Moderation and Mediation Analysis of the Relationship between Total Protein Concentration and the Risk of Depressive Disorders in Older Adults with Function Dependence in Home Care
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Measurements
2.3. Anthropometric Measurements
2.4. Blood Collection and Biochemical Analysis
2.5. Statistical Analysis
- Providing the coefficient for a given mediator (after controlling for total protein concentration) with 95% confidence interval (95% CI), path b.
- Direct effect (c`), coefficient of regression model for the total protein concentration after controlling for mediating variable (mediator) with 95% CI.
- Indirect effect with 95% CI, calculated taking into consideration “bias-corrected” and “accelerated” corrections. The effect is the product (a*b, on the attached scheme) of the coefficients (in regression model) between the total protein concentration and the studied mediating variable which examines the relationship between the coefficient (in the regression model) between the mediating variable and depression.
3. Results
3.1. Characteristics of the Studied Groups According to Sociodemographic and Medical Data
3.2. Relationship between GDS-SF and Studied Criteria
3.3. Moderation Model
3.4. Mediation Model
4. Discussion
4.1. Implications of the Present Findings
4.2. Limitations
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Variable | n = 132 |
---|---|
Medical interview | |
Under long-term care (years) | 3.91 ± 2.61 a |
Result on the Barthel index | 43.20 ± 27.06 a |
Result on GDS-SF scale | 7.34 ± 3.10 a |
Amount of medicinal substances taken | 7.9 ± 2.8 a |
Comorbidities | |
Respiratory system | 19 (14.4) b |
Endocrine system | 54 (40.9) b |
Nervous system | 35 (26.5) b |
Sensory | 12 (9.1) b |
Psychiatric | 55 (41.7) b |
Rheumatic | 77 (58.3) b |
Laboratory test results | |
Total protein (g/dL) | 7.09(6.61–7.37) c |
25(OH)D vitamin(ng/mL) | 14.41 (8.64–26.63) c |
B12 vitamin (pg/mL) | 390.76 ± 143.35 a |
Folic acid (ng/mL) | 5.4 (3.74–9.92) c |
Total cholesterol (mg/dL) | 183 (158.0–218.0) c |
HDL Cholesterol (mg/dL) | 53.55 (42.62–64.22) c |
LDL Cholesterol(mg/dL) | 106.5 (86.0–130.75) c |
Triglycerides (mg/dL) | 115 (88.25–158.75) c |
Anthropometric variables | |
Calf circumference (cm) | 36.05 ± 5.42 a |
Mid-upper arm circumference(cm) | 30.79 ± 7.90 a |
Tibial bone length (cm) | 48.02 ± 5.44 a |
Thickness of the skinfold under the shoulder (cm) | 2.6 (2.1–4.0) c |
Skinfold of arm muscle triceps (cm) | 2.3 (2.0–3.8) c |
Variable | b | 95% CI |
---|---|---|
Gender | ||
Male | 0.40 | (−0.89; 1.70) |
Age | 0.02 | (−0.04; 0.09) |
Marital status | ||
In a relationship | −0.86 | (−1.97; 0.24) |
Cohabitant | ||
None | 0.75 | (−0.54; 2.03) |
Medical interview | ||
Under long-term healthcare (years) | −0.04 | (−0.26; 0.17) |
Results in the Barthel index | −0.02 | (−0.04; −0.004) * |
Amount of medicinal substances taken | 0.004 | (−0.36; 0.36) |
Comorbidities: | ||
Respiratory system | −1.45 | (−2.95; 0.06) |
Endocrine system | −0.33 | (−1.42; 0.76) |
Nervous system | 0.23 | (−0.98; 1.44) |
Sensory | −0.36 | (−2.22; 1.50) |
Psychiatric | −0.35 | (−1.42; 0.72) |
Rheumatic | 0.51 | (−0.58; 1.60) |
Laboratory tests results | ||
Total protein | −1.10 | (−2.08; −0.13) * |
25(OH)D Vitamin | −0.008 | (−0.02; 0.007) |
B12 Vitamin | −0.001 | (−0.004; 0.003) |
Folic acid | 0.001 | (−0.05; 0.06) |
Total cholesterol | −0.004 | (−0.01; 0.007) |
HDL Cholesterol | −0.03 | (−0.07; −0.002) * |
LDL Cholesterol | 0.001 | (−0.01; 0.01) |
Triglycerides | −0.001 | (−0.01; 0.009) |
Anthropometric variables | ||
Calf circumference | −0.08 | (−0.18; 0.02) |
Mid-upper arm circumference | −0.079 | (−0.15; −0.01) * |
Tibia bone length from foot base to the knee | −0.003 | (−0.10; 0.10) |
Thickness of under the shoulder skinfold | 0.05 | (−0.007; 0.12) |
Skinfold of arm triceps muscle | 0.06 | (−0.008; 0.12) |
Model | Moderator Coefficient (95% CI) | Protein Coefficient (95% CI) | Interaction Coefficient | F |
---|---|---|---|---|
Gender | ||||
