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Socioeconomic Status, Waist-to-Hip Ratio, and Short-Term Heart Rate Variability in Cambodians with Type 2 Diabetes

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Abstract

Background

Diabetes, adiposity, and socioeconomic status (SES) are all associated with decreased heart rate variability (HRV), a marker of autonomic function predictive of mortality. Cambodians have high rates of diabetes and low SES. How these factors interact to explain HRV has not been examined.

Purpose

The aims of this study were to investigate associations among waist-to-hip ratio, socioeconomic status, and HRV among Cambodians with diabetes.

Method

Sixty patients with type 2 diabetes for ≥1 year, not taking insulin, aged 35–80 years were recruited from the Cambodian Diabetes Association. The 2010 Ministry of Health survey regarding household conditions was used to measure SES. Waist-to-hip ratio was measured two times and averaged. For HRV, beat-to-beat intervals were recorded on ambulatory ECG recorders, and short-term HRV was calculated in the time domain and in the frequency domain using spectral analysis. Cross-sectional data were analyzed using a series of multiple linear regressions using SPSS v21.

Results

Participants were of mean age of 56 years old, 60 % female, with National Glycohemoglobin Standardization Program (NGSP) HbA1c mean = 8.4. Participants were poor (e.g., 18 % did not have flush toilets), had high waist-to-hip ratios (mean = 0.91), and had HRV values below published norms. In linear regression, there was a significant interaction between waist-to-hip ratio and SES explaining HRV in the time domain (standard deviation of the R-R interval (SDNN), beta = .33, t = 2.61, p < .05) and the frequency domain (log transformed very low frequency (Ln VLF), LF, and total power; all p < .05). Among those with lower SES only, higher waist-to-hip ratio was associated with lower HRV. Findings remained significant after controlling for age, sex, and HbA1c.

Conclusion

Central adiposity shows a stronger deleterious association with autonomic tone among individuals with more adverse social conditions.

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Acknowledgments

We thank Peter Gloor, MD for his assistance with this project.

Conflict of interest

Authors Julie Wagner, Lim Keuky, Rachel Lampert, Lorraine Fraser-King, Richard Feinn, Theanvy Kuoch, and Mary Scully declare that they have no conflict of interest.

Ethics

The authors conformed to the Helsinki Declaration concerning human rights and followed correct procedures concerning treatment of human subjects.

Author information

Authors and Affiliations

  1. University of Connecticut Health Center, Farmington, CT, USA

    Julie Wagner

  2. Cambodian Diabetes Association, Siem Reap, Cambodia

    Lim Keuky

  3. Yale University School of Medicine, New Haven, CT, USA

    Rachel Lampert

  4. Cambodian Diabetes Association, Siem Reap, Cambodia

    Lorraine Fraser-King

  5. Quinnipiac University, Hamden, CT, USA

    Richard Feinn

  6. Khmer Health Advocates, West Hartford, CT, USA

    Theanvy Kuoch & Mary Scully

Authors
  1. Julie Wagner
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  2. Lim Keuky
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Correspondence to Julie Wagner.

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Wagner, J., Keuky, L., Lampert, R. et al. Socioeconomic Status, Waist-to-Hip Ratio, and Short-Term Heart Rate Variability in Cambodians with Type 2 Diabetes. Int.J. Behav. Med. 22, 786–791 (2015). https://doi.org/10.1007/s12529-015-9468-0

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