Physical activity, sedentary leisure-time and risk of incident type 2 diabetes: a prospective study of 512 000 Chinese adults

ObjectiveAim to examine the independent and joint associations of physical activity (PA) and sedentary leisure-time (SLT) with risk of diabetes and assess the extent to which these associations were mediated by adiposity.Research design and methodsThe prospective China Kadoorie Biobank recruited ~512 000 adults from 10 diverse areas across China. Self-reported PA was estimated based on type, frequency and duration of specific types of PA, covering four domains (occupation, leisure, household and commuting). SLT was defined as hours per day spent watching television, reading or playing card games. Stratified Cox proportional hazards models were used to estimate adjusted HRs (aHRs) for PA and SLT associated with incident diabetes. Analyses were stratified by age-at-risk (5-year intervals), sex and region and adjusted for household income, education, alcohol consumption, smoking, fresh fruit intake, self-reported general health status, family history of diabetes and body mass index (BMI) status. Analyses of total PA, occupational and non-occupational PA and SLT were mutually adjusted for each other, as appropriate.ResultsAfter ~9 years of follow-up, there were 14 940 incident diabetes cases among 460 736 participants without prior diabetes or cardiovascular diseases at baseline. The mean (SD) age at baseline was 51 (10.6) years, 59% were women and 43% resided in urban areas. Overall, the mean BMI was 23.5 (3.3) kg/m2, which differed by ~0.5 kg/m2 among individuals in the highest compared with the lowest PA and SLT groups. PA was inversely associated the risk of diabetes 16% (aHR: 0.84, 95% CI 0.81 to 0.88) lower in top than bottom fifth. After further adjustment for BMI this was attenuated to 0.99 (95% CI 0.98 to 1.00). SLT was positively associated with diabetes and each 1 hour per day higher usual level was associated with aHR of 1.13 (95% CI 1.09 to 1.17) for diabetes, attenuated to 1.05 (95% CI 1.01 to 1.09) after further adjustment for BMI.ConclusionsAmong Chinese adults, higher levels of PA and lower levels of SLT were associated with lower risks of diabetes with no evidence of effect modification by each other. These associations appeared to arise mainly through adiposity.

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Increased leisure-time physical activity associated with lower onset of diabetes in 44 828 adults with impaired fasting glucose: a population-based prospective cohort study

British Journal of Sports Medicine ◽

10.1136/bjsports-2017-098199 ◽

2018 ◽

Vol 53 (14) ◽

pp. 895-900 ◽

Cited By ~ 12

Author(s):

Xiang Qian Lao ◽

Han-Bing Deng ◽

Xudong Liu ◽

Ta-Chien Chan ◽

Zilong Zhang ◽

...

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Prospective Cohort ◽

Leisure Time ◽

Fasting Glucose ◽

Leisure Time Physical Activity ◽

Chinese Adults ◽

Incident Type ◽

Incident Type 2 Diabetes

AimsTo evaluate the effects of habitual leisure-time physical activity (LTPA) on incident type 2 diabetes in a prospective cohort of Chinese adults with impaired fasting glucose (IFG).Methods44 828 Chinese adults aged 20–80 years with newly detected IFG but free from cardiovascular and cerebrovascular disease were recruited and followed up from 1996 to 2014. Incident type 2 diabetes was identified by fasting plasma glucose ≥7 mmol/L. The participants were classified into four categories based on their self-reported weekly LTPA: inactive, low, moderate, or high. Hazard ratios (HRs) and population attributable fractions (PAFs) were estimated with adjustment for established diabetic risk factor.ResultsAfter 214 148 person-years of follow-up, we observed an inverse dose–response relationship between LTPA and diabetes risk. Compared with inactive participants, diabetes risk in individuals reporting low, moderate and high volume LTPA were reduced by 12% (HR 0.88, 95% CI 0.80 to 0.99; P=0.015), 20% (HR 0.80, 95% CI 0.71 to 0.90; P<0.001), and 25% (HR 0.75, 95% CI 0.67 to 0.83; P<0.001), respectively. At least 19.2% (PAF 19.2%, 95% CI 5.9% to 30.6%) of incident diabetes cases could be avoided if the inactive participants had engaged in WHO recommendation levels of LTPA. This would correspond to a potential reduction of at least 7 million diabetic patients in the Greater China area.ConclusionsOur results show higher levels of LTPA are associated with a lower risk of diabetes in IFG subjects. These data emphasise the urgent need for promoting physical activity as a preventive strategy against diabetes to offset the impact of population ageing and the growing obesity epidemic.