R2 = 0.04 | 2.28 (−13.40; 17.96) | −0.77 (−3.75; 2.21) | 0.27 (−2.50; 1.97) | 1.81 |
ΔR2 = 0.0004 | 0.42 (−0.86; 1.69) | −1.11 (−2.09; −0.13) | 2.71 | |
Age | ||||
R2 = 0.037 | 0.06 (−56.86; 77.60) | −0.44 (-9.94; 9.06) | −0.008 (−0.12; 0.11) | 1.66 |
ΔR2 = 0.0001 | 0.0002 (−0.065; 0.065) | −1.1 (−2.15; −0.056) | 2.49 | |
Comorbidities | ||||
Respiratory system | ||||
R2 = 0.06 | −0.67 (−18.78; 17.43) | −0.89 (−5.73; 3.95) | −0.10 (−2.69; 2.48) | 2.86 |
ΔR2 = 0.000 | −1.41 (−2.89; 0.08) | −1.09 (−2.005; 0.12) * | 4.33 | |
Endocrine system | ||||
R2 = 0.05 | −8.34 (−22.14; 5.46) | −2.84 (−5.97; 0.28) | 1.17 (−0.80; 3.14) | 2.16 |
ΔR2 = 0.01 | −0.18 (-1.26; 0.90) | −1.08 (−2.07; −0.10) | 2.55 | |
Nervous system | ||||
R2 = 0.04 | 6.86 (−9.29; 23.01) | 0.51 (−3.72; 4.73) | −0.93 (−3.26; 1.39) | 2.01 |
ΔR2 = 0.005 | 0.39 (−0.81; 1.59) | −1.14 (−2.13; −0.16) * | 2.71 | |
Sensory | ||||
R2 = 0.075 | −39.7 (−74.85; −4.55) | −11.95 (−21.69; −2.21) * | 5.52 (0.58; 10.47) * | 3.44 |
ΔR2 = 0.035 * | −0.49 (−2.33; 1.35) | −1.12 (−2.10; −0.14) * | 2.64 | |
Psychiatric | ||||
R2 = 0.043 | 0.09 (−13.69; 13.87) | −1.04 (−4.33; 2.24) | −0.05(−2.01; 1.92) | 1.89 |
ΔR2 = 0.000 | −0.24 (−1.29; 0.82) | −1.12 (−2.08; -0.16) * | 2.86 | |
Rheumatic | ||||
R2 = 0.046 | 1.59 (−12.31; 15.49) | −0.93 (−3.92; 2.07) | −0.14 (−2.12; 1.83) | 2.05 |
ΔR2 = 0.0002 | 0.58 (−0.49; 1.64) | −1.13 (−2.11; −0.16) * | 3.08 |
Mediator (M) A (Path b) | Direct Effect (Path c’) B of Protein→ GDS-SF | Indirect Effect (a*b) of Protein→M→GDS-SF | ||||
---|---|---|---|---|---|---|
b | 95% CI | b | 95% CI | b | 95% CI | |
Laboratory parameters: | ||||||
25 (OH)D vitamin | −0.05 | (−0.10; −0.007) * | −0.786 | (−1.78; 0.21) | −0.162 | (−0.45; −0.01) * |
B12 vitamin | −0.0003 | (−0.004; 0.003) | −1.09 | (−2.12; −0.06) * | −0.012 | (−0.31; 0.13) |
Folic acid | 0.045 | (−0.05; 0.14) | −1.135 | (−2.12; −0.15) | 0.032 | (−0.04; 0.23) |
Total Cholesterol | −0.003 | (−0.01; 0.007) | −1.078 | (−2.06; −0.09) * | −0.027 | (−0.25; 0.04) |
HDL Cholesterol | −0.027 | (−0.06; 0.006) | −0.908 | (−1.91; −0.09) * | −0.197 | (−0.63; 0.01) |
LDL Cholesterol | 0.0004 | (−0.13; 0.014) | −1.10 | (−2.08; −0.12) * | −0.0013 | (−0.13; 0.09) |
Triglycerides | 0.001 | (−0.008; 0.01) | −1.132 | (−2.13; −0.13) * | 0.027 | (−0.12; 0.30) |
Result on the Barthel index | −0.02 | (−0.04; −0.0002) * | −0.882 | (−1.87; 0.11) | −0.223 | (−0.54; −0.05) * |
Anthropometric variables: | ||||||
Calf circumference | −0.073 | (−0.17; 0.02) | −1.039 | (−2.01; −0.07) * | −0.035 | (−0.35; 0.07) |
Mid-upper arm circumference | −0.141 | (−0.25; −0.035) * | −0.900 | (−1.86; 0.06) | −0.174 | (−0.50; 0.02) |
Tibia bone length from foot base to the knee | −0.011 | (−0.11; 0.09) | −1.082 | (−2.06; −0.10) * | 0.008 | (−0.12; 0.24) |
Thickness of under the shoulder skinfold | 0.05 | (−0.01; 0.11) | −1.014 | (−1.99; −0.04) * | −0.059 | (−0.50; 0.06) |
Arm triceps muscle skinfold | 0.05 | (−0.01; 0.12) | −1.014 | (−1.99; −0.04) * | −0.600 | (−0.47; 0.07) |
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Nowicki, G.J.; Ślusarska, B.; Bartoszek, A.; Kocka, K.; Deluga, A.; Kachaniuk, H.; Łuczyk, M. Moderation and Mediation Analysis of the Relationship between Total Protein Concentration and the Risk of Depressive Disorders in Older Adults with Function Dependence in Home Care. Nutrients 2018, 10, 1374. https://doi.org/10.3390/nu10101374
Nowicki GJ, Ślusarska B, Bartoszek A, Kocka K, Deluga A, Kachaniuk H, Łuczyk M. Moderation and Mediation Analysis of the Relationship between Total Protein Concentration and the Risk of Depressive Disorders in Older Adults with Function Dependence in Home Care. Nutrients. 2018; 10(10):1374. https://doi.org/10.3390/nu10101374
Chicago/Turabian StyleNowicki, Grzegorz Józef, Barbara Ślusarska, Agnieszka Bartoszek, Katarzyna Kocka, Alina Deluga, Hanna Kachaniuk, and Marta Łuczyk. 2018. "Moderation and Mediation Analysis of the Relationship between Total Protein Concentration and the Risk of Depressive Disorders in Older Adults with Function Dependence in Home Care" Nutrients 10, no. 10: 1374. https://doi.org/10.3390/nu10101374