Association of 20-Year Changes in Cardiorespiratory Fitness With Incident Type 2 Diabetes: The Coronary Artery Risk Development in Young Adults (CARDIA) fitness study

Abstract Objectives There has been limited study of long-term change towards a plant-centered diet in relation to incident type 2 diabetes (T2DM). We examined this question in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort. Methods Analyses included 2717 participants in CARDIA, a US multicenter, community-based prospective cohort study, currently with 30 years of follow-up. Participants were free of diabetes through year 20, with follow-up for incident T2DM through year 30. Dietary intake at years 0 and 20 was assessed by interviewer-administered diet history; overall dietary quality was assessed using a hypothesis-driven index based on 46 food groups, the A Priori Diet Quality Score (APDQS). The APDQS has possible scores 0 to 132 and increasing score is largely led by consumption of nutritionally rich plant foods–fruits and vegetables and plant-derived fats (e.g., seeds, nut, vegetable oils) and proteins (e.g., avocado, legume, soy). Change in diet quality (year 20 – year 0) and its quintiles were calculated. Diagnosis of T2DM was based on self-reported use of antidiabetic medication treatment or lab tests (fasting glucose, 2-hour glucose, or glycated hemoglobin). In proportional hazards regression, covariates included sociodemographics, baseline APDQS, and time-varying energy intake, smoking, and physical activity. Results Mean baseline age was 25.0 ± 3.6y, 43% were black, and 58% were women. During 10 years of follow-up after year 20, 206 cases of incident T2DM occurred. Mean year 0 APDQS was 64 ± 13 points and mean 20-year changes in APDQS was 7 ± 11. In multivariable-adjusted analysis, we found that the greatest increase in dietary quality over 20 years (median APDQS increased by 22 points) was associated with a 60% decrease in risk of T2DM as compared to a small decrease in diet quality (median APDQS decreased by 8 points); HRQ5 vs. Q1: 0.40; 95% CI:0.24–0.67). For every 10-point increase in APDQS over 20 years, there was a 23% decrease in risk of T2DM (95% CI: 0.67–0.88, P-trend = 0.0009). The pattern of findings persisted within below median and within above median year 0 APDQS. Conclusions Our finding suggests that young adults would benefit from improving diet quality by shifting toward a more plant-centered diet over time for the prevention of T2DM. Funding Sources This research was funded by an NHLBI contract and the University of Minnesota Healthy Food, Healthy Lives Institute. Supporting Tables, Images and/or Graphs

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Abstract MP32: Muscular Strength and Type 2 Diabetes Prevention

Circulation ◽

10.1161/circ.137.suppl_1.mp32 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Duck-chul Lee ◽

Angelique Brellenthin ◽

Xuemei Sui ◽

Steven Blair

Keyword(s):

Type 2 Diabetes ◽

Cardiorespiratory Fitness ◽

Diabetes Prevention ◽

Lower Risk ◽

Muscular Strength ◽

Incident Type ◽

Type 2 Diabetes Prevention ◽

Incident Type 2 Diabetes ◽

History Of

Introduction: There is little evidence on the effects of muscular strength, independent of cardiorespiratory fitness, on the development of type 2 diabetes. Hypothesis: We hypothesised that muscular strength, independent of cardiorespiratory fitness, has significant benefits in type 2 diabetes prevention. Methods: Participants were 5,578 men and women aged 18 to 100 years (mean age, 44) who received preventive medical examinations during 1980-2006 in the Aerobics Center Longitudinal Study. Participants were free of myocardial infarction, stroke, cancer, and diabetes at baseline. Total body muscular strength was quantified by combining 1 repetition maximum (1-RM) measures for leg and bench presses and categorized into three groups, lower (weak), middle, and upper (strong), based on the tertiles (thirds) of muscular strength. Cardiorespiratory fitness was measured by a maximal treadmill exercise test. Type 2 diabetes was defined as a fasting plasma glucose level of ≥126 mg/dl, a history of diabetes, or current insulin therapy. Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident type 2 diabetes by muscular strength after adjusting for baseline age, sex, examination year, body mass index (BMI), current smoking, heavy alcohol drinking, parental history of diabetes, hypertension, hypercholesterolemia, glucose level, and maximum treadmill test time. Results: During an average follow-up of 8 years, 270 (4.8%) individuals developed type 2 diabetes. Compared with the individuals in the lower third of muscular strength, individuals in the middle third had a 30% lower risk of developing type 2 diabetes (HR: 0.70, 95% CI: 0.51-0.95), whereas no significant benefit was found in individuals in the upper third (HR: 1.16, 95% CI: 0.86-1.57) after adjusting for potential confounders and cardiorespiratory fitness. We found similar results in men and women, young (<50 years) and old (≥50 years), and normal (BMI <25 kg/m 2 ) and overweight/obese (BMI ≥25 kg/m 2 ) individuals. In the combined analysis of muscular strength and cardiorespiratory fitness, we also found similar results that individuals in the middle third of muscular strength showed lower risks of developing type 2 diabetes in both low (lower 50%) and high (upper 50%) cardiorespiratory fitness, compared with individuals in the lower third of muscular strength and low cardiorespiratory fitness. Conclusions: We found that a moderate level of muscular strength, independent of cardiorespiratory fitness, is associated with a lower risk of developing type 2 diabetes. Additional studies on the dose-response relationship of muscular strength and incident type 2 diabetes are warranted.

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