Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China.
Peking University Clinical Research Institute Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China.
Front Endocrinol (Lausanne). 2021 Nov 30;12:769549. doi: 10.3389/fendo.2021.769549. eCollection 2021.
Uncertainty remains concerning association between long-term physical activity and incident type 2 diabetes mellitus (DM). We intended to evaluate physical activity participation over a 6-year span and assess association with subsequent 10-year incident DM risk, as well as examine mediation role by obesity.
A total of 9757 community-dwelling adults aged ≥ 50 years in England were included in the population-based cohort. Physical activity participation, including trajectories and cumulative participation were assessed using weighted score over a 6-year span from wave 1 (2002-2003) to wave 4 (2008-2009). Incident DM recorded over a 10-year span from wave 4 (2008-2009) to wave 9 (2018-2019) was outcome.
5 distinct activity trajectories were identified, including persistently low (N=3037, incident DM=282), initially low then improving (1868, 90), initially high then declining (325, 20), persistently moderate (2489, 170), and persistently high (2038, 108). Compared with persistently low, participants of initially low then improving, persistently moderate and high were associated with lower incident DM risk, with multivariable-adjusted hazard ratios (HR) of 0.41 (95% confidence interval [CI]: 0.32 to 0.53, <0.001), 0.70 (95% CI: 0.56 to 0.89, =0.004) and 0.49 (95% CI: 0.37 to 0.65, 0.001), respectively. Elevated cumulative activity was also associated with lower DM risk, with each quintile increment in cumulative weighted score corresponding to HR of 0.76 (95% CI: 0.71 to 0.82, 0.001). Mediation analysis found that body mass index, waist circumference and change in body mass index mediate 10% (0.001), 17% (0.001) and 9% (0.001) of the observed association between activity and incident DM, respectively.
For middle aged and older adults, both gradually improved and persistently active participation in physical activity were associated with subsequent lower risk of incident DM, with obesity playing a potential mediator. Strategies focusing on improving and maintaining active participation in physical activity might be beneficial from DM prevention perspective.
长期身体活动与 2 型糖尿病（DM）发病之间的关系仍存在不确定性。我们旨在评估 6 年内的身体活动参与情况，并评估其与随后 10 年 DM 发病风险的关系，以及检验肥胖的中介作用。
该基于人群的队列纳入了英格兰 9757 名年龄≥50 岁的社区居住成年人。使用加权评分在 6 年的时间跨度内（第 1 波[2002-2003 年]至第 4 波[2008-2009 年]）评估身体活动参与情况，包括轨迹和累积参与情况。第 4 波（2008-2009 年）至第 9 波（2018-2019 年）期间记录的 DM 发病为结局。
确定了 5 种不同的活动轨迹，包括持续低水平（N=3037，DM 发病 282）、先低后改善（1868，90）、先高后低（325，20）、持续中等水平（2489，170）和持续高水平（2038，108）。与持续低水平相比，先低后改善、持续中等水平和高水平参与者的 DM 发病风险较低，多变量调整后的危险比（HR）分别为 0.41（95%置信区间[CI]：0.32 至 0.53，<0.001）、0.70（95% CI：0.56 至 0.89，=0.004）和 0.49（95% CI：0.37 至 0.65，0.001）。累积活动量的增加也与 DM 发病风险降低相关，累积加权评分每增加一个五分位，HR 为 0.76（95% CI：0.71 至 0.82，0.001）。中介分析发现，体重指数、腰围和体重指数的变化分别解释了活动与 DM 发病之间观察到的关联的 10%（0.001）、17%（0.001）和 9%（0.001）。
对于中年和老年人，逐渐改善和持续积极的身体活动参与与随后较低的 DM 发病风险相关，肥胖可能是一个潜在的中介因素。从 DM 预防的角度来看，关注改善和维持身体活动的积极参与可能是有益的。
