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Independent and combined effects of physical activity and body mass index on the development of Type 2 Diabetes - a meta-analysis of 9 prospective cohort studies.

Cloostermans L, Wendel-Vos W, Doornbos G, Howard B, Craig CL, Kivimäki M, Tabak AG, Jefferis BJ, Ronkainen K, Brown WJ, Picavet SH, Ben-Shlomo Y, Laukkanen JA, Kauhanen J, Bemelmans WJ - Int J Behav Nutr Phys Act (2015)

Bottom Line: Hazard ratios from individual studies were combined in a random-effects meta-analysis.Mean follow-up time was 9.1 years.Individuals who were both obese and had low physical activity had 7.4-fold (95 % CI 3.47-15.89) increased risk of type 2 diabetes compared with normal weight, high physically active participants.

View Article: PubMed Central - PubMed

Affiliation: National Institute for Public Health and the Environment, Bilthoven, The Netherlands. Laura.Cloostermans@rivm.nl.

ABSTRACT

Background: The aim of this harmonized meta-analysis was to examine the independent and combined effects of physical activity and BMI on the incidence of type 2 diabetes.

Methods: Our systematic literature review in 2011 identified 127 potentially relevant prospective studies of which 9 fulfilled the inclusion criteria (total N = 117,878, 56.2 % female, mean age = 50.0 years, range = 25-65 years). Measures of baseline physical activity (low, intermediate, high), BMI-category [BMI < 18.4 (underweight), 18.5-24.9 (normal weight), 25.0-29.9 (overweight), 30+ (obese)] and incident type 2 diabetes were harmonized across studies. The associations between physical activity, BMI and incident type 2 diabetes were analyzed using Cox regression with a standardized analysis protocol including adjustments for age, gender, educational level, and smoking. Hazard ratios from individual studies were combined in a random-effects meta-analysis.

Results: Mean follow-up time was 9.1 years. A total of 11,237 incident type 2 diabetes cases were recorded. In mutually adjusted models, being overweight or obese (compared with normal weight) and having low physical activity (compared with high physical activity) were associated with an increased risk of incident type 2 diabetes (hazard ratios 2.33, 95 % CI 1.95-2.78; 6.10, 95 % CI: 4.63-8.04, and 1.23, 95 % CI: 1.09-1.39, respectively). Individuals who were both obese and had low physical activity had 7.4-fold (95 % CI 3.47-15.89) increased risk of type 2 diabetes compared with normal weight, high physically active participants.

Conclusions: This harmonized meta-analysis shows the importance of maintaining a healthy weight and being physically active in diabetes prevention.

No MeSH data available.


Related in: MedlinePlus

Flow chart showing the selection of the cohorts
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Fig1: Flow chart showing the selection of the cohorts

Mentions: Cross-sectional, case–control studies, clinical trials and other intervention studies which aimed to reduce weight and/or increase physical activity, to reduce T2D incidence were excluded. We included cohort studies according to their study characteristics rather than on the basis of the published analyses. Studies were included if: they included a generally ‘healthy’, predominantly white (>50 %) sample; the age range was 25–65 years at baseline; the study included measures of PA (with an indication of frequency, duration and intensity), height and weight, educational level or socio-economic status and smoking; the follow-up was at least 4 years; and incidence T2D was available at follow-up. Applying these criteria reduced the number of 127 potential cohorts to 35 eligible cohorts (Fig. 1).Fig. 1


Independent and combined effects of physical activity and body mass index on the development of Type 2 Diabetes - a meta-analysis of 9 prospective cohort studies.

Cloostermans L, Wendel-Vos W, Doornbos G, Howard B, Craig CL, Kivimäki M, Tabak AG, Jefferis BJ, Ronkainen K, Brown WJ, Picavet SH, Ben-Shlomo Y, Laukkanen JA, Kauhanen J, Bemelmans WJ - Int J Behav Nutr Phys Act (2015)

Flow chart showing the selection of the cohorts
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4666059&req=5

Fig1: Flow chart showing the selection of the cohorts
Mentions: Cross-sectional, case–control studies, clinical trials and other intervention studies which aimed to reduce weight and/or increase physical activity, to reduce T2D incidence were excluded. We included cohort studies according to their study characteristics rather than on the basis of the published analyses. Studies were included if: they included a generally ‘healthy’, predominantly white (>50 %) sample; the age range was 25–65 years at baseline; the study included measures of PA (with an indication of frequency, duration and intensity), height and weight, educational level or socio-economic status and smoking; the follow-up was at least 4 years; and incidence T2D was available at follow-up. Applying these criteria reduced the number of 127 potential cohorts to 35 eligible cohorts (Fig. 1).Fig. 1

Bottom Line: Hazard ratios from individual studies were combined in a random-effects meta-analysis.Mean follow-up time was 9.1 years.Individuals who were both obese and had low physical activity had 7.4-fold (95 % CI 3.47-15.89) increased risk of type 2 diabetes compared with normal weight, high physically active participants.

View Article: PubMed Central - PubMed

Affiliation: National Institute for Public Health and the Environment, Bilthoven, The Netherlands. Laura.Cloostermans@rivm.nl.

ABSTRACT

Background: The aim of this harmonized meta-analysis was to examine the independent and combined effects of physical activity and BMI on the incidence of type 2 diabetes.

Methods: Our systematic literature review in 2011 identified 127 potentially relevant prospective studies of which 9 fulfilled the inclusion criteria (total N = 117,878, 56.2 % female, mean age = 50.0 years, range = 25-65 years). Measures of baseline physical activity (low, intermediate, high), BMI-category [BMI < 18.4 (underweight), 18.5-24.9 (normal weight), 25.0-29.9 (overweight), 30+ (obese)] and incident type 2 diabetes were harmonized across studies. The associations between physical activity, BMI and incident type 2 diabetes were analyzed using Cox regression with a standardized analysis protocol including adjustments for age, gender, educational level, and smoking. Hazard ratios from individual studies were combined in a random-effects meta-analysis.

Results: Mean follow-up time was 9.1 years. A total of 11,237 incident type 2 diabetes cases were recorded. In mutually adjusted models, being overweight or obese (compared with normal weight) and having low physical activity (compared with high physical activity) were associated with an increased risk of incident type 2 diabetes (hazard ratios 2.33, 95 % CI 1.95-2.78; 6.10, 95 % CI: 4.63-8.04, and 1.23, 95 % CI: 1.09-1.39, respectively). Individuals who were both obese and had low physical activity had 7.4-fold (95 % CI 3.47-15.89) increased risk of type 2 diabetes compared with normal weight, high physically active participants.

Conclusions: This harmonized meta-analysis shows the importance of maintaining a healthy weight and being physically active in diabetes prevention.

No MeSH data available.


Related in: MedlinePlus