Sedentary behaviour, physical activity and a continuous metabolic syndrome risk score in adults

Associations of 24 h time-use compositions of sitting, standing, physical activity and sleeping with optimal cardiometabolic risk and glycaemic control: The Maastricht Study

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.

METHODS

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, HbA1c, 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.

RESULTS

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 HbA1c 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.

Influence of Central Obesity on Associations Between Physical Activity, Sitting Time, and Metabolic Syndrome Among Middle-Aged and Older Adults in Urban China: A Cross-Sectional Study

Objective

This study assessed possible associations among physical activity (PA), sitting time (ST), metabolic syndrome (MetS), and the individual components thereof. We analyzed the entire study sample and subpopulations stratified by visceral fat area (VFA). We hypothesized that individuals with elevated VFA might respond differently to modifiers of metabolic health, including PA and ST.

Methods

This cross-sectional study, conducted between March and May 2010, enrolled 957 adults with abdominal magnetic resonance imaging (MRI) aged 40-65 years living in the urban communities in Hangzhou, China. PA and ST were recorded using the standard International Physical Activity Questionnaire (IPAQ) and categorized into three levels. The ethnicity-specific cutoff for central obesity was VFA ≥ 80 cm2 on MRI according to Chinese population-based research. Multiple logistic regression models were used to analyze the associations between PA, ST, MetS and its components.

Results

In the total subject population, participants reporting high level of PA were at a lower risk of MetS (OR = 0.46, 95% CI: 0.25, 0.86) than those declaring low PA. In the subgroup population with VFA ≥ 80 cm2 (ie, with central obesity), moderate-to-high PA levels were associated with a lower risk of MetS (p for trend < 0.05) and a lower risk of decreased high-density lipoprotein cholesterol (HDL-C) concentrations (p for trend < 0.05). In addition, ST > 3 h/day was a risk factor for both MetS (p for trend < 0.05) and hypertriglyceridemia (p for trend < 0.05) in the total subject population. While in the central obesity subgroup, ST > 3 h/day was found a stronger risk factor.

Conclusion

Our study suggests that moderate-to-high levels of PA may have a role in prevention of MetS, and ST > 3 h/day was associated with a higher risk of MetS, particularly in individuals with central obesity.

A longitudinal exploration of self-reported TV behaviours as a surrogate for sedentary behaviour in older adults with an intellectual disability from the intellectual disability supplement to the Irish longitudinal study on aging (IDS-TILDA) study

This study presents the findings of an investigation into the self-reported TV habits of adults with an intellectual disability, where time watching TV was used as a proxy for sedentary behaviour (SB). Risk factors identified for the general and intellectual disability populations and standard covariates of age, sex, level of intellectual disability, living circumstances and BMI were explored to determine their viability as contributors to increased TV viewing and SB. Missing data was imputed using Multiple Imputation Chained Equation (MICE). Multinomial logistic regression and Chi-squared Automatic Interaction Detector Analysis (CHAID) analyses of risk factors for increased TV viewing were explored and compared. The Systems of Sedentary Behaviour (SOS) framework was used to structure results. Novel risk factors for increased TV viewing were identified.

A new metabolic syndrome prediction model for self-evaluation as a primary screening tool in an apparently MetS-free population

BACKGROUND

Metabolic syndrome (MetS) is a growing global public health concern associated with increased morbidity and mortality. The study aimed to establish a simple self-evaluated prediction model to identify MetS.

METHODS

A cross-sectional study based on the American National Health and Nutrition Examination Survey database was performed. Participants aged ≥20 in the 2009-2018 surveys, with no current pregnancy or major morbidities, were included. The model was built with data from 2009 to 2016 and validated using 2017-2018 data. MetS was defined according to AHA/NHLBI guidelines. Multivariable logistic regression was applied to build a prediction model. The area under the receiver operating characteristic curve (AUC) was used to assess the discrimination ability and the maximal Youden's index was used to identify the optimal cut-off value.

RESULTS

The study included 4245 individuals (median age 37, IQR 28-49, 51.8% females) in the training group and 911 individuals (median age 37, IQR 28-52, 52.5% females) in the validation group. Older age, male gender, non-Black race, no postsecondary education, and higher BMI were significantly associated with increased risk of MetS. The final model included age, gender, race, education, and BMI, and showed good discrimination ability (AUC = 0.810, 95% CI 0.793-0.827, sensitivity 80.4%, specificity 66.2%, positive likelihood ratio 2.379, negative likelihood ratio 0.296, PPV 59.6% and NPV 84.5%).

CONCLUSION

A new model for self-evaluation may serve as a primary, easy-to-use screening tool to identify MetS in an apparently MetS-free population. A simple application may serve for primary and secondary prevention, thus enabling risk reduction in the development of cardiovascular morbidity and health expenditure.

Neighborhood socioeconomic status and cardiometabolic risk: mediating roles of domain-specific physical activities and sedentary behaviors

PURPOSE

We examined the potential mediating roles of domain-specific physical activities and sedentary behaviors in the relationship between area-level socioeconomic status (SES) and cardiometabolic risk.

