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The 4 sets of multilevel models and adjusted ICCs. Inside the
Fast-food outlet and healthful meals resource availability were not statistically considerably associated with transform in HbA1c within this sample and area. However, higher healthful meals sources reduced the unhealthful influence on the overweight/obesity norm around the price of improve in HbA1c. This observation supports the premise that the availability of meals resources can modify relationships in between neighborhood descriptive health-related norms and well being outcomes. Associations amongst subjective descriptive norms and individual health-related outcomes have previously been reported for social networks. A longitudinal (32 years) social network study identified associations between normsfor overweight and a person becoming overweight [45]. Similarly, the dietary norms of peers are.The four sets of multilevel models and adjusted ICCs. Inside the fourth set, the inclusion of an interaction term among the featured environmental predictors, namely overweight/obesity norm and healthful meals resources, improved model fit. In Models 1?, lesser overweight/obesity norm was statistically considerably connected with higher baseline HbA1c concentration ( = -0.03 to -0.04 depending on model; i.e., a 2.21 [1SD] increment in overweight/obesity prevalence was related using a -0.03 to -0.04 reduced HbA1c concentration). Insufficient fruit intake norm, fast-food outlets, and healthful food resources have been not associated with baseline HbA1c. HbA1c elevated over the 10-year follow-up period (time was statistically considerably positively linked with HbA1c concentration in all models) with an increase in HbA1c concentration of 0.03 per year. Statistically significant positive time x norm interactions indicate that greater prevalences for the overweight/obesity norm, and higher insufficient fruit intake norm, have been every single related with higher prices of increasing HbA1c over time (e.g., in model 3 with speedy food availability: overweight/obesity norm x time = 0.008 indicating that a two.21 [1SD] increment in overweight/obesity prevalence was connected with a additional 0.008 raise in HbA1c per year). Fast-food outlets and healthful food sources were not related with alter in HbA1c more than time. There were no statistically considerable two-way (neighborhood descriptive norm and food resource availability) interactions related to baseline HbA1c concentration. The three-way interaction on the overweight/obesity norm x healthful food resource x time was statistically considerably associated with HbA1c ( = -0.0057 [95 CI -0.0092 to -0.0022], p = 0.001). The impact of healthful meals resource availability on the connection between regional descriptive overweight/obesity norm and also the trajectory of HbA1c is shown graphically in Fig. 2. The figure shows that greater healthful food resource availability decreased the influence in the overweight/obesity norm on escalating HbA1c concentration. Models like the food environment measures as density instead of count measures identified similar benefits (not reported here).covariates. This study identified that local descriptive norms, operationalised as the prevalence of neighborhood residents getting overweight/obese or not meeting fruit intake suggestions, were each associated with the rate of raise in HbA1c levels over 10 years. These relationships had been robust to the inclusion of contextual measures (fastfood outlet and healthful meals resource availability), arealevel education, and individual-level demographic and smoking info. Fast-food outlet and healthful food resource availability were not statistically significantly related with change in HbA1c within this sample and area. Nevertheless, greater healthful food resources reduced the unhealthful influence from the overweight/obesity norm around the rate of increase in HbA1c.
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