Racial and ethnic disparities in predictors of glycemia: a moderated mediation analysis of inflammation-related predictors of diabetes in the NHANES 2007–2010,Nutrition & Diabetes

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Racial and ethnic disparities in predictors of glycemia: a moderated mediation analysis of inflammation-related predictors of diabetes in the NHANES 2007–2010
Nutrition & Diabetes ( IF 4.6 ) Pub Date : 2018-10-22 , DOI: 10.1038/s41387-018-0064-7
Sarah Nowlin ₁ , Charles M Cleland ₂ , Niyati Parekh ₃ , Holly Hagan ₄ , Gail Melkus ₅

Affiliation

Background/Objective

Racial/ethnic disparities in type 2 diabetes (T2D) outcomes exist, and could be explained by nutrition- and inflammation-related differences. The objective of this study is to identify associations between race/ethnicity and glucose control among participants from NHANES 2007–2010, as influenced by diet quality, body mass, and inflammation and grouped by T2D status.

Subjects/Methods

The following is a cross-sectional, secondary data analysis of two NHANES data cycles spanning 2007–2010. The association between race/ethnicity and hemoglobin A1c (HbA1c) as mediated by dietary intake score, body mass index (BMI), and C-reactive protein (CRP) was assessed, as was the strength of the difference of that association, or moderation, by T2D status. The sample included n = 7850 non-pregnant adult participants ≥ 20 years of age who had two days of reliable dietary recall data, and no missing data on key variables included in the analysis. The primary outcome examined was HbA1c.

Results

The model accurately explained the variation in HbA1c measures in participants without T2D, as mediated by diet quality, BMI, and CRP. However, significant variation in HbA1c remained after accounting for aforementioned mediators when contrasting non-Hispanic White to non-Hispanic Black participants without T2D. The model was not a good fit for explaining racial/ethnic disparities in HbA1c in participants with T2D. A test of the index of moderated mediation for this model was not significant for the differences in the effect of race/ethnicity on HbA1c by T2D status (moderator).

Conclusions

This study demonstrated that diet quality, BMI, and CRP mediated the effect of race/ethnicity on HbA1c in persons without T2D, but not in persons with T2D. Further research should include additional inflammatory markers, and other inflammation- and T2D-related health outcomes, and their association with racial/ethnic disparities in diabetes.

中文翻译：

血糖预测因子的种族和民族差异：2007-2010 年 NHANES 中糖尿病炎症相关预测因子的调节中介分析

背景/目标

2 型糖尿病 (T2D) 结局存在种族/民族差异，这可以通过营养和炎症相关差异来解释。本研究的目的是确定 2007-2010 年 NHANES 参与者的种族/民族与血糖控制之间的关联，该关联受饮食质量、体重和炎症的影响，并按 T2D 状态分组。

主题/方法

以下是对 2007 年至 2010 年两个 NHANES 数据周期的横截面二次数据分析。评估了由饮食摄入评分、体重指数 (BMI) 和 C 反应蛋白 (CRP) 介导的种族/民族与糖化血红蛋白 (HbA1c) 之间的关联，以及该关联差异的强度或调节程度，按 T2D 状态。该样本包括n = 7850 名 ≥ 20 岁的非怀孕成人参与者，他们拥有两天可靠的饮食回忆数据，并且分析中包含的关键变量没有缺失数据。检查的主要结果是 HbA1c。

结果

该模型准确地解释了非 T2D 参与者的 HbA1c 测量值的变化，该变化是由饮食质量、BMI 和 CRP 介导的。然而，在将非西班牙裔白人与没有 T2D 的非西班牙裔黑人参与者进行对比时，考虑上述中介因素后，HbA1c 仍存在显着差异。该模型不太适合解释 T2D 参与者 HbA1c 的种族/民族差异。对于该模型的调节中介指数测试，对于种族/民族对 T2D 状态（调节器）HbA1c 影响的差异并不显着。