Understanding socioeconomic differences in incident metabolic syndrome among adults: What is the mediating role of health behaviours?

Liza A. Hoveling*, Aart C. Liefbroer, Ute Bültmann, Nynke Smidt

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Background: The incidence of metabolic syndrome (MetS) strongly varies by socioeconomic position (SEP), but little is known about the mediating role of health behaviours in this association. This study examines the associations between the SEP measures, education, income and occupational prestige, and incident MetS and whether the associations are mediated by health behaviours, including physical activity, smoking, alcohol intake and diet quality. Methods: A subsample (n = 85,910) of the adult Lifelines Cohort Study without MetS at baseline was used. MetS was measured at the second assessment (median follow-up time 3.8 years) defined according to the NCEP-ATPIII criteria. Direct associations between SEP, health behaviours and incident MetS were estimated using multivariable logistic regression analyses. The mediating percentages of health behaviours explaining the associations between SEP and incident MetS were estimated using the Karlson-Holm-Breen method. Analyses were independent of age, sex, the other SEP measures and follow-up time. Results: Education and occupational prestige were inversely associated with MetS. Income was not associated with MetS. Health behaviours explained only partly (13.8%) the association between education and MetS, with smoking as the strongest mediating factor (8.8%). Health behaviours played also a minor role (2.7%) in explaining occupational MetS differences, with physical activity as the strongest suppressing factor (−9.4%). Conclusion: Individuals with more years of education or a higher occupational prestige had a lower risk to develop MetS. This was mainly because of non-smoking, less excessive alcohol intake and a higher diet quality. However, individuals with a higher SEP were more often physically inactive.

Original languageEnglish
Article number106537
Pages (from-to)1-8
Number of pages8
JournalPreventive Medicine
Volume148
Issue numberJuly
Early online date31 Mar 2021
DOIs
Publication statusPublished - Jul 2021

Bibliographical note

Funding Information:
This work was supported by The Netherlands Organization for Health Research and Development (ZonMw) [grant number 531003011 ]. ZonMw has not been involved in the research process.

Publisher Copyright:
© 2021 The Authors

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

Funding

This work was supported by The Netherlands Organization for Health Research and Development (ZonMw) [grant number 531003011 ]. ZonMw has not been involved in the research process.

Keywords

  • Alcohol drinking
  • Diet
  • Longitudinal studies
  • Mediation
  • Metabolic syndrome
  • Physical activity
  • Smoking
  • Socioeconomic factors

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