BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
BMJ Open. 2021 Jul 30;11(7):e050493. doi: 10.1136/bmjopen-2021-050493.
Overweight and obesity (OWOB) is a modifiable risk factor for both hypertension and diabetes. However, the association between OWOB and diabetes among Bangladeshi adults and how hypertension may mediate this relationship are not well explored. This study aimed to examine (1) whether OWOB is independently associated with diabetes among Bangladeshi adults, (2) whether this association is mediated by hypertension, and (3) the effect modification by wealth status and place of residence in the relationships.
We used data of 9305 adults aged ≥18 years from the most recent nationally representative cross-sectional study of Bangladesh Demographic and Health Survey 2017-2018. Design-based logistic regression was used to assess the association between OWOB and diabetes, and counterfactual framework-based weighting approach was used to evaluate the mediation effect of hypertension in the OWOB-diabetes relationship. We used stratified analyses for the effect modifications.
The prevalence of OWOB, diabetes and hypertension was 48.5%, 11.7% and 30.3%, respectively. We observed a significant association between OWOB and diabetes and a mediating role of hypertension in the OWOB-diabetes association. The odds of diabetes was 51% higher among adults with OWOB than those without OWOB (adjusted OR: 1.51, 95% CI 1.29 to 1.77). We observed that 18.64% (95% CI 9.84% to 34.07%) of the total effect of OWOB on the higher odds of diabetes was mediated through hypertension, and the mediation effect was higher among adults from non-poor households and from both rural and urban areas.
Adult OWOB status is independently associated with diabetes in Bangladesh, and hypertension mediates this association. Therefore, prevention policies should target adults with both OWOB and hypertension, particularly those from non-poor households and from both rural and urban areas, to reduce the growing burden of diabetes and its associated risk.
超重和肥胖（OWOB）是高血压和糖尿病的可改变风险因素。然而，OWOB 与孟加拉国成年人糖尿病之间的关系以及高血压如何介导这种关系尚未得到充分探索。本研究旨在检验：（1）OWOB 是否与孟加拉国成年人糖尿病独立相关；（2）这种关联是否通过高血压介导；以及（3）财富状况和居住地在这些关系中的调节作用。
我们使用了 2017-2018 年孟加拉国最新的全国代表性横断面研究——孟加拉国人口与健康调查的数据，该调查涵盖了 9305 名年龄在 18 岁及以上的成年人。我们采用基于设计的逻辑回归来评估 OWOB 与糖尿病之间的关联，并采用基于反事实框架的加权方法来评估高血压在 OWOB 与糖尿病关系中的中介作用。我们进行了分层分析以检验调节作用。
OWOB、糖尿病和高血压的患病率分别为 48.5%、11.7%和 30.3%。我们观察到 OWOB 与糖尿病之间存在显著关联，高血压在 OWOB 与糖尿病的关联中起中介作用。与无 OWOB 的成年人相比，OWOB 成年人患糖尿病的几率高出 51%（调整后的比值比：1.51，95%置信区间 1.29 至 1.77）。我们发现，OWOB 对糖尿病高发病的总效应的 18.64%（95%置信区间 9.84%至 34.07%）是通过高血压介导的，而这种中介效应在来自非贫困家庭和来自农村和城市地区的成年人中更高。
在孟加拉国，成年人的 OWOB 状况与糖尿病独立相关，高血压介导了这种关联。因此，预防政策应针对同时患有 OWOB 和高血压的成年人，特别是来自非贫困家庭和农村及城市地区的成年人，以减轻糖尿病及其相关风险日益增加的负担。