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Leisure-time, occupational, and commuting physical activity and the risk of chronic kidney disease in a working population

Scientific Reports ◽

10.1038/s41598-021-91525-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shohei Yamamoto ◽

Yosuke Inoue ◽

Keisuke Kuwahara ◽

Takako Miki ◽

Tohru Nakagawa ◽

...

Keyword(s):

Physical Activity ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Confidence Interval ◽

Leisure Time ◽

Proportional Hazards ◽

Leisure Time Physical Activity ◽

Cox Proportional Hazards ◽

Physical Activities ◽

Dipstick Test

AbstractPhysical activity has been linked to a lower risk of chronic kidney disease (CKD); however, evidence on the relationship between domain-specific physical activity and CKD is scarce. This study aimed to examine the risk of CKD in relation to leisure-time, occupational, and commuting physical activities in a large occupational cohort in Japan. Participants were 17,331 workers (20–65 years old) without CKD and were followed-up for a maximum period of 13 years. Incident CKD was defined as an estimated glomerular filtration rate of < 60 mL/min/1.73 m2 and/or proteinuria determined using the dipstick test. The Cox proportional hazards models were used to examine the associations. During 147,752 person-years of follow-up, 4013 participants developed CKD. Workers who were standing or walking at work and those who were fairly active at work had adjusted hazard ratios of 0.88 (95% confidence interval 0.86–0.96) and 0.89 (95% confidence interval 0.78–1.02), respectively, for developing CKD than sedentary workers. Leisure-time physical activity and walking for commute were not associated with CKD risk. Our findings suggest that occupational, but not leisure-time and commuting physical activities, is associated with a lower CKD risk.

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Abstract P154: Pericardial Adiposity Predicts Incident Diabetes: The Multi-Ethnic Study of Atherosclerosis

Circulation ◽

10.1161/circ.131.suppl_1.p154 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Amy C Alman ◽

David R Jacobs ◽

Matthew A Allison ◽

John J Carr ◽

Fang-Chi Hsu ◽

...

Keyword(s):

Adipose Tissue ◽

Proportional Hazards ◽

Cox Regression ◽

Cox Proportional Hazards ◽

Incident Diabetes ◽

Ct Scans ◽

Ethnic Study ◽

Pericardial Adipose Tissue ◽

The Mean

Pericardial adipose tissue (PAT) is ectopic fat deep (epicardial adipose tissue) and superficial (paracardial adipose tissue) to the pericardium of the heart. PAT has been cross-sectionally associated with diabetes, but the association with development of diabetes is unclear. Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), we tested whether PAT at baseline was associated with incident diabetes over nearly 10 years of follow-up. The baseline visit (visit 1) was conducted between 2000-2002. Four follow-up visits were conducted at 2 year intervals with visit 5 between 2010 and 2012. Diabetes was defined as a fasting glucose ≥126 mg/dl or the use of antidiabetic medication. Diabetes-free participants at baseline were followed for incident diabetes at any subsequent visit (visits 2-5). Volume of PAT was measured from computed tomographic (CT) scans taken at visits 1 - 4. CT scans were completed on all participants at baseline. Repeat scans were performed on random halves at visits 2 and 3, and a subset at visit 4. Multivariable Cox proportional hazards models were used to assess the association between PAT and incident diabetes. The figure presents the mean PAT by visit and the mean PAT at baseline among those without diabetes at any time during the study period and those that develop diabetes over the 10 years of follow-up. In Cox regression models adjusted for age, race, and sex, each SD increment of baseline PAT (42.0 mL) was associated with a hazard ratio (HR) for incident diabetes of 1.6 (95% CI 1.5-1.7, p<0.0001). After adjusting for baseline BMI and waist-to-hip ratio, the HR was attenuated somewhat, but remained significant: HR 1.3 (95% CI 1.2-1.4, p<0.0001). Addition of waist circumference to the model did not alter PAT results further. We found that PAT was highly stable over time, accumulating very slowly. Its baseline value strongly predicts incident diabetes independent of overall body mass and central fatness.

