International Journal of Behavioral Medicine

, Volume 24, Issue 2, pp 161–170 | Cite as

The Association Between Social Support, Body Mass Index and Increased Risk of Prediabetes: the Cardiovascular Risk in Young Finns Study

  • Anna Serlachius
  • Marko Elovainio
  • Markus Juonala
  • Steven Shea
  • Matthew Sabin
  • Terho Lehtimäki
  • Olli Raitakari
  • Liisa Keltikangas-Järvinen
  • Laura Pulkki-Råback



The psychosocial determinants of prediabetes are poorly understood. The aims of our study were (1) to analyse the association between perceived social support in young adulthood and fasting glucose levels and prediabetes in mid-adulthood in a cohort of healthy Finns, (2) to explore whether body mass index (BMI), inflammation or depression mediate this relationship, (3) and to examine the association between social support trajectory groups and fasting glucose.


A prospective design was used with an analytic sample of 1250 participants aged 3–18 years at baseline (1980) and aged 12–39 years when social support was measured. Fasting glucose and prediabetes were assessed 32 years after baseline. Linear and logistic regression was used to examine the association between social support and the outcome measures. A bootstrapping technique was used to examine mediation effects.


Social support was associated with future glucose levels in women after adjusting for childhood socioeconomic status (SES) and youth depression (β = −0.136, p = 0.001) and also predicted prediabetes in women after adjusting for childhood SES (β = 1.31, 95 % CI 1.02 to 1.69, p = 0.031). Both associations were attenuated after adjusting for BMI in mid-adulthood. BMI was found to mediate the relationship between social support and prediabetes in women (β for indirect effect β = 0.09, SE = 0.03, CI = 0.03 to 0.16).


Low perceived social support in young adulthood is associated with high fasting glucose and prediabetes in mid-adulthood in women but not men. The association between social support and prediabetes in women can be partly explained by BMI.


Fasting glucose Prediabetes Prospective study Social support Type 2 diabetes 



We greatly acknowledge Irina Lisinen, Johanna Ikonen and Ville Aalto for assistance in managing the Cardiovascular Risk in Young Finns dataset.

Compliance with Ethical Standards


The Young Finns Study has been financially supported by the Academy of Finland: grants 126925, 121584, 124282, 129378 (Salve), 117787 (Gendi), 41071 (Skidi), 265869, 258711, 258578, 265977 and 286284; the Social Insurance Institution of Finland, Kuopio, Tampere and Turku University Hospital Medical Funds (grants 9N035 and X51001), the Juho Vainio Foundation, the Signe and Ane Gyllenberg Foundation, the Emil Aaltonen Foundation, the Paavo Nurmi Foundation, the Finnish Foundation of Cardiovascular Research, the Finnish Cultural Foundation, the Osk. Huttunen Foundation and the Tampere Tuberculosis Foundation.

