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2型糖尿病患者的身体活动、久坐行为与心血管疾病患病风险的关系——MIDiab研究
Yafei Wu, Guijun Qin, Guixia Wang, Libin Liu, Bing Chen, Qingbo Guan, Zhongshang Yuan, Xu Hou, Ling Gao, Chao Xu, Haiqing Zhang, Xu Zhang, Qiu Li, Yongfeng Song, Fei Jing, Shizhan Ma, Shanshan Shao, Meng Zhao, Qingling Guo, Nanwei Tong, Hongyan Zhao, Xiaomin Xie, Chao Liu, Zhongyan Shan, Zhifeng Cheng, Xuefeng Yu, Shulin Chen, Tao Yang, Yangang Wang, Dongmei Li, Zhaoli Yan, Lixin Guo, Qiuhe Ji, Wenjuan Wang, Jiajun Zhao
工程（英文） ›› 2023, Vol. 20 ›› Issue (1) : 26-35.
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2型糖尿病患者的身体活动、久坐行为与心血管疾病患病风险的关系——MIDiab研究
Physical Activity, Sedentary Behavior, and the Risk of Cardiovascular Disease in Type 2 Diabetes Mellitus Patients: The MIDiab Study
本文的研究目的是探讨中国2型糖尿病（type 2 diabetes mellitus, T2DM）患者的中等至剧烈强度身体活动（Moderate-to-vigorous-intensity physical activity, MVPA）时间和久坐（sedentary, SED）时间与心血管疾病（cardiovascular disease, CVD）风险及多种因素[即血压（blood pressure, BP）、体重指数（body mass index, BMI）、低密度脂蛋白胆固醇（low-density lipoprotein cholesterol, LDL-C）和糖化血红蛋白A1（glycated hemoglobin A1c, HbA1c）]控制状况的关系。本研究为一项基于9152名T2DM人群的横断面研究，数据来自于“Multifactorial Intervention on Type 2 Diabetes Study”，简称MIDiab研究。根据患者自我报告的MVPA时间和SED时间，将身体活动水平分为：低（< 150 min·week−1）、中（150~450 min·week−1）、高（≥ 450 min·week−1）三组；久坐行为水平也分为：低（< 4 h·d–1）、中（4~8 h·d–1）、高（≥ 8 h·d–1）三组。本研究的主要结局指标是CVD，将有自我报告CVD疾病史的患者定义为有CVD风险。采用混合效应逻辑回归模型估计与MVPA时间和SED时间相关的CVD风险和多因素控制状态的优势比（odds ratio, OR）及95%置信区间（confidence interval, CI），对中国地理区域特征进行调整。本研究人群年龄的平均±标准差为（60.87 ± 8.44）岁，其中44.5%为女性，25.1%的患者自我报告有CVD疾病史。校正潜在的混杂因素后，发现高水平的MVPA时间与CVD风险之间存在负相关关系，且独立于SED时间，然而在中等水平MVPA时间组没有观察到这种关联。与低水平身体活动组的参与者相比，高水平身体活动组的人更容易达到BMI的目标水平。进一步评估二者对CVD风险的联合作用，与参照组（即SED时间< 4 h·d–1和MVPA时间≥ 450 min·week−1）相比，低水平身体活动组（MVPA时间< 150 min·week−1）的CVD患病风险显著升高。其中，与SED时间< 4 h·d–1相关的OR值为1.270（95% CI为1.040~1.553），与SED时间≥ 8 h·d–1相关的OR值为1.499（95% CI为1.149~1.955）。在T2DM患者中，长时间的久坐行为（即≥ 8 h·d–1的SED时间）与CVD风险增加有关；高水平的身体活动（即MVPA时间≥ 450 min·week−1）与CVD患病风险降低有关，且独立于SED时间。
The aim of this study was to explore the associations of moderate-to-vigorous-intensity physical activity (MVPA) time and sedentary (SED) time with a history of cardiovascular disease (CVD) and multifactorial (i.e., blood pressure (BP), body mass index (BMI), low-density lipoprotein cholesterol (LDL-C), and glycated hemoglobin A1c (HbA1c)) control status among type 2 diabetes mellitus (T2DM) patients in China. A cross-sectional analysis of 9152 people with type 2 diabetes from the Multifactorial Intervention on Type 2 Diabetes (MIDiab) study was performed. Patients were grouped according to their self-reported MVPA time (low, < 150 min·week−1; moderate, 150 to < 450 min·week−1; high, ≥ 450 min·week−1) and SED time (low, < 4 h·d–1; moderate, 4 to < 8 h·d–1; high, ≥ 8 h·d–1). Participants who self-reported a history of CVD were identified as having a CVD risk. Odds ratios (ORs) and 95% confidence intervals (95% CI) of CVD risk and multifactorial control status associated with MVPA time and SED time were estimated using mixed-effect logistic regression models, adjusting for China's geographical region characteristics. The participants had a mean ± standard deviation (SD) age of (60.87 ± 8.44) years; 44.5% were women, and 25.1% had CVD. After adjustment for potential confounding factors, an inverse association between high MVPA time and CVD risk that was independent of SED time was found, whereas this association was not observed in the moderate-MVPA group. A higher MVPA time was more likely to have a positive effect on the control of BMI. Compared with the reference group (i.e., those with MVPA time ≥ 450 min·week−1 and SED time < 4 h·d–1), CVD risk was higher in the low-MVPA group: The OR associated with an SED time < 4 h·d–1 was 1.270 (95% CI, 1.040–1.553) and that associated with an SED time ≥ 8 h·d–1 was 1.499 (95% CI, 1.149–1.955). We found that a high MVPA time (i.e., ≥ 450 min·week−1) was associated with lower odds of CVD risk regardless of SED time among patients with T2DM.
