Life-course pathways from childhood socioeconomic status to type 2 diabetes in mid-late Chinese adulthood

AbstractThe relationship between childhood socioeconomic status (SES) and type 2 diabetes (T2D) remains inconclusive, and the pathways and mechanisms driving this relationship have yet to be clarified. This study aimed to examine the pathways linking childhood SES to T2D prevalence in mid-late adulthood in a low- and middle-income country. The incidence of T2D diagnosed in mid-late Chinese adulthood was assessed using self-reports from the Health and Retirement Longitudinal Study (CHARLS). Childhood SES was assessed by the education, occupation, survivorship of the parents and the financial situation of the family, whereas adulthood SES was assessed by education and wage. This study performed structural equation modeling to clarify the direct and indirect pathways from childhood SES to T2D via childhood health, childhood food shortage, adulthood SES and physical activity. A total of 15,132 participants were included, and the prevalence of T2D was 5.24%. This study found that childhood SES was directly associated with T2D in mid-late adulthood, the probability of developing T2D increased by 9.20% of the standard deviation for each decrease in standard deviation in childhood SES. Childhood SES was indirectly associated with T2D via adulthood SES, physical activity, childhood health and food shortage. Adulthood SES and physical activity mainly mediated the indirect pathway from childhood SES and T2D. This study showed direct and indirect pathways from disadvantaged childhood SES to increased risk of T2D in mid-late Chinese adulthood. Childhood SES, adulthood SES, physical activity, childhood health and food shortage were identified as life-course interventional targets that should be considered in the development of effective strategies to reduce the burden of T2D and SES-related health inequities in childhood.

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Childhood Socioeconomic Status and Type 2 Diabetes Mellitus among Mid-late Chinese: A Structural Equation Modeling Analysis

10.21203/rs.2.23074/v1 ◽

2020 ◽

Author(s):

xiaoning zhang ◽

xue jiang ◽

qiong zhou

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Socioeconomic Status ◽

Type 2 Diabetes Mellitus ◽

Structural Equation ◽

Goodness Of Fit ◽

Equation Modeling ◽

Cross Sectional ◽

Childhood Socioeconomic Status

Abstract Objectives This present study was aimed to examine the associations between childhood socioeconomic status (CSES) and type 2 diabetes mellitus (T2DM) among mid-late Chinese and disentangle the pathways using structural equation modelling (SEM). Methods Using cross-sectional data from China Health and Retirement Longitudinal Study (CHARLS), this study included 19767 participants aged 45 and over. SEM models were constructed to decompose the intricate relationships between CSES, childhood health history (CHH), adulthood socioeconomic status (ASES), health-related behaviors (HRB) and T2DM. Results The results showed that T2DM was significantly associated with CSES (sβ = -0.239; P = 0.001), CHH (sβ = -0.016; P = 0.005) and ASES (sβ = -0.180; P = 0.002) directly, While the indirect effect of CSES on T2DM was sβ = -0.111; P = 0.001with an acceptable goodness-of-fit. The model presented an acceptable goodness of fit: RMSA0.082, CFI 0.803, GFI 0.938, AGFI 0.904, and SRMR 0.060. Conclusions CSES had direct and indirect effects on later incidence of T2DM, which was mediated by ASES and CHH, supporting the life course theory, indicating that optimal interventions should be conducted in the early stages of life to narrow the socioeconomic and obtain maximal health benefits.

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Life course trajectories of weight status and risk of type 2 diabetes

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.873 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

D Yacaman-Mendez ◽

P Tyrnelius ◽

H Gudjonsdottir ◽

A Ponce de leon ◽

Y Trolle-Lagerros ◽

...

Keyword(s):

Type 2 Diabetes ◽

Life Course ◽

Weight Status ◽

Early Adulthood ◽

Normal Weight ◽

Overweight And Obesity ◽

Oral Glucose ◽

Preventive Program ◽

Late Adulthood

Abstract Background Overweight and obesity are risk factors for type 2 diabetes (T2D) with a cumulative effect. However, individuals experience important variation throughout life. We aimed to identify life-course trajectories of changes in weight categories among men and women and their association with T2D. Methods 4,820 women and 3,128 men participants of the Stockholm Diabetes Preventive Program (1992-2017) provided self-reported weight status at age 7 and 18, BMI 10 and 5 years before the study and measured BMI at baseline. Exposure was categorized as low weight, normal weight and high weight. Diagnosis of T2D was assessed with an oral glucose tolerance tests (OGTT) or taken from inpatient and outpatient registries. The life course trajectories were estimated using latent group mixture models, risk of T2D and population attributable fractions with Poisson regression. Results We found five trajectories in women and men: stable normal (44.8%, 34.2%), low increasing (17.4%, 18.7%), high in early adulthood (18.6%, 27.8%), high in late adulthood (14.7%, 14.5%), and stable high (4.5%, 4.5%). Compared to stable normal, the risk of T2D was higher in the low increasing (RR: 1.4 (95%CI: 1.0-2.0), RR:1.54(95%CI: 1.0-2.2)), high in early adulthood ((RR: 2.79 (95%CI: 2.1-3.7), RR: 2.8 (95%CI: 2.0-3.6)), high in late adulthood ((RR: 1.6 (95%CI: 1.1-2.2), RR: 1.6 (95%CI: 1.1-2.3)) and stable high groups ((RR: 2.9 (95%CI: 1.9-4.3), RR: 2.7 (95%CI 1.8-4.0)), and 48.2% (95% CI: 36.3% - 57.8%) of the cases of T2D in women and 41.2% (95%CI: 27.4% - 52.3%) in men could have been avoided if participants had been in the stable normal group. PAF was higher for the high in early adulthood group -25.5% (19%-31%) and (27.2% (19%-35%)-. Conclusions We identified five life course trajectories of changes in weight status. Risk of T2D was greater in the stable high and high in early adulthood groups but the proportion of T2D cases that can be attributed to the high in early adulthood group was greater. Key messages Different life-course trajectories of high body weight are associated to the risk of diabetes in late adulthood. The largest proportion of cases of T2D can be attributed to weight gain in early adulthood.

