University of Oulu

Lowry, E., Rautio, N., Karhunen, V., Miettunen, J., Ala-Mursula, L., Auvinen, J., Keinänen-Kiukaanniemi, S., Puukka, K., Prokopenko, I., Herzig, K., Lewin, A., Sebert, S., Järvelin, M. (2018) Understanding the complexity of glycaemic health: systematic bio-psychosocial modelling of fasting glucose in middle-age adults; a DynaHEALTH study. International Journal of Obesity.

Understanding the complexity of glycaemic health : systematic bio-psychosocial modelling of fasting glucose in middle-age adults; a DynaHEALTH study

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Author: Lowry, Estelle1,2; Rautio, Nina1,3; Karhunen, Ville1,4;
Organizations: 1Center for Life Course Health Research, P.O. Box 5000, 90014 University of Oulu, Oulu, Finland
2Biocenter Oulu, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
3Unit of Primary Health Care, Oulu University Hospital, P.O. Box 20 90029 OYS, Oulu, Finland
4Department of Epidemiology and Biostatistics, Imperial College London, St. Mary’s Campus, W2 1PG, London, United Kingdom
5Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, 90014 University of Oulu, Oulu, Finland
6NordLab Oulu, Medical Research Center Oulu, Oulu University Hospital and Department of Clinical Chemistry, University of Oulu, Oulu, Finland
7Section of Genomics of Common Disease, Department of Medicine, Imperial College London, Hammersmith Hospital Campus, Burlington Danes Building, Du Cane Road, London, W12 0NN, UK
8Department of Gastroenterology and Metabolism, Poznan University of Medical Sciences, Poznan, Poland
9Brunel University London, Kingston Lane, Uxbridge, Middlesex, UB8 3PH, United Kingdom
10MRC-PHE Centre for Environment and Health, Imperial College London, Praed Street Wing, St Mary’s Campus, Paddington, W2 IPG, London, United Kingdom
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1 MB)
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Language: English
Published: Springer Nature, 2019
Publish Date: 2019-05-06


Background: The prevention of the risk of type 2 diabetes (T2D) is complicated by multidimensional interplays between biological and psychosocial factors acting at the individual level. To address the challenge we took a systematic approach, to explore the bio-psychosocial predictors of blood glucose in mid-age.

Methods: Based on the 31-year and 46-year follow-ups (5,078 participants, 43% male) of Northern Finland Birth Cohort 1966, we used a systematic strategy to select bio-psychosocial variables at 31 years to enable a data-driven approach. As selection criteria, the variable must be (i) a component of the metabolic syndrome or an indicator of psychosocial health using WHO guidelines, (ii) easily obtainable in general health check-ups and (iii) associated with fasting blood glucose at 46 years (P < 0.10). Exploratory and confirmatory factor analysis were used to derive latent factors, and stepwise linear regression allowed exploration of relationships between factors and fasting glucose.

Results: Of all 26 variables originally considered, 19 met the selection criteria and were included in an exploratory factor analysis. Two variables were further excluded due to low loading (<0.3). We derived four latent factors, which we named as socioeconomic, metabolic, psychosocial and blood pressure status. The combination of metabolic and psychosocial factors, adjusted for sex, provided best prediction of fasting glucose at 46 years (explaining 10.7% of variation in glucose; P < 0.001). Regarding different bio-psychosocial pathways and relationships, the importance of psychosocial factors in addition to established metabolic risk factors was highlighted.

Conclusions: The present study supports evidence for the bio-psychosocial nature of adult glycemic health and exemplifies an evidence-based approach to model the bio-psychosocial relationships. The factorial model may help further research and public health practice in focusing also on psychosocial aspects in maintaining normoglycaemia in the prevention of cardio-metabolic diseases.

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Series: International journal of obesity
ISSN: 0307-0565
ISSN-E: 1476-5497
ISSN-L: 0307-0565
Volume: 43
Issue: 6
Pages: 1181 - 1192
DOI: 10.1038/s41366-018-0175-1
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 633595.
EU Grant Number: (633595) DYNAHEALTH - Understanding the dynamic determinants of glucose homeostasis and social capability to promote Healthy and active aging
Copyright information: © The Author(s) 2018. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit