Gender differences in the pathways from childhood disadvantage to metabolic syndrome in adulthood: An examination of health lifestyles.

We investigate whether socioeconomic status (SES) in childhood shapes adult health lifestyles in domains of physical activity (leisure, work, chores) and diet (servings of healthy [i.e., nutrient-dense] vs. unhealthy [energy-dense] foods). Physical activity and food choices vary by gender and are key factors in the development of metabolic syndrome (MetS). Thus, we examined gender differences in the intervening role of these behaviors in linking early-life SES and MetS in adulthood. We used survey data (n = 1054) from two waves of the Midlife in the U.S. Study (MIDUS 1 and 2) and biomarker data collected at MIDUS 2. Results show that individuals who were disadvantaged in early life are more likely to participate in physical activity related to work or chores, but less likely to participate in leisure-time physical activity, the domain most consistently linked with health benefits. Women from low SES families were exceedingly less likely to complete recommended amounts of physical activity through leisure. Men from low SES consumed more servings of unhealthy foods and fewer servings of healthy foods. The observed associations between childhood SES and health lifestyles in adulthood persist even after controlling for adult SES. For men, lack of leisure-time physical activity and unhealthy food consumption largely explained the association between early-life disadvantage and MetS. For women, leisure-time physical activity partially accounted for the association, with the direct effect of childhood SES remaining significant. Evidence that material deprivation in early life compromises metabolic health in adulthood calls for policy attention to improve economic conditions for disadvantaged families with young children where behavioral pathways (including gender differences therein) may be shaped. The findings also underscore the need to develop gender-specific interventions in adulthood

Leisure-time, occupational, household physical activity and insulin resistance (HOMAIR) in the Midlife in the United States (MIDUS) national study of adults

Physical activity is a critical cornerstone of successful diabetes prevention and management. Current U.S. physical activity guidelines do not differentiate among physical activity for leisure, work, or other purposes, effectively implying that physical activity in any domain confers the same health benefits. It is currently unknown whether physical activity performed in different domains (leisure-time physical activity = LTPA, occupational physical activity = OPA, and household physical activity = HPA) is associated with insulin resistance. The associations between LTPA, OPA, HPA, and insulin resistance (indexed by homeostatic model assessment of insulin resistance = HOMAIR) were determined in the MIDUS (Midlife in the U.S.; 1995–2006) national study (N = 1229, ages 34–84). Not meeting physical activity guidelines with LTPA was associated with a 34% higher HOMAIR among participants with diabetes, 42% higher HOMAIR among participants with prediabetes, and 17% higher HOMAIR among participants with normal glucoregulation. These associations were slightly attenuated but remained significant after further adjusting for obesity status, education, smoking, and alcohol intake. There was no evidence that engaging in OPA or HPA was significantly associated with HOMAIR. These results confirm the health-promoting role of LTPA and suggest that LTPA may provide unique glucoregulatory benefits, as opposed to HPA and OPA. Physical activity domain is an important dimension that potentially belongs in the guidelines, similarly to intensity, frequency, duration, and type

Depression Amplifies the Influence of Central Obesity on 10-Year Incidence of Diabetes: Findings from MIDUS.

Central obesity is a major risk factor for diabetes but many obese individuals never develop diabetes, suggesting the presence of important effect modifiers. Depression has emerged as a key risk factor for poor glycemic control, but to our knowledge, no previous work has investigated whether depression amplifies the effect of central obesity on glucoregulation.We used a national sample of adults without prevalent diabetes (MIDUS; N = 919) to test for synergy between central obesity and depression in the development of diabetes 10 years later. We found that depression amplified the association of waist-to-hip ratio (WHR) with incident diabetes adjusted for age, race, gender, education, physical activity, and sleep problems (p = 0.01 for test of interaction). The relative risk for incident diabetes per every 0.1 increment in WHR was 1.75 (95% CI: 1.31; 2.33) in those without depression and 3.78 in those with depression (95% CI: 2.14; 6.66).These results confirm the role of depression as a robust risk factor for the development of diabetes and for the first time, demonstrate a synergy between depression and central obesity. Identifying and addressing depression could prove to be an effective approach to preventing diabetes in at risk individuals. Ultimately, elucidating the interplay among risk factors from different domains will be key to understanding multifactorial diseases such as diabetes and informing theory-based, patient-centered interventions aimed at reducing diabetes risk

Descriptive Statistics.

<p>Descriptive Statistics.</p

Waist-to-hip ratio (WHR) and Depression Predict Incident Diabetes and Level of Glucose Dysregulation.

<p>Waist-to-hip ratio (WHR) and Depression Predict Incident Diabetes and Level of Glucose Dysregulation.</p

Model-predicted level of glucose dysregulation levels 10 years later as function of baseline depression (yes/no) and waist-to-hip ratio.

<p>Legend: The effect size reported is the rate ratio at which an individual moves up a level of glucose dysregulation.</p

Childhood Socioeconomic Disadvantage, Occupational, Leisure-Time, and Household Physical Activity, and Diabetes in Adulthood.

BACKGROUND:Regular physical activity is a key way to prevent disease. However, we have a limited understanding of the socioeconomic precursors and glucoregulatory sequelae of engaging in physical activity in different domains. METHODS:We examined the associations among life course socioeconomic disadvantage; meeting the physical activity guidelines with leisure-time physical activity, occupational physical activity, or household physical activity; and prediabetes and diabetes in the Midlife in the United States national study (N = 986). RESULTS:Childhood disadvantage was associated with lower odds of meeting the guidelines with leisure-time physical activity (odds ratio = 0.75; 95% confidence interval, 0.65-0.86). Adulthood disadvantage was associated with higher odds of meeting the guidelines with occupational physical activity (odds ratio = 1.94; 95% confidence interval, 1.49-2.53). Importantly, while meeting the guidelines with leisure-time physical activity was associated with lower odds of prediabetes and diabetes, we found no evidence for associations among occupational physical activity, household physical activity, and glucoregulation. CONCLUSION:Current US physical activity guidelines do not differentiate between physical activity for leisure or work, assuming that physical activity in any domain confers comparable health benefits. We documented important differences in the associations among lifetime socioeconomic disadvantage, physical activity domain, and diabetes, suggesting that physical activity domain potentially belongs in the guidelines, similar to other characteristics of activity (eg, type, intensity)