Aolin Wang1, Karien Stronks2, Onyebuchi A Arah3. 1. Department of Epidemiology, The Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA. 2. Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands. 3. Department of Epidemiology, The Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands UCLA Center for Health Policy Research, Los Angeles, California, USA.
Abstract
BACKGROUND: Despite the well-established link between body mass index (BMI) and diabetes mellitus (DM), it remains unclear whether this association is more pronounced at certain levels of education. This study assessed the modifying effect of educational attainment on the associations between BMI and DM-as well as the joint associations of BMI and education with DM-in low-income countries (LICs) and middle-income countries (MICs). METHODS: The authors used cross-sectional data from 160 381 participants among 49 LICs and MICs in the World Health Survey. Overweight and obesity levels were defined using WHO's classification. Educational attainment was classified in four categories: 'no formal education', 'some/completed primary school', 'secondary/high school completed' and 'college and beyond'. We used random-intercept multilevel logistic regressions to investigate the modifying influence of educational attainment on the associations of different BMI levels-as well as their joint associations-with DM. RESULTS: We found positive associations between excessive BMI and DM at each education level in both LICs and MICs. We found that the joint associations of BMI and education with DM were larger than the product of their separate single associations among females in LICs. With joint increases in BMI and education, males and females in LICs had similar increased odds of DM, but males had higher such odds than females in MICs. CONCLUSIONS: BMI and education are associated with the DM, but the associations seem to differ in complex ways between LICs and MICs and by gender. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
BACKGROUND: Despite the well-established link between body mass index (BMI) and diabetes mellitus (DM), it remains unclear whether this association is more pronounced at certain levels of education. This study assessed the modifying effect of educational attainment on the associations between BMI and DM-as well as the joint associations of BMI and education with DM-in low-income countries (LICs) and middle-income countries (MICs). METHODS: The authors used cross-sectional data from 160 381 participants among 49 LICs and MICs in the World Health Survey. Overweight and obesity levels were defined using WHO's classification. Educational attainment was classified in four categories: 'no formal education', 'some/completed primary school', 'secondary/high school completed' and 'college and beyond'. We used random-intercept multilevel logistic regressions to investigate the modifying influence of educational attainment on the associations of different BMI levels-as well as their joint associations-with DM. RESULTS: We found positive associations between excessive BMI and DM at each education level in both LICs and MICs. We found that the joint associations of BMI and education with DM were larger than the product of their separate single associations among females in LICs. With joint increases in BMI and education, males and females in LICs had similar increased odds of DM, but males had higher such odds than females in MICs. CONCLUSIONS: BMI and education are associated with the DM, but the associations seem to differ in complex ways between LICs and MICs and by gender. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Sukumar Vellakkal; Christopher Millett; Sanjay Basu; Zaky Khan; Amina Aitsi-Selmi; David Stuckler; Shah Ebrahim Journal: J Epidemiol Community Health Date: 2014-12-30 Impact factor: 3.710
Authors: Silvia Stringhini; Terrence E Forrester; Jacob Plange-Rhule; Estelle V Lambert; Bharathi Viswanathan; Walter Riesen; Wolfgang Korte; Naomi Levitt; Liping Tong; Lara R Dugas; David Shoham; Ramon A Durazo-Arvizu; Amy Luke; Pascal Bovet Journal: BMC Public Health Date: 2016-09-09 Impact factor: 3.295