID: PMC8536137 DOI: 10.3390/ijerph182010907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 12/23/2022]
Abstract
Modifiable risk factors are of interest for chronic disease prevention. Few studies have assessed the system of modifiable and mediating pathways leading to diabetes mellitus. We aimed to develop a pathway model for Diabetes Risk with modifiable Lifestyle Risk factors as the start point and Physiological Load as the mediator. As there are no standardised risk thresholds for lifestyle behaviour, we derived a weighted composite for Lifestyle Risk. Physiological Load was based on an index using clinical thresholds. Sociodemographics are non-modifiable risk factors and were specified as covariates. We used structural equation modeling to test the model, first using 2014/2015 data from the Indonesian Family Life Survey. Next, we fitted a smaller model with longitudinal data (2007/2008 to 2014/2015), given limited earlier data. Both models showed the indirect effects of Lifestyle Risk on Diabetes Risk via the mediator of Physiological Load, whereas the direct effect was only supported in the cross-sectional analysis. Specifying Lifestyle Risk as an observable, composite variable incorporates the cumulative effect of risk behaviour and differentiates this study from previous studies assessing it as a latent construct. The parsimonious model groups the multifarious risk factors and illustrates modifiable pathways that could be applied in chronic disease prevention efforts.
Collapse
Affiliation(s)
- Yi-Ching Lynn Ho
- Office of Regional Health, Singapore Health Services, 167 Jalan Bukit Merah, Singapore 150167, Singapore; (V.S.Y.L.); (G.J.L.); (J.T.)
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Rd., Singapore 169857, Singapore
- Correspondence:
| | - Vivian Shu Yi Lee
- Office of Regional Health, Singapore Health Services, 167 Jalan Bukit Merah, Singapore 150167, Singapore; (V.S.Y.L.); (G.J.L.); (J.T.)
| | - Moon-Ho Ringo Ho
- School of Social Sciences, Nanyang Technological University, 48 Nanyang Ave., Singapore 639818, Singapore;
| | - Gladis Jing Lin
- Office of Regional Health, Singapore Health Services, 167 Jalan Bukit Merah, Singapore 150167, Singapore; (V.S.Y.L.); (G.J.L.); (J.T.)
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Rd., Singapore 169857, Singapore
| | - Julian Thumboo
- Office of Regional Health, Singapore Health Services, 167 Jalan Bukit Merah, Singapore 150167, Singapore; (V.S.Y.L.); (G.J.L.); (J.T.)
- Department of Rheumatology and Immunology, Singapore General Hospital, Outram Rd., Singapore 169608, Singapore
- Medicine Academic Clinical Programme, Duke-NUS Medical School, 8 College Rd., Singapore 169857, Singapore
| |
Collapse
|
12
|
Latif R, Rafique N. Prevalence and Risk Factors of Prediabetes in Young Saudi Females in a University Setting. Ethiop J Health Sci 2021; 30:929-940. [PMID: 33883838 PMCID: PMC8047230 DOI: 10.4314/ejhs.v30i6.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Studies reporting prediabetes prevalence in young Saudis are almost a decade old. The present study determined prediabetes prevalence and its associated risk factors (body composition, lipid profile, blood pressure and physical activity) in young Saudi females. Methods Three hundred Saudi females (18–20 years old), studying in year 2 and 3 at Imam Abdulrahman Bin Faisal University, were categorized as normoglycemic or prediabetic based on fasting plasma glucose criteria of World Health Organization (WHO) and American Diabetes Association (ADA). Anthropometric measurements, lipid profile, atherogenic indices, and physical activity data were compared. Association between fasting blood glucose and study variables was found by Bivariate analysis (Spearman Correlation for non-parametric variables and Pearson correlation for parametric) followed by Binary Logistic Regression analysis. Results Prevalence of prediabetes by WHO and ADA criteria were 11.3% and 18.7% respectively. Systolic, diastolic and mean arterial pressures, waist circumference, waist-hip and waist-stature-ratios were significantly raised in prediabetics compared to normoglycemic (WHO criteria p-values; 0.03, 0.003, 0.005, 0.01, 0.01, 0.04 respectively; ADA criteria 0.04, 0.001, 0.02, 0.02, 0.03, 0.01 respectively). For each unit increase in systolic, diastolic and mean arterial pressures, and waist circumference, the odds of becoming prediabetic increased by a factor of 1.02, 1.05, 1.04 and 1.03 respectively by WHO criteria: and 1.01, 1.03, 1.02, and 1.02 respectively by ADA criteria Conclusion Substantial numbers of young females in our university are suffering from prediabetes. An increase in systolic, diastolic, and mean arterial pressures and waist circumference are significant risk factors for prediabetes in young females.
Collapse
Affiliation(s)
- Rabia Latif
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University
| | - Nazish Rafique
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University
| |
Collapse
|
13
|
Xiao L, Le C, Wang GY, Fan LM, Cui WL, Liu YN, Shen JR, Golden AR. Socioeconomic and lifestyle determinants of the prevalence of hypertension among elderly individuals in rural southwest China: a structural equation modelling approach. BMC Cardiovasc Disord 2021; 21:64. [PMID: 33530935 PMCID: PMC7851929 DOI: 10.1186/s12872-021-01885-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background This study examines the association between socioeconomic and lifestyle factors and the prevalence of hypertension among elderly individuals in rural Southwest China. Methods A cross-sectional survey of 4833 consenting adults aged ≥ 60 years in rural regions of Yunnan Province, China, was conducted in 2017. Data on individual socioeconomic status, sleep quality, physical activity level, and family history of hypertension were collected with a standardized questionnaire. Blood pressure, fasting blood glucose, height, weight, and waist circumference were also measured. An individual socioeconomic position (SEP) index was constructed using principal component analysis. Structural equation modelling (SEM) was applied to analyse the association between socioeconomic and lifestyle factors and the prevalence of hypertension. Results The overall prevalence of hypertension was 50.6% in the study population. Body fat distribution, including measures of obesity and central obesity, had the greatest total effect on hypertension (0.21), followed by family history of hypertension (0.14), biological sex (0.08), sleep quality (− 0.07), SEP (− 0.06), physical inactivity (0.06), and diabetes (0.06). Body fat distribution, SEP, and family history of hypertension had both direct and indirect effects on hypertension, whereas physical inactivity, diabetes, and sleep quality were directly associated with the prevalence of hypertension. Biological sex was indirectly associated with the prevalence of hypertension. Conclusions SEP, body fat distribution, physical inactivity, diabetes, and sleep quality critically influence the prevalence of hypertension. Future interventions to prevent and control hypertension should give increased attention to individuals with low SEP and should focus on controlling diabetes and obesity, increasing physical activity levels, and improving quality of sleep among older adults aged ≥ 60 years in rural Southwest China.
Collapse
Affiliation(s)
- Li Xiao
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China.,First Affiliated Hospital of Dali Medical University, Dali, China
| | - Cai Le
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China.
| | - Gui-Yi Wang
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China
| | - Lu-Ming Fan
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China
| | - Wen-Long Cui
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China
| | - Ying-Nan Liu
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China
| | - Jing-Rong Shen
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China
| | - Allison Rabkin Golden
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming, 650500, China
| |
Collapse
|
14
|
Wang CP, Lu YC, Hung WC, Tsai IT, Chang YH, Hu DW, Hsu CC, Wu CC, Wei CT, Chung FM, Lee YJ. Inter-relationship of risk factors and pathways associated with chronic kidney disease in patients with type 2 diabetes mellitus: a structural equation modelling analysis. Public Health 2021; 190:135-144. [PMID: 33451823 DOI: 10.1016/j.puhe.2020.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/12/2020] [Accepted: 02/10/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Diabetes mellitus is the most common cause of chronic kidney disease (CKD); however, the inter-relationships and pathogenetic mechanisms among risk factors are still largely unknown. Structural equation modelling (SEM) was applied to test a hypothesis of causal pathways related to CKD in patients with type 2 diabetes mellitus (T2DM). STUDY DESIGN This is a prospective observational study. METHODS A total of 3395 patients with T2DM were enrolled in this study. A hypothesised SEM was applied to assess associations among demographic data, diabetic self-management behaviours, diabetes control, lifestyle, psycho-social, chronic inflammation factors, anthropometric and metabolic variables simultaneously and the risk of CKD. RESULTS Demographic data (including education, marital status and mini-mental state examination score) (-0.075), white blood cell count (0.084), high blood pressure (0.144), World Health Organisation (WHO) 5 well-being index (-0.082), diabetes control (0.099), triglyceride (0.091) and uric acid (0.282) levels had direct effects on the risk of CKD. The final model could explain 26% of the variability in baseline CKD status. In addition, the same direct and specific indirect factors at baseline CKD status analysis contributed to the risk of CKD at the 12-month follow-up. The final model could explain 31% of the variability in the risk of CKD at the 12-month follow-up. CONCLUSIONS This study investigates associations between factors obtained from real-world daily practice and CKD status simultaneously and delineates the potential pathways and inter-relationships of the risk factors that contribute to the development of CKD in patients with T2DM.