METHODS

Data were from the 2011/2012 Australian Diabetes, Obesity and Lifestyle study (n = 3431). The outcome was a clustered cardiometabolic risk (CCR) score, and the exposure was suburb-level SES. Potential mediators were domain-specific physical activities and sedentary behaviors. Multilevel linear regression models examined associations between SES and potential mediators (α) and between mediators and CCR (β). Mediation was assessed using the joint-significance test.

RESULTS

Higher SES was associated with a lower CCR score. Lower SES was associated with less frequent walking for transport, lower vigorous-intensity recreational physical activity, and higher TV time, which were associated with higher CCR scores. However, higher SES was associated with longer transport-related sitting time (all modes and in cars), which were associated with higher CCR scores.

CONCLUSIONS

The SES-cardiometabolic risk relationship may be partially explained by walking for transport, vigorous-intensity recreational physical activity, and TV viewing. These findings, which require corroboration from prospective evidence and clarification of the roles of transport-related sitting and occupational physical activity, can inform initiatives addressing socioeconomic inequalities in cardiometabolic health.

Occupational sitting and work engagement among university employees

Objective: This study sought to determine the relationship between occupational sitting and work engagement among university employees. Participants: Participants included 103 university employees (age: 48.5 ± 10.4 years, 80% female, 77% staff). Methods: Participants completed an online survey based on the Utrecht Work Engagement Survey (UWES) and the Occupational Sitting and Physical Activity Questionnaire (OSPAQ). The UWES assessed elements of work engagement. The OSPAQ assessed time spent sitting, standing, walking, and in heavy labor during a workday. Results: Compared to staff members, faculty members self-reported less time seated during the workday (373.8 ± 109.7 min/day vs. 321.1 ± 97.3 min/day, p = 0.03). Work engagement was comparable among faculty and staff members (vigor: p = 0.44; absorption: p = 0.68; dedication: p = 0.71). Associations of work engagement with occupational sitting were not significant. Conclusions: These pilot findings suggest that university staff tend to engage in more occupational sitting compared to faculty. Being absorbed and engaged at work is not associated with occupational sitting.

A systematic review of prevalence of metabolic syndrome in occupational groups - Does occupation matter in the global epidemic of metabolic syndrome?

Many occupations can influence the development of metabolic syndrome (MetS). This systematic review aims to evaluate studies on MetS prevalence in different occupational groups from different countries. An integrative review of the literature was conducted within the PubMed and Web of Science databases between January 2005 and February 2022. Only studies with over 3000 subjects that presented data about the prevalence of MetS in different occupational groups were included. The classification of occupational groups was based on the statistical category of economic activities in the European Community (EC). Of a total of 1942 screened records, ten studies were included, showing that MetS is a common health (main) risk factor in all occupational groups. However, the prevalence of MetS varies between nationalities, between and within occupational groups, and between genders. The reasons for this variation appear complex and supported by several causal explanations. The prevalence of MetS was highest among women in a group of Korean skilled agricultural, forestry, and fishery workers (Prevalence: 39.2%). Similarly, among men, the highest prevalence was found in Korean equipment, machine operating, and assembling workers (Prevalence: 35.4%). Male information and communication technology professionals from the Netherlands (Prevalence: 6.2%) and Spanish female catering and hospitality, personal, and security service workers (Prevalence: 5.9%) had the lowest rates of MetS. Overall, the results indicated that valid data on this topic are insufficient, and more randomized controlled trials are needed. Moreover, the different definitions of MetS complicate the accurate comparison between studies, paving the way to achieving consensus on a universal definition of MetS.

Desk based prompts to replace workplace sitting with stair climbing; a pilot study of acceptability, effects on behaviour and disease risk factors

Background

Prolonged sitting is associated with increased risk of obesity, type 2 diabetes and cardiovascular disease. Occupational sitting accounts for up to 50 h/week for employees. This pilot study assessed the acceptability of stair climbing as an interruption to sitting throughout working hours, and provided preliminary data of the effects on glucose and lipid profiles.

Methods

A quasi-experimental design was conducted involving 16 sedentary office workers (five females and 11 males) for intervention (n = 8) and control groups (n = 8) with mean age of 36.38 (5.58). For the eight-week intervention, a continuous four-floor stair climb and descent was performed eight times/day spread evenly over the working day. A prompt to climb was presented on the participant’s computer eight times/day. Participants in the experimental group recorded daily floors climbed and steps (measured using pedometers) in a weekly log sheet. Blood samples were collected pre and post intervention to test effects on fasting glucose and 2 h plasma glucose, triglycerides, and total (TC), LDL and HDL cholesterol. Experimental participants were interviewed at the end of the study. The Wilcoxon signed rank test was used to compare the median changes (pre-post) of the dependent variables.

