title: Global educational disparities in the associations between body mass index and diabetes mellitus in 49 low-income and middle-income countries.
abstract: BACKGROUND
  Despite the well-established link between body mass index (BMI) and diabetes mellitus (DM), it remains unclear whether this association is more pronounced at certain levels of education. This study assessed the modifying effect of educational attainment on the associations between BMI and DM-as well as the joint associations of BMI and education with DM-in low-income countries (LICs) and middle-income countries (MICs).
  
  
  METHODS
  The authors used cross-sectional data from 160 381 participants among 49 LICs and MICs in the World Health Survey. Overweight and obesity levels were defined using WHO's classification. Educational attainment was classified in four categories: 'no formal education', 'some/completed primary school', 'secondary/high school completed' and 'college and beyond'. We used random-intercept multilevel logistic regressions to investigate the modifying influence of educational attainment on the associations of different BMI levels-as well as their joint associations-with DM.
  
  
  RESULTS
  We found positive associations between excessive BMI and DM at each education level in both LICs and MICs. We found that the joint associations of BMI and education with DM were larger than the product of their separate single associations among females in LICs. With joint increases in BMI and education, males and females in LICs had similar increased odds of DM, but males had higher such odds than females in MICs.
  
  
  CONCLUSIONS
  BMI and education are associated with the DM, but the associations seem to differ in complex ways between LICs and MICs and by gender.
authors.affiliation: Department of Epidemiology, The Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA.
authors.forename: Aolin
authors.initials: A
authors.lastname: Wang
authors.affiliation: Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
authors.affiliation: Department of Epidemiology, The Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands UCLA Center for Health Policy Research, Los Angeles, California, USA.
authors.forename: Onyebuchi A
authors.initials: OA
authors.lastname: Arah
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003906:Developing Countries; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications*