Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia.
Diabetologia. 2024 Jul;67(7):1356-1367. doi: 10.1007/s00125-024-06145-0. Epub 2024 Apr 24.
AIMS/HYPOTHESIS: The associations of sitting, standing, physical activity and sleep with cardiometabolic health and glycaemic control markers are interrelated. We aimed to identify 24 h time-use compositions associated with optimal metabolic and glycaemic control and determine whether these varied by diabetes status.
Thigh-worn activPAL data from 2388 participants aged 40-75 years (48.7% female; mean age 60.1 [SD = 8.1] years; n=684 with type 2 diabetes) in The Maastricht Study were examined. Compositional isometric log ratios were generated from mean 24 h time use (sitting, standing, light-intensity physical activity [LPA], moderate-to-vigorous physical activity [MVPA] and sleeping) and regressed with outcomes of waist circumference, fasting plasma glucose (FPG), 2 h plasma glucose, HbA, the Matsuda index expressed as z scores, and with a clustered cardiometabolic risk score. Overall analyses were adjusted for demographics, smoking, dietary intake and diabetes status, and interaction by diabetes status was examined separately. The estimated difference when substituting 30 min of one behaviour with another was determined with isotemporal substitution. To identify optimal time use, all combinations of 24 h compositions possible within the study footprint (1st-99th percentile of each behaviour) were investigated to determine those cross-sectionally associated with the most-optimal outcome (top 5%) for each outcome measure.
Compositions lower in sitting time and with greater standing time, physical activity and sleeping had the most beneficial associations with outcomes. Associations were stronger in participants with type 2 diabetes (p<0.05 for interactions), with larger estimated benefits for waist circumference, FPG and HbA when sitting was replaced by LPA or MVPA in those with type 2 diabetes vs the overall sample. The mean (range) optimal compositions of 24 h time use, considering all outcomes, were 6 h (range 5 h 40 min-7 h 10 min) for sitting, 5 h 10 min (4 h 10 min-6 h 10 min) for standing, 2 h 10 min (2 h-2 h 20 min) for LPA, 2 h 10 min (1 h 40 min-2 h 20 min) for MVPA and 8 h 20 min (7 h 30 min-9 h) for sleeping.
CONCLUSIONS/INTERPRETATION: Shorter sitting time and more time spent standing, undergoing physical activity and sleeping are associated with preferable cardiometabolic health. The substitutions of behavioural time use were significantly stronger in their associations with glycaemic control in those with type 2 diabetes compared with those with normoglycaemic metabolism, especially when sitting time was balanced with greater physical activity.
目的/假设：坐姿、站立、体力活动和睡眠与心脏代谢健康和血糖控制标志物的关联是相互关联的。我们的目的是确定与最佳代谢和血糖控制相关的 24 小时时间利用组成，并确定这些组成是否因糖尿病状态而异。
从马斯特里赫特研究中的 2388 名年龄在 40-75 岁的参与者（48.7%为女性；平均年龄 60.1[SD=8.1]岁；684 名 2 型糖尿病患者）的大腿佩戴的 activPAL 数据中进行了检查。从平均 24 小时时间利用（坐姿、站立、低强度体力活动[LPA]、中等到剧烈体力活动[MVPA]和睡眠）生成组成等比对数，并与腰围、空腹血糖（FPG）、2 小时血糖、HbA、Matsuda 指数表示为 z 分数以及聚类的心脏代谢风险评分进行回归。总体分析调整了人口统计学因素、吸烟、饮食摄入和糖尿病状态，并分别检查了糖尿病状态的交互作用。通过等时替代来确定用 30 分钟替代一种行为的估计差异。为了确定最佳时间利用，研究了研究范围内（每种行为的第 1-99 百分位）可能的所有 24 小时组成的组合，以确定每个结果测量的横截面与每个结果的最佳结果（前 5%）相关的组合。
与结果最有益的是，坐姿时间减少，站立时间、体力活动和睡眠时间增加的组合。在 2 型糖尿病患者中，这些关联更强（p<0.05 交互作用），与总体样本相比，2 型糖尿病患者中用 LPA 或 MVPA 替代坐姿时，腰围、FPG 和 HbA 的估计益处更大。考虑到所有结果，24 小时时间利用的最佳组成平均为 6 小时（范围 5 小时 40 分钟-7 小时 10 分钟）用于坐姿，5 小时 10 分钟（4 小时 10 分钟-6 小时 10 分钟）用于站立，2 小时 10 分钟（2 小时-2 小时 20 分钟）用于 LPA，2 小时 10 分钟（1 小时 40 分钟-2 小时 20 分钟）用于 MVPA，8 小时 20 分钟（7 小时 30 分钟-9 小时）用于睡眠。
结论/解释：坐姿时间减少，站立、进行体力活动和睡眠时间增加与心脏代谢健康状况更好相关。与血糖控制相比，在 2 型糖尿病患者中，行为时间利用的替代与代谢和血糖控制的关联明显更强，尤其是在平衡坐姿与更大的体力活动时。
