Towards a Parsimonious Pathway Model of Modifiable and Mediating Risk Factors Leading to Diabetes Risk

Yi-Ching Lynn Ho, Vivian Shu Yi Lee, Moon-Ho Ringo Ho, Gladis Jing Lin and Julian Thumboo
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Yi-Ching Lynn Ho: Office of Regional Health, Singapore Health Services, 167 Jalan Bukit Merah, Singapore 150167, Singapore
Vivian Shu Yi Lee: Office of Regional Health, Singapore Health Services, 167 Jalan Bukit Merah, Singapore 150167, Singapore
Moon-Ho Ringo Ho: School of Social Sciences, Nanyang Technological University, 48 Nanyang Ave., Singapore 639818, Singapore
Gladis Jing Lin: Office of Regional Health, Singapore Health Services, 167 Jalan Bukit Merah, Singapore 150167, Singapore
Julian Thumboo: Office of Regional Health, Singapore Health Services, 167 Jalan Bukit Merah, Singapore 150167, Singapore

IJERPH, 2021, vol. 18, issue 20, 1-20

Abstract: Modifiable risk factors are of interest for chronic disease prevention. Few studies have assessed the system of modifiable and mediating pathways leading to diabetes mellitus. We aimed to develop a pathway model for Diabetes Risk with modifiable Lifestyle Risk factors as the start point and Physiological Load as the mediator. As there are no standardised risk thresholds for lifestyle behaviour, we derived a weighted composite for Lifestyle Risk. Physiological Load was based on an index using clinical thresholds. Sociodemographics are non-modifiable risk factors and were specified as covariates. We used structural equation modeling to test the model, first using 2014/2015 data from the Indonesian Family Life Survey. Next, we fitted a smaller model with longitudinal data (2007/2008 to 2014/2015), given limited earlier data. Both models showed the indirect effects of Lifestyle Risk on Diabetes Risk via the mediator of Physiological Load, whereas the direct effect was only supported in the cross-sectional analysis. Specifying Lifestyle Risk as an observable, composite variable incorporates the cumulative effect of risk behaviour and differentiates this study from previous studies assessing it as a latent construct. The parsimonious model groups the multifarious risk factors and illustrates modifiable pathways that could be applied in chronic disease prevention efforts.

Keywords: diabetes; risk factors; modifiable; mediators; lifestyle; physiological; pathways; mediation analysis; structural equation modeling; Indonesia (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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