The Combined Effects of Animal Products Intake and Physical Activity With Cause-specific and All-cause Mortality Among Patients With Type 2 Diabetes Mellitus in China: A Prospective Cohort Study

BackgroundTo determine the associations of animal products intake and physical activity and their combined effects with cause-specific and all-cause mortality among type 2 diabetes mellitus (T2DM) patients in China.MethodsBaseline data of 7311 type 2 diabetes mellitus (T2DM) patients recruited with a stratified random cluster sampling method were collected from December 2013 to January 2014. Participants were followed up until the date of their death or December 2019 for survivors, whichever came first. Nonlinear trends of cause-specific and all-cause mortality were assessed using restricted cubic splines with three knots placed at centiles 10, 50, and 90 of diet intake. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the combined relationship of physical activity and animal products with cause-specific and all-cause mortality.ResultsDuring a median follow-up of 6.1 years, 692 (9.5%) T2DM patients died. The main cause of death was cardiovascular disease (CVD) (35.8%), followed by cancer (20.6%). After multivariable adjustment, a higher level of physical activity was nonlinearly associated with lower all-cause and CVD mortality in a J-shaped pattern, with the protective effect observed >8 MET-h/d. Higher consumption of red meat, poultry, and aquatic products was associated with a lower risk of all-cause mortality (HR = 0.75, 0.64, 0.75, respectively, all P<0.05). In the highest tertiles of physical activity, a higher intake of red meat, poultry, and aquatic products was associated with a lower risk for all-cause mortality than in the lowest tertiles (red meat, HR = 0.80, 0.62, 0.51, and 0.48; poultry, HR = 0.85, 0.51, 0.48, and 0.45; aquatic products, HR = 0.80, 0.57, 0.55, and 0.40, respectively). Similarly, the protective effect of moderate to high intake of poultry, aquatic products, and eggs on CVD mortality in high physical activity was found. ConclusionsOur study highlights that in T2DM patients, better adherence to moderate to high consumption of animal products, including red meat, poultry, and aquatic products, together with engaging in moderate to high levels of physical activity exerts a beneficial effect in lowering cause-specific and all-cause mortality in China.