Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.
Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland.
Cardiovasc Diabetol. 2024 Oct 29;23(1):387. doi: 10.1186/s12933-024-02486-7.
Sedentary behavior, such as excessive sitting, increases risk of cardiovascular disease and premature mortality in the general population, but this has not been assessed in type 1 diabetes. Occupational sitting is increasingly ubiquitous and often constitutes the largest portion of daily sitting time. Our aim was to identify clinical factors associated with excessive occupational sitting in type 1 diabetes and, in a prospective setting, to explore its association with cardiovascular events and all-cause mortality, independent of leisure-time physical activity.
An observational follow-up study of 1,704 individuals (mean age 38.9 ± 10.1 years) from the Finnish Diabetic Nephropathy Study. Excessive occupational sitting, defined as ≥ 6 h of daily workplace sitting, was assessed using a validated self-report questionnaire. Data on cardiovascular events and mortality were retrieved from national registries. Multivariable logistic regression identified independently associated factors, while Kaplan-Meier curves and Cox proportional hazard models were used for prospective analyses.
Factors independently and positively associated with excessive occupational sitting included a high occupational category [OR 6.53, 95% CI (4.09‒10.40)] and older age [1.02 (1.00‒1.03)], whereas negatively associated factors included current smoking [0.68 (0.50‒0.92)], moderate albuminuria [0.55 (0.38‒0.80)], and high leisure-time physical activity [0.52 (0.36‒0.74)]. During a median follow-up of 12.5 (6.5-16.4) years, 163 individuals (9.6%) suffered cardiovascular events, and during a median follow-up of 13.7 (9.4-16.6) years, 108 (6.3%) deaths occurred. Excessive occupational sitting increased cardiovascular event risk (hazard ratio [HR] 1.55 [95% CI 1.10‒2.18]) after adjustment for confounders and other covariates. Furthermore, in a stratified multivariable analysis among current smokers, excessive occupational sitting increased the risk of all-cause mortality (2.06 [1.02‒4.20]).
Excessive occupational sitting is associated with a higher risk of cardiovascular events and all-cause mortality in individuals with type 1 diabetes. This association persists regardless of leisure-time physical activity, after adjusting for independently associated variables identified in our cross-sectional analyses. These findings underscore the need to update physical activity guidelines to better address sedentary behavior and improve outcomes for individuals with type 1 diabetes. Targeting occupational sitting should be considered a key focus for interventions aimed at reducing overall sedentary time.
久坐行为，如过度久坐，会增加普通人群患心血管疾病和过早死亡的风险，但这在 1 型糖尿病患者中尚未得到评估。职业性久坐行为日益普遍，通常构成日常久坐时间的最大部分。我们的目的是确定与 1 型糖尿病患者过度职业性久坐相关的临床因素，并在前瞻性研究中，探索其与心血管事件和全因死亡率的关系，而不考虑休闲时间的体育活动。
这是一项对来自芬兰糖尿病肾病研究的 1704 名（平均年龄 38.9±10.1 岁）个体的观察性随访研究。通过验证过的自我报告问卷评估每日工作场所久坐时间是否超过 6 小时来确定是否存在过度职业性久坐。从国家登记处检索心血管事件和死亡率的数据。多变量逻辑回归确定独立相关因素，而 Kaplan-Meier 曲线和 Cox 比例风险模型用于前瞻性分析。
与过度职业性久坐独立且呈正相关的因素包括高职业类别[比值比（OR）6.53，95%可信区间（CI）（4.09‒10.40）]和年龄较大[1.02（1.00‒1.03）]，而与之呈负相关的因素包括当前吸烟[0.68（0.50‒0.92）]、中度白蛋白尿[0.55（0.38‒0.80）]和高休闲时间体育活动[0.52（0.36‒0.74）]。在中位随访 12.5（6.5-16.4）年后，有 163 名（9.6%）患者发生心血管事件，在中位随访 13.7（9.4-16.6）年后，有 108 名（6.3%）患者死亡。调整混杂因素和其他协变量后，过度职业性久坐会增加心血管事件的风险（危险比[HR]1.55[95%CI 1.10‒2.18]）。此外，在当前吸烟者的分层多变量分析中，过度职业性久坐会增加全因死亡率的风险（2.06[1.02‒4.20]）。
在 1 型糖尿病患者中，过度职业性久坐与心血管事件和全因死亡率风险增加相关。在调整我们的横断面分析中确定的独立相关变量后，这种关联仍然存在，而与休闲时间体育活动无关。这些发现强调需要更新体育活动指南，以更好地解决久坐行为问题，并改善 1 型糖尿病患者的结局。针对职业性久坐行为应被视为减少总体久坐时间干预措施的重点。
