PMID- 32636120
OWN - NLM
STAT- MEDLINE
DCOM- 20201110
LR  - 20201110
IS  - 1590-3729 (Electronic)
IS  - 0939-4753 (Linking)
VI  - 30
IP  - 10
DP  - 2020 Sep 24
TI  - The contribution of physical inactivity and socioeconomic factors to type 2 
      diabetes in Nepal: A structural equation modelling analysis.
PG  - 1758-1767
LID - S0939-4753(20)30230-1 [pii]
LID - 10.1016/j.numecd.2020.06.003 [doi]
AB  - BACKGROUND AND AIM: Type 2 diabetes mellitus (T2DM) is emerging as a significant 
      public health challenge in Nepal. Behavioural, social and economic changes are 
      likely to play a part in the rise of this chronic disease, as they are in many 
      developing countries. A better understanding of the relationship between physical 
      activity (PA), socioeconomic factors and T2DM can inform the design of prevention 
      programs. This study aimed to identify the path relationships between PA, 
      socioeconomic position, anthropometric and metabolic variables and T2DM. METHODS 
      AND RESULTS: This study analysed data from 1977 Nepalese adults aged 40-69 years 
      from the cross-sectional WHO STEPS survey undertaken in 2013. The latent variable 
      "PA" was created using the information on domains of PA while the latent variable 
      "socioeconomic position" was created using the variables education, occupation 
      and ethnicity. Participants' fasting blood glucose was used to determine their 
      diabetes status. Structural equation modelling was conducted, and correlations 
      and adjusted regression coefficients are reported. Individuals with higher 
      education, in paid employment and from advantaged ethnic groups were more likely 
      to have T2DM. Waist circumference, triglycerides and hypertension were found to 
      have a statistically significant positive direct effect on T2DM. PA had indirect 
      effects on T2DM, mediated by waist circumference. The indirect effects of 
      socioeconomic position on T2DM were mediated by body mass index, waist 
      circumference, triglycerides and total cholesterol. CONCLUSION: Among Nepalese 
      adults, higher socioeconomic position had a significant direct effect on T2DM, 
      while both PA and higher socioeconomic position had significant indirect effects. 
      Policies and programs to address T2DM in Nepal should address the factors 
      contributing to unhealthy weight status, particularly among those of higher 
      socioeconomic status.
CI  - Copyright (c) 2020 The Italian Diabetes Society, the Italian Society for the Study 
      of Atherosclerosis, the Italian Society of Human Nutrition and the Department of 
      Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. 
      All rights reserved.
FAU - Paudel, Susan
AU  - Paudel S
AD  - School of Public Health and Preventive Medicine, Monash University, Melbourne, 
      Australia. Electronic address: susan.paudelsubedi@monash.edu.
FAU - Tran, Thach
AU  - Tran T
AD  - School of Public Health and Preventive Medicine, Monash University, Melbourne, 
      Australia.
FAU - Owen, Alice J
AU  - Owen AJ
AD  - School of Public Health and Preventive Medicine, Monash University, Melbourne, 
      Australia.
FAU - Smith, Ben J
AU  - Smith BJ
AD  - School of Public Health and Preventive Medicine, Monash University, Melbourne, 
      Australia; Sydney School of Public Health, The University of Sydney, Sydney, 
      Australia.
LA  - eng
PT  - Journal Article
DEP - 20200613
PL  - Netherlands
TA  - Nutr Metab Cardiovasc Dis
JT  - Nutrition, metabolism, and cardiovascular diseases : NMCD
JID - 9111474
RN  - 0 (Biomarkers)
RN  - 0 (Triglycerides)
RN  - 97C5T2UQ7J (Cholesterol)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Biomarkers/blood
MH  - Body Mass Index
MH  - Cholesterol/blood
MH  - Cross-Sectional Studies
MH  - Diabetes Mellitus, Type 2/diagnosis/*epidemiology
MH  - Dyslipidemias/diagnosis/epidemiology
MH  - Educational Status
MH  - Employment
MH  - Female
MH  - Health Surveys
MH  - Humans
MH  - Income
MH  - Male
MH  - Middle Aged
MH  - *Models, Theoretical
MH  - Nepal/epidemiology
MH  - Obesity/diagnosis/epidemiology
MH  - Risk Assessment
MH  - Risk Factors
MH  - *Sedentary Behavior
MH  - Social Class
MH  - *Social Determinants of Health
MH  - *Socioeconomic Factors
MH  - Triglycerides/blood
MH  - Waist Circumference
OTO - NOTNLM
OT  - Nepal
OT  - Physical activity
OT  - STEPS survey
OT  - Socioeconomic position
OT  - Structural equation modelling
OT  - Type 2 diabetes mellitus
COIS- Declaration of Competing Interest The authors declare that they have no financial 
      and non-financial competing interests.
EDAT- 2020/07/09 06:00
MHDA- 2020/11/11 06:00
CRDT- 2020/07/09 06:00
PHST- 2020/01/12 00:00 [received]
PHST- 2020/06/02 00:00 [revised]
PHST- 2020/06/02 00:00 [accepted]
PHST- 2020/07/09 06:00 [pubmed]
PHST- 2020/11/11 06:00 [medline]
PHST- 2020/07/09 06:00 [entrez]
AID - S0939-4753(20)30230-1 [pii]
AID - 10.1016/j.numecd.2020.06.003 [doi]
PST - ppublish
SO  - Nutr Metab Cardiovasc Dis. 2020 Sep 24;30(10):1758-1767. doi: 
      10.1016/j.numecd.2020.06.003. Epub 2020 Jun 13.