title: educational level, obesity and incidence of diabetes among Chinese adult men and women aged 18-59 years old: an 11-year follow-up study.
abstract: OBJECTIVE
  To determine whether educational level and overweight/obesity was associated with the development of diabetes among Chinese adult men and women.
  
  
  METHODS
  A cohort (2000-2011) of 10 704 participants aged 18-59 years (8 238 men, 2 466 women) in Qingdao Port Health Study (QPHS) were recruited in this study. The personal lifestyle, height, weight, waist circumference, resting heart rate, blood pressure, fasting blood glucose, total cholesterol, triglycerides and plasma uric acid were collected annually in a comprehensive health checkup program. Cox proportional hazards regression models were used to estimate the association of factors and incidence of diabetes.
  
  
  RESULTS
  During 110 825 person-years of follow-up, 1 056 new onset cases (9.5 per 1 000 person-years) of diabetes were identified. With normal weight as reference, the multiple-adjusted hazard ratio (HR) (95%CI) of diabetes was 1.69(1.38-2.09) for overweight and 2.24(1.66-3.02) for obesity among men, which was 1.81(1.12-2.92) and 2.58(1.37-4.86) among women, respectively. Compared with the participants with high educational level, those with low educational level had a higher risk of diabetes (multiple-adjusted HR (95%CI): 1.43(1.11-1.86)) among men. The association was not found among women and the adjusted HR (95%CI) of diabetes was 1.56(0.89-2.76). The increased risks of low educational level were independent of mediators among men, through normal weight (P for trend = 0.0313) and overweight (P for trend = 0.0212) group but not obesity group (P for trend = 0.0957).
  
  
  CONCLUSIONS
  Baseline overweight/obesity was an independent risk factor for diabetes for both men and women. Low educational level was adversely associated with incidence of diabetes through normal weight, overweight and obesity groups, with the association being substantially attenuated by mediating factors only in the obesity group among men. The association was not found among women.
authors.affiliation: State Key Laboratory of Cardiovascular Disease, China Oxford Centre for International Health Research, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China.
authors.forename: Xianwen
authors.initials: X
authors.lastname: Shang
authors.forename: Jiongyi
authors.initials: J
authors.lastname: Li
authors.forename: Qiushan
authors.initials: Q
authors.lastname: Tao
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.forename: Xi
authors.initials: X
authors.lastname: Li
authors.forename: Lihua
authors.initials: L
authors.lastname: Zhang
authors.forename: Xiancheng
authors.initials: X
authors.lastname: Liu
authors.forename: Qing
authors.initials: Q
authors.lastname: Wang
authors.forename: Xiuzhong
authors.initials: X
authors.lastname: Shi
authors.forename: Yuhong
authors.initials: Y
authors.lastname: Zhao
authors.forename: Shuang
authors.initials: S
authors.lastname: Hu
authors.forename: Lixin
authors.initials: L
authors.lastname: Jiang
authors.forename: Ying
authors.initials: Y
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000209:etiology; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012680:Sensitivity and Specificity; D055815:Young Adult