Results

On average, the experimental group climbed 121 floors/week when prompted. There were significant reductions in fasting blood glucose, TC and LDL, as well as the derived measures of ‘bad’ cholesterol and the TC/HDL ratio in the experimental group. Post-experimental interviews indicated that the interruption to sitting was well tolerated.

Conclusion

Prompted stair climbing activity had impacts on health outcomes and was found acceptable to employees at work.

Trial registration

Ethics for this study was approved by Science, Technology, Engineering and Mathematics Ethical Review Committee, University of Birmingham with ethics reference number ERN_15_0491.

Supplementary information

The online version contains supplementary material available at 10.1186/s12889-022-14393-1.

Association of domain-specific physical activity and sedentary behavior with cardiometabolic health among office workers

OBJECTIVE

Previous studies have reported opposite effects of occupational or non-occupational physical activity (PA) and sedentary behavior (SB) on health outcomes. However, no study has investigated the relationship between domain-specific movement behaviors and cardiometabolic health (CMH) among office workers, considering the compositional nature of time-use data. We investigated the associations of accelerometer-measured PA and SB for each domain (working time, non-working time on workday, and non-workday) with CMH indicators among office workers, using compositional data analysis.

METHODS

This cross-sectional study included 1258 Japanese office workers. The time spent on SB, light-intensity PA (LPA), and moderate- to vigorous-intensity PA (MVPA) were assessed using an accelerometer. CMH indicators were retrieved from the annual health check-up data.

RESULTS

Compositional multiple linear regression indicated that PA and SB during non-working time on workdays, but not working time or non-workdays, were significantly associated with CMH. In particular, during non-working time, time reallocations from SB to LPA and from SB to MVPA were associated with favorable changes in cardiometabolic risk score and lipid metabolism, respectively. Paradoxically, a greater proportion of LPA during non-working time was associated with favorable diastolic blood pressure (β = 1.61; 95% confidence interval [CI] = 0.02, 3.19), whereas occupational LPA was detrimental (β = -2.48; 95% CI = -4.87, -0.09).

CONCLUSION

Our results suggested that reducing SB and increasing PA during non-working time on workdays may be effective for managing CMH among office workers. Future longitudinal studies using compositional data analysis are required to confirm our results.

Self-care practice among adult hypertensive patients at ambulatory clinic of tertiary teaching Hospital in Ethiopia: a cross-sectional study

BACKGROUND

Globally, hypertension is a major public health problem and a strong predictor of cardiovascular disease complications. To reduce and prevent complications from hypertension, it is important to adapt self-care behaviors. This study aimed to assess the self-care practices of adult hypertensive patients at a tertiary teaching hospital in Ethiopia.

METHODS

A health facility-based prospective cross-sectional study was conducted at Jimma Medical Center in Ethiopia between February 2021 and July 2021. Binary and logistic regression was performed to assess the strength of associations between independent and dependent variables. Data entry and analysis were done using Statistical Package for social science (SPSS) software version 22.0. A p-value < 0.05 was considered to declare statistical significance.

RESULTS

From a total of 422 respondents included to the study, male accounted 55.7% and the mean ± SD age of the respondents was 58.7 ± 9.75 years. About 53.1% of patients had poor self-care practices toward hypertension. Not attending formal education [AOR = 2.15; 95% CI (1.74, 6.39); p ≤ 0.001], uncontrolled blood pressure [AOR = 2.14 95% CI (1.27, 3.61); p = 0.003], chronic disease co-morbidity [AOR = 1.48; 95% CI (0.25, 7.73); p ≤ 0.001], unfavorable attitude toward hypertension[AOR = 3.13; 95% CI (1.95, 7.52); p ≤ 0.001], and poor social support [AOR = 2.75; 95% CI (1.45, 6.43); p ≤ 0.001] were independent predictors of poor self-care practice.

CONCLUSION

The level of self-care practices for hypertension in the study area was low. In particular, the level of adherence to the DASH diet, exercise, and weight control was very low. Patient-specific targeted interventions are required to improve self-care practices for hypertension.

Change in Metabolic Syndrome and Cardiorespiratory Fitness Following Exercise Training - The Ball State Adult Fitness Longitudinal Lifestyle Study (BALL ST)

PURPOSE

To evaluate how the changes in directly measured cardiorespiratory fitness (CRF) relate to the changes in metabolic syndrome (MetS) status following 4-6 months of exercise training.

METHODS

Maximal cardiopulmonary exercise (CPX) tests and MetS risk factors were analyzed prospectively from 336 adults (46% women) aged 45.8 ± 10.9 years. MetS was defined according to the National Cholesterol Education Program-Adult Treatment Panel III criteria, as updated by the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI). Pearson correlations, chi-squares, and dependent 2-tail t-tests were used to assess the relationship between the change in CRF and the change in MetS risk factors, overall number of MetS risk factors, and a MetS severity score following 4-6 months of participation in a self-referred, community-based exercise program.

