Original Data

Association Between Socioeconomic Determinants and the Metabolic Syndrome in the German Health Interview and Examination Survey for Adults (DEGS1) – A Mediation Analysis

Diego Montano

Abstract

BACKGROUND: Metabolic syndrome and different socioeconomic characteristics including education and occupational status have been found to be associated in previous research. Nonetheless, theoretical models defining core variables and causal processes accounting for these associations are lacking. OBJECTIVES: The main objectives of the present investigation are (1) to present a theoretical model integrating physiological, biochemical, and psychosocial factors determining metabolic syndrome prevalence and (2) to corroborate the hypothesis that socioeconomic determinants are (partially) mediated by health-related behaviors, health risks, and dietary habits. METHODS: The research hypothesis is tested with cross-sectional data from the German Health Interview and Examination Survey for Adults (DEGS1) conducted from 2008 to 2011 (n = 7,987) by means of multivariate regression models which appropriately take into account the stochastic dependence of metabolic syndrome components. RESULTS: The results suggest that the metabolic syndrome is less frequent among individuals with a higher educational level and those who have a partner. These associations may point to protective effects of social support, self-efficacy, and other socio-psychological constructs in relation to metabolic syndrome incidence. Furthermore, frequent consumption of wine, muesli, fruits, and raw vegetables are associated with lower prevalence rates of metabolic syndrome components. The associations of occupational status, income, and employment are partially mediated by health-related behavior, physiological and psychosocial factors, and dietary habits. Sensitivity analyses have suggested that even small changes in the distribution of potential risk and protective factors may reduce the prevalence of metabolic syndrome components. CONCLUSIONS: Healthrelated behavior (smoking, physical activity) and physiological and psychosocial factors mediate the association between socioeconomic characteristics and metabolic syndrome prevalence. However, metabolic syndrome components were much less frequent among individuals with a higher educational level, higher income and occupational status, and those having a life partner.

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Socioeconomic Deprivation, Household Education, and Employment are Associated With Increased Hospital Admissions and Poor Glycemic Control in Children With Type 1 Diabetes Mellitus

Louise J. Apperley, Sze M. Ng

Abstract

BACKGROUND: Socioeconomic deprivation, obesity, and emotional discomfort are important determinants of health inequalities and poor glycemic control in children and young people with type 1 diabetes mellitus (T1D). OBJECTIVES: The aims of this study were to evaluate the incidence of hospital admissions of T1D children in relation to socioeconomic deprivation, and to determine the effects of social deprivation, body mass index (BMI), and patient-reported emotional well-being on glycemic control. METHODS: All hospital admissions of T1D patients aged 1-18 years were identified during 2007 and 2012. Admission cause and glycemic control were related to social deprivation, BMI, and psychological, emotional well-being. Indices of Multiple Deprivation (IMD) 2010 were applied to the United Kingdom data. The associations were calculated using the Spearman's rank correlation coefficient. RESULTS: A significant correlation was found between hospital admission rates and overall deprivation scores (r = -0.18, p = 0.04). Patients living in deprived areas were more likely to selfpresent to the accident and emergency department (r = -0.24, p = 0.02). Poor glycemic control (n = 124) was significantly associated with lower levels of education (r = -0.22, p = 0.02) and unemployment (r = -0.19, p = 0.04). Significance was not reached for level of income (r = -0.16, p = 0.07) and overall deprivation (r = -0.17, p = 0.06). Glycemic control was not found to be associated with BMI, standard deviation scores (SDS), or emotional well-being. CONCLUSION: Early intervention and education from primary care and specialist diabetes teams within the community in deprived areas may be effective in reducing hospital admissions for diabetes-related problems and improving glycemic control.

