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Title: Towards a parsimonious pathway model of modifiable and mediating risk factors leading to diabetes risk
Authors: Ho, Lynn Yi-Ching
Lee, Vivian Shu Yi
Ho, Ringo Moon-Ho
Lin, Gladis Jing
Thumboo, Julian
Keywords: Social sciences::General
Issue Date: 2021
Source: Ho, L. Y., Lee, V. S. Y., Ho, R. M., Lin, G. J. & Thumboo, J. (2021). Towards a parsimonious pathway model of modifiable and mediating risk factors leading to diabetes risk. International Journal of Environmental Research and Public Health, 18(20), 10907-.
Project: NMRC/CG/C027/2017 
Journal: International Journal of Environmental Research and Public Health 
Abstract: Modifiable risk factors are of interest for chronic disease prevention. Few studies have assessed the system of modifiable and mediating pathways leading to diabetes mellitus. We aimed to develop a pathway model for Diabetes Risk with modifiable Lifestyle Risk factors as the start point and Physiological Load as the mediator. As there are no standardised risk thresholds for lifestyle behaviour, we derived a weighted composite for Lifestyle Risk. Physiological Load was based on an index using clinical thresholds. Sociodemographics are non-modifiable risk factors and were specified as covariates. We used structural equation modeling to test the model, first using 2014/2015 data from the Indonesian Family Life Survey. Next, we fitted a smaller model with longitudinal data (2007/2008 to 2014/2015), given limited earlier data. Both models showed the indirect effects of Lifestyle Risk on Diabetes Risk via the mediator of Physiological Load, whereas the direct effect was only supported in the cross-sectional analysis. Specifying Lifestyle Risk as an observable, composite variable incorporates the cumulative effect of risk behaviour and differentiates this study from previous studies assessing it as a latent construct. The parsimonious model groups the multifarious risk factors and illustrates modifiable pathways that could be applied in chronic disease prevention efforts.
ISSN: 1660-4601
DOI: 10.3390/ijerph182010907
Schools: School of Social Sciences 
Rights: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (
Fulltext Permission: open
Fulltext Availability: With Fulltext
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