Conflict of Interest

No conflict of interest declared.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047–53.CrossRefPubMedGoogle Scholar
  2. 2.
    Bullard KM, Saydah SH, Imperatore G, Cowie CC, Gregg EW, Geiss LS, et al. Secular changes in U.S. prediabetes prevalence defined by hemoglobin A1c and fasting plasma glucose: National Health and nutrition examination surveys, 1999–2010. Diabetes Care. 2013;36(8):2286–93.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Nathan DM, Davidson MB, DeFronzo RA, Heine RJ, Henry RR, Pratley R, et al. Impaired fasting glucose and impaired glucose tolerance: implications for care. Diabetes Care. 2007;30(3):753–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Evans JM, Newton RW, Ruta DA, MacDonald TM, Morris AD. Socio-economic status, obesity and prevalence of type 1 and type 2 diabetes mellitus. Diabet Med. 2000;17(6):478–80.CrossRefPubMedGoogle Scholar
  5. 5.
    Knol MJ, Twisk JWR, Beekman ATF, Heine RJ, Snoek FJ, Pouwer F. Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis. Diabetologia. 2006;49(5):837–45.CrossRefPubMedGoogle Scholar
  6. 6.
    Heraclides A, Chandola T, Witte DR, Brunner EJ. Psychosocial stress at work doubles the risk of type 2 diabetes in middle-aged women: evidence from the Whitehall II study. Diabetes Care. 2009;32(12):2230–5.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Lett HS, Blumenthal JA, Babyak MA, Strauman TJ, Robins C, Sherwood A. Social support and coronary heart disease: epidemiologic evidence and implications for treatment. Psychosom Med. 2005;67(6):869–78.CrossRefPubMedGoogle Scholar
  8. 8.
    Hilding A, Shen C, Östenson C-G. Social network and development of prediabetes and type 2 diabetes in middle-aged Swedish women and men. Diabetes Res Clin Pract. 2015;107(1):166–77.CrossRefPubMedGoogle Scholar
  9. 9.
    Meisinger C, Kandler U, Ladwig K-H. Living alone is associated with an increased risk of type 2 diabetes mellitus in men but not women from the general population: the MONICA/KORA Augsburg cohort study. Psychosom Med. 2009;71(7):784–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Thoits PA. Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav. 2011;52(2):145–61.CrossRefPubMedGoogle Scholar
  11. 11.
    Rosmond R. Stress induced disturbances of the HPA axis: a pathway to type 2 diabetes? Med Sci Monit. 2003;9(2):RA35–9.PubMedGoogle Scholar
  12. 12.
    Grant N, Hamer M, Steptoe A. Social isolation and stress-related cardiovascular, lipid, and cortisol responses. Ann Behav Med. 2009;37(1):29–37.CrossRefPubMedGoogle Scholar
  13. 13.
    Wang ML, Pbert L, Lemon SC. Influence of family, friend and coworker social support and social undermining on weight gain prevention among adults. Obesity (Silver Spring). 2014;22(9):1973–80.CrossRefGoogle Scholar
  14. 14.
    Wing RR, Matthews KA, Kuller LH, Meilahn EN, Plantinga P. Waist to hip ratio in middle-aged women. Associations with behavioral and psychosocial factors and with changes in cardiovascular risk factors. Arterioscler Thromb Vasc Biol. 1991;11(5):1250–7.CrossRefGoogle Scholar
  15. 15.
    Midei AJ, Matthews KA. Social relationships and negative emotional traits are associated with central adiposity and arterial stiffness in healthy adolescents. Health Psychol. 2009;28(3):347–53.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Aneshensel CS, Stone JD. Stress and depression: a test of the buffering model of social support. Arch Gen Psychiatry. 1982;39(12):1392–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Thoits PA. Stress, coping, and social support processes: where are we? What next? J Health Soc Behav. 1995:53–79.Google Scholar
  18. 18.
    Aspinwall LGA. Stitch in time: self-regulation and proactive coping. Psychol Bull. 1997;121(3):417–36.CrossRefPubMedGoogle Scholar
  19. 19.
    Emmons KM, Barbeau EM, Gutheil C, Stryker JE, Stoddard AM. Social influences, social context, and health behaviors among working-class, multi-ethnic adults. Health Educ Behav. 2007;34(2):315–34.CrossRefPubMedGoogle Scholar
  20. 20.
    Raitakari OT, Juonala M, Rönnemaa T, Keltikangas-Järvinen L, Räsänen L, Pietikäinen M, et al. Cohort profile: the cardiovascular risk in young Finns study. Int J Epidemiol. 2008;37(6):1220–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Alberti KG, Zimmet P, Shaw J. The metabolic syndrome: a new world-wide definition. Lancet. 2005;366:1059–62.CrossRefPubMedGoogle Scholar
  22. 22.
    Blumenthal JA, Burg MM, Barefoot J, Williams RB, Haney T, Zimet G. Social support, type a behavior, and coronary artery disease. Psychosom Med. 1987;49(4):331–40.CrossRefPubMedGoogle Scholar
  23. 23.
    Ravaja N, Keltikangas-Järvinen L, Viikari J. Perceived social support and abdominal fat distribution in adolescents and young adults: a structural equation analysis of prospective data. Appetite. 1998;31(1):21–35.CrossRefPubMedGoogle Scholar
  24. 24.
