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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.
Nutr Diabetes 2018; 8(1):56ND

Abstract

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.

Authors+Show Affiliations

Postdoctoral Fellow, New York University Rory Meyers College of Nursing, 433 First Avenue, 7th Floor, New York, NY, 10010, USA. syn216@nyu.edu.New York University Rory Meyers College of Nursing, 433 First Avenue, 7th Floor Room 737, New York, NY, 10010, USA.New York University Global Public Health 715-719 Broadway Room 1220, New York, NY, 10003, USA.New York University Rory Meyers College of Nursing, 433 First Avenue, 7th Floor Room 752, New York, NY, 10010, USA.New York University Rory Meyers College of Nursing, 433 First Avenue, 7th Floor Room 744, New York, NY, 10010, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

30348948

Citation

Nowlin, Sarah, et al. "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, vol. 8, no. 1, 2018, p. 56.
Nowlin S, Cleland CM, Parekh N, et al. Racial and ethnic disparities in predictors of glycemia: a moderated mediation analysis of inflammation-related predictors of diabetes in the NHANES 2007-2010. Nutr Diabetes. 2018;8(1):56.
Nowlin, S., Cleland, C. M., Parekh, N., Hagan, H., & Melkus, G. (2018). 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, 8(1), p. 56. doi:10.1038/s41387-018-0064-7.
Nowlin S, et al. Racial and Ethnic Disparities in Predictors of Glycemia: a Moderated Mediation Analysis of Inflammation-related Predictors of Diabetes in the NHANES 2007-2010. Nutr Diabetes. 2018 10 22;8(1):56. PubMed PMID: 30348948.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Racial and ethnic disparities in predictors of glycemia: a moderated mediation analysis of inflammation-related predictors of diabetes in the NHANES 2007-2010. AU - Nowlin,Sarah, AU - Cleland,Charles M, AU - Parekh,Niyati, AU - Hagan,Holly, AU - Melkus,Gail, Y1 - 2018/10/22/ PY - 2018/04/16/received PY - 2018/10/02/accepted PY - 2018/09/10/revised PY - 2018/10/24/entrez PY - 2018/10/24/pubmed PY - 2019/4/2/medline SP - 56 EP - 56 JF - Nutrition & diabetes JO - Nutr Diabetes VL - 8 IS - 1 N2 - 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. SN - 2044-4052 UR - https://www.unboundmedicine.com/medline/citation/30348948/Racial_and_ethnic_disparities_in_predictors_of_glycemia:_a_moderated_mediation_analysis_of_inflammation_related_predictors_of_diabetes_in_the_NHANES_2007_2010_ L2 - http://dx.doi.org/10.1038/s41387-018-0064-7 DB - PRIME DP - Unbound Medicine ER -