Towards a Parsimonious Pathway Model of Modifiable and Mediating Risk Factors Leading to Diabetes Risk

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.

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Towards a Parsimonious Pathway Model of Modifiable and Mediating Risk Factors Leading to Diabetes Risk

10.21203/rs.3.rs-429757/v1 ◽

2021 ◽

Author(s):

Yi-Ching Lynn Ho ◽

Vivian Shu Yi Lee ◽

Moon-Ho Ringo Ho ◽

Gladis Jing Lin ◽

Julian Thumboo

Keyword(s):

Risk Factors ◽

Disease Prevention ◽

Structural Equation ◽

Diabetes Risk ◽

Risk Indicators ◽

Equation Modeling ◽

Pathway Model ◽

Physiological Load ◽

Modifiable Factors ◽

Lifestyle Risk

Abstract Background: The development of diabetes mellitus has been closely linked to multiple risk factors, of which modifiable factors are of particular interest for disease prevention. Yet few studies have assessed the system of pathways though which risk factors lead to diabetes, and how the different groups of risk factors may interact,both as independent or mediating factors. Methods: We aimed to develop a broad pathway model for diabetes risk with modifiable lifestyle risk factors as the start point, hypothesising that Lifestyle Risk (physical inactivity, smoking, poor diet and insufficient sleep) would impact Diabetes Risk (HbA1c) through the mediating factor of Physiological Load (BMI, resting pulse rate, CRP, systolic and diastolic blood pressure). The lifestyle and physiological factors were grouped via principal components analysis and a summary index respectively. Non modifiable risk factors, such as sociodemographics were specified as covariates. We used structural equation modeling to test this model, first using Wave 5 data from the Indonesian Family Life Survey (IFLS), as this was the only wave that collected all indicators of interest. To fit in longitudinal data from an earlier wave (IFLS4), we further tested a smaller model with the two Lifestyle Risk indicators available. Results: Both models showed indirect effects of Lifestyle Risk on Diabetes Risk via Physiological Load, with the cross-sectional model also showing a direct effect. The effect sizes were within the range of other studies that assessed the variables separately. Conclusion: Taken together, the results support the model of an indirect effect of Lifestyle Risk on Diabetes through Physiological Load. 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. We were able to assess causality with retrospective cohort data. Finally, the parsimonious model groups and summarises the multifarious risk factors and illustrates parsimonious and modifiable pathways that could be applied in chronic disease prevention efforts.

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