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Untangling pathways of risk factors associated with hypertension among dysglycemia adults in eastern China: a structural equation model approach

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Abstract

Background and aims

Using structural equation model (SEM) to test a conceptual model of pathways of developing hypertension among dysglycemia (IFG and T2DM) adults in Eastern China, emphasizing the unique mediation effect of insulin resistance and obesity on the relationship between modified/unmodified factors and hypertension.

Methods and results

Participants with dysglycemia (n = 10,401) were extracted from the survey of Chronic Disease and Risk Factor Surveillance in Nanjing, the capital of Jiangsu Province in China. Dietary patterns were identified by using principal component analysis (PCA). SEM was employed to evaluate multiple pathways of hypertension among participants with IFG and T2DM. Three dietary patterns were derived using PCA. The tuber animal food pattern (OR = 0.825, 95% CI 0.723–0.940) and the balanced food pattern (OR = 0.812, 95% CI 0.715–0.922) were negatively associated with hypertension, while the Chinese rural food pattern (OR = 1.163, 95% CI 1.019–1.328) was positively associated with hypertension. The best SEM model showed that BMI (0.140), smoking (0.048) and Chinese rural food pattern (0.022) positively associated with hypertension; while tuber animal food pattern (− 0.025) had a negative direct effect on hypertension. Notably, insulin resistance could mediate the link between lifestyles (smoking and dietary patterns) and hypertension.

Conclusion

Accordingly, we emphasized the importance of lifestyle intervention, mainly including obesity management, choosing healthy diets and decreasing smoking control, which may profoundly benefit this high-risk group among Chinese population.

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Data availability

The data were not publicly available due to privacy or ethical restrictions.

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Acknowledgements

We give thanks to all the dedicated fieldworkers who have been involved in the surveys and all participants who have facilitated the survey implementation at each community.

Funding

This study was supported by Nanjing Medical Science and Technique Development Foundation, China (ZKX18049; ZKX21054). The funders played no roles.

Author information

Author notes

  1. Yichao Chen and Yingqian Song have contributed equally for this work.

Authors and Affiliations

  1. Department of Noncommunicable Disease Prevention, Nanjing Medical University Affiliated Nanjing Center for Disease Control and Prevention, No. 2 Zi’ZhuLin, Nanjing, 210003, China

    Yichao Chen, Yingqian Song, Xin Hong, Jinling Du, Weiwei Wang & Nan Zhou

  2. Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China

    Yichao Chen, Yingqian Song, Xin Hong, Jinling Du & Nan Zhou

Authors
  1. Yichao Chen
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  2. Yingqian Song
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  3. Xin Hong
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  4. Jinling Du
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  5. Weiwei Wang
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  6. Nan Zhou
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Contributions

YS and YC conceived the study and edited the manuscript. YC conducted data analyses and drafted the manuscript. XH organized and supervised the whole survey. JD, XH, NZ, and WW contributed to the project administration. All authors read and approved the final manuscript. All authors take responsibility for the integrity and accuracy of the data.

Corresponding author

Correspondence to Nan Zhou.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval and consent to participate

The study was approved by the academic ethics committee of Nanjing Municipal Center for Disease Control and Prevention (approval number: PJ2017-B001-01).

Informed consent

All participants were informed and signed the informed consent in this study.

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Chen, Y., Song, Y., Hong, X. et al. Untangling pathways of risk factors associated with hypertension among dysglycemia adults in eastern China: a structural equation model approach. Acta Diabetol 61, 587–597 (2024). https://doi.org/10.1007/s00592-024-02236-x

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  • DOI: https://doi.org/10.1007/s00592-024-02236-x

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