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Factors that contribute to urban–rural gradients in risk of schizophrenia: Comparing Danish and Western Australian registers

Australian & New Zealand Journal of Psychiatry ◽

10.1177/00048674211009615 ◽

2021 ◽

pp. 000486742110096

Author(s):

Oleguer Plana-Ripoll ◽

Patsy Di Prinzio ◽

John J McGrath ◽

Preben B Mortensen ◽

Vera A Morgan

Keyword(s):

Confidence Interval ◽

Western Australia ◽

Urban Areas ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Indigenous Status ◽

Increased Risk ◽

The Relationship ◽

Western Australian

Introduction: An association between schizophrenia and urbanicity has long been observed, with studies in many countries, including several from Denmark, reporting that individuals born/raised in densely populated urban settings have an increased risk of developing schizophrenia compared to those born/raised in rural settings. However, these findings have not been replicated in all studies. In particular, a Western Australian study showed a gradient in the opposite direction which disappeared after adjustment for covariates. Given the different findings for Denmark and Western Australia, our aim was to investigate the relationship between schizophrenia and urbanicity in these two regions to determine which factors may be influencing the relationship. Methods: We used population-based cohorts of children born alive between 1980 and 2001 in Western Australia ( N = 428,784) and Denmark ( N = 1,357,874). Children were categorised according to the level of urbanicity of their mother’s residence at time of birth and followed-up through to 30 June 2015. Linkage to State-based registers provided information on schizophrenia diagnosis and a range of covariates. Rates of being diagnosed with schizophrenia for each category of urbanicity were estimated using Cox proportional hazards models adjusted for covariates. Results: During follow-up, 1618 (0.4%) children in Western Australia and 11,875 (0.9%) children in Denmark were diagnosed with schizophrenia. In Western Australia, those born in the most remote areas did not experience lower rates of schizophrenia than those born in the most urban areas (hazard ratio = 1.02 [95% confidence interval: 0.81, 1.29]), unlike their Danish counterparts (hazard ratio = 0.62 [95% confidence interval: 0.58, 0.66]). However, when the Western Australian cohort was restricted to children of non-Aboriginal Indigenous status, results were consistent with Danish findings (hazard ratio = 0.46 [95% confidence interval: 0.29, 0.72]). Discussion: Our study highlights the potential for disadvantaged subgroups to mask the contribution of urban-related risk factors to risk of schizophrenia and the importance of stratified analysis in such cases.

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Creatinine-to-body weight ratio is a predictor of incident diabetes: a population-based retrospective cohort study

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-021-00776-8 ◽

2022 ◽

Vol 14 (1) ◽

Author(s):

Jiacheng He

Keyword(s):

Body Weight ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Proportional Hazards ◽

Weight Ratio ◽

Threshold Effect ◽

Population Based ◽

Cox Proportional Hazards ◽

Incident Type

Abstract Purpose Creatinine to body weight (Cre/BW) ratio is considered the independent risk factor for incident type 2 diabetes mellitus (T2DM), but research on this relationship is limited. The relationship between the Cre/BW ratio and T2DM among Chinse individuals is still ambiguous. This study aimed to evaluate the correlation between the Cre/BW ratio and the risk of T2DM in the Chinese population. Methods This is a retrospective cohort study from a prospectively collected database. We included a total of 200,658 adults free of T2DM at baseline. The risk of incident T2DM according to Cre/BW ratio was estimated using multivariable Cox proportional hazards models, and a two-piece wise linear regression model was developed to find out the threshold effect. Results With a median follow-up of 3.13 ± 0.94 years, a total of 4001 (1.99%) participants developed T2DM. Overall, there was an L-shaped relation of Cre/BW ratio with the risk of incident T2DM (P for non-linearity < 0.001). When the Cre/BW ratio (× 100) was less than 0.86, the risk of T2DM decreased significantly as the Cre/BW ratio increased [0.01 (0.00, 0.10), P < 0.001]. When the Cre/BW ratio (× 100) was between 0.86 and 1.36, the reduction in the risk of developing T2DM was not as significant as before [0.22 (0.12, 0.38), P < 0.001]. In contrast, when the Cre/BW ratio (× 100) was greater than 1.36, the reduction in T2DM incidence became significantly flatter than before [0.73 (0.29,1.8), P = 0.49]. Conclusion There was an L-shaped relation of Cre/BW ratio with incidence of T2DM in general Chinese adults. A negative curvilinear association between Cre/BW ratio and incident T2DM was present, with a saturation effect predicted at 0.86 and 1.36 of Cre/BW ratio (× 100).