Collapse
Affiliation(s)
- C-P Wang
- Department of Internal Medicine, Division of Cardiology, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan; School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, 82445, Taiwan
| | - Y-C Lu
- Department of Internal Medicine, Division of Endocrinology and Metabolism, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan; School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, 82445, Taiwan
| | - W-C Hung
- Department of Internal Medicine, Division of Cardiology, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan; The School of Chinese Medicine for Post Baccalaureate, College of Medicine, I-Shou University, Kaohsiung, 82445, Taiwan
| | - I-T Tsai
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 82445, Taiwan
| | - Y-H Chang
- Lee's Endocrinologic Clinic, Pingtung, 90000, Taiwan
| | - D-W Hu
- Lee's Endocrinologic Clinic, Pingtung, 90000, Taiwan
| | - C-C Hsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan; The School of Chinese Medicine for Post Baccalaureate, College of Medicine, I-Shou University, Kaohsiung, 82445, Taiwan; Health Examination Center, E-Da Dachang Hospital, Kaohsiung, Taiwan
| | - C-C Wu
- Department of Internal Medicine, Division of Cardiology, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan; The School of Chinese Medicine for Post Baccalaureate, College of Medicine, I-Shou University, Kaohsiung, 82445, Taiwan; Division of Cardiology, Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung, 82445, Taiwan
| | - C-T Wei
- Division of General Surgery, Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan
| | - F-M Chung
- Department of Internal Medicine, Division of Cardiology, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan
| | - Y-J Lee
- Lee's Endocrinologic Clinic, Pingtung, 90000, Taiwan.
| |
Collapse
|
15
|
Darbandi M, Najafi F, Pasdar Y, Rezaeian S. Structural equation model analysis for the evaluation of factors associated with overweight and obesity in menopausal women in RaNCD cohort study. ACTA ACUST UNITED AC 2020; 27:208-215. [PMID: 31895176 DOI: 10.1097/gme.0000000000001452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Weight gain and increased body fat mass are among the common complications of menopause. In addition to hormonal changes, behavioral and environmental factors aggravate transition through this phase. This study uses a structural equation model (SEM) to evaluate factors associated with overweight and obesity in menopausal women. METHODS This is a cross-sectional study of 4,471 women (pre/perimenopausal 3,150, menopausal 1,321) from baseline data of the Ravansar Non-Communicable Disease (RaNCD) cohort study in the west region of Iran in 2018. Obesity and overweight were the outcome variables. SEM was used to examine the relationships, using IBM SPSS, AMOS version 23. RESULTS The mean body fat percentage and visceral fat area in menopausal women was significantly greater than among pre/perimenopause women. The direct association of higher socioeconomic status (SES) with a healthy dietary pattern was stronger among pre/perimenopausal women than among menopausal women (ß = 0.574 vs ß = 0.552). In both groups, less physical activity was associated with depression and musculoskeletal disorders, and this association was stronger in menopausal women (ß = -0.174 vs ß = -0.215; P > 0.05). Overweight and obesity were directly decreased (ß = -0.011, P > 0.05) and indirectly increased (ß = 0.013, P > 0.05) in pre/perimenopausal women by sleep duration, but they were directly and indirectly decreased in menopausal women. CONCLUSIONS The direct and indirect effects of well-known risk factors associated with overweight and obesity were found to be different in pre/perimenopausal and menopausal groups. Some risk factors showed stronger effects among menopausal women compared with the pre/perimenopausal women. Physical activity and healthy dietary pattern had a mediator impact in the two study groups.
Collapse
Affiliation(s)
- Mitra Darbandi
- Student Research Committee, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | | | | |
Collapse
|
16
|
Paudel S, Tran T, Owen AJ, Smith BJ. The contribution of physical inactivity and socioeconomic factors to type 2 diabetes in Nepal: A structural equation modelling analysis. Nutr Metab Cardiovasc Dis 2020; 30:1758-1767. [PMID: 32636120 DOI: 10.1016/j.numecd.2020.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM Type 2 diabetes mellitus (T2DM) is emerging as a significant public health challenge in Nepal. Behavioural, social and economic changes are likely to play a part in the rise of this chronic disease, as they are in many developing countries. A better understanding of the relationship between physical activity (PA), socioeconomic factors and T2DM can inform the design of prevention programs. This study aimed to identify the path relationships between PA, socioeconomic position, anthropometric and metabolic variables and T2DM. METHODS AND RESULTS This study analysed data from 1977 Nepalese adults aged 40-69 years from the cross-sectional WHO STEPS survey undertaken in 2013. The latent variable "PA" was created using the information on domains of PA while the latent variable "socioeconomic position" was created using the variables education, occupation and ethnicity. Participants' fasting blood glucose was used to determine their diabetes status. Structural equation modelling was conducted, and correlations and adjusted regression coefficients are reported. Individuals with higher education, in paid employment and from advantaged ethnic groups were more likely to have T2DM. Waist circumference, triglycerides and hypertension were found to have a statistically significant positive direct effect on T2DM. PA had indirect effects on T2DM, mediated by waist circumference. The indirect effects of socioeconomic position on T2DM were mediated by body mass index, waist circumference, triglycerides and total cholesterol. CONCLUSION Among Nepalese adults, higher socioeconomic position had a significant direct effect on T2DM, while both PA and higher socioeconomic position had significant indirect effects. Policies and programs to address T2DM in Nepal should address the factors contributing to unhealthy weight status, particularly among those of higher socioeconomic status.
Collapse
Affiliation(s)
- Susan Paudel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Thach Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alice J Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ben J Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
17
|
Ferreira FG, Juvanhol LL, Silva-Costa A, Longo GZ. The mediating role of visceral adiposity in the relationship among schooling, physical inactivity, and unhealthy metabolic phenotype. Am J Hum Biol 2020; 32:e23425. [PMID: 32335996 DOI: 10.1002/ajhb.23425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 03/27/2020] [Accepted: 04/06/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To explore the mediating role of visceral adiposity, as assessed by the visceral adiposity index (VAI), in the relationship among schooling, physical inactivity, and unhealthy metabolic phenotype (UMP). METHODS A cross-sectional population-based study was conducted with 854 adult individuals of both sexes from a Brazilian city. Data were collected through interviews, anthropometric evaluation, and clinical and laboratorial tests. We used multivariate path analysis, which simultaneously analyzes multiple relationships between variables. The analyses were adjusted by sex and age and stratified according to nutritional status. RESULTS A positive direct effect of visceral adiposity on the UMP was observed for normal weight, standardized estimate (SE) = 0.632; confidence interval (CI 95%) = 0.547, 0.707) and overweight individuals (SE = 0.732; CI 95% = 0.647, 0.808), and negative direct effect of schooling on physical inactivity (normal weight: SE = -0.408; CI 95% = -0.550, -0.265) and overweight (SE = -0.304; CI 95% = -0.479, -0.129). Among normal-weight individuals, there was a positive direct effect (SE = 0.193; CI 95% = 0.059, 0.328) of physical inactivity on VAI. In relation to indirect effects, there was a mediating role of visceral adiposity in the association of schooling level and physical inactivity with the UMP only among normal-weight individuals. CONCLUSIONS Visceral adiposity has a direct effect on the UMP regardless of nutritional status, and there is a mediating effect of VAI on the relationship among schooling, physical inactivity, and UMP in normal-weight individuals.