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Determinants of Glycemic Control among Urban Patients with Type 2 Diabetes: A mediation analysis from real-world evidence

10.21203/rs.2.23586/v1 ◽

2020 ◽

Author(s):

Rubén Silva-Tinoco ◽

Teresa Cuatecontzi-Xochitiotzi ◽

Viridiana De la Torre-Saldaña ◽

Enrique León-García ◽

Javier Serna-Alvarado ◽

...

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Primary Care ◽

Socioeconomic Status ◽

Low Income ◽

Self Care ◽

P Value ◽

Diabetes Knowledge ◽

Care Behavior

Abstract Background Evidence suggests there is a relationship between determinants of health and worse diabetes outcomes, especially among individuals with low socioeconomic status and education level. Few studies have shown the relationship between diabetes knowledge, self-care behaviors, and clinical outcomes in low-income urban populations. This study aimed to explore the determinants of glycemic control (GC) in a low-income urban population and to provide insight into the pathways of the effect of diabetes knowledge on GC. Methods A multicenter cross-sectional study was conducted in patients with type 2 diabetes (PwD) from 28 primary care outpatient centers located in Mexico City. Using the multivariable-adjusted models, we determined the associations between diabetes knowledge, self-care behaviors, and GC. The mediation analyses used linear regression models, where the significance of indirect effects was calculated with bootstrapping. Results The population (N=513) had a mean age of 53.8 years (standard deviation: 11.3 yrs.), and 65.9% were women. Both socioeconomic status and level of education were directly associated with diabetes knowledge. Using multivariable-adjusted linear models, we found that diabetes knowledge was associated with GC (β: -0.102, 95% Confidence Interval [95% CI] -0.189, -0.014). Diabetes knowledge was also independently associated with self-care behavior (for physical activity: β: 0.181, 95% CI 0.088, 0.273), and self-care behavior was associated with GC (for physical activity: β: -0.112, 95% CI -0.194, -0.029).The association between diabetes knowledge and GC was lost after adjustment for self-care behaviors, especially physical activity (β: -0.084, 95% CI -0.182, 0.014, p -value: 0.062). Finally, the mediation models showed that the effect of diabetes knowledge on GC was 17% independently mediated by physical activity ( p -value: 0.049). Conclusions Socioeconomic and educational gradients influence diabetes knowledge among primary care patients with type 2 diabetes. Self-care activities, particularly physical activity, mediated the effect of diabetes knowledge on GC. Our results indicate that diabetes knowledge should be reinforced in low-income PwD, with an emphasis on the benefits physical activity has on improving GC.

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Abstract #217: Combined Predictability of Physical Activity and Bodyweight on Healthrelated Quality of Life Among Nigerian Type 2 Diabetes Mellitus

Endocrine Practice ◽

10.1016/s1530-891x(20)42523-6 ◽

2015 ◽

Vol 21 ◽

pp. 31

Author(s):

Akolade Idowu ◽

Adeyinka Idowu ◽

Adesoji Tade

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Healthrelated Quality Of Life

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How to Maintain a Healthy Body Weight

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831.76.4.208 ◽

2006 ◽

Vol 76 (4) ◽

pp. 208-215 ◽

Cited By ~ 10

Author(s):

Astrup

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Weight Loss ◽

Body Weight ◽

Glycemic Index ◽

Dairy Products ◽

Weight Control ◽

Healthy Body Weight ◽

Healthy Body

The epidemic of both obesity and type 2 diabetes is due to environmental factors, but the individuals developing the conditions possess a strong genetic predisposition. Observational surveys and intervention studies have shown that excess body fatness is the major environmental cause of type 2 diabetes, and that even a minor weight loss can prevent its development in high-risk subjects. Maintenance of a healthy body weight in susceptible individuals requires 45–60 minutes physical activity daily, a fat-reduced diet with plenty of fruit, vegetables, whole grain, and lean meat and dairy products, and moderate consumption of calorie containing beverages. The use of table values to predict the glycemic index of meals is of little – if any – value, and the role of a low-glycemic index diet for body weight control is controversial. The replacement of starchy carbohydrates with protein from lean meat and lean dairy products enhances satiety, and facilitate weight control. It is possible that dairy calcium also promotes weight loss, although the mechanism of action remains unclear. A weight loss of 5–10% can be induced in almost all obese patients providing treatment is offered by a professional team consisting of a physician and dieticians or nurses trained to focus on weight loss and maintenance. Whereas increasing daily physical activity and regular exercise does not significantly effect the rate of weight loss in the induction phase, it plays an important role in the weight maintenance phase due to an impact on daily energy expenditure and also to a direct enhancement of insulin sensitivity.

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