The Link Between Health Literacy and Three Conditions of Metabolic Syndrome: Obesity, Diabetes and Hypertension

Abstract

Purpose

Health literacy (HL) intervention could be a potential prevention strategy to reduce the risk of metabolic syndrome (MS), but the association between low HL and MS is controversial. Therefore, the aim of this study was to investigate whether low HL is associated with obesity, diabetes, and hypertension, considering them as one cluster.

Methods

We used data from the Hamburg Diabetes Prevention Survey, a population-based cross-sectional study in Germany. The 1349 eligible subjects were 18–60 years old. The European Health Literacy Questionnaire (HLS-EU-Q16) was used to assess HL. Depending on the reported number of metabolic syndrome conditions (CMS), four groups were categorized as follows: “0”, any “1”, any “2” and “3” CMS. Ordered logistic regression was used to analyze the relationship between HL level (independent variable) and the reported number of CMS (dependent variable) adjusted for age, gender and education.

Results

63.9% of subjects (n=862) reported having “0”, 25.7% (n=346) only “1”, 8.2% (n=111) only “2” and 2.2% (n=30) “3” of the three CMS. In the group with sufficient HL, rates of “1,” “2,” or “3” CMS were lower than in the group with problematic or inadequate HL. Subjects with inadequate HL showed a 1.62-fold higher risk of having a higher number of CMS than subjects with sufficient HL (OR 1.62; 95% CI 1.13 to 2.31). The risk increased with each life year (OR 1.05; 95% CI 1.04 to 1.06), and was higher in persons with low education (OR 2.89; 95% CI 2.08 to 4.01) than in highly educated persons. Women showed lower risk (OR 0.73; 95% CI 0.58 to 0.91) than men.

Conclusion

Lower HL was associated with a higher number of MS conditions. Our findings suggest that HL intervention on health-promoting behaviors could help reduce MS risk in people with limited HL.

Keywords:

• diabetes
• overweight
• health literacy intervention

Abbreviations

ADM, Arbeitskreis Deutscher Markt- und Sozialforschungsinstitut; CASMIN, Comparative Analysis of Social Mobility in Industrial Nations; HL, Health Literacy; IDF, International Diabetes Federation; MS, Metabolic Syndrome; CMS, Conditions of Metabolic Syndrome; HLS, Health Literacy Score; HLS-EU-Q16, European Health Literacy Survey Questionnaire, 16 items version; HDPS, the Hamburg Diabetes Prevention Survey; USUMA, Unabhängiger Service für Umfragen, Methoden und Analysen.

Data Sharing Statement

The data that support the findings of this study are available from the Department of Primary Care at Hamburg University Medical Center. Restrictions apply to the availability of these data which were used under license for the current study, and so are not publicly available. However, data are available from the authors upon reasonable request and with permission of the Hamburg Authority of Health and Consumer Protection.

Ethics Approval and Informed Consent

For this analysis we used data from the Hamburg Diabetes Prevention Survey which were collected between December 2017 and March 2018. The informed consent to participate was verbally obtained as the survey was conducted by using telephone interviews, and the data were collected in anonymized form. The use of the survey data for our study was approved by the “Local Psychological Ethics Committee at the Center for Psychosocial Medicine of the University Medical Center Hamburg-Eppendorf” on July 24th 2019 (Approval-No. LPEK-0057). We confirm that our study complies with the Declaration of Helsinki.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Prof. Dr. Martin Scherer reports A+ Videoclinic GmbH; M. Scherer is Partner and Medical Director President of the German College of General Practitioners and Family Physicans (DEGAM). The authors declare that they have no competing interests.

Additional information

Funding

The HDPS study was supported by the Hamburg Authority for work, health, social affairs, family and integration. The funding body participated in the study design, but had no role in collection, analysis, and interpretation of data and in writing the manuscript.