Department of Endocrinology and Metabolism, Zhongshan City People's Hospital, 2 East Sunwen Road, Zhongshan, 528403, Guangdong, China.
Department of Rehabilitation, Zhongshan City People's Hospital, 2 East Sunwen Road, Zhongshan, 528403, Guangdong, China.
Acta Diabetol. 2021 May;58(5):567-574. doi: 10.1007/s00592-020-01647-w. Epub 2021 Jan 6.
Observational studies have reported a negative association between educational attainment and type 2 diabetes (T2D), but the causality remains largely unknown. The aim of this study is to investigate the potential causal effect of educational attainment on T2D and whether such an effect is independent of cognitive performance.
We conducted two-sample Mendelian randomization (MR) analysis using genetic variants strongly associated with educational attainment and cognitive performance to estimate the causal associations with T2D, among 61,714 T2D cases and 593,952 controls. We also performed multivariable MR to explore the independent effects of educational attainment and cognitive performance on T2D risk.
In univariable MR, we found evidence that genetically predicted higher educational attainment [odds ratio (OR) 0.53 per 1-standard deviation (SD) increase; 95% confidence interval (CI) 0.47-0.60] and cognitive performance (OR 0.79 per 1-SD increase; 95%CI 0.69-0.91) were related to decreased risk of T2D. Our further multivariable MR results suggested that more years of education led to a reduced likelihood of T2D independently of cognitive performance (OR 0.52; 95%CI 0.42-0.64). However, the protective effect of cognitive performance on T2D was attenuated once educational attainment was controlled for (OR 1.08; 95%CI 0.88-1.32).
We provided evidence to suggest that educational attainment protects against T2D independently of cognitive performance, but does not support a negative causal association between cognitive performance and T2D independently of educational attainment. Education might represent a potential target for intervention to battle type 2 diabetes risk.
观察性研究报告称，教育程度与 2 型糖尿病（T2D）之间呈负相关，但因果关系仍知之甚少。本研究旨在探讨教育程度对 T2D 的潜在因果影响，以及这种影响是否独立于认知表现。
我们使用与教育程度和认知表现高度相关的遗传变异进行两样本孟德尔随机化（MR）分析，以估计在 61714 例 T2D 病例和 593952 例对照中，教育程度与 T2D 之间的因果关系。我们还进行了多变量 MR 分析，以探讨教育程度和认知表现对 T2D 风险的独立影响。
在单变量 MR 中，我们发现有证据表明，遗传预测的较高教育程度[每增加 1 个标准差（SD）的比值比（OR）为 0.53；95%置信区间（CI）为 0.47-0.60]和认知表现（OR 每增加 1-SD 增加 0.79；95%CI 为 0.69-0.91）与 T2D 风险降低相关。我们进一步的多变量 MR 结果表明，受教育年限的增加与认知表现无关，独立于认知表现降低 T2D 的可能性（OR 0.52；95%CI 0.42-0.64）。然而，一旦控制了教育程度，认知表现对 T2D 的保护作用就会减弱（OR 1.08；95%CI 0.88-1.32）。
我们提供的证据表明，教育程度独立于认知表现保护人们免受 T2D 的侵害，但不支持认知表现与 T2D 之间存在独立于教育程度的负因果关系。教育可能是对抗 2 型糖尿病风险的一个潜在干预目标。