Collapse
Affiliation(s)
- Fabrícia Geralda Ferreira
- Escola Preparatória de Cadetes do Ar, Barbacena, Brazil.,Programa de Pós-Graduação em Ciência da Nutrição, Universidade Federal de Viçosa, Viçosa, Brazil
| | - Leidjaira Lopes Juvanhol
- Programa de Pós-Graduação em Ciência da Nutrição, Universidade Federal de Viçosa, Viçosa, Brazil
| | - Aline Silva-Costa
- Departamento de Saúde Coletiva, Universidade Federal do Triângulo Mineiro, Uberaba, Brazil
| | - Giana Zarbato Longo
- Programa de Pós-Graduação em Nutrição, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| |
Collapse
|
18
|
Sneed NM, Patrician PA, Morrison SA. Influences of added sugar consumption in adults with type 2 diabetes risk: A principle-based concept analysis. Nurs Forum 2019; 54:698-706. [PMID: 31612529 DOI: 10.1111/nuf.12399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study is to describe the concept added sugar in the context of type 2 diabetes (T2D) risk in adults. BACKGROUND Dietary added sugars are associated with a greater risk for T2D; however, it is unclear if added sugars influence T2D risk directly or if their effects are mediated by excess caloric intake and weight gain. DESIGN A principle-based concept analysis following the PRISMA guidelines was conducted to clarify the concept of added sugar. A systematic search was conducted using PubMed and Embase. Multidisciplinary, empirical evidence was appraised using four guiding principles outlined by the principle-based concept analysis method. RESULTS Thirty-five publications were included in this concept analysis. The concept, added sugar in the context of T2D risk, was found to be epistemologically immature and lacked conceptual clarity. CONCLUSIONS Added sugar is an immature concept warranting further refinement for conceptual advancement. To enhance conceptual clarity, the term "added sugar" should be used consistently in the scientific literature when discussing foods or beverages containing added sugars or caloric sweeteners. A clearer delineation of added sugar and its association with T2D risk in adults is critical to advance this concept within the scientific literature.
Collapse
Affiliation(s)
| | - Patricia A Patrician
- Department of Family, Community Health, and Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Shannon A Morrison
- Department of Family, Community Health, and Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
19
|
Ezquerra-Lázaro I, Cea-Soriano L, Giraldez-García C, Ruiz A, Franch-Nadal J, Diez-Espino J, Nogales P, Carramiñana F, Javier Sangros F, Regidor E. Lifestyle factors do not explain the difference on diabetes progression according to type of prediabetes: Results from a Spanish prospective cohort of prediabetic patients. Diabetes Res Clin Pract 2019; 153:66-75. [PMID: 31152806 DOI: 10.1016/j.diabres.2019.05.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/29/2019] [Accepted: 05/23/2019] [Indexed: 12/19/2022]
Abstract
AIMS We studied the role of lifestyle factors associated to type 2 diabetes (T2DM) onset according to type of prediabetes. METHODS We used data from the observational prospective cohort study in Primary Health Care on the Evolution of Patients with Prediabetes in Spain (PREDAPS). Participants were classified by American Diabetes Association criteria using either fasting plasma glucose levels (100-125 mg/dL) (group 1), HbA1c (5.7%-6.4%) (group 2) or both impaired parameters (group 3). Relationship between lifestyles and diabetes onset according to prediabetes at third year of follow up were estimated by Hazard Ratios (HRs) using three sequential models. RESULTS Incidence rate of diabetes was 2.27 cases per 1000 person-years (95% CI: 1.4-3.6) for group 1, 1.18 (95% CI: 0.65-2.13) for group 2 and 6.68 (95% CI: 5.71-8.23) for group 3. The most important risk factors were: abdominal obesity (HR: 2.29 (95% CI: 1.49-3.52)) and hypertension (HR: 2.16 (95% CI: 1.41-3.30)). Using as reference group 2, group 3 had a HR of 5.82 (3.13-10.82) and 1.83 (95% CI: 0.85-3.93) for group 1, estimates remained constant when adjusting by lifestyle and metabolic factors. CONCLUSIONS Lifestyle and metabolic do not seem to explain the differences on T2DM onset by type of prediabetes.
Collapse
Affiliation(s)
- Isabel Ezquerra-Lázaro
- Department of Public Health and Maternal Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Spain
| | - Lucía Cea-Soriano
- Department of Public Health and Maternal Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Spain; redGDPSFoundation, Madrid, Spain.
| | | | - Antonio Ruiz
- redGDPSFoundation, Madrid, Spain; Centro de Salud Pinto, Madrid, Spain
| | - Josep Franch-Nadal
- redGDPSFoundation, Madrid, Spain; USR Barcelona ciutat - IDIAP Jordi Gol, Barcelona, Spain; CIBER Diabetes y EnfermedadesMetabólicasAsociadas (CIBERDEM), Madrid, Spain; Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Javier Diez-Espino
- redGDPSFoundation, Madrid, Spain; Centro de Salud Tafalla, Navarra, Spain
| | - Pedro Nogales
- redGDPSFoundation, Madrid, Spain; Centro de Salud Las Águilas, Madrid, Spain
| | | | - F Javier Sangros
- redGDPSFoundation, Madrid, Spain; Centro de Salud Torrero-La Paz, Zaragoza, Spain
| | - Enrique Regidor
- Department of Public Health and Maternal Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Spain; redGDPSFoundation, Madrid, Spain; CIBER Epidemiología y SaludPública (CIBERESP), Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| |
Collapse
|
20
|
Younes N, Atallah M, Alam R, Chehade NH, Gannagé-Yared MH. HbA1c AND BLOOD PRESSURE MEASUREMENTS: RELATION WITH GENDER, BODY MASS INDEX, STUDY FIELD, AND LIFESTYLE IN LEBANESE STUDENTS. Endocr Pract 2019; 25:1101-1108. [PMID: 31241365 DOI: 10.4158/ep-2019-0163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective: The purpose of this study is to determine the prevalence of prediabetes/diabetes in Lebanese university students and to examine the relationship between both hemoglobin A1c (HbA1c) and blood pressure (BP) and gender, body mass index (BMI), study field, and lifestyle factors. Methods: This cross-sectional study was carried out at the Saint-Joseph University of Beirut. A total of 603 students aged 18 to 25 years were recruited from both the medical science campus (MSC) and the social science campus (SSC) between January, 2016, and May, 2018. Waist circumference (WC), BMI, and BP were determined for each student and HbA1c was measured using the Siemens vintage DCA device. Participants completed a self-administered questionnaire about their eating habits and level of physical activity. Results: The mean age of the population was 20.31 ± 1.76 years. The percentage of participants recruited from the MSC was 59.2%. The prevalence of prediabetes was 2.5%. Lower BMI, WC, and HbA1c values, and higher diastolic BP (DBP) were found in MSC students compared to SSC ones. HbA1c, systolic BP (SBP), and DBP were correlated with BMI (P = .02, P<.0001, and P = .017, respectively). HbA1c was not associated with eating habits or physical activity. DBP was inversely associated with physical activity (P = .002), while SBP was positively associated with fast food consumption (P = .003). Conclusion: The present study shows a low prevalence of prediabetes in Lebanese students. BMI and the study field are the main factors predicting HbA1c and BP. Further studies are needed to extrapolate our results to the overall young Lebanese population. Abbreviations: ADA = American Diabetes Association; BMI = body mass index; BP = blood pressure; DBP = diastolic blood pressure; HbA1c = hemoglobin A1c; HTN = hypertension; MSC = medical science campus; SBP = systolic blood pressure; SSC = social science campus; T2D = type 2 diabetes; US = United States; USJ = Saint-Joseph University; WC = waist circumference.