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Inverse Association of Peripheral Orexin-A with Insulin Resistance in Type 2 Diabetes Mellitus: A Randomized Clinical Trial

Mitra Zarifkar, Sina Noshad, Mona Shahriari, Mohsen Afarideh, Elias Khajeh, Zahra Karimi, Alireza Ghajar, Alireza Esteghamati

Abstract

AIMS: To investigate the association between serum orexin concentrations and insulin resistance/sensitivity in a sample of patients with type 2 diabetes mellitus, and to study the effects of anti-hyperglycemic treatment on orexin concentrations over three months. METHODS: This study was designed as a randomized, open-label, clinical trial. Before allocation, sixty medication-naïve, newly-diagnosed, type 2 diabetes patients underwent a 75 g oral glucose tolerance test (OGTT). Afterwards, using a randomized trial design (IRCT201102275917N1) patients were allocated to either the metformin (1000 mg daily) or pioglitazone (30 mg daily) arm, and were reexamined after three months. Serum insulin, plasma glucose, and orexin concentrations were measured at baseline, during OGTT, and after three months. RESULTS: Orexin concentrations significantly decreased after OGTT (0 vs. 120 min: 0.63 ± 0.07 vs. 0.31 ± 0.03 ng/ml, p < 0.001). Insulin resistance determined by homeostasis model assessment of insulin resistance (HOMA-IR) was significantly and negatively correlated with orexin (r = -0.301, p = 0.024). Furthermore, orexin concentrations were significantly and positively correlated with the insulin sensitivity index derived from OGTT (r = 0.326, p = 0.014). Three-month treatment with metformin and pioglitazone significantly improved insulin sensitivity and increased orexin concentrations by 26% (p = 0.025) and 14% (p = 0.076), respectively. Between-group analysis showed that changes in orexin concentrations with metformin and pioglitazone were not significantly different (p = 0.742). CONCLUSIONS: There was a negative association between peripheral orexin concentrations and insulin resistance in type 2 diabetes patients. Three-month anti-hyperglycemic treatment with proportionate doses of metformin or pioglitazone increased orexin concentrations via amelioration of insulin resistance and improvement of glycemic control.

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Variations in ADIPOR1 But Not ADIPOR2 are Associated With Hypertriglyceridemia and Diabetes in an Admixed Latin American Population

Gustavo Mora-García¹, María S. Ruiz-Díaz¹, Fabian Espitia-Almeida², Doris Gómez-Camargo¹

Abstract

BACKGROUND: Adiponectin is a hormone secreted by adipose tissue. It regulates glycolysis and lipolysis and is involved in the pathophysiology of diabetes and related disorders. Its activity is mainly mediated by the transmembrane receptors AdipoR1 and AdipoR2, which are encoded by ADIPOR1 (1q32.1) and ADIPOR2 (12p13.33) genes, respectively. In genetic association studies, single nucleotide polymorphisms (SNPs) in or near these genes have been associated with metabolic alterations. However, these relationships are still controversial. AIM: The aim of this work was to analyze possible associations between ADIPOR1/2 and diabetes and other metabolic disorders. METHODS: A genetic association study was carried out in an admixed Latin American population. A sample of 200 adults was analyzed. Clinical and serum-biochemical characteristics were measured to diagnose obesity, abdominal obesity, hypertension, hyperglycemia, hypertriglyceridemia, low HDLc, insulin resistance (HOMA-IR), and diabetes. Three SNPs were genotyped in ADIPOR1 (rs10494839, rs12733285, and rs2275737) and ADIPOR2 (rs11061937, rs11612383, and rs2286383). For the association analysis, an additive model was assessed through logistic regression. An admixture adjustment was performed using a Monte-Carlo-Markov-Chain method, assuming a three-hybrid substructure (k = 3). RESULTS: Two SNPs in ADIPOR1 were associated with diabetes: rs10494839 (OR = 3.88, adjusted p < 0.03) and rs12733285 (OR = 4.72, adjusted p < 0.03). Additionally, rs10494839 was associated with hypertriglyceridemia (OR = 2.16, adjusted p < 0.01). None of the SNPs in ADIPOR2 were associated with metabolic disorders. CONCLUSIONS: ADIPOR1 was consistently associated with diabetes and hypertriglyceridemia. This association was maintained even after adjusting for genetic stratification. There were no significant associations involving ADIPOR2.

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