TY - JOUR
T1 - Lifestyle and Psychosocial Patterns and Diabetes Incidence Among Women with and Without Obesity
T2 - a Prospective Latent Class Analysis
AU - Hendryx, Michael
AU - Dinh, Paul
AU - Chow, Angela
AU - Kroenke, Candyce H.
AU - Hingle, Melanie
AU - Shadyab, Aladdin H.
AU - Garcia, Lorena
AU - Howard, Barbara V.
AU - Luo, Juhua
N1 - Funding Information:
The implications of these findings include that efforts to prevent the development of diabetes, for persons with or without obesity, might benefit from an appreciation of the holistic context of risk. People are often advised—either informally, by their healthcare providers or on popular websites—to engage in multiple healthy behaviors as a general health promotion strategy—eat a healthy diet, exercise, avoid tobacco, manage stress, and get adequate sleep (Zelman ). Yet formal diabetes prevention programs are often focused on single goals such as dietary management, perhaps in combination with physical activity, but rarely formally test multi-component programs that include attention to psychosocial and lifestyle variables jointly. Perhaps the best-known intervention program is the Diabetes Prevention Program (DPP), which is an ongoing outcomes study funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (DPP ; NIDDK ). This program has been shown to be effective in reducing the onset of diabetes, especially among persons aged 60 and over. It focuses primarily on a combination of dietary change and increasing physical activity. It would be intriguing to examine whether the impacts of the program might be even stronger by attention to additional lifestyle or psychosocial factors, or whether the success of the program may be stronger among persons who are already characterized by relatively favorable psychosocial characteristics such as optimism or higher social support.
Funding Information:
The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services through contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C.
Publisher Copyright:
© 2020, Society for Prevention Research.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - We conducted latent class analyses to identify women with homogeneous combinations of lifestyle and behavioral variables and tested whether latent classes were prospectively associated with diabetes incidence for women with or without baseline obesity. A total of 64,710 postmenopausal women aged 50–79 years without prevalent diabetes at baseline (years 1993–1998) were followed until 2018 with a mean follow-up of 14.6 years (sd = 6.4). Lifestyle variables included smoking, diet quality, physical activity, and sleep quality. Psychosocial variables included social support, depression, and optimism. Multivariable Cox proportional hazards regression models tested associations between latent classes and diabetes incidence controlling for age, race/ethnicity, and education. During follow-up, 8076 (12.4%) women developed diabetes. For women without baseline obesity, five latent classes were identified. Compared with a lower risk referent, diabetes incidence was higher in classes characterized by high probability of multiple lifestyle and psychosocial risks (HR = 1.45; 95% CI 1.28, 1.64), poor diet and exercise (HR = 1.23; 95% CI 1.13, 1.33), and psychosocial risks alone (HR = 1.20; 95% CI 1.12, 1.29). For women with baseline obesity, four latent classes were identified. Compared with a lower risk referent, diabetes incidence was higher for women with obesity in classes characterized by high probability of multiple lifestyle and psychosocial risks (HR = 1.48; 95% CI 1.32, 1.66), poor diet and exercise (HR = 1.32; 95% CI 1.19, 1.47), and intermediate probabilities of multiple risks (HR = 1.17; 95% CI 1.05, 1.30). Diabetes prevention efforts that focus on diet and exercise may benefit from attention to how lifestyle behaviors interact with psychosocial variables to increase diabetes risks, and conversely, how psychological or social resources may be leveraged with lifestyle changes to reduce the risk for women with and without obesity.
AB - We conducted latent class analyses to identify women with homogeneous combinations of lifestyle and behavioral variables and tested whether latent classes were prospectively associated with diabetes incidence for women with or without baseline obesity. A total of 64,710 postmenopausal women aged 50–79 years without prevalent diabetes at baseline (years 1993–1998) were followed until 2018 with a mean follow-up of 14.6 years (sd = 6.4). Lifestyle variables included smoking, diet quality, physical activity, and sleep quality. Psychosocial variables included social support, depression, and optimism. Multivariable Cox proportional hazards regression models tested associations between latent classes and diabetes incidence controlling for age, race/ethnicity, and education. During follow-up, 8076 (12.4%) women developed diabetes. For women without baseline obesity, five latent classes were identified. Compared with a lower risk referent, diabetes incidence was higher in classes characterized by high probability of multiple lifestyle and psychosocial risks (HR = 1.45; 95% CI 1.28, 1.64), poor diet and exercise (HR = 1.23; 95% CI 1.13, 1.33), and psychosocial risks alone (HR = 1.20; 95% CI 1.12, 1.29). For women with baseline obesity, four latent classes were identified. Compared with a lower risk referent, diabetes incidence was higher for women with obesity in classes characterized by high probability of multiple lifestyle and psychosocial risks (HR = 1.48; 95% CI 1.32, 1.66), poor diet and exercise (HR = 1.32; 95% CI 1.19, 1.47), and intermediate probabilities of multiple risks (HR = 1.17; 95% CI 1.05, 1.30). Diabetes prevention efforts that focus on diet and exercise may benefit from attention to how lifestyle behaviors interact with psychosocial variables to increase diabetes risks, and conversely, how psychological or social resources may be leveraged with lifestyle changes to reduce the risk for women with and without obesity.
KW - Latent class analysis
KW - Lifestyle
KW - Postmenopausal
KW - Psychosocial risks
KW - Type 2 diabetes
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U2 - 10.1007/s11121-020-01130-6
DO - 10.1007/s11121-020-01130-6
M3 - Article
C2 - 32405807
AN - SCOPUS:85084966301
VL - 21
SP - 850
EP - 860
JO - Prevention Science
JF - Prevention Science
SN - 1389-4986
IS - 6
ER -