Collapse
|
21
|
Understanding psychological determinants to promote the adoption of general practitioner by Chinese elderly. HEALTH POLICY AND TECHNOLOGY 2019. [DOI: 10.1016/j.hlpt.2019.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
22
|
Wang L, Hou J, Hu C, Zhou Y, Sun H, Zhang J, Li T, Gao E, Wang G, Chen W, Yuan J. Mediating factors explaining the associations between polycyclic aromatic hydrocarbons exposure, low socioeconomic status and diabetes: A structural equation modeling approach. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 648:1476-1483. [PMID: 30340292 DOI: 10.1016/j.scitotenv.2018.08.255] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/19/2018] [Accepted: 08/19/2018] [Indexed: 06/08/2023]
Abstract
Exposure to polycyclic aromatic hydrocarbons (PAHs) is linked with increased risk of diabetes, whereas socioeconomic status (SES) may contribute to the development of diabetes. However, the mechanisms underlying the relationships between them are unclear. We used structural equation modeling (SEM) to identify mediating factors in the associations of PAHs exposure, low SES with diabetes risk. Data were collected from 2751 Wuhan participants at baseline from the Wuhan-Zhuhai Cohort Study (n = 3053). They answered the questionnaires regarding socio-demographic, participated physical examinations and provided urine samples for measurements of urinary monohydroxy-polycyclic aromatic hydrocarbons (OH-PAHs) levels. SEM was used to identify the mediating factors (such as hypertension, body mass index (BMI), triglycerides (TG) and total cholesterol (TCHO)) in the associations of low SES or PAHs exposure with diabetes risk. We observed that partial effect of PAHs exposure (β = 0.281, p = 0.034), BMI (β = 0.182, p = 0.000), TG (β = 0.358, p = 0.000), TCHO (β = 0.203, p = 0.009) or hypertension (β = 0.385, p = 0.000) on diabetes was directive. Moreover, low SES also exhibited a directive effect on PAHs exposure (β = -0.084, p = 0.000), BMI (β = 0.301, p = 0.000), hypertension (β = 0.134, p = 0.003) and TG (β = 0.087, p = 0.001). PAHs exposure directly affected TCHO levels (β = 0.080, p = 0.002) and TG (β = 0.076, p = 0.017). The proportion of the effect of PAHs exposure on diabetes mediated by TG and TCHO was 15.6%. The proportion of the effect of low SES on diabetes mediated by BMI, hypertension and TG was 89.1%. The results suggested that low SES increased diabetes risk, which may be partially explained by BMI, hypertension and triglycerides, and exposure to high levels of PAHs may have indirect contribution to increased risk for diabetes with dyslipidemia.
Collapse
Affiliation(s)
- Lu Wang
- Department of Occupational and Environmental Health, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China
| | - Jian Hou
- Department of Occupational and Environmental Health, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China
| | - Chen Hu
- Department of Occupational and Environmental Health, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China
| | - Yun Zhou
- Department of Occupational and Environmental Health, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China
| | - Huizhen Sun
- Department of Occupational and Environmental Health, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China
| | - Jiafei Zhang
- Department of Occupational and Environmental Health, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China
| | - Tian Li
- Department of Occupational and Environmental Health, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China
| | - Erwei Gao
- Department of Occupational and Environmental Health, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China
| | - Guiyang Wang
- Department of Occupational and Environmental Health, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China
| | - Weihong Chen
- Department of Occupational and Environmental Health, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China
| | - Jing Yuan
- Department of Occupational and Environmental Health, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China..
| |
Collapse
|
23
|
Taherian R, Jalali-Farahani S, Karimi M, Amiri P, Maghsoudi E, Mirmiran P, Azizi F. Factors Associated with Pre-Hypertension Among Tehranian Adults: A Novel Application of Structural Equation Models. Int J Endocrinol Metab 2018; 16:e59706. [PMID: 30197658 PMCID: PMC6113714 DOI: 10.5812/ijem.59706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 04/08/2018] [Accepted: 04/09/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Pre-hypertension is proposed as an independent risk factor for the incidence of cardiovascular diseases. OBJECTIVES This study aimed to explore the main factors associated with pre-hypertension via testing a hypothesized model in Tehranian adults. METHODS The study was conducted within the framework of the Tehran Lipid and Glucose Study (TLGS) between 2009 - 2011 on 4640 adults without hypertension, aged ≥ 20 years. RESULTS The mean age of participants was 38.61 ± 12.14 years and 56.6% of them were female. More than one third of the studied participants had pre-hypertension (35.4%) with significantly higher prevalence in males compared to females (46.5% vs. 26.9%; χ2 = 190.7, P < 0.001). Age, waist circumference (WC), and serum triglyceride concentrations (TG) were directly associated with pre-hypertension in both men (β = 0.16, β = 0.25, and β = 0.11, respectively) and women (β = 0.16, β = 0.21 and β = 0.09, respectively). Physical activity, only in men (β = 0.07), and marital status only, in women (β = -0.06), were also directly associated with pre-hypertension. Both healthy and poor dietary patterns showed indirect associations with pre-hypertension in both genders via WC and TG. Higher age and lower education in both genders, being married only in men, and unemployed status only in women, were positively associated with pre-hypertension via behavioral and cardio-metabolic factors. CONCLUSIONS Level of TG and WC in both genders are direct modifiable associated factors of pre-hypertension. These findings could be considered in designing future health promotion programs aimed at preventing high blood pressure and its consequences among Tehranian adults.
Collapse
Affiliation(s)
- Reza Taherian
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Sara Jalali-Farahani
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mehrdad Karimi
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Parisa Amiri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding authors: Parisa Amiri, Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Tel: +98-2122432500, Fax: +98-212402463, E-mail: ; Parvin Mirmiran, PhD, Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2122402463, Fax: +98-2122432500, E-mail:
| | - Emad Maghsoudi
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding authors: Parisa Amiri, Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Tel: +98-2122432500, Fax: +98-212402463, E-mail: ; Parvin Mirmiran, PhD, Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2122402463, Fax: +98-2122432500, E-mail:
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| |
Collapse
|
24
|
Tripathy JP, Thakur JS, Jeet G, Jain S. Structural equation modeling to identify the risk factors of diabetes in the adult population of North India. Trop Med Health 2018; 46:23. [PMID: 29983621 PMCID: PMC6019304 DOI: 10.1186/s41182-018-0104-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/13/2018] [Indexed: 01/24/2023] Open
Abstract
Background A non-communicable disease risk factor survey (based on World Health Organization STEP approach to Surveillance, i.e., WHO-STEPS) was done in the state of Punjab, India in a multistage stratified sample of 5127 individuals. The study subjects were administered the WHO STEPS questionnaire and also underwent anthropometric and biochemical measurements. This study aimed at exploring the risk factors of diabetes using a Structural Equation Modeling (SEM) approach in the North Indian state of Punjab. Results Overall prevalence of diabetes mellitus among the study participants was found out to be 8.3% (95% CI 7.3-9.4%). The final SEM had excellent fit considering the model parameters. The following risk factors deemed to have a direct statistically significant effect on blood sugar status: family history of diabetes (4.5), urban residence (3.1), triglycerides (0.46), increasing waist circumference (0.18), systolic blood pressure (0.11), and increasing age (0.05). There are specific indirect effects of alcohol use (1.43, p = 0.001), family h/o diabetes (0.844, p = 0.001), age (0.156, p < 0.001), waist circumference (0.028, p = < 0.001) and weekly fruit intake (- 0.009, p = 0.034) on fasting blood glucose. Indirect effects of waist circumference, alcohol intake and age on blood sugar levels are mediated by raised blood pressure. Waist circumference mediates the indirect effects of age, family h/o of diabetes, alcohol intake and weekly fruit intake on blood sugar levels. Triglycerides also mediated the indirect effects between age and diabetes. Conclusions Family history of diabetes, urban residence, alcohol use, increasing age, and waist circumference are the key variables affecting diabetes status in the Indian population. The results of this study further strengthens the evidence that lifestyle changes in the form of physical activity and healthy diet are required to prevent and control diabetes. Those with family h/o diabetes constitute a high risk group and should be targeted with regular screening and lifestyle intervention package.