RESULTS

Overall prevalence of MetS decreased from 23% to 14% following the exercise program (P < 0.05), while CRF improved 15% (4.7 ± 8.4 mL/kg/min, P < 0.05). Following exercise training, the number of positive risk factors declined from 1.4 ± 1.3 to 1.2 ± 1.2 in the overall cohort (P < 0.05). The change in CRF was inversely related to the change in the overall number of MetS risk factors (r = -0.22; P < 0.05) and the MetS severity score (r = -0.28; p < 0.05).

CONCLUSION

This observational cohort study indicates an inverse relationship between the change in CRF and the change in MetS severity following exercise training. These results suggest that participation in a community-based exercise program yields significant improvements in CRF, MetS risk factors, the prevalence of the binary MetS, and the MetS severity score. Improvement in CRF through exercise training should be a primary prevention strategy for MetS.

Risk assessment of metabolic syndrome prevalence involving sedentary occupations and socioeconomic status

OBJECTIVES

To determine whether occupation type, distinguished by socioeconomic status (SES) and sedentary status, is associated with metabolic syndrome (MetS) risk.

METHODS

We analysed two data sets covering 73 506 individuals. MetS was identified according to the criteria of the modified Adult Treatment Panel III. Eight occupational categories were considered: professionals, technical workers, managers, salespeople, service staff, administrative staff, manual labourers and taxi drivers; occupations were grouped into non-sedentary; sedentary, high-SES; and sedentary, non-high-SES occupations. A multiple logistic regression was used to determine significant risk factors for MetS in three age-stratified subgroups. R software for Windows (V.3.5.1) was used for all statistical analyses.

RESULTS

MetS prevalence increased with age. Among participants aged ≤40 years, where MetS prevalence was low at 6.23%, having a non-sedentary occupation reduced MetS risk (OR=0.88, p<0.0295). Among participants aged >60 years, having a sedentary, high-SES occupation significantly increased (OR=1.39, p<0.0247) MetS risk.

CONCLUSIONS

The influence of occupation type on MetS risk differs among age groups. Non-sedentary occupations and sedentary, high-SES occupations decrease and increase MetS risk, respectively, among younger and older adults, respectively. Authorities should focus on individuals in sedentary, high-SES occupations.

Physical inactivity and sitting time prevalence and trends in Mexican adults. Results from three national surveys

BACKGROUND

Physical inactivity and high sitting time are directly related to mortality and morbidity of non-communicable diseases (NCDs). Thus, improved understanding of the prevalence and trends of these behaviors could support the design of policies and interventions for NCDs prevention.

OBJECTIVE

To determine the current prevalence of physical inactivity and high sitting time, to analyze the trends, and to estimate the association of meeting/not meeting physical activity recommendations and low/high sitting time with sociodemographic characteristics and body mass index categories.

METHODOLOGY

Data from the 2018 National Health and Nutrition Survey were used. Moderate-to-vigorous physical activity (MVPA) and sitting minutes per week were calculated using the International Physical Activity Questionnaire short form (IPAQ). In total, 38,033 questionnaires of adults aged 20 to 69-year-old were analyzed. Adults were classified as physically inactive if they achieved less than 150 minutes per week of MVPA and as with high sitting time if they accumulated more than 420 minutes of sitting per day. Health and Nutrition National Surveys (ENSANUT) 2006, 2012 and 2018 were used to estimate the trends.

RESULTS

In total, 16.5% were classified as physically inactive and 11.3% within the high sitting time category. Both prevalences increased more than 40% during the 12-y period (2006-2018). In 2018, men, younger adults, those living in urban areas, and people within the highest socioeconomical status and educational levels were more likely to not achieve physical activity recommendations and to be classified in the highest sitting time category.

CONCLUSION

To stop current increased trends and achieve global targets, stronger and more concerted efforts to promote physical activity and reduce sitting time are required. Thus, continued surveillance of these behaviors is necessary.

The impact of sitting time and physical activity on mental health during COVID-19 lockdown

Objective

The primary aim of this study was to investigate the association between physical activity (PA) and sitting time on adults' mental health (i.e., depression, anxiety and wellbeing) and the influence of mediators and confounders.

Methods

An online survey was disseminated in the UK between May and June 2020. A total of 284 participants (33.5 ± 12.4 years) self-reported their PA, sitting time and mental health through validated questionnaires.

Results

Multiple stepwise regression analysis revealed that being of younger age, female, on a lower income, with one or more comorbid health conditions, with a previous diagnosis of mood disorder and increased sitting time independently correlated with higher depression scores (F (13,219) = 12.31, p < 0.001), and explained 42% of the variance. Similar results were found for wellbeing where socio-demographic, health outcomes and sitting time influenced the subjective wellbeing (F (14,218) = 5.77, p < 0.001, 27% variance), although only socio-demographic and health outcomes contributed to the variation in anxiety score (F (13,219) = 7.84, p < 0.001, 32% variance). PA did not explain variation when sitting time was taken into account in any of the models. Combined analysis revealed that participants with lower sedentary time (< 8 h) and with both low or moderate and high PA presented a significantly lower depression score [low PA: (B = -2.7, 95% CI -4.88, -0.52); moderate and high PA (B = -2.7, -4.88, -0.52)].