    Keltikangas-Järvinen L, Ravaja N. Relationships between hostility and physiological coronary heart disease risk factors in young adults: moderating influence of perceived social support and sociability. Psychol Health. 2002;17(2):173–90.CrossRefGoogle Scholar
  25. 25.
    Nagin DS, Tremblay RE. Analyzing developmental trajectories of distinct but related behaviors: a group-based method. Psychol Methods. 2001;6(1):18–34.CrossRefPubMedGoogle Scholar
  26. 26.
    Kaup AR, Byers AL, Falvey C, Simonsick EM, Satterfield S, Ayonayon HN, et al. Trajectories of depressive symptoms in older adults and risk of dementia. JAMA psychiatry. 2016.Google Scholar
  27. 27.
    Katainen S, Räikkönen K, Keltikangas-Järvinen L. Adolescent temperament, perceived social support, and depressive tendencies as predictors of depressive tendencies in young adulthod. Eur J Pers. 1999;13:183–207.CrossRefGoogle Scholar
  28. 28.
    Rosenström T, Jokela M, Puttonen S, Hintsanen M, Pulkki-Råback L, Viikari JS, et al. Pairwise measures of causal direction in the epidemiology of sleep problems and depression. PLoS One. 2012;7(11) e50841.Google Scholar
  29. 29.
    Elovainio M, Keltikangas-Järvinen L, Pulkki-Råback L, Kivimäki M, Puttonen S, Viikari L, et al. Depressive symptoms and c-reactive protein: the cardiovascular risk in Young Finns Study. Psychol Med. 2006;36(6):797–805.CrossRefPubMedGoogle Scholar
  30. 30.
    Herbert V, Lau KS, Gottlieb CW, Bleicher SJ. Coated charcoal immunoassay of insulin. J Clin Endocrinol Metab. 1965;25(10):1375–84.CrossRefPubMedGoogle Scholar
  31. 31.
    Statistics Finland. Distribution of household income in Finland. Helsinki: Statistics Finland, 1983.Google Scholar
  32. 32.
    Preacher KJ, Hayes AFSPSS. SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, and Computers. 2004;36:717–31.CrossRefPubMedGoogle Scholar
  33. 33.
    Hu FB, Manson JE, Stampfer MJ, Colditz G, Liu S, Solomon CG, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345(11):790–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Kouvonen A, De Vogli R, Stafford M, Shipley MJ, Marmot MG, Cox T, et al. Social support and the likelihood of maintaining and improving levels of physical activity: the Whitehall II Study. Eur J Public Health. 2011:ckr091.Google Scholar
  35. 35.
    Flaherty J, Richman J. Gender differences in the perception and utilization of social support: theoretical perspectives and an empirical test. Social Sciences and Medicine. 1989;28:1221–122.CrossRefGoogle Scholar
  36. 36.
    Robles TF, Slatcher RB, Trombello JM, McGinn MM. Marital quality and health: a meta-analytic review. Psychol Bull. 2014;140(1):140–87.CrossRefPubMedGoogle Scholar
  37. 37.
    Heraclides AM, Chandola T, Witte DR, Brunner EJ. Work stress, obesity and the risk of type 2 diabetes: gender-specific bidirectional effect in the Whitehall II study. Obesity. 2012;20(2):428–33.CrossRefPubMedGoogle Scholar
  38. 38.
    Rohleder N, Schommer NC, Hellhammer DH, Engel R, Kirschbaum C. Sex differences in glucocorticoid sensitivity of Proinflammatory cytokine production after psychosocial stress. Psychosom Med. 2001;63(6):966–72.CrossRefPubMedGoogle Scholar
  39. 39.
    Taylor SE, Klein LC, Lewis BP, Gruenewald TL, Gurung RAR, Updegraff JA. Biobehavioral responses to stress in females: tend-and-befriend, not fight-or-flight. Psychol Rev. 2000;107(3):411.CrossRefPubMedGoogle Scholar
  40. 40.
    Slopen N, Goodman E, Koenen KC, Kubzansky LD. Socioeconomic and other social stressors and biomarkers of cardiometabolic risk in youth: a systematic review of less studied risk factors. PLoS One. 2013;8(5):e64418.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Evans GW. The environment of childhood poverty. Am Psychol. 2004;59(2):77.CrossRefPubMedGoogle Scholar
  42. 42.
    Uchino BN. Social support and health: a review of physiological processes potentially underlying links to disease outcomes. J Behav Med. 2006;29(4):377–87.CrossRefPubMedGoogle Scholar
  43. 43.
    Hakulinen C, Pulkki-Råback L, Jokela M, E Ferrie J, Aalto A-M, Virtanen M, et al. Structural and functional aspects of social support as predictors of mental and physical health trajectories: Whitehall II cohort study. J Epidemiol Community Health. 2016;2016.Google Scholar
  44. 44.
    Havranek EP, Mujahid MS, Barr DA, Blair IV, Cohen MS, Cruz-Flores S, et al. Social determinants of risk and outcomes for cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2015;2015.Google Scholar
  45. 45.
    Juonala M, Juhola J, Magnussen CG, Wurtz P, Viikari JS, Thomson R, et al. Childhood environmental and genetic predictors of adulthood obesity: the cardiovascular risk in young Finns study. J Clin Endocrinol Metab. 2011;96(9):E1542–E9.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Shaw BA, Krause N, Chatters LM, Connell CM, Ingersoll-Dayton B. Emotional support from parents early in life, aging, and health. Psychol Aging. 2004;19(1):4–12.CrossRefPubMedGoogle Scholar