Type 2 diabetes / Physical activity / Sedentary time / Cardiovascular disease
| [1] |
Li Y, Teng D, Shi X, Qin G, Qin Y, Quan H, et al. Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study. BMJ 2020;369:m997.
|
| [2] |
Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge AW, et al. IDF Diabetes Atlas: global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract 2018;138:271–81.
|
| [3] |
IDF. IDF Diabetes Atlas. 10th edition [Internet]. Brussels: IDF; 2021 Dec 6 [cited 2021 Dec 6]. Available from: https://diabetesatlas.org/en/resources/.
|
| [4] |
Einarson TR, Acs A, Ludwig C, Panton UH. Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007–2017. Cardiovasc Diabetol 2018;17(1):83.
|
| [5] |
Jia W, Weng J, Zhu D, Ji L, Lu J, Zhou Z, et al. CDS. Standards of medical care for type 2 diabetes in China 2019. Diabetes Metab Res Rev 2019;35(6):e3158.
|
| [6] |
Llavero-Valero M, Escalada San Martín J, Martínez-González MA, Alvarez-Mon MA, Alvarez-Alvarez I, Martínez-González J, et al. Promoting exercise, reducing sedentarism or both for diabetes prevention: the ‘‘Seguimiento Universidad De Navarra” (SUN) cohort. Nutr Metab Cardiovasc Dis 2021;31(2):411–9.
|
| [7] |
Patnode CD, Evans CV, Senger CA, Redmond N, Lin JS. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without known cardiovascular disease risk factors: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2017;318(2):175–93.
|
| [8] |
Boulé NG, Kenny GP, Haddad E, Wells GA, Sigal RJ. Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in type 2 diabetes mellitus. Diabetologia 2003;46(8):1071–81.
|
| [9] |
Balducci S, D’Errico V, Haxhi J, Sacchetti M, Orlando G, Cardelli P, et al. Level and correlates of physical activity and sedentary behavior in patients with type 2 diabetes: a cross-sectional analysis of the Italian Diabetes and Exercise Study_2. PLoS One 2017;12(3):e0173337.
|
| [10] |
Lear SA, Hu W, Rangarajan S, Gasevic D, Leong D, Iqbal R, et al. The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study. Lancet 2017;390(10113):2643–54.
|
| [11] |
Biswas A, Oh PI, Faulkner GE, Bajaj RR, Silver MA, Mitchell MS, et al. Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and meta-analysis. Ann Intern Med 2015;162(2):123–32.
|
| [12] |
Lamb MJE, Westgate K, Brage S, Ekelund U, Long GH, Griffin SJ, et al. Prospective associations between sedentary time, physical activity, fitness and cardiometabolic risk factors in people with type 2 diabetes. Diabetologia 2016;59(1):110–20.
|
| [13] |
Rossen J, Von Rosen P, Johansson UB, Brismar K, Hagströmer M. Associations of physical activity and sedentary behavior with cardiometabolic biomarkers in prediabetes and type 2 diabetes: a compositional data analysis. Phys Sportsmed 2020;48(2):222–8.
|
| [14] |
Rossen J, Buman MP, Johansson UB, Yngve A, Ainsworth B, Brismar K, et al. Reallocating bouted sedentary time to non-bouted sedentary time, light activity and moderate-vigorous physical activity in adults with prediabetes and type 2 diabetes. PLoS ONE 2017;12(7):e0181053.
|
| [15] |
Joseph JJ, Deedwania P, Acharya T, Aguilar D, Bhatt DL, Chyun DA, et al. Comprehensive management of cardiovascular risk factors for adults with type 2 diabetes: a scientific statement from the American Heart Association. Circulation 2022;145(9):e722–59.
|
| [16] |
Yao WY, Han MG, De Vito G, Fang H, Xia Q, Chen Y, et al. Physical activity and glycemic control status in Chinese patients with type 2 diabetes: a secondary analysis of a randomized controlled trial. Int J Environ Res Public Health 2021;18(8):4292.