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Association Between Change in Accelerometer-Measured and Self-Reported Physical Activity and Cardiovascular Disease in the Look AHEAD Trial

10.2337/figshare.17157926 ◽

2022 ◽

Author(s):

John M. Jakicic ◽

Robert I. Berkowitz ◽

Paula Bolin ◽

George A. Bray ◽

Jeanne M. Clark ◽

...

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Proportional Hazards ◽

Secondary Analysis ◽

Cox Proportional Hazards ◽

Self Report ◽

Look Ahead ◽

The Look

OBJECTIVE: To conduct post-hoc secondary analysis examining the association between change in physical activity (PA), measured with self-report and accelerometry, from baseline to 1 and 4 years and cardiovascular disease (CVD) outcomes in the Look AHEAD Trial. RESEARCH DESIGN AND METHODS: Participants were adults with overweight/obesity and type 2 diabetes with PA data at baseline and year 1 or 4 (n = 1,978). Participants were randomized to diabetes support and education or intensive lifestyle intervention. Measures included accelerometry-measured moderate-to-vigorous PA (MVPA), self-reported PA, and composite (morbidity and mortality) CVD outcomes. RESULTS: In pooled analyses of all participants, using Cox proportional hazards models, each 100 MET-min/wk increase in accelerometry-measured MVPA from baseline to 4 years was associated with decreased risk of the subsequent primary composite outcome of CVD. Results were consistent for changes in total MVPA [HR=0.97 (95% CI: 0.95, 0.99)] and MVPA accumulated in >10-minute bouts [HR=0.95 (95% CI: 0.91, 0.98)], with a similar pattern for secondary CVD outcomes. Change in accelerometry-measured MVPA at 1 year and self-reported change in PA at 1 and 4 years were not associated with CVD outcomes. CONCLUSIONS: Increased accelerometry-measured MVPA from baseline to year 4 is associated with decreased risk of CVD outcomes. This suggests the need for long-term engagement in MVPA to reduce the risk of CVD in adults with overweight/obesity and type 2 diabetes.

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Temporal Trends and Recent Correlates in Sedentary Behaviors among Chinese Adults from 2002 to 2010–2012

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17010158 ◽

2019 ◽

Vol 17 (1) ◽

pp. 158 ◽

Cited By ~ 1

Author(s):

Caicui Ding ◽

Ganyu Feng ◽

Fan Yuan ◽

Weiyan Gong ◽

Yecheng Yao ◽

...

Keyword(s):