Conclusion

Sitting time was strongly associated with adverse mental health during COVID-19 lockdown and should be considered in future public health recommendations.

Untargeted GC/TOFMS unravel metabolic profiles in cerebrospinal fluid of Chinese people living with HIV

Background

Metabolic syndrome becomes a focus of clinical cares to people living with HIV (PLHIV) globally. This study aimed to explore the metabolic profiles in cerebrospinal fluid (CSF) of Chinese people living with HIV (PLHIV).

Methods

Cerebrospinal fluid samples from PLHIV and healthy controls were collected from our hospital. Then, the metabolic profiles of CSFs were analyzed PLHIV with healthy individual as the normal controls using the untargeted GC/TOFMS. Following this, kyoto encyclopedia of genes and genomes annotation and pathway analysis were performed to further explore the underlying mechanism of these metabolic alterations in cognitive impairment of PLHIV.

Results

Both PCA analysis and OPLS‐DA had presented that most samples were localized in 95% CI and the gap between control and HIV could significantly separate from each other. Upon this quality control, a total of 82 known metabolites were identified in CSF between PLHIV and healthy controls. Clustering of these metabolites presented that these differentially expressed metabolites could markedly distinguish HIV from healthy controls. Further pathway analyses showed that TCA cycle (citric acid, fumaric acid, lactate, et al.), amino acid (arginine, proline, alanine, aspartate, glutamine, et al.), lipid (cholesterol, butyrate, et al.) metabolisms were significantly changed in CSF of PLHIV, which might affect the cognitive status of PLHIV via affecting neuron energy support, signaling transduction, and neuroinflammation.

Conclusion

Metabolic profiles were significantly altered in CSF and might play key roles in the etiology of cognitive impairment of PHLIV. Further explore the exact mechanism for these metabolic changes might be useful for cognitive impairment management of PHLIV.

Sedentary Time and Metabolic Risk in Extremely Active Older Adults

OBJECTIVE

Increasing evidence suggests that time spent sedentary predicts increasing cardiometabolic risk independent of other physical activity. We objectively measured activity levels in active older adults and examined the association between sedentary behavior and the continuous metabolic syndrome risk score (cMSy).

RESEARCH DESIGN AND METHODS

Older adults (age ≥65 years) were recruited from the Whistler Masters ski team, a group of active older adults who undergo organized group training. Daily activity levels were recorded with accelerometers (SenseWear) worn for 7 days. A compositional approach was used to determine proportion of the time spent sedentary as compared with all other nonsedentary behaviors (isometric log-ratio transformation for time spent sedentary [ILR1]). Waist circumference, triglycerides, HDL, systolic blood pressure, and fasting glucose were measured, and cMSy was calculated using principal component analysis (sum of eigenvalues ≥1.0).

RESULTS

Fifty-four subjects (30 women and 24 men, mean ± SE age 71.4 ± 0.6 years) were recruited. Subjects demonstrated high levels of physical activity (2.6 ± 0.2 h light activity and 3.9 ± 0.2 h moderate/vigorous activity). In our final parsimonious model, ILR1 showed a significant positive association with increasing cMSy (standardized β = 0.368 ± 0.110, R ² = 0.40, P = 0.002), independent of age and biological sex.

CONCLUSIONS

Despite high levels of activity, ILR1 demonstrated a strong association with cMSy. This suggests that even in active older adults, sedentary behavior is associated with increasing cardiometabolic risk.

Relationship Between Daily Sedentary Behaviors and Metabolic Syndrome in Middle-Aged Adults: Results from a Health Survey in Taean-Gun, Republic of Korea

Background: It is unclear whether sedentary behavior is associated with metabolic risk, being independent of physical activity and other possible confounders. This study aimed to evaluate an association between sedentary behaviors and metabolic syndrome (MetS). Methods: A community-based cross-sectional study was conducted in a total of 987 Korean adults aged 40 years or older. Information on study variables, including physical activity, awake and sitting time, and components of MetS, was collected by a self-administered questionnaire, physical measurement, and laboratory test. MetS was defined according to the modified National Cholesterol Education Program's Adult Treatment Panel III and Korean Society for the Study of Obesity. Multiple logistic regression analysis was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for MetS associated with absolute sitting time, high sedentary ratio (>0.5), and other selected covariates, including age, sex, smoking, alcohol intake, educational attainment, daily meal times, regular exercise, intensity of physical activities, and sleep and nap duration. Results: After considering other selected variables, the risk of MetS was found to be higher by about 54% among subjects who had a higher sedentary ratio (OR: 1.54, 95% CI: 1.04-2.28). Every hour increase in sitting time was associated with increased risk of MetS (OR: 1.05, 95% CI: 0.99-1.11) with borderline significance (P = 0.119). Conclusions: Sedentary behavior was independently associated with an increased risk of MetS, suggesting that efforts to reduce the sedentary time might be also important for metabolic health in addition to encouraging adequate physical exercise. Clinical trial number is not applicable to this study.

