School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
Faculty of Public Health, Kasetsart University, Chalermphrakiat Sakon Nakhon Province Campus, Sakon Nakhon, Thailand.
Diabetes Obes Metab. 2023 Jul;25(7):1900-1910. doi: 10.1111/dom.15053. Epub 2023 Apr 3.
To investigate the combined association of adiposity and walking pace with incident type 2 diabetes.
We undertook a prospective cohort study in 194 304 White-European participants (mean age 56.5 years, 55.9% women). Participants' walking pace was self-reported as brisk, average or slow. Adiposity measures included body mass index (BMI), waist circumference (WC) and body fat percentage (BF%). Associations were investigated using Cox proportional hazard models, with a 2-year landmark analysis. A four-way decomposition analysis was used for mediation and additive interaction.
The median (interquartile range) follow-up was 5.4 (4.8-6.3) years. During the follow-up period, 4564 participants developed type 2 diabetes. Compared to brisk-walking participants with normal BMI, those with obesity who walked briskly were at an approximately 10- to 12-fold higher risk of type 2 diabetes (hazard ratio [HR] 9.64, 95% confidence interval [CI] 7.24-12.84, in women; HR 11.91, 95% CI 8.80-16.12, in men), whereas those with obesity and walked slowly had an approximately 12- to 15-fold higher risk (HR 12.68, 95% CI 9.62-16.71, in women; HR 15.41, 95% CI 11.27-21.06, in men). There was evidence of an additive interaction between WC and BF% and walking pace among women, explaining 17.8% and 47.9% excess risk respectively. Obesity mediated the association in women and men, accounting for 60.1% and 44.9%, respectively.
Slow walking pace is a risk factor for type 2 diabetes independent of adiposity. Promoting brisk walking as well as weight management might be an effective type 2 diabetes prevention strategy given their synergistic effects.
研究肥胖程度和行走速度与 2 型糖尿病发病风险的联合相关性。
我们进行了一项前瞻性队列研究，纳入了 194304 名白种欧洲人（平均年龄 56.5 岁，55.9%为女性）。参与者的行走速度自我报告为轻快、平均或缓慢。肥胖程度的测量指标包括体重指数（BMI）、腰围（WC）和体脂百分比（BF%）。使用 Cox 比例风险模型进行关联分析，并采用 2 年时间点分析。采用四向分解分析进行中介和附加交互作用分析。
中位（四分位间距）随访时间为 5.4（4.8-6.3）年。在随访期间，4564 名参与者发生 2 型糖尿病。与 BMI 正常且行走速度较快的轻快步行者相比，肥胖且行走速度较快的参与者发生 2 型糖尿病的风险约高 10-12 倍（女性：危险比[HR]9.64，95%置信区间[CI]7.24-12.84；男性：HR 11.91，95%CI 8.80-16.12），而肥胖且行走速度较慢的参与者发生 2 型糖尿病的风险约高 12-15 倍（女性：HR 12.68，95%CI 9.62-16.71；男性：HR 15.41，95%CI 11.27-21.06）。女性中，WC 和 BF%与行走速度之间存在附加交互作用，分别解释了 17.8%和 47.9%的额外风险。肥胖程度在女性和男性中均介导了这种关联，分别占 60.1%和 44.9%。
与肥胖程度相比，缓慢的行走速度是 2 型糖尿病的一个独立风险因素。鉴于两者的协同作用，促进轻快行走和体重管理可能是一种有效的 2 型糖尿病预防策略。