Urban Areas ◽

Leisure Time ◽

Sedentary Time ◽

Temporal Trends ◽

Physical Activities ◽

Sedentary Behaviors ◽

Chinese Adults ◽

Nutrition And Health ◽

Sociodemographic Correlates ◽

Using Data

Evidence suggests that more time spent in sedentary behaviors (SB) increases health risk independent of physical activities. Trends in SB among adults have not been fully described in China, and the sociodemographic correlates of SB have not been systematically evaluated either. This study examined the temporal trends of SB among 184,257 adults (2002: n = 52,697, 2010–2012: n = 131,560) using data from the China National Nutrition and Health Survey in 2002 and 2010–2012, and analyzed the recent correlates of SB in Chinese adults. Overall, an increase (+0.29 h/d) was seen in total SB across the survey years, and there was a slight increase (+0.14 h/d) in leisure time SB and a decrease (−0.39 h/d) in occupational SB. From 2002 to 2012, the proportion of Chinese adults whose total SB time over 4 h/d increased from 35.4% to 43.0%, and the proportion of leisure SB time over 3 h/d increased from 42.0% to 48.0%, and the proportion of occupational SB time over 4 h/d decreased from 63.4% to 53.0%. Male, urban areas, employed, unmarried, and with higher educational and family economic level were all positively associated with high sedentary time (HST) in 2010–2012. These trends and correlates are important for health policy in China and other countries that are facing similar challenges.

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Physical activity types and atrial fibrillation risk in the middle-aged and elderly: The Rotterdam Study

European Journal of Preventive Cardiology ◽

10.1177/2047487318780031 ◽

2018 ◽

Vol 25 (12) ◽

pp. 1316-1323 ◽

Cited By ~ 7

Author(s):

Marijn Albrecht ◽

Chantal M Koolhaas ◽

Josje D Schoufour ◽

Frank JA van Rooij ◽

M Kavousi ◽

...

Keyword(s):

Physical Activity ◽

Atrial Fibrillation ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Total Physical Activity ◽

Rotterdam Study ◽

Cox Proportional Hazards Models ◽

Activity Types ◽

Study Population

Background The association between physical activity and atrial fibrillation remains controversial. Physical activity has been associated with a higher and lower atrial fibrillation risk. These inconsistent results might be related to the type of physical activity. We aimed to investigate the association of total and types of physical activity, including walking, cycling, domestic work, gardening and sports, with atrial fibrillation. Design Prospective cohort study. Methods Our study was performed in the Rotterdam Study, a prospective population-based cohort. We included 7018 participants aged 55 years and older with information on physical activity between 1997–2001. Cox proportional hazards models were used to examine the association of physical activity with atrial fibrillation risk. Models were adjusted for biological and behavioural risk factors and the remaining physical activity types. Physical activity was categorised in tertiles and the low group was used as reference. Results During 16.8 years of follow-up (median: 12.3 years, interquartile range: 8.7–15.9 years), 800 atrial fibrillation events occurred (11.4% of the study population). We observed no association between total physical activity and atrial fibrillation risk in any model. After adjustment for confounders, the hazard ratio and 95% confidence interval for the high physical activity category compared to the low physical activity category was: 0.71 (0.80–1.14) for total physical activity. We did not observe a significant association between any of the physical activity types with atrial fibrillation risk. Conclusion Our results suggest that physical activity is not associated with higher or lower risk of atrial fibrillation in older adults. Neither total physical activity nor any of the included physical activity types was associated with atrial fibrillation risk.

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Associations Between Leisure-Time Sedentary Behaviors with Unhealthy Dietary Behaviors and Leisure-Time Physical Activity Among Chinese Adults: A Cross-Sectional Study

Current Developments in Nutrition ◽

10.1093/cdn/nzaa066_026 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1771-1771

Author(s):

Yun Wang ◽

Yi-Fei Ouyang ◽

Xiao-Fang Jia ◽

Bing Zhang ◽

Zhihong Wang ◽

...

Keyword(s):