|
| [17] |
Wang Y, Guan Q, Hou X, Zhang X, Zhang H, Xu C, et al. Multifactorial Intervention on Type 2 Diabetes (MIDiab) study: a multicenter, open-label, randomized, parallel controlled, community trial. J Diabetes 2020;12 (11):862–4.
|
| [18] |
Alberti KGMM, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998;15 (7):539–53.
|
| [19] |
Fan M, Lyu J, He P. Chinese guidelines for data processing and analysis concerning the International Physical Activity Questionnaire. Chin J Epidemiol 2014;35(8):961–4. Chinese.
|
| [20] |
Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003;35(8):1381–95.
|
| [21] |
Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med 2020;54(24):1451–62.
|
| [22] |
Bames J, Behrens TK, Benden ME, Biddle S, Bond D, Brassard P, et al. Letter to the editor: standardized use of the terms ‘‘sedentary” and ‘‘sedentary behaviours”. Appl Physiol Nutr Metab 2012;37(3):540–2.
|
| [23] |
Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007;39(8):1423–34.
|
| [24] |
Sattelmair J, Pertman J, Ding EL, Kohl 3rd HW, Haskell W, Lee IM. Dose response between physical activity and risk of coronary heart disease: a metaanalysis. Circulation 2011;124(7):789–95.
|
| [25] |
Colberg SR, Albright AL, Blissmer BJ, Braun B, Chasan-Taber L, Fernhall B, et al. Exercise and type 2 diabetes: American College of Sports Medicine and the American Diabetes Association: joint position statement. Exercise and type 2 diabetes. Med Sci Sports Exerc 2010;42(12):2282–303.
|
| [26] |
Buse JB, Ginsberg HN, Bakris GL, Clark NG, Costa F, Eckel R, et al. Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation 2007;115(1):114–26.
|
| [27] |
Hamasaki H. Daily physical activity and type 2 diabetes: a review. World J Diabetes 2016;7(12):243–51.
|
| [28] |
Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, Salem GJ, et al.; American College of Sports Medicine Position Stand. Exercise and physical activity for older adults. Med Sci Sports Exerc 2009;41 (7):1510–30.
|
| [29] |
Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012(9):CD007146.
|
| [30] |
Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, et al. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care 2016;39(11):2065–79.
|
| [31] |
Ekelund U, Brown WJ, Steene-Johannessen J, Fagerland MW, Owen N, Powell KE, et al. Do the associations of sedentary behaviour with cardiovascular disease mortality and cancer mortality differ by physical activity level? A systematic review and harmonised meta-analysis of data from 850 060 participants. Br J Sports Med 2019;53(14):886–94.
|
| [32] |
Carter S, Hartman Y, Holder S, Thijssen DH, Hopkins ND. Sedentary behavior and cardiovascular disease risk: mediating mechanisms. Exerc Sport Sci Rev 2017;45(2):80–6.
|
| [33] |
Paz-Krumdiek M, Rodriguez-Vélez SG, Mayta-Tristán P, Bernabe-Ortiz A. Association between sitting time and obesity: a population-based study in Peru. Nutr Diet 2020;77(2):189–95.
|
| [34] |
Kachur S, Lavie CJ, de Schutter A, Milani RV, Ventura HO. Obesity and cardiovascular diseases. Minerva Med 2017;108(3):212–28.
|
| [35] |
Durrer C, Francois M, Neudorf H, Little JP. Acute high-intensity interval exercise reduces human monocyte Toll-like receptor 2 expression in type 2 diabetes. Am J Physiol Regul Integr Comp Physiol 2017;312(4):R529–38.
|
| [36] |
Healy GN, Dunstan DW, Salmon J, Cerin E, Shaw JE, Zimmet PZ, et al. Breaks in sedentary time: beneficial associations with metabolic risk. Diabetes Care 2008;31(4):661–6.
|
| [37] |
Benatti FB, Ried-Larsen M. The effects of breaking up prolonged sitting time: a review of experimental studies. Med Sci Sports Exerc 2015;47 (10):2053–61.
|
| [38] |
Jarvie JL, Pandey A, Ayers CR, McGavock JM, Sénéchal M, Berry JD, et al. Aerobic fitness and adherence to guideline-recommended minimum physical activity among ambulatory patients with type 2 diabetes mellitus. Diabetes Care 2019;42(7):1333–9.
|
| [39] |
Archundia Herrera MC, Subhan FB, Chan CB. Dietary patterns and cardiovascular disease risk in people with type 2 diabetes. Curr Obes Rep 2017;6(4):405–13.
|
| [40] |
Holtermann A, Schnohr P, Nordestgaard BG, Marott JL. The physical activity paradox in cardiovascular disease and all-cause mortality: the contemporary Copenhagen General Population Study with 104 046 adults. Eur Heart J 2021;42(15):1499–511.
|
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