A Novel Use of Structural Equation Modeling to Examine Diet and metabolic traits Associated with Micro-Vascular Endothelial Dysfunction in Middle-aged Chinese Males

Abstract

Abstract Background: The present study aims to use structural equation modeling with multiple regression pathways to examine direct and indirect links from diet and metabolic traits to micro-vascular endothelial dysfunction (ED) among middle-aged Chinese males. Methods: The study was conducted in middle-aged Chinese males, who underwent a health checkup between 2018 and 2019. Data on life-style behavior factors (physical activity, diet pattern, sleep quality, and diet data underwent factor analysis in advance) and metabolic risk factors referring to metabolic traits were introduced into the structural equation model (SEM) to examine interrelationship among these factors and their association with ED, as evaluated by the reactive hyperemia index (RHI). Results: Both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) identified two major dietary patterns: "prudent pattern" and "western pattern". The univariate test suggested that only triglycerides (TG) and prudent dietary pattern were directly associated with RHI. Furthermore, prudent dietary pattern had an indirect association with RHI via triglyceride (Prudent diet→TG: β=-0.15, P<0.05; TG→RHI: β=-0.17, P<0.001). As to confirming the hypothesized association between variables apart, physical activity frequency was correlated to the decrease in TG (β=-0.29, P<0.001), but had no direct correlation to RHI. Conclusion: The network of direct and indirect associations among diet pattern and cardio-metabolic risk factors with RHI measured ED among middle-aged males. The most significant modifiable factors identified were TG and prudent diet pattern, which needs to be targeted as preventive strategies for early micro-vascular impairment.