Association of rs662799 variant and APOA5 gene haplotypes with metabolic syndrome and its components: a meta-analysis in North Africa

Apolipoprotein A5 (APOA5) has been linked to metabolic syndrome (MetS) in several populations. In North Africa, only the Tunisian and Moroccan populations were investigated. Our aim is to assess the association between APOA5 gene variant (rs662799) and haplotypes with MetS in Tunisian population and to perform a meta-analysis in North Africa. A total of 594 Tunisian participants were genotyped for polymorphism rs662799 using KASPar technology. Two polymorphisms rs3135506 and rs651821 in APOA5 gene genotyped in our previous study, were used in addition to rs662799 to assess the haplotype association with MetS. The genotype of 875 participants was used for the meta-analysis. Statistical analyses were performed with R software.

The rs662799 increases the risk of MetS under the dominant (P=0.018) and the additive models (P=0.028) in the Tunisian population. After stratification of the cohort following the sex and the geographic origin, a positive association of rs662799 with MetS was found for participant from the Northern region and for the women group. Only the haplotype AGT showed a significant association with MetS by decreasing the risk of the disease.

The meta-analysis reported a significant association of rs662799 and rs3135506 with MetS.

Our results showed a significant association between the APOA5 gene variants rs662799 and haplotypes with MetS and its traits in Tunisia. An impact of the sex and the geographic origin on the genotype distribution was highlighted. Our funding emphasizes the role of APOA5 in the development of MetS in North Africa.

Physical deterioration and adaptive recovery in physically inactive breast cancer patients during adjuvant chemotherapy: a randomised controlled trial

Cardiorespiratory fitness is an independent risk factor for cardiovascular disease and shortened life expectancy in breast cancer survivors. This randomised controlled trial (n = 153) was designed for patients with a physically inactive lifestyle prediagnosis and concurrently referred to adjuvant chemotherapy. We compared two 12-week exercise interventions aimed at physiological and patient-reported outcomes (cardiorespiratory fitness, muscle strength, metabolic markers, physical activity, pain, fatigue), including a 39-week follow-up. A supervised hospital-based moderate to high intensity group exercise intervention was compared to an instructed home-based individual pedometer intervention. The two 12-week interventions included oncologists’ recommendations and systematic health counselling. Outcomes were measured at baseline and week 6, 12 and 39. Primary outcome cardiorespiratory fitness declined significantly during chemotherapy and was restored in both interventions at follow-up. The interventions effectively engaged breast cancer patients in sustaining physical activities during and following adjuvant treatment. A composite metabolic score improved significantly. Positive cardiorespiratory fitness responders had improved clinical effects on fatigue, pain and dyspnoea versus negative responders. We conclude that a loss of cardiorespiratory fitness among physically inactive breast cancer patients may be restored by early initiated interventions and by adapting to physical activity recommendations, leading to a decreased cardiovascular risk profile in breast cancer survivors.

The Effect of Domain-Specific Sitting Time and Exercise Habits on Metabolic Syndrome in Japanese Workers: A Cross-Sectional Study

The effects of domain-specific (i.e., occupational, leisure-time on workday, and holiday) sitting time (ST), and exercise on metabolic syndrome (MetS) development are insufficiently studied. The present study aimed to examine the single and combined effects of each domain-specific ST and exercise habits on MetS. The total and domain-specific STs of 5530 participants were collected using a validated questionnaire. The multiple logistic regression analyses determined the effects of each domain-specific ST and exercise habit on MetS. Of all participants, 7.8% had MetS. Odds ratios (ORs) for MetS were significant only in the group with the longest leisure-time ST on holidays (OR, 1.43; 95% confidence interval [CI], 1.12-1.83); we found no significant associations with any other domain-specific ST after statistical adjustment for confounders. The no-habitual-exercise group clearly had a higher risk for MetS (OR, 1.44; 95% CI, 1.15-1.80). The significantly higher ORs for MetS was shown in only the combined longer total ST (OR, 1.64; 95% CI, 1.12-2.39) and holiday ST (OR, 1.83; 95% CI, 1.30-2.59) with no habitual exercise. These findings suggested that accumulated daily total ST, particularly leisure-time ST on holidays with no-habitual exercise, can increase the risk of MetS and it could possibly be mitigated by habitual exercise.

Relationship of sociodemographic and lifestyle factors and diet habits with metabolic syndrome (MetS) among three ethnic groups of the Malaysian population

Objectives

Literature shows a high prevalence of MetS among Malaysians, varying across the major ethnicities. Since sociodemographic characteristics, lifestyle factors and diet habits of such communities have been reported to be diverse, the objective of this study was to investigate the association of various sociodemographic characteristics, lifestyle factors and diet habits with MetS overall, as well as with the three major ethnic communities in Malaysia, specifically.

