Associations of polysocial risk score, lifestyle and genetic factors with incident type 2 diabetes: a prospective cohort study,Diabetologia

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Associations of polysocial risk score, lifestyle and genetic factors with incident type 2 diabetes: a prospective cohort study
Diabetologia ( IF 8.2 ) Pub Date : 2022-07-21 , DOI: 10.1007/s00125-022-05761-y
Yimin Zhao ₁ , Yueying Li ₁ , Zhenhuang Zhuang ₁ , Zimin Song ₁ , Wenxiu Wang ₁ , Ninghao Huang ₁ , Xue Dong ₁ , Wendi Xiao ₁ , Jinzhu Jia ₂ , Zhonghua Liu ₃ , Duo Li _{4,

5} , Tao Huang _{1,

6,

7}

Affiliation

Aim/hypothesis

We aimed to investigate the association between polysocial risk score (PsRS), an estimator of individual-level exposure to cumulative social risks, and incident type 2 diabetes in the UK Biobank study.

Methods

This study includes 319,832 participants who were free of diabetes, cardiovascular disease and cancer at baseline in the UK Biobank study. The PsRS was calculated by counting the 12 social determinants of health from three social risk domains (namely socioeconomic status, psychosocial factors, and neighbourhood and living environment) that had a statistically significant association with incident type 2 diabetes after Bonferroni correction. A healthy lifestyle score was calculated using information on smoking status, alcohol intake, physical activity, diet quality and sleep quality. A genetic risk score was calculated using 403 SNPs that showed significant genome-wide associations with type 2 diabetes in people of European descent. The Cox proportional hazards model was used to analyse the association between the PsRS and incident type 2 diabetes.

Results

During a median follow-up period of 8.7 years, 4427 participants were diagnosed with type 2 diabetes. After adjustment for major confounders, an intermediate PsRS (4–6) and high PsRS (≥7) was associated with higher risks of developing type 2 diabetes with the HRs being 1.38 (95% CI 1.26, 1.52) and 2.02 (95% CI 1.83, 2.22), respectively, compared with those with a low PsRS (≤3). In addition, an intermediate to high PsRS accounted for approximately 34% (95% CI 29, 39) of new-onset type 2 diabetes cases. A healthy lifestyle slightly, but significantly, mitigated PsRS-related risks of type 2 diabetes (p_interaction=0.030). In addition, the additive interactions between PsRS and genetic predisposition led to 15% (95% CI 13, 17; p<0.001) of new-onset type 2 diabetes cases (p_interaction<0.001).

Conclusions/interpretation

A higher PsRS was related to increased risks of type 2 diabetes. Adherence to a healthy lifestyle may attenuate elevated diabetes risks due to social vulnerability. Genetic susceptibility and disadvantaged social status may act synergistically, resulting in additional risks for type 2 diabetes.

Graphical abstract

中文翻译：

多社会风险评分、生活方式和遗传因素与 2 型糖尿病的关联：一项前瞻性队列研究

目标/假设

我们旨在调查多社会风险评分 (PsRS) 与英国生物银行研究中 2 型糖尿病事件之间的关联，PsRS 是个体水平暴露于累积社会风险的估计量。

方法

这项研究包括 319,832 名参与者，他们在 UK Biobank 研究的基线时没有患糖尿病、心血管疾病和癌症。PsRS 是通过计算来自三个社会风险领域（即社会经济地位、心理社会因素以及邻里和生活环境）的 12 个健康社会决定因素来计算的，这些因素在 Bonferroni 校正后与 2 型糖尿病事件具有统计学显着相关性。使用有关吸烟状况、饮酒量、身体活动、饮食质量和睡眠质量的信息计算出健康生活方式评分。使用 403 个 SNP 计算遗传风险评分，这些 SNP 显示与欧洲人后裔的 2 型糖尿病有显着的全基因组关联。Cox 比例风险模型用于分析 PsRS 与 2 型糖尿病事件之间的关联。

结果

在 8.7 年的中位随访期间，4427 名参与者被诊断出患有 2 型糖尿病。调整主要混杂因素后，中等 PsRS (4-6) 和高 PsRS (≥7) 与更高的 2 型糖尿病风险相关，HR 分别为 1.38 (95% CI 1.26, 1.52) 和 2.02 (95% CI) 1.83, 2.22)，分别与低 PsRS (≤3) 的患者相比。此外，中度至高度 PsRS 约占新发 2 型糖尿病病例的 34% (95% CI 29, 39)。健康的生活方式略微但显着地减轻了 2 型糖尿病的 PsRS 相关风险（p_相互作用=0.030）。此外，PsRS 与遗传易感性之间的累加相互作用导致 15%（95% CI 13、17；p <0.001）的新发 2 型糖尿病病例（p_相互作用<0.001)。