Copyright information

© International Society of Behavioral Medicine 2016

Authors and Affiliations

  • Anna Serlachius
    • 1
    • 2
  • Marko Elovainio
    • 1
    • 3
  • Markus Juonala
    • 4
    • 5
  • Steven Shea
    • 2
    • 6
  • Matthew Sabin
    • 7
    • 8
  • Terho Lehtimäki
    • 9
    • 10
  • Olli Raitakari
    • 4
    • 11
  • Liisa Keltikangas-Järvinen
    • 1
  • Laura Pulkki-Råback
    • 1
    • 12
  1. 1.Institute of Behavioural SciencesThe University of HelsinkiHelsinkiFinland
  2. 2.The Department of Medicine, Division of General MedicineColumbia UniversityNew York CityUSA
  3. 3.Institute for Health and WelfareHelsinkiFinland
  4. 4.Research Centre of Applied and Preventive Cardiovascular MedicineUniversity of TurkuTurkuFinland
  5. 5.The Division of MedicineTurku University HospitalTurkuFinland
  6. 6.The Department of Epidemiology, Joseph Mailman School of Public HealthColumbia UniversityNew York CityUSA
  7. 7.The Department of PaediatricsUniversity of MelbourneMelbourneAustralia
  8. 8.Murdoch Childrens Research InstituteRoyal Children’s HospitalMelbourneAustralia
  9. 9.The Department of Clinical ChemistryFimlab LaboratoriesTampereFinland
  10. 10.School of MedicineUniversity of TampereTampereFinland
  11. 11.The Department of Clinical Physiology and Nuclear MedicineTurku University HospitalTurkuFinland
  12. 12.The Collegium for Advanced StudiesUniversity of HelsinkiHelsinkiFinland

Personalised recommendations