Using Structural Equation Modelling to Untangle Pathways of Factors Associated with Type 2 Diabetes

Autor: Louise H. Dekker, Juan Jesus Carrero, Ming-Jie Duan, Gerjan Navis
Rok vydání: 2020
Předmět:
Zdroj: European Journal of Public Health. 30
ISSN: 1464-360X
1101-1262
DOI: 10.1093/eurpub/ckaa165.592
Popis: Background Risk factors for type 2 diabetes (T2D) are multi-facet and interrelated. We aimed to apply structural equation modelling to examine and quantify pathways of modifiable risk factors related to incident type 2 diabetes. Methods Analysis was based on 68 649 participants (35-80 years, without diabetes at baseline) from the Lifelines cohort study. We proposed a conceptual model that illustrates the pathways of risk factors related to incident type 2 diabetes: socio-economic status (income and education) → lifestyle behaviors (diet quality, physical activity, TV watching, and smoking) → clinical markers (blood lipids and obesity status) → incident type 2 diabetes. Structural equation modeling was performed to test this proposed model. Results After a median follow-up of 41 months, 1124 new cases of type 2 diabetes were identified. The best-fitting model indicated that among all modifiable risk factors included, waist circumference had the biggest direct effect on type 2 diabetes (β: 0.213 ), followed by HDL-cholesterol (β: -0.141). 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 direct effects on all lifestyle behaviors. Conclusions Using this innovative approach, our analysis provides a more nuanced assessment of the interplay of type 2 diabetes risk factors, compared to traditional risk estimates. Our results indicated that reducing large waist circumference may be prioritized as the main target for the prevention of type 2 diabetes, and lifestyle interventions are urgently warranted with additional support for those with a low education. Key messages Our study elucidated the multiple causal pathways to type 2 diabetes in a prospective setting. Our results identified the most critical targets for future prevention strategies for type 2 diabetes.
Databáze: OpenAIRE
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