van Etten Soraya, Crielaard Loes, Muilwijk Mirthe, van Valkengoed Irene, Snijder Marieke B, Stronks Karien, Nicolaou Mary
Amsterdam UMC, Univ of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, Meibergdreef 9, PO Box 11660, Amsterdam 1100 DD, Netherlands.
Prev Med. 2020 Aug;137:106141. doi: 10.1016/j.ypmed.2020.106141. Epub 2020 May 23.
Little is known about how health-related behaviours cluster across different populations and how lifestyle clusters are associated with type 2 diabetes (T2D) risk. We investigated lifestyle clusters and their association with T2D in a multi-ethnic population. 4396 Dutch, 2850 South-Asian Surinamese, 3814 African Surinamese, 2034 Ghanaian, 3328 Turkish, and 3661 Moroccan origin participants of the HELIUS study were included (2011-2015). K-medoids cluster analyses were used to identify lifestyle clusters. Logistic and cox regression analyses were performed to investigate the association of clusters with prevalent and incident T2D, respectively. Pooled analysis revealed three clusters: a 'healthy', 'somewhat healthy', and 'unhealthy' cluster. Most ethnic groups were unequally distributed: Dutch participants were mostly present in the 'healthy' cluster, Turkish and Moroccan participants in the 'somewhat healthy' cluster, while the Surinamese and Ghanaian participants were equally distributed across clusters. When stratified for ethnicity, analysis revealed three clusters per ethnic group. While the 'healthy' and 'somewhat healthy' clusters were similar to those of the pooled analysis, we observed considerable differences in the ethnic-specific 'unhealthy' clusters. Fruit consumption (3-4 days/week) was the only behaviour that was consistent across all ethnic-specific 'unhealthy' clusters. The pooled 'unhealthy' cluster was positively associated with prediabetes (OR: 1.34, 95%CI 1.21-1.48) and incident T2D (OR: 1.23, 95%CI 0.89-1.69), and negatively associated with prevalent T2D (OR: 0.80, 95%CI 0.69-0.93). Results were similar for most, but not all, ethnic-specific clusters. This illustrates that targeting multiple behaviours is relevant in prevention of T2D but that ethnic differences in lifestyle clusters should be taken into account.
对于不同人群中与健康相关的行为如何聚集，以及生活方式集群与2型糖尿病（T2D）风险之间的关联，我们所知甚少。我们在一个多民族人群中调查了生活方式集群及其与T2D的关联。纳入了HELIUS研究中4396名荷兰裔、2850名南亚苏里南人、3814名非洲苏里南人、2034名加纳人、3328名土耳其人和3661名摩洛哥裔参与者（2011 - 2015年）。采用K-中心点聚类分析来识别生活方式集群。分别进行逻辑回归和Cox回归分析，以研究集群与T2D患病率和发病率之间的关联。汇总分析揭示了三个集群：“健康”、“较为健康”和“不健康”集群。大多数种族群体分布不均：荷兰参与者大多在“健康”集群中，土耳其和摩洛哥参与者在“较为健康”集群中，而苏里南和加纳参与者在各集群中分布均匀。按种族分层分析时，每个种族群体都揭示出三个集群。虽然“健康”和“较为健康”集群与汇总分析中的类似，但我们观察到特定种族的“不健康”集群存在相当大的差异。水果消费（每周3 - 4天）是所有特定种族的“不健康”集群中唯一一致的行为。汇总的“不健康”集群与糖尿病前期（OR：1.34，95%CI 1.21 - 1.48）以及T2D发病率（OR：1.23，95%CI 0.89 - 1.69）呈正相关，与T2D患病率呈负相关（OR：0.80，95%CI 0.69 - 0.93）。大多数但并非所有特定种族的集群结果相似。这表明针对多种行为进行干预对于预防T2D很重要，但应考虑生活方式集群中的种族差异。