Collapse
Affiliation(s)
- Jaya Prasad Tripathy
- 1International Union Against Tuberculosis and Lung Disease, The Union South East Asia Office, New Delhi, India.,2International Union Against Tuberculosis and Lung Disease, Paris, France
| | - J S Thakur
- 3Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gursimer Jeet
- 3Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Jain
- 3Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
25
|
Martinez SA, Beebe LA, Thompson DM, Wagener TL, Terrell DR, Campbell JE. A structural equation modeling approach to understanding pathways that connect socioeconomic status and smoking. PLoS One 2018; 13:e0192451. [PMID: 29408939 PMCID: PMC5800669 DOI: 10.1371/journal.pone.0192451] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 01/23/2018] [Indexed: 11/19/2022] Open
Abstract
The inverse association between socioeconomic status and smoking is well established, yet the mechanisms that drive this relationship are unclear. We developed and tested four theoretical models of the pathways that link socioeconomic status to current smoking prevalence using a structural equation modeling (SEM) approach. Using data from the 2013 National Health Interview Survey, we selected four indicator variables (poverty ratio, personal earnings, educational attainment, and employment status) that we hypothesize underlie a latent variable, socioeconomic status. We measured direct, indirect, and total effects of socioeconomic status on smoking on four pathways through four latent variables representing social cohesion, financial strain, sleep disturbance, and psychological distress. Results of the model indicated that the probability of being a smoker decreased by 26% of a standard deviation for every one standard deviation increase in socioeconomic status. The direct effects of socioeconomic status on smoking accounted for the majority of the total effects, but the overall model also included significant indirect effects. Of the four mediators, sleep disturbance and psychological distress had the largest total effects on current smoking. We explored the use of structural equation modeling in epidemiology to quantify effects of socioeconomic status on smoking through four social and psychological factors to identify potential targets for interventions. A better understanding of the complex relationship between socioeconomic status and smoking is critical as we continue to reduce the burden of tobacco and eliminate health disparities related to smoking.
Collapse
Affiliation(s)
- Sydney A. Martinez
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma, United States of America
| | - Laura A. Beebe
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma, United States of America
| | - David M. Thompson
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma, United States of America
| | - Theodore L. Wagener
- Department of Pediatrics, Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma, United States of America
| | - Deirdra R. Terrell
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma, United States of America
| | - Janis E. Campbell
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma, United States of America
| |
Collapse
|
26
|
Abdalla MMI, Soon SC. Salivary adiponectin concentration in healthy adult males in relation to anthropometric measures and fat distribution. Endocr Regul 2017; 51:185-192. [DOI: 10.1515/enr-2017-0019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Abstract
Objectives. Body fat content, fat distribution, and adiponectin level are important variables in the development of obesity related complications. Anthropometric indices may provide an economic and faster method in measuring the risk for complications through their predictive effect of fat distribution and adiponectin concentration. We aimed to determine, which of the waist circumference (WC), waist-to-hip ratio (WHR), and body mass index (BMI) may be the best predictor for the total fat percentage (WF), visceral fat level (VF), and subcutaneous whole-body fat (SCWBF). We aimed also to investigate the potential use of the anthropometric measures and fat distribution as predictors for the salivary adiponectin level in the healthy adult males. Subjects. A total of 88 adult males aged between 18−25 years with a wide range of BMI were studied. Anthropometric indices were measured using standardized methods and salivary adiponectin level was assessed using an enzyme-linked immunosorbent assay. Results. In path analysis of the Structural Equation Model (SEM) using IBM@SPSS AMOS, version22, BMI and WC, but not WHR, were strong predictors for WF and SCWBF (p<0.05). BMI but not WC was a strong predictor for VF (p<0.001). WF was strong predictor for SCWBF (p<0.001), but not for VF. BMI, WC, WHR, WF, VF, and SCWBF were poor predictors of the salivary adiponectin level. Conclusion. BMI is the best predictor for the total body fat and fat distribution. However, WHR seems to be of a little value and the salivary adiponectin level independent of BMI and body fat in healthy adult Malay males.
Collapse
Affiliation(s)
- Mona Mohamed Ibrahim Abdalla
- Physiology Department, Faculty of Medicine, MAHSA University, Kuala Lumpur , Malaysia
- Physiology Department, Faculty of Medicine, Minia University, Minia , Egypt
| | - S. C. Soon
- Physiology Department, Faculty of Medicine, MAHSA University, Kuala Lumpur , Malaysia
| |
Collapse
|
27
|
Factors associated with pre-diabetes in Tehranian men and women: A structural equations modeling. PLoS One 2017; 12:e0188898. [PMID: 29216229 PMCID: PMC5720750 DOI: 10.1371/journal.pone.0188898] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 11/15/2017] [Indexed: 12/18/2022] Open
Abstract
Objective To examine associations of sex-specific related factors with pre-diabetes in Tehranian non-diabetic adults. Methods This study has been conducted within the framework of the Tehran Lipid and Glucose Study (TLGS) between 2008–2010. A total of 5568 (55.4% female) non-diabetic adults, aged ≥20 years, selected from among participants of the TLGS, were recruited for the study. Data on socio-behavioral factors, family history of diabetes and cardio-metabolic risk factors were included in the hypothesized model to test their direct and indirect associations with pre-diabetes in men and women separately, using structural equation modeling. Results Pre-diabetes was diagnosed in 23.6% of participants, with significantly higher prevalence in men compared to women (27.4% and 20.5%, respectively; p<0.001). Body mass index (BMI) and triglycerides (TG) in both sexes and hypertension and high density lipoprotein only in women, were directly associated with pre-diabetes (p<0.05). Poor diet in women was the only behavioral factor directly associated with pre-diabetes (p<0.05). Age in both sexes and education, only in women, were directly associated with pre-diabetes. In both genders, age, marital status, education, employment, poor diet and leisure time physical activity were indirectly associated with pre-diabetes through cardio-metabolic risk factors. Conclusions The main modifiable factors directly associated with pre-diabetes were TG in women and BMI in men, which need to be prioritized in health policies for diabetes prevention programs in Tehranian adults. Future research should focus on the gender-specific determinants and underlying mechanisms for TG levels and BMI status among this population.
Collapse
|
28
|
Vitharana VHP, Chinda T. Structural equation modelling of lower back pain due to whole-body vibration exposure in the construction industry. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2017; 25:257-267. [PMID: 28795908 DOI: 10.1080/10803548.2017.1366119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Whole-body vibration (WBV) exposure is a health hazard among workers, causing lower back pain (LBP) in the construction industry. This study examines key factors affecting LBP due to WBV exposure using exploratory factor analysis and structural equation modelling. The results confirm five key factors (equipment, job related, organizational, personal, social context) with their 17 associated items. The organizational factor is found the most important, as it influences the other four factors. The results also show that appropriate seat type, specific training programme, job rotation, workers' satisfaction and workers' physical condition are crucial in reducing LBP due to WBV exposure. Moreover, provision of new machines without proper training and good working condition might not help reduce LBP due to WBV exposure. The results help the construction companies to better understand key factors affecting LBP due to WBV exposure, and to plan for a better health improvement programme.
