Stress increases the risk of type 2 diabetes onset in women: A 12-year longitudinal study using causal modelling
Stress increases the risk of type 2 diabetes onset in women: A 12-year longitudinal study using causal modelling
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DOI：
10.1371/journal.pone.0172126
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发表时间：
2017-02-21
期刊：
影响因子：
3.7
通讯作者：
Attia, John
中科院分区：
文献类型：
--
作者：
Harris, Melissa L.;Oldmeadow, Christopher;Attia, John
背景2型糖尿病与显著的发病率和死亡率相关。已发现可改变的风险因素导致高达60%的2型糖尿病风险。然而，尽管实施了基于传统风险因素的干预措施，2型糖尿病仍在继续上升。显然需要确定预防慢性病的其他风险因素。本研究的目的是探讨感知压力和2型糖尿病发病之间的关系，并划分成直接和间接effects.Methods和调查结果出生于1946 - 1951年（n = 12,844）的妇女完成了调查，澳大利亚纵向研究妇女的健康在1998年，2001年，2004年，2007年和2010年。使用逻辑回归和边际结构模型估计总因果效应。通过回归模型中的条件作用估计受控的直接效应。在多变量时滞分析中，发现感知压力和所有介质之间存在分级关联。高血压、体力活动和体重指数与糖尿病之间存在显著相关性，但与吸烟或饮食质量无关。中度/高度压力水平与三年后患糖尿病的几率增加2.3倍有关，总的估计影响。结果只有轻微衰减时，感知压力对糖尿病的直接和间接影响被分割，介质只解释10-20%的过度变化在diabetes.Conclusions感知压力是一个强大的危险因素为2型糖尿病。大多数压力对糖尿病风险的影响评估不是由高血压、体力活动、吸烟、饮食质量和体重指数等传统风险因素介导的。这为糖尿病预防试验和临床实践提供了新的途径。
Background Type 2 diabetes is associated with significant morbidity and mortality. Modifiable risk factors have been found to contribute up to 60% of type 2 diabetes risk. However, type 2 diabetes continues to rise despite implementation of interventions based on traditional risk factors. There is a clear need to identify additional risk factors for chronic disease prevention. The aim of this study was to examine the relationship between perceived stress and type 2 diabetes onset, and partition the estimates into direct and indirect effects.Methods and findings Women born in 1946 -1951 (n = 12,844) completed surveys for the Australian Longitudinal Study on Women's Health in 1998, 2001, 2004, 2007 and 2010. The total causal effect was estimated using logistic regression and marginal structural modelling. Controlled direct effects were estimated through conditioning in the regression model. A graded association was found between perceived stress and all mediators in the multivariate time lag analyses. A significant association was found between hypertension, as well as physical activity and body mass index, and diabetes, but not smoking or diet quality. Moderate/high stress levels were associated with a 2.3-fold increase in the odds of diabetes three years later, for the total estimated effect. Results were only slightly attenuated when the direct and indirect effects of perceived stress on diabetes were partitioned, with the mediators only explaining 10-20% of the excess variation in diabetes.Conclusions Perceived stress is a strong risk factor for type 2 diabetes. The majority of the effect estimate of stress on diabetes risk is not mediated by the traditional risk factors of hypertension,physical activity, smoking, diet quality, and body mass index. This gives a new pathway for diabetes prevention trials and clinical practice.