Research Article
Positive Psychosocial Factors in Childhood Predicting Lower Risk for Adult Type 2 Diabetes: The Cardiovascular Risk in Young Finns Study, 1980–2012

https://doi.org/10.1016/j.amepre.2017.01.042Get rights and content

Introduction

Type 2 diabetes is a public health concern, but psychosocial factors that may protect against the disease are unknown. This study examines whether a positive psychosocial environment in childhood is associated with lower risk for Type 2 diabetes in adulthood or healthier glucose trajectories over the life course, and whether BMI mediates the associations.

Methods

A cohort of 3,596 Finnish children was followed into adulthood over 32 years. An overall positive psychosocial score, consisting of six subdomains, was measured at study baseline (1980). Relative risk ratios and multilevel growth curve modeling were used to examine associations of the psychosocial score with Type 2 diabetes (2012) and glucose trajectories (1986–2012). The mediating effect by BMI was examined using mediation analysis. The analyses were conducted between June 2015 and January 2016.

Results

There was a 21% decrease in the rate of Type 2 diabetes (relative risk ratio, 0.79; 95% CI=0.66, 0.94) for each 1-SD increase in the positive psychosocial score after adjustment for childhood cardiovascular risk factors and dietary behaviors. Adult BMI mediated 52% and weight gain mediated 25% of the association. The growth curve model showed healthier glucose trajectories (age X psychosocial score interaction, b= –0.01; p=0.010) for participants with higher versus lower positive psychosocial score in childhood.

Conclusions

Positive psychosocial environment in childhood seems to have beneficial influences on the risk for Type 2 diabetes over the life span. RCTs will be required to see if interventions directed at early-life circumstances are warranted.

Introduction

Type 2 diabetes is one of the most important contemporary public health challenges.1, 2 There are 29.1 million people with diabetes (of whom 90% have Type 2 diabetes) in the U.S. and it has been estimated that one in three Americans will develop disease by 2050.3 Although Type 2 diabetes is usually diagnosed later in life, the silent process underlying manifestation of the disease starts decades earlier.4, 5 An alarming new trend is that Type 2 diabetes is developing in younger people more than seen previously,1, 6 thus suggesting a need for more efficient early prevention.6

The developmental roots of adult health lie in early life, as a mixture of genetic and environmental factors.7, 8 Although early-life interventions have traditionally focused on reducing risky health behaviors (e.g., unhealthy diet),9 there is growing recognition that the effects of such prevention efforts remain limited if the social and psychosocial contexts are ignored.6, 10, 11, 12 Identifying psychosocial factors in early life that may protect from developing Type 2 diabetes over the life course may help to target early prevention more effectively. For children and adolescents, the family’s social and emotional situation powerfully defines the social context, setting the foundation for many of the factors that matter for life course health.7, 13

Most research on psychosocial factors identifies whether harmful factors are present14, 15, 16, 17, 18, 19, 20 and evaluates their contribution to future disease. Recent evidence suggests, however, that positive environmental and personal attributes play a protective role in health, and therefore it may be valuable to identify these as well.21, 22, 23, 24 Even with extensive research on risk factors, it has not yet been determined how to reduce the burden of diabetes. In fact, research focusing on identifying protective factors may provide new insight, given that recent findings have suggested that the absence of harmful factors does not necessarily indicate the presence of factors that actively promote adaptive functioning.25, 26 Greater understanding of how to attain and maintain positive health outcomes will be achieved by examining the full spectrum of factors that contribute to health.21, 25, 26 Such effort will require identifying factors that not only accelerate risk but also may promote restoration and serve as “health assets.”21 Children with supportive parenting,27, 28 high environmental stability,29 good ability to regulate negative emotions,14, 24, 30 and a combination thereof31, 32 appear to be well protected against health risks, but whether these factors protect against Type 2 diabetes has not been examined previously.

Using follow-up data over 32 years, the current study examines whether a combination of psychosocial factors across distinct domains—including economic, social, emotional, health behavioral, and dispositional—in childhood is associated with lower rates of Type 2 diabetes or pre-diabetes (indicating early signs of diabetes)33 in adulthood or with healthier development of glucose levels from childhood to adulthood. To elucidate potential explanatory mechanisms, BMI is examined as an intermediate pathway from childhood factors to Type 2 diabetes.

Section snippets

Study Population

The Cardiovascular Risk in Young Finns Study is a 32-year follow-up study set up to determine the contribution made by childhood lifestyle, biological, and psychological measures to the risk of cardiovascular diseases in adulthood.34 The participants (N=3,596) were randomly chosen from the population register of Finland, aged 3–18 years at study baseline in 1980, and followed up regularly until 2012.

Participants with Type 1 diabetes at the baseline (n=19) or at any of the follow-up visits (n

Results

Mean glucose levels increased from 4.63 to 5.44 mmol/L. Prevalence of Type 2 diabetes was 3.4% (n=120) and prevalence of prediabetes was 33.4% (n=1,172) in imputed data. (Appendix Table 4 [available online] provides values for observed data.)

Table 1 shows a decrease of 21% in the rate of Type 2 diabetes (p=0.008) and a decrease of 8% in the rate of pre-diabetes (p=0.011) with each 1-SD increase in the positive psychosocial score after adjusting for all covariates. The pseudo-R2 showed that the

Discussion

This study following individuals prospectively over 32 years showed that a set of positive psychosocial factors in childhood predicted a 21% reduction in risk for Type 2 diabetes in adulthood. The association remained after taking into account the effect of traditional cardiovascular risk factors known to predict Type 2 diabetes. Positive childhood factors were also associated with slower pre-diabetic development, as evidenced by a less rapid rise in glucose levels in people with more positive

Conclusions

Having a broad set of positive psychosocial factors in childhood seems to be associated with healthier body weight in adulthood and healthier glucose trajectories over the life span, thereby protecting against Type 2 diabetes. Whether interventions directed at early-life circumstances are warranted remains to be examined in RCTs. The current findings suggest that child psychosocial factors have a role in the development of diabetes, and this knowledge may provide new insight for building

Acknowledgments

Acknowledgements go to Irina Lisinen, Johanna Ikonen, and Ville Aalto at the Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland, for assistance in managing the Cardiovascular Risk in Young Finns data set.

This work was supported by the Academy of Finland (grants 265869 [MIND program], 258711, and 256977); the Social Insurance Institution of Finland; Kuopio, Tampere, and Turku University Hospital Medical Funds; the Signe and Ane Gyllenberg Foundation;

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      The temporal nature of the latter relationship warrants further investigation. Our findings are consistent with emerging evidence suggesting that positive psychosocial factors, both in childhood and in adulthood, are associated with long-term protective effects on metabolic functioning [26,27]. The Young Finns Study has been financially supported by the Academy of Finland: grants 286284, 134309 (Eye), 126925, 121584, 124282, 129378 (Salve), 117787 (Gendi), and 41071 (Skidi); the Social Insurance Institution of Finland; Competitive State Research Financing of the Expert Responsibility area of Kuopio, Tampere and Turku University Hospitals (grant X51001); Juho Vainio Foundation; Paavo Nurmi Foundation; Finnish Foundation for Cardiovascular Research; Finnish Cultural Foundation; Tampere Tuberculosis Foundation; Emil Aaltonen Foundation; Yrjö Jahnsson Foundation; Signe and Ane Gyllenberg Foundation; and Diabetes Research Foundation of Finnish Diabetes Association.

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