Collapse
Affiliation(s)
| | - Thanwadee Chinda
- a Sirindhorn International Institute of Technology, Thammasat University , Thailand
| |
Collapse
|
29
|
Childhood Socioeconomic Disadvantage, Occupational, Leisure-Time, and Household Physical Activity, and Diabetes in Adulthood. J Phys Act Health 2017; 14:766-772. [PMID: 28513316 DOI: 10.1123/jpah.2016-0438] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Regular physical activity is a key way to prevent disease. However, we have a limited understanding of the socioeconomic precursors and glucoregulatory sequelae of engaging in physical activity in different domains. METHODS We examined the associations among life course socioeconomic disadvantage; meeting the physical activity guidelines with leisure-time physical activity, occupational physical activity, or household physical activity; and prediabetes and diabetes in the Midlife in the United States national study (N = 986). RESULTS Childhood disadvantage was associated with lower odds of meeting the guidelines with leisure-time physical activity (odds ratio = 0.75; 95% confidence interval, 0.65-0.86). Adulthood disadvantage was associated with higher odds of meeting the guidelines with occupational physical activity (odds ratio = 1.94; 95% confidence interval, 1.49-2.53). Importantly, while meeting the guidelines with leisure-time physical activity was associated with lower odds of prediabetes and diabetes, we found no evidence for associations among occupational physical activity, household physical activity, and glucoregulation. CONCLUSION Current US physical activity guidelines do not differentiate between physical activity for leisure or work, assuming that physical activity in any domain confers comparable health benefits. We documented important differences in the associations among lifetime socioeconomic disadvantage, physical activity domain, and diabetes, suggesting that physical activity domain potentially belongs in the guidelines, similar to other characteristics of activity (eg, type, intensity).
Collapse
|
30
|
Fred Wen CK, Hsieh S, Huh J, Martinez LC, Davis JN, Weigensberg M, Spruijt-Metz D. The Role of Assimilating to the US Culture and the Relationship Between Neighborhood Ethnic Composition and Dietary Intake Among Hispanic Youth. J Racial Ethn Health Disparities 2016; 4:10.1007/s40615-016-0293-1. [PMID: 27753052 PMCID: PMC5529269 DOI: 10.1007/s40615-016-0293-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 09/26/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dietary fiber and sugar intake have been shown to affect metabolic health in overweight Hispanic youth. Evidence on the influence of culture on fiber and sugar intake in Hispanic youth is limited. METHODS The associations among score for levels of assimilation, neighborhood ethnic characteristics, and daily total and added dietary sugar and dietary fiber intake were assessed using regression analyses. RESULTS One hundred twenty-four Hispanic youth (age = 13.6 ± 3.0, 106 female) were included. The proportion of Hispanic population in the neighborhood was positively associated with fiber intake (standardized β = 0.205, p < 0.01) and inversely associated with added (standardized β = -0.234, p < 0.01) and total sugar intake (standardized β = -0.229, p < 0.01). Youth's self-identified levels of assimilation inversely moderated (standardized β = -0.465, p = 0.036) the association between %HP and dietary fiber intake. CONCLUSIONS Hispanic youth residing in areas of that are predominantly populated with Hispanics may be protected from conforming to unhealthy dietary behaviors. This protective effect is weaker among Hispanic youth with higher level of assimilation.
Collapse
Affiliation(s)
- Cheng K Fred Wen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Stephanie Hsieh
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jimi Huh
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lauren Cook Martinez
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jamie N Davis
- Department of Nutrition, University of Texas, Austin, Austin, TX, USA
| | - Marc Weigensberg
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Institute for Integrative Health, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Donna Spruijt-Metz
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Center for Social and Economic Research, University of Southern California, Los Angeles, CA, USA
- Department of Psychology, Dana and David Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
31
|
Poltavskiy E, Kim DJ, Bang H. Comparison of screening scores for diabetes and prediabetes. Diabetes Res Clin Pract 2016; 118:146-53. [PMID: 27371780 PMCID: PMC4972666 DOI: 10.1016/j.diabres.2016.06.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/02/2016] [Accepted: 06/06/2016] [Indexed: 02/03/2023]
Abstract
AIMS There are numerous risk or screening scores for the prediction of type-2 diabetes mellitus (DM). In contrast, few scores are available for preDM. In this paper, we compare the two screening scores from the American Diabetes Association (ADA) and Centers for Disease Control and Prevention (CDC) that can be used for DM as well as preDM. METHODS Adult participants (N=9391) without known DM from the National Health and Nutrition Examination Surveys 2009-12 were included. We fitted the factors/items in the ADA and CDC scores in logistic regression with the outcomes of undiagnosed DM, preDM, and combination, and assessed the association and discrimination accuracy. We also evaluated the suggested cutpoints that define high risk individuals. We mimicked the original models/settings but also tested various deviations/modifications often encountered in practice. RESULTS Both scores performed well and robustly, while the ADA score performed somewhat better (e.g., AUC=0.77 for ADA and 0.73-0.74 for CDC for DM; 0.72-0.74 and 0.70-0.71 for preDM). The same predictors and scoring rules seem to be reasonably justified with different cutpoints for DM and preDM, which can make usage easier and consistent. Some factors such as race and HDL/LDL cholesterols may be useful additions to health education. CONCLUSIONS Current DM education and screening focus on the prevention and management of DM. The ADA and CDC scores could further help when we identify individuals at high risk for preDM, and teach the importance of preDM during which lifestyle intervention can be effective and urgently needed.
Collapse
Affiliation(s)
- Eduard Poltavskiy
- Graduate Group in Epidemiology, University of California, Davis, USA
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Heejung Bang
- Graduate Group in Epidemiology, University of California, Davis, USA; Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, USA.
| |
Collapse
|
32
|
|
33
|
Gutierrez JL, Arentson-Lantz EJ. Dietary Management of Glycemic Control in Older Adults. Curr Nutr Rep 2016. [DOI: 10.1007/s13668-016-0159-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
34
|
Moody A, Cowley G, Ng Fat L, Mindell JS. Social inequalities in prevalence of diagnosed and undiagnosed diabetes and impaired glucose regulation in participants in the Health Surveys for England series. BMJ Open 2016; 6:e010155. [PMID: 26857106 PMCID: PMC4746474 DOI: 10.1136/bmjopen-2015-010155] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To ascertain the extent of socioeconomic and health condition inequalities in people with diagnosed and undiagnosed diabetes and impaired glucose regulation (IGR) in random samples of the general population in England, as earlier diagnosis of diabetes and treatment of people with IGR can reduce adverse sequelae of diabetes. Various screening instruments were compared to identify IGR, in addition to undiagnosed diabetes. DESIGN 5, annual cross-sectional health examination surveys; data adjusted for complex survey design. SETTING Random selection of private homes across England, new sample annually 2009-2013. PARTICIPANTS 5, nationally representative random samples of the general, free-living population: ≥ 1 adult interviewed in 24,254 of 36,889 eligible addresses selected. 18,399 adults had a valid glycated haemoglobin (HbA1c) measurement and answered the diabetes questions. MAIN OUTCOME MEASURES Diagnosed diabetes, undiagnosed diabetes (HbA1c ≥ 48 mmol/mol), IGR (HbA1c 42-47 mmol/mol). RESULTS Overall, 11% of the population had IGR, 2% undiagnosed and 6% diagnosed diabetes. Age-standardised prevalence was highest among Asian (19% (95% CI 16% to 23%), 3% (2% to 5%) and 12% (9% to 16%) respectively) and black participants (17% (13% to 21%), 2% (1% to 4%) and 14% (9% to 20%) respectively). These were also higher among people with lower income, less education, lower occupational class and greater deprivation. Education (OR 1.49 (95% CI 1.27 to 1.74) for no qualifications vs degree or higher) and income (1.35 (1.12 to 1.62) for lowest vs highest income quintile) remained significantly associated with IGR or undiagnosed diabetes on multivariate regression. The greatest odds of IGR or undiagnosed diabetes were with increasing age over 34 years (eg, OR 18.69 (11.53 to 30.28) aged 65-74 vs 16-24). Other significant associations were ethnic group (Asian (3.91 (3.02 to 5.05)), African-American (2.34 (1.62 to 3.38)) or 'other' (2.04 (1.07 to 3.88)) vs Caucasian); sex (OR 1.32(1.19 to 1.46) for men vs women); body mass index (3.54 (2.52 to 4.96) for morbidly obese vs not overweight); and waist circumference (2.00 (1.67 to 2.38) for very high vs low). CONCLUSIONS Social inequalities in hyperglycaemia exist, additional to well-known demographic and anthropometric risk factors for diabetes and IGR.
