Promoting exercise, reducing sedentarism or both for diabetes prevention: The "Seguimiento Universidad De Navarra" (SUN) cohort.

Affiliation

Llavero-Valero M(1), Escalada San Martín J(2), Martínez-González MA(3), Alvarez-Mon MA(4), Alvarez-Alvarez I(5), Martínez-González J(6), Bes-Rastrollo M(7).
Author information:
(1)Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Department of Endocrinology and Nutrition, University of Navarra, Pamplona Spain.
(2)Department of Endocrinology and Nutrition, University of Navarra, Pamplona Spain; Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition
(CIBEROBN), Institute of Health Carlos III, Madrid, Spain; IDISNA, Healthcare Research Institute of Navarra, Pamplona, Spain.
(3)Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition
(CIBEROBN), Institute of Health Carlos III, Madrid, Spain; IDISNA, Healthcare Research Institute of Navarra, Pamplona, Spain; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA.
(4)Department of Psychiatry, University of Navarra, Pamplona, Spain.
(5)Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Centre for Nutrition Research, Department of Nutrition and Food Sciences, Physiology and Toxicology, University of Navarra, Pamplona, Spain.
(6)Department of Internal Medicine, Hospital Carlos Haya, Málaga, Spain.
(7)Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition
(CIBEROBN), Institute of Health Carlos III, Madrid, Spain; IDISNA, Healthcare Research Institute of Navarra, Pamplona, Spain. Electronic address: [Email]

Abstract

BACKGROUND AND AIM: Both physical activity (PA) and sedentary behaviors have demonstrated independent associations with the development of type 2 diabetes mellitus (T2DM). However, the combination of both, has been less explored. We aimed to compare the associations of PA-only versus the simultaneous effect of PA and sedentary behaviors on T2DM in a Mediterranean cohort. METHODS AND RESULTS: Participants (n = 19,524) initially free of T2DM from the SUN Project were followed-up for a median of 10.4 years. Analyses were conducted in 2018. PA and sedentary parameters (TV viewing time and sitting time) were assessed through a validated questionnaire. The amount of each PA was expressed in METs-h/wk. After that, a previously developed 8-item active + sedentary lifestyle score was computed. T2DM was defined according to ADA criteria. To adjust for potential confounders, Cox regression models were adjusted. Among 19,524 participants, 175 cases of new-onset T2DM were observed during follow-up. After multivariable adjustment, higher PA was strongly inversely associated with T2DM, showing highly significant differences between extreme quartiles (HR = 0.51; 95% CI 0.32-0.79 p for trend<0.001). When considering not only PA, but also the more comprehensive active + sedentary lifestyle combined score, even stronger differences were found between the lowest and the highest categories (HR = 0.40; 95%CI 0.20-0.80; p for trend<0.001). CONCLUSION: Sedentary lifestyles, in addition to PA patterns, should be included in the assessment of T2DM risk. Promoting PA should be coupled with the avoidance of a sedentary lifestyle to lower the risk of T2DM.