Factors associated with pre-diabetes in Tehranian men and women: A structural equations modeling

OBJECTIVE To examine associations of sex-specific related factors with pre-diabetes in Tehranian non-diabetic adults. METHODS This study has been conducted within the framework of the Tehran Lipid and Glucose Study (TLGS) between 2008-2010. A total of 5568 (55.4% female) non-diabetic adults, aged ≥20 years, selected from among participants of the TLGS, were recruited for the study. Data on socio-behavioral factors, family history of diabetes and cardio-metabolic risk factors were included in the hypothesized model to test their direct and indirect associations with pre-diabetes in men and women separately, using structural equation modeling. RESULTS Pre-diabetes was diagnosed in 23.6% of participants, with significantly higher prevalence in men compared to women (27.4% and 20.5%, respectively; p<0.001). Body mass index (BMI) and triglycerides (TG) in both sexes and hypertension and high density lipoprotein only in women, were directly associated with pre-diabetes (p<0.05). Poor diet in women was the only behavioral factor directly associated with pre-diabetes (p<0.05). Age in both sexes and education, only in women, were directly associated with pre-diabetes. In both genders, age, marital status, education, employment, poor diet and leisure time physical activity were indirectly associated with pre-diabetes through cardio-metabolic risk factors. CONCLUSIONS The main modifiable factors directly associated with pre-diabetes were TG in women and BMI in men, which need to be prioritized in health policies for diabetes prevention programs in Tehranian adults. Future research should focus on the gender-specific determinants and underlying mechanisms for TG levels and BMI status among this population.