Materials and methods

We conducted a cross-sectional study among 481 Malaysians of ages 18 years and above living in the state of Johor, Malaysia. Information on demographics, lifestyle and diet habits were collected using a structured questionnaire. Harmonized criteria were used to assess the status of MetS. Multiple logistic regression was employed to determine any associations between sociodemographic and lifestyle factors and dietary behaviours with MetS.

Results

MetS was found among 32.2% of the respondents and was more prevalent among the Indians (51.9%), followed by the Malays (36.7%) and the Chinese (20.2%). Overall, increasing age (AOR = 2.44[95%CI = 1.27–4.70] at 40–49 years vs. AOR = 4.14[95%CI = 1.97–8.69] at 60 years and above) and Indian ethnicity (AOR = 1.95[95%CI = 1.12–3.38)] increased the odds of MetS, while higher education (AOR = 0.44[95%CI = 0.20–0.94] decreased the odds of MetS in this population. Quick finishing of meals (AOR = 2.17[95%CI = 1.02–4.60]) and low physical activity (AOR = 4.76[95%CI = 1.49–15.26]) were associated with increased odds of MetS among the Malays and the Chinese, respectively.

Conclusion

The population of Johor depicts a diverse lifestyle and diet behaviour, and some of these factors are associated with MetS in certain ethnic groups. In the light of such differences, ethnic specific measures would be needed to reduce the prevalence of MetS among those in this population.

Metabolic Syndrome and Cardiovascular Disease Impacts on the Pathophysiology and Phenotype of HIV-Associated Neurocognitive Disorders

Evidence from epidemiological studies on the general population suggests that midlife cardiovascular disease (CVD) and/or metabolic syndrome (MetS) are associated with an increased risk of cognitive impairment and dementia later in life. In the modern combined antiretroviral therapy (cART) era, as in the general population, CVD and MetS were strongly and independently associated with poorer cognitive performances of sustained immunovirologically controlled persons living with human immunodeficiency viruses (PLHIVs). Those findings suggest that CV/metabolic comorbidities could be implicated in the pathogenesis of HIV-associated neurocognitive disorders (HAND) and might be more important than factors related to HIV infection or its treatment, markers of immunocompetence, or virus replication. The association between CVD/MetS and cognition decline is driven by still not well-understood mechanisms, but risk might well be the consequence of increased brain inflammation and vascular changes, notably cerebral small-vessel disease. In this review, we highlight the correspondences observed between the findings concerning CVD and MetS in the general population and virus-suppressed cART-treated PLHIVs to evaluate the real brain-aging processes. Indeed, incomplete HIV control mainly reflects HIV-induced brain damage described during the first decades of the pandemic. Given the growing support that CVD and MetS are associated with HAND, it is crucial to improve early detection and assure appropriate management of these conditions.

Association of sedentary behavior and metabolic syndrome

OBJECTIVES

To examine the association of sedentary behavior (SB) with metabolic syndrome (MetS) in adults, as well as to identify the impact of physical inactivity and economic condition on such association.

STUDY DESIGN

This is a cross-sectional study.

METHODS

This study was conducted in the city of Bauru, São Paulo State, Brazil (n = 970). Television (TV) viewing and physical activity (PA) were assessed by questionnaire. MetS was assessed via medical records. Descriptive statistics and binary logistic regression were used in data analyses.

RESULTS

Participants with moderate TV viewing were associated with MetS when compared with low TV viewing group, even after adjustments for age, sex, economic status, smoking, and PA (odds ratio [OR] = 1.49 [95% confidence interval {CI}: 1.01-2.20]). The fully adjusted model showed an association between high exposure to TV viewing with MetS (OR = 1.77 [95%CI: 1.11-2.82]). The combination of physical inactivity and high TV viewing boosted the likelihood of having MetS (OR = 1.89 [95%CI: 1.08-3.29]).

CONCLUSION

The results of the present study suggest that moderate and high TV viewing time is associated with the presence of MetS, mainly in insufficiently active adults and those living in lower economic condition.

Associations of context-specific sitting time with markers of cardiometabolic risk in Australian adults

Background

High volumes of sitting time are associated with an elevated risk of type 2 diabetes and cardiovascular disease, and with adverse cardiometabolic risk profiles. However, previous studies have predominately evaluated only total sitting or television (TV) viewing time, limiting inferences about the specific cardiometabolic health impacts of sitting accumulated in different contexts. We examined associations of sitting time in four contexts with cardiometabolic risk biomarkers in Australian adults.

Methods

Participants (n = 3429; mean ± SD age 58 ± 10 years) were adults without clinically diagnosed diabetes or cardiovascular disease from the 2011–2012 Australian Diabetes, Obesity and Lifestyle (AusDiab) study. Multiple linear regressions examined associations of self-reported context-specific sitting time (occupational, transportation, TV-viewing and leisure-time computer use) with a clustered cardiometabolic risk score (CMR) and with individual cardiometabolic risk biomarkers (waist circumference, BMI, resting blood pressure, triglycerides, HDL- and LDL-cholesterol, and fasting and 2-h post-load plasma glucose).

