Impact of Social Networks on Diabetes & CVD Risk

Having larger and closer-knit social networks is linked to healthier lifestyles among people at risk for diabetes and CVD, according to a study published online in PLoS One.

“[T]his study presents empirical evidence for the relation between several social network characteristics and lifestyle behaviours in adults at risk of type 2 diabetes and CVD… [A] larger, denser network, more friends living nearby and more intense relationships were associated with healthier behaviours,” wrote first author Sandra Bot, PhD, of VU Medical Centre Amsterdam, Amsterdam, the Netherlands, and colleagues.

“Lifestyle behaviours are influenced by many factors, and our findings confirm the importance of social-structural conditions. The density, size and proximity of one’s social network may be important factors that have not received a lot of attention yet,” they added.

If confirmed, the findings could help improve primary prevention strategies for chronic conditions like CVD and diabetes, which are heavily influenced by lifestyle.

Other studies have suggested that social networks can have an important impact on healthy lifestyle behaviors. Past studies have linked social networks to smoking cessation, decreased alcohol consumption, increased levels of physical activity, and improved diet, according to background information in the article.

One possible explanation is that birds of a feather flock together: people with similar lifestyles tend to associate with each other. Also, members of the same social network may tend to emulate each other. 

Another explanation is that people with more developed social networks may garner more support for behavior change. One’s social network may also provide companionship, emotional support, and education about maintaining a healthy lifestyle, while emphasizing the risks of unhealthy lifestyles.

In the small, explorative study researchers enrolled members of the control group of the Hoorn Prevention study, which included women and men aged 30-50 years who were at risk for diabetes and CVD and lived in a semi-rural area of The Netherlands. Researchers conducted detailed, structured interviews of 50 control group members between April and August 2010. Selected members of the participant’s social network, including spouses, best friends, neighbors and colleagues (n=170), provided information via self-reported questionnaires on their lifestyles. 

Key results:

• Response rate: 62% for control group participants, 89% for social network members

• Vegetable consumption: Higher among those with more close-knit relationships

♦ Each additional intense relationship was associated with an additional 8 grams per day of vegetable intake

♦ Spouses had similar rates of vegetable intake, but other social network members did not

• Physical activity: Higher among those with larger social networks

♦ Each additional relative or friend living close by was associated with an additional 15 minutes of physical activity per day 

• Sedentary behavior: Lower among those with more close-knit relationships and larger social networks

• Gender differences:

♦ Women: Each additional network member was linked to nine additional minutes of activity per day and eight minutes less of sedentary behavior for women but not for men

♦ Men: A higher network density was linked to less sedentary behavior

• Social support and educational status did not moderate the relationship between social network and lifestyle

• Placing a large emphasis on social support and the influence of friends on lifestyle change showed no significant associations with healthy lifestyle

The authors noted that social networks mainly influenced physical activity and sedentariness. On the other hand, vegetable consumption was only associated with relationship intensity. They hypothesized that vegetable intake may be influenced more by family members and partners at home, rather than friends, relatives, and colleagues.

They also highlighted gender differences, pointing out that the influence of social networks was more strongly linked to increased physical activity in women. In men, social networks were more strongly linked to decreased sedentary behavior.

While results suggested a minimal role for social support in promoting a healthy lifestyle, the authors pointed out that only about 40% of respondents reported high social support. They also mentioned that the study could not adjust for possible confounders like smoking, age, and body weight. Likewise, the study could not evaluate factors related to causality, such as whether being more physically active encourages larger social networks.

“The current results from this exploratory study suggest a minimal role of social support and modelling, but underlying pathways should be further explored in studies that are powered to do so,” they concluded.

Take-home Points

• A small, exploratory study in The Netherlands suggests that having a larger, denser social network, more friends living nearby, and more intense relationships is linked to healthier lifestyles among people at risk for diabetes and heart disease.

• Vegetable consumption was higher among those with more close-knit relationships.

• Physical activity was higher among those with larger social networks.

• Sedentary behavior was lower among those with more close-knit relationships and larger social networks.

• The influence of social networks was more strongly linked to increased physical activity in women, and decreased sedentariness in men.

• Social support and educational status did not moderate the relationship between social networks and lifestyle.

Reference: Bot SD, et al. Association between social network characteristics and lifestyle behaviours in adults at risk of diabetes and cardiovascular disease. PLoS One. 2016 Oct 31;11(10):e0165041.