A Comparison of Biological, Physical, and Psychological Risk Factors for Cardiovascular Disease In Overweight/Obese Individuals With and Without Prediabetes Open Access
Liu, Tingting (2015)
Background: Poor lifestyle choices, coupled with the obesity epidemic, have dramatically increased the number of adults living with prediabetes. Compared with type 2 diabetes, much less is known about the effects of prediabetes on biological, physical, and psychological risk factors that heighten adverse cardiovascular disease (CVD) outcomes among overweight/obese adults. The primary aim of the study was to compare baseline biological, physical, and psychological risk factors for CVD among overweight/obese adults with and without prediabetes. Methods: A secondary data analysis was performed using a large database of healthy adults employed at an academic health sciences center located in the southeastern United States. Baseline biological, physical and psychological risk factors were included in the analysis. Linear or logistic regression models were used to evaluate the association between prediabetes and biological, physical, and psychological risk factors, controlling for age, gender and education. Results: Three hundred forty one overweight/obese participants were included in the analysis: 44 had prediabetes (fasting blood glucoseâ‰¥100 but <126 mg/dl) 297 were without prediabetes. Participant median age with and without prediabetes was 55 and 48 (p<0.0001), respectively. The majority of participants were Caucasian (69.5%), high income (median income $100,000-$150,000), and well-educated (median education level 18 years). There were significant differences for several baseline biological risk factors among prediabetics versus nonprediabetics and included higher fasting blood glucose (104.8 vs 86.3 mg/dl, p<0.0001), body mass index (31.2 vs 28.8 kg/m2, p<0.017), waist-hip ratio (0.9 vs 0.8, p=0.014), triglycerides (111 vs 91 mg/dl, p=0.0002). Prediabetics were also more likely to be insulin resistant (47.7% vs 14.1%, p<0.0001) than nonprediabetics. Among the baseline physical risk factors examined, participants with prediabetes had much lower cardiorespiratory fitness than those without prediabetes (28.5 vs 32 ml/kg/min, p=0.029). Participants with prediabetes were also more likely to have lower self-reported physical functioning (53.8 vs 49.9, p=0.003). No differences in baseline psychological risk factors were observed between groups. Conclusions: Findings from this study suggest that healthy overweight/obese adults with prediabetes were likely at higher biological and physical risk for CVD at baseline compared to those without prediabetes. Early intervention to improve CVD risk progression among persons with prediabetes is essential.
Table of Contents
Table of Contents Chapter 1. Statement of the Problem 1 Introduction 1 Background 1 Purpose of the Study 8 Significance of the Study 10 Summary 11 Chapter 2. Review of the Literature 12 Introduction 12 Epidemiology of Type 2 Diabetes Mellitus and Prediabetes 12 Lifestyle Interventions and Type 2 Diabetes Mellitus Prevention 16 Prediabetes and Cardiovascular Disease 20 Prediabetes as an Independent Risk Factor for Cardiovascular Disease 20 Mechanisms of Vascular Damage of Prediabetes 23 Conceptual Framework 23 Overview 23 Theoretical Assumptions 26 Age 28 Gender 28 Educational Level 29 Overweight/Obesity 30 Biological Risk Factors 35 Physical Risk Factors 48 Psychological Risk Factors 54 Health Outcomes 57 Summary 77 Chapter 3. Methodology 79 Introduction 79 Research Design 79 Design 79 Setting and Sample 83 Sample Size and Power Calculation 85 Variables, Definitions, and Measures 86 Overview 87 Conceptual and Operational Definitions (Instruments) 87 Statistical Analysis 93 Summary 96 Chapter 4. Results 98 Baseline Sample Characteristics 98 Baseline Sample Characteristics by Prediabetic State 98 Baseline Characteristics of Biological, Physical, and Psychological Risk Factors 99 Baseline Characteristics of Biological Risk Factors 99 Differences in Biological Risk Factors Between Participants With and Without Prediabetes at Baseline 101 Baseline Characteristics of Physical Risk Factors 102 Baseline Characteristics of Psychological Risk Factors 103 Differences in Physical and Psychological Risk Factors Between Participants With and Without Prediabetes at Baseline 104 Changes in Biological, Physical, and Psychological Risk Factors At One-Year Follow-up Visit 105 Changes in Biological Risk Factors at One-Year Follow-up Visit 105 Compare Changes in Biological Risk Factors at One-Year Follow-up Visit Between Those With and Without Prediabetes 111 Changes in Physical Risk Factors at One-Year Follow-up Visit 112 Compare Changes in Physical Risk Factors at One-Year Follow-up Visit Between Those With and Without Prediabetes 114 Changes in Psychological Risk Factors at One-Year Follow-up Visit 115 Compare Changes in Psychological Risk Factors at One-Year Follow-up Visit Between Those With and Without Prediabetes 117 Checking for Multicollinearity Assumptions 118 Chapter 5. Discussion 119 Introduction 119 Summary of Major Findings 119 Comparison to Findings of Previous Literature/Research 120 Strengths of the Study 140 Limitations of the Study 141 Recommendations for Future Research 144 Implications for Clinical Practice 147 Conclusions 148 Appendices 151 Appendix A. Mechanisms of Vascular Damage in Prediabetes 151 Appendix B. Literature Review Table 162 Appendix C. Underlying Pathophysiological Mechanisms Associated With Dyslipidemia 184 Appendix D. Study Approval from the Institutional Review Board 186 Appendix E. Checking for Multicollinearity Assumptions 187 Appendix F. Copies of the Study Instruments 193 Beck Depression Inventory-II 193 CAPS Typical Week Physical Activity Questionnaire 197 References 202
About this Dissertation
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