Collapse
Affiliation(s)
- Alison Moody
- Research Department of Epidemiology & Public Health, UCL, London, UK
| | | | - Linda Ng Fat
- Research Department of Epidemiology & Public Health, UCL, London, UK
| | | |
Collapse
|
35
|
Roman-Urrestarazu A, Ali FMH, Reka H, Renwick MJ, Roman GD, Mossialos E. Structural equation model for estimating risk factors in type 2 diabetes mellitus in a Middle Eastern setting: evidence from the STEPS Qatar. BMJ Open Diabetes Res Care 2016; 4:e000231. [PMID: 27752326 PMCID: PMC5051333 DOI: 10.1136/bmjdrc-2016-000231] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/18/2016] [Accepted: 07/21/2016] [Indexed: 12/28/2022] Open
Abstract
AIMS Understanding type 2 diabetes mellitus is critical for designing effective diabetes prevention policies in Qatar and the Middle East. METHODS Using the Qatar 2012 WHO STEPwise approach to surveillance survey, a subsample of 1224 Qatari participants aged 18-64 years was selected. Subjects had their fasting blood glucose levels tested, had not been diagnosed with or treated for diabetes, had a fasting time >12 hours and were not pregnant. We applied a hypothesized structural equation model (SEM) to assess sociodemographic, behavioral, anthropometric and metabolic variables affecting persons with type 2 diabetes mellitus. RESULTS There is a direct effect of triglyceride levels (0.336) and body mass index (BMI) (0.164) on diabetes status. We also found that physical activity levels negatively affect BMI (-0.148) and positively affect high-density lipoprotein (HDL) (0.106); sociodemographic background negatively affects diet (-0.522) and BMI (-0.352); HDL positively affects total cholesterol (0.230) and has a negative effect on BMI (-0.108), triglycerides (-0.128) and waist circumference (-0.104). Diet has a positive effect on triglycerides (0.281) while family history of diabetes negatively affects total cholesterol (-0.104). BMI has a positive effect on waist circumference (0.788) and mediates the effects of physical activity over diabetes status (-0.028). BMI also mediates the effects that sociodemographic factors (-0.058) and physical activity (-0.024) have on diabetes status. BMI and HDL (-0.002) together mediate the effect of physical activity on diabetes status and similarly HDL and tryglycerides (-0.005) also mediate the effect of physical activity on diabetes status. Finally diet and tryglycerides mediate the effects that sociodemographic factors have on diabetes status (-0.049). CONCLUSIONS This study's main finding is that triglyceride levels and BMI are the main variables directly affecting diabetes status in the Qatari population.
Collapse
Affiliation(s)
| | | | - Husein Reka
- Qatar Supreme Council of Health, Doha, Qatar
| | - Matthew J Renwick
- LSE Health, London School of Economics and Political Science, London, UK
| | - Gabriela D Roman
- Institute of Criminology, University of Cambridge, Cambridge, UK
| | - Elias Mossialos
- LSE Health, London School of Economics and Political Science, London, UK
| |
Collapse
|
36
|
Okwechime IO, Roberson S, Odoi A. Prevalence and Predictors of Pre-Diabetes and Diabetes among Adults 18 Years or Older in Florida: A Multinomial Logistic Modeling Approach. PLoS One 2015; 10:e0145781. [PMID: 26714019 PMCID: PMC4699892 DOI: 10.1371/journal.pone.0145781] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 12/08/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Individuals with pre-diabetes and diabetes have increased risks of developing macro-vascular complications including heart disease and stroke; which are the leading causes of death globally. The objective of this study was to estimate the prevalence of pre-diabetes and diabetes, and to investigate their predictors among adults ≥18 years in Florida. METHODS Data covering the time period January-December 2013, were obtained from Florida's Behavioral Risk Factor Surveillance System (BRFSS). Survey design of the study was declared using SVYSET statement of STATA 13.1. Descriptive analyses were performed to estimate the prevalence of pre-diabetes and diabetes. Predictors of pre-diabetes and diabetes were investigated using multinomial logistic regression model. Model goodness-of-fit was evaluated using both the multinomial goodness-of-fit test proposed by Fagerland, Hosmer, and Bofin, as well as, the Hosmer-Lemeshow's goodness of fit test. RESULTS There were approximately 2,983 (7.3%) and 5,189 (12.1%) adults in Florida diagnosed with pre-diabetes and diabetes, respectively. Over half of the study respondents were white, married and over the age of 45 years while 36.4% reported being physically inactive, overweight (36.4%) or obese (26.4%), hypertensive (34.6%), hypercholesteremic (40.3%), and 26% were arthritic. Based on the final multivariable multinomial model, only being overweight (Relative Risk Ratio [RRR] = 1.85, 95% Confidence Interval [95% CI] = 1.41, 2.42), obese (RRR = 3.41, 95% CI = 2.61, 4.45), hypertensive (RRR = 1.69, 95% CI = 1.33, 2.15), hypercholesterolemic (RRR = 1.94, 95% CI = 1.55, 2.43), and arthritic (RRR = 1.24, 95% CI = 1.00, 1.55) had significant associations with pre-diabetes. However, more predictors had significant associations with diabetes and the strengths of associations tended to be higher than for the association with pre-diabetes. For instance, the relative risk ratios for the association between diabetes and being overweight (RRR = 2.00, 95% CI = 1.55, 2.57), or obese (RRR = 4.04, 95% CI = 3.22, 5.07), hypertensive (RRR = 2.66, 95% CI = 2.08, 3.41), hypercholesterolemic (RRR = 1.98, 95% CI = 1.61, 2.45) and arthritic (RRR = 1.28, 95% CI = 1.04, 1.58) were all further away from the null than their associations with pre-diabetes. Moreover, a number of variables such as age, income level, sex, and level of physical activity had significant association with diabetes but not pre-diabetes. The risk of diabetes increased with increasing age, lower income, in males, and with physical inactivity. Insufficient physical activity had no significant association with the risk of diabetes or pre-diabetes. CONCLUSIONS There is evidence of differences in the strength of association of the predictors across levels of diabetes status (pre-diabetes and diabetes) among adults ≥18 years in Florida. It is important to monitor populations at high risk for pre-diabetes and diabetes, so as to help guide health programming decisions and resource allocations to control the condition.
Collapse
Affiliation(s)
- Ifechukwude Obiamaka Okwechime
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee, United States of America
| | - Shamarial Roberson
- Florida Department of Health, Bureau of Chronic Disease Prevention, Tallahassee, Florida, United States of America
| | - Agricola Odoi
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee, United States of America
| |
Collapse
|
37
|
Chen MF, Wang RH, Hung SL. Predicting health-promoting self-care behaviors in people with pre-diabetes by applying Bandura social learning theory. Appl Nurs Res 2015; 28:299-304. [PMID: 26608429 DOI: 10.1016/j.apnr.2015.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 10/23/2022]
Abstract
AIMS The aim of this study was to apply Bandura social learning theory in a model for identifying personal and environmental factors that predict health-promoting self-care behaviors in people with pre-diabetes. BACKGROUND The theoretical basis of health-promoting self-care behaviors must be examined to obtain evidence-based knowledge that can help improve the effectiveness of pre-diabetes care. However, such behaviors are rarely studied in people with pre-diabetes. METHODS This quantitative, cross-sectional survey study was performed in a convenience sample of two hospitals in southern Taiwan. Two hundred people diagnosed with pre-diabetes at a single health examination center were recruited. A questionnaire survey was performed to collect data regarding personal factors (i.e., participant characteristics, pre-diabetes knowledge, and self-efficacy) and data regarding environmental factors (i.e., social support and perceptions of empowerment process) that may have associations with health-promoting self-care behaviors in people with pre-diabetes. RESULTS Multiple linear regression showed that the factors that had the largest influence on the practice of health-promoting self-care behaviors were self-efficacy, diabetes history, perceptions of empowerment process, and pre-diabetes knowledge. These factors explained 59.3% of the variance in health-promoting self-care behaviors. CONCLUSIONS To prevent the development of diabetes in people with pre-diabetes, healthcare professionals should consider both the personal and the environmental factors identified in this study when assessing health promoting self-care behaviors in patients with pre-diabetes and when selecting the appropriate interventions.