Physical Activity ◽

Leisure Time ◽

Leisure Time Physical Activity ◽

Computer Time ◽

Cross Sectional Study ◽

Dietary Behaviors ◽

Sedentary Behaviors ◽

Chinese Adults ◽

Cross Sectional ◽

Television Time

Abstract Objectives Evidence that sedentary behaviors were correlated with unhealthy diet and physical activity were mostly among children and adolescents, but still limited for adults. The aim of this study was to examine the associations between screen-based leisure-time sedentary behaviors (LTSB) including television time and computer time with unhealthy dietary behaviors, and leisure-time physical activity (LTPA) among Chinese adults. Methods Participants (n = 10,108, aged 18–59 years) from a recent cross-sectional study of CHNS (China Health and Nutrition Survey) conducted in 2015 were analyzed. Time spent in LTSB and LTPA were collected from questionnaire. Unhealthy dietary behaviors were collected from three consecutive 24-hour food recalls and the food frequency method. Multivariable logistic regression models were produced to study the odds ratios for unhealthy dietary behaviors and LTPA as the function of the quintile of LTSB. Results Versus the lowest quartile, the OR(95%CI) of the highest quintile of computer time for insufficient vegetable intake (< 300 g/d) was 1.4(1.0,2.0) for male and 1.5(1.1,2.2) for female; the OR(95%CI) for excessive snack intake (≥1 time/day) was 1.6(1.0,2.3) for male and 1.7(1.3,2.4) for female; the OR(95%CI) for excessive western fast food intake (≥1 time/week) was 2.4(1.2,4.4) for male and 2.7(1.4,4.9) for female. The OR(95%CI) of the highest quintile of television time for no LTPA group (0 Mets.h/w) was 1.8(1.3,2.6) for male and 1.5(1.1,2.0) for female; the OR(95%CI) for sufficient LTPA group (≥8 Mets.h/w) was 0.5(0.4,0.8) for male and 0.7(0.5,0.9) for female. The OR(95%CI) of the highest quintile of computer time for no LTPA group (0 Mets.h/w) was 0.4(0.3,0.6) for male and 0.5(0.4,0.7) for female; the OR(95%CI) for sufficient LTPA (≥8 Mets.h/w) group was 2.4(1.7,3.3) for male and was 2.1(1.5,2.9) for female. Conclusions LTSB were associated with unhealthy dietary behaviors and mixed LTPA among Chinese adults. The patterns of “Television time-less LTPA” and “Computer time-unhealthy diet-more LTPA” for Chinese adults were principal associations. Our findings suggest the need for different behavior preventive intervention on different types of screen-based LTSB among Chinese adults. Funding Sources The survey received funding from NIH and from Ministry of Finance of the People's Republic of China.

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Physical activity during video capsule endoscopy correlates with shorter bowel transit time

Endoscopy International Open ◽

10.1055/s-0043-115385 ◽

2017 ◽

Vol 05 (09) ◽

pp. E856-E860 ◽

Cited By ~ 1

Author(s):

Peter Stanich ◽

Joshua Peck ◽

Christopher Murphy ◽

Kyle Porter ◽

Marty Meyer

Keyword(s):

Physical Activity ◽

Transit Time ◽

Capsule Endoscopy ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Step Count ◽

Video Capsule Endoscopy ◽

Logistic Regression Models ◽

Cox Proportional Hazards Models ◽

Transit Times

Abstract Background and study aim Video capsule endoscopy (VCE) is limited by reliance on bowel motility for propulsion, and lack of physical activity has been proposed as a cause of incomplete studies. Our aim was to prospectively investigate the association between physical activity and VCE bowel transit. Patients and methods Ambulatory outpatients receiving VCE were eligible for the study. A pedometer was attached at the time of VCE ingestion and step count was recorded at the end of the procedure. VCE completion was assessed by logistic regression models, which included step count (500 steps as one unit). Total transit time was analyzed by Cox proportional hazards models. The hazard ratios (HR) with 95 % confidence interval (CI) indicated the “hazard” of completion, such that HRs > 1 indicated a reduced transit time. Results A total of 100 patients were included. VCE was completed in 93 patients (93 %). The median step count was 2782 steps. Step count was not significantly associated with VCE completion (odds ratio 1.45, 95 %CI 0.84, 2.49). Pedometer step count was significantly associated with shorter total, gastric, and small-bowel transit times (HR 1.09, 95 %CI 1.03, 1.16; HR 1.05, 95 %CI 1.00, 1.11; HR 1.07, 95 %CI 1.01, 1.14, respectively). Higher body mass index (BMI) was significantly associated with VCE completion (HR 1.87, 95 %CI 1.18, 2.97) and shorter bowel transit times (HR 1.05, 95 %CI 1.02, 1.08). Conclusions Increased physical activity during outpatient VCE was associated with shorter bowel transit times but not with study completion. In addition, BMI was a previously unreported clinical characteristic associated with VCE completion and should be included as a variable of interest in future studies.

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