Socio-economic differences in cardiometabolic risk markers are mediated by diet and body fatness in 8- to 11-year-old Danish children: a cross-sectional study

Abstract

Objective: To explore whether socio-economic differences exist in cardiometabolic risk markers in children and whether lifestyle-related factors potentially mediate these differences. Design: Cross-sectional study including measurements of fasting blood lipids, glucose, homeostasis model assessment of insulin resistance (HOMA-IR), blood pressure and heart rate. Potential mediators examined were fat mass index (FMI); intakes of fruit, vegetables, dietary fibre and added sugar; whole-blood n-3 longchain PUFA (LCPUFA) as a biomarker of fish intake; and physical activity and sedentary time. Setting: Nine primary schools in Denmark. Subjects: Children aged 8-11 years (n 715). Results: Children of parents with the shortest compared with longest education had higher TAG by 0·12 (95 % CI 0·04, 0·21) mmol/l and HOMA-IR by 0·36 (0·10, 0·62), whereas children of parents with a vocational education had higher total cholesterol by 0·14 (0·02, 0·27) mmol/l and LDL cholesterol by 0·14 (0·03, 0·25) mmol/l compared with children of parents with the longest education; all P < 0·05. FMI explained 25 % of the difference in TAG, 64 % of the difference in HOMA-IR and 21-29 % of the differences in cholesterols. FMI and whole-blood n-3 LCPUFA combined explained 42 % of the difference in TAG, whereas FMI, whole-blood n-3 LCPUFA and dietary fibre explained 89 % of the difference in HOMA-IR. Conclusions: Socio-economic differences were present in blood lipids and insulin resistance among 8-to 11-year-olds and were mediated by body fatness, wholeblood n-3 LCPUFA and dietary fibre. These lifestyle factors may be targets in public initiatives to reduce socio-economic differences. Confirmation in longitudinal studies and trials is warranted.

Effects and prevalence of responders after a multicomponent intervention on cardiometabolic risk factors in children and adolescents with overweight/obesity: Action for health study

“…The literature regarding interindividual variability in the adaptations to exercise in health outcomes is limited in children and adolescents (Alvarez, Ramírez-Campillo, Ramírez-Vélez, & Izquierdo, 2017b), especially considering a wide range of cardiometabolic risk factors and a multicomponent intervention. Also, we have evaluated children and adolescents of low-income status because some studies have shown a higher IR, a more adverse lipid profile and high rates of overweight among the lowest socioeconomic groups (Hauger et al, 2016;WHO, 2017).…”

Mediation analysis for logistic regression with interactions: Application of a surrogate marker in ophthalmology

“…The marginal models approach may also be useful for carrying out more complex types of mediation analysis [ 21 ], i.e., mediation analysis in observational studies where adjustment for covariates is important and where focus may be on multiple mediators. One such application using linear mixed models used for assessing mediated effects of socio-economic differences in cardio-metabolic risk markers has been reported previously by [ 22 ]. Specifically, these authors fitted linear mixed models of the form: where the random effects in both models ( b 1 and b 2 ) were bivariate normal distributed with mean 0 and a diagonal variance-covariance matrix (reflecting the hierarchical data structure with children in classes nested within schools).…”

“…Specifically, these authors fitted linear mixed models of the form: where the random effects in both models ( b 1 and b 2 ) were bivariate normal distributed with mean 0 and a diagonal variance-covariance matrix (reflecting the hierarchical data structure with children in classes nested within schools). Subsequently, estimated mediated effects for individual and groups of potential mediators with 95% confidence intervals were derived [ 22 ].…”

Obesity mediates the opposite association of education and diabetes in Chinese men and women: Results from the REACTION study

“…Previous studies investigating the education-diabetes association have already identified several possible mediators. [9][10][11] Unhealthy behaviors like obesity, smoking, and depressive symptoms were shown to play a role in this association. 9,12,13 However, few studies assessed the specific mediating effect of each mediator separately.…”