Collapse
Affiliation(s)
- Mei-Fang Chen
- Department of Nursing, National Tainan Junior College of Nursing, Taiwan.
| | - Ruey-Hsia Wang
- College of Nursing, Kaohsiung Medical University, Taiwan
| | - Shu-Ling Hung
- Department of Nursing, National Tainan Junior College of Nursing, Taiwan
| |
Collapse
|
38
|
Díaz-Redondo A, Giráldez-García C, Carrillo L, Serrano R, García-Soidán FJ, Artola S, Franch J, Díez J, Ezkurra P, Millaruelo JM, Seguí M, Sangrós J, Martínez-Candela J, Muñoz P, Goday A, Regidor E. Modifiable risk factors associated with prediabetes in men and women: a cross-sectional analysis of the cohort study in primary health care on the evolution of patients with prediabetes (PREDAPS-Study). BMC FAMILY PRACTICE 2015; 16:5. [PMID: 25609029 PMCID: PMC4316391 DOI: 10.1186/s12875-014-0216-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/16/2014] [Indexed: 12/18/2022]
Abstract
Background Prediabetes is a high-risk state for diabetes development, but little is known about the factors associated with this state. The aim of the study was to identify modifiable risk factors associated with the presence of prediabetes in men and women. Methods Cohort Study in Primary Health Care on the Evolution of Patients with Prediabetes (PREDAPS-Study) is a prospective study on a cohort of 1184 subjects with prediabetes and another cohort of 838 subjects without glucose metabolism disorders. It is being conducted by 125 general practitioners in Spain. Data for this analysis were collected during the baseline stage in 2012. The modifiable risk factors included were: smoking habit, alcohol consumption, low physical activity, inadequate diet, hypertension, dyslipidemia, and obesity. To assess independent association between each factor and prediabetes, odds ratios (ORs) were estimated using logistic regression models. Results Abdominal obesity, low plasma levels of high-density lipoprotein cholesterol (HDL-cholesterol), and hypertension were independently associated with the presence of prediabetes in both men and women. After adjusting for all factors, the respective ORs (95% Confidence Intervals) were 1.98 (1.41-2.79), 1.88 (1.23-2.88) and 1.86 (1.39-2.51) for men, and 1.89 (1.36-2.62), 1.58 (1.12-2.23) and 1.44 (1.07-1.92) for women. Also, general obesity was a risk factor in both sexes but did not reach statistical significance among men, after adjusting for all factors. Risky alcohol consumption was a risk factor for prediabetes in men, OR 1.49 (1.00-2.24). Conclusions Obesity, low HDL-cholesterol levels, and hypertension were modifiable risk factors independently related to the presence of prediabetes in both sexes. The magnitudes of the associations were stronger for men than women. Abdominal obesity in both men and women displayed the strongest association with prediabetes. The findings suggest that there are some differences between men and women, which should be taken into account when implementing specific recommendations to prevent or delay the onset of diabetes in adult population.
Collapse
Affiliation(s)
- Alicia Díaz-Redondo
- Department of Preventive Medicine and Public Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Carolina Giráldez-García
- Department of Preventive Medicine, Public Health (History of Science), Universidad Complutense de Madrid, Madrid, Spain.
| | - Lourdes Carrillo
- La Victoria de Acentejo Health Centre, Santa Cruz de Tenerife, Spain.
| | | | | | | | | | | | | | | | - Mateu Seguí
- Es Castell Basic Health Unit, Islas Baleares, Spain.
| | | | | | - Pedro Muñoz
- Family & Community Medicine Teaching Unit, Cantabria, Spain.
| | - Albert Goday
- Endocrinology & Nutrition Department, Del Mar Hospital, Barcelona, Spain.
| | - Enrique Regidor
- Department of Preventive Medicine, Public Health (History of Science), Universidad Complutense de Madrid, Madrid, Spain. .,Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain.
| |
Collapse
|
39
|
Yang MH, Hall SA, Piccolo RS, Maserejian NN, McKinlay JB. Do Behavioral Risk Factors for Prediabetes and Insulin Resistance Differ across the Socioeconomic Gradient? Results from a Community-Based Epidemiologic Survey. Int J Endocrinol 2015; 2015:806257. [PMID: 26089894 PMCID: PMC4452327 DOI: 10.1155/2015/806257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 09/29/2014] [Indexed: 12/15/2022] Open
Abstract
To examine whether behavioral risk factors associated with diabetes (diet, BMI, waist circumference, physical activity, and sleep duration) are also related to both prediabetes and insulin resistance (IR), we used data from Boston Area Community Health (BACH) Survey (2010-2012, n = 3155). Logistic and linear regression models were used to test the association of lifestyle factors with prediabetes status, insulin resistance, and prediabetes or insulin resistance. All regression models were stratified by education and income levels (to examine whether risk factors had differential effects across socioeconomic factors) and adjusted for age, gender, race/ethnicity, family history of diabetes, and smoking status. We found that large waist circumference was consistently associated with higher levels of insulin resistance (IR) and increased odds of prediabetes. While the association between large waist circumference and IR was consistent across all levels of SES (P < 0.001), the association between large waist circumference and prediabetes was only statistically significant in the highest socioeconomic strata with odds ratios of 1.68 (95% CI 1.07-2.62) and 1.88 (95% CI 1.22-2.92) for postgraduate degree and income strata, respectively. There was no association between diet, physical activity, sleep duration, and the presence of multiple risk factors and prediabetes or IR within SES strata.
Collapse
Affiliation(s)
- May H. Yang
- New England Research Institutes, Inc., Watertown, MA 02472, USA
| | - Sue A. Hall
- New England Research Institutes, Inc., Watertown, MA 02472, USA
| | | | | | - John B. McKinlay
- Department of Epidemiology, New England Research Institutes, Inc., 480 Pleasant Street, Suite 100A, Watertown, MA 02472, USA
- *John B. McKinlay:
| |
Collapse
|
40
|
Tsenkova V, Pudrovska T, Karlamangla A. Childhood socioeconomic disadvantage and prediabetes and diabetes in later life: a study of biopsychosocial pathways. Psychosom Med 2014; 76:622-8. [PMID: 25272201 PMCID: PMC4229367 DOI: 10.1097/psy.0000000000000106] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE We examined the relationship between childhood socioeconomic status (SES) and glucoregulation in later life and used a life-course framework to examine critical periods and underlying pathways. METHODS Data came from the Midlife in the US (MIDUS) national study (n = 895). Childhood SES indicators retrospectively reported at MIDUS I were used to create a childhood SES disadvantage index. Adult SES disadvantage and potential pathways were measured at MIDUS I and included waist circumference, depressive symptoms, and physical activity. Glucose and hemoglobin A1c, measured approximately 9 to 10 years later at MIDUS II, were used to create the ordinal outcome measure (no diabetes/prediabetes/diabetes). RESULTS Childhood SES disadvantage predicted increased odds of prediabetes and diabetes net of age, sex, race, and smoking (odds ratio = 1.11, 95% confidence interval = 1.01-1.22). Childhood SES disadvantage predicted adult SES disadvantage (β = .26, p = .001) and the three key mediators: waist circumference (β = 0.10, p = .002), physical activity (β = -0.11, p = .001), and depressive symptoms (β = 0.07, p = .072). When childhood and adult SES disadvantage were in the same model, only adult SES predicted glucoregulation (odds ratio = 1.07, 95% confidence interval = 1.01-1.13). The SES disadvantage measures were no longer significantly associated with glucoregulation after including waist circumference, physical activity, and depressive symptoms, all of which were significant predictors of glucoregulation. CONCLUSIONS The consequences of childhood SES disadvantage are complex and include both critical period and pathway effects. The lack of a direct effect of childhood SES on glucoregulation does not negate the importance of early environment but suggests that early-life socioeconomic factors propel unequal life-course trajectories that ultimately influence health.
Collapse
Affiliation(s)
- Vera Tsenkova
- Center for Women’s Health and Health Disparities Research, University of Wisconsin-Madison
| | | | | |
Collapse
|