Results

Higher CMR was significantly associated with greater TV-viewing and computer sitting time (b [95%CI] = 0.07 [0.04, 0.09] and 0.06 [0.03, 0.09]), and tended to be associated with higher occupational and transport sitting time (0.01 [− 0.01, 0.03] and 0.03 [− 0.00, 0.06]), after adjustment for potential confounders. Furthermore, keeping total sitting time constant, accruing sitting via TV-viewing and computer use was associated with significantly higher CMR (0.05 [0.02, 0.08] and 0.04 [0.01, 0.06]), accruing sitting in an occupational context was associated with significantly lower CMR (− 0.03 [− 0.05, − 0.01]), while no significant association was seen for transport sitting (0.00 [− 0.03, 0.04]). Results varied somewhat between the respective biomarkers; however, higher sitting time in each domain tended to be associated detrimentally with individual biomarkers except for fasting glucose (non-significant associations) and systolic blood pressure (a beneficial association was observed). Overall, associations were stronger for TV-viewing and computer use, and weaker for occupational sitting.

Conclusions

Higher context-specific sitting times tended to be detrimentally associated, albeit modestly, with CMR and several cardiometabolic risk biomarkers. There was some evidence suggesting that the context in which people sit is relevant above and beyond total sitting time. Methodological issues notwithstanding, these findings may assist in identifying priorities for sitting-reduction initiatives, in order to achieve optimal cardiometabolic health benefits.

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0748-3) contains supplementary material, which is available to authorized users.

Problematic Gaming Behavior Among Finnish Junior High School Students: Relation to Socio-Demographics and Gaming Behavior Characteristics

Multiplatform digital media use and gaming have been increased in recent years. The aim of this study was to examine associations between sociodemographics and digital gaming behavior characteristics (i.e., gaming time, medium, and genres) with problematic gaming behavior in adolescents. A convenience sample of Finnish junior high school students (n = 560; mean age 14 years, ranging from 12 to 16 years) participated in the cross-sectional survey, of which, 83% (n = 465) reported having played digital games regularly. Sociodemographic data, different forms of digital media use, gaming behavior characteristics and problematic gaming behavior was assessed. Study participants spent on average one hour per day playing digital games; casual games (23.9%), shooting games (19.8%), and sport games (12.9%), were the most popular games among participants. By using regression analysis, a blended family structure and gaming time related positively to problematic gaming behavior. Preferences for game genres such as solo, Massively Multiplayer Online Role-Playing and strategy-management games were also positively associated with problematic use of digital games. These findings provide knowledge that can be utilized in the prevention of the possible negative consequences of digital gaming.

Routine Assessment and Promotion of Physical Activity in Healthcare Settings: A Scientific Statement From the American Heart Association

Physical inactivity is one of the most prevalent major health risk factors, with 8 in 10 US adults not meeting aerobic and muscle-strengthening guidelines, and is associated with a high burden of cardiovascular disease. Improving and maintaining recommended levels of physical activity leads to reductions in metabolic, hemodynamic, functional, body composition, and epigenetic risk factors for noncommunicable chronic diseases. Physical activity also has a significant role, in many cases comparable or superior to drug interventions, in the prevention and management of >40 conditions such as diabetes mellitus, cancer, cardiovascular disease, obesity, depression, Alzheimer disease, and arthritis. Whereas most of the modifiable cardiovascular disease risk factors included in the American Heart Association’s My Life Check - Life’s Simple 7 are evaluated routinely in clinical practice (glucose and lipid profiles, blood pressure, obesity, and smoking), physical activity is typically not assessed. The purpose of this statement is to provide a comprehensive review of the evidence on the feasibility, validity, and effectiveness of assessing and promoting physical activity in healthcare settings for adult patients. It also adds concrete recommendations for healthcare systems, clinical and community care providers, fitness professionals, the technology industry, and other stakeholders in order to catalyze increased adoption of physical activity assessment and promotion in healthcare settings and to contribute to meeting the American Heart Association’s 2020 Impact Goals.

Twelve-Year Television Viewing Time Trajectories and Physical Function in Older Adults

INTRODUCTION

The purposes of this study were to identify trajectories of older adults' television viewing (TV) time for 12 yr and to examine their associations with performance-based measures of physical function.

METHODS

Data on TV time (h·wk) and sociodemographic factors were collected at each assessment of the Australian Diabetes, Obesity and Lifestyle Study (1999/2000, 2004/2005, and 2011/2012), with objective measures of physical function (2.44 m timed up and go [TUG, s] and knee extensor strength [KES, kg] tests) collected at the final (2011/2012) assessment. Regression analyses examined predictors of trajectory membership and associations with TUG and KES in those 60+ yr of age in 2011/2012.

RESULTS

Six TV time trajectories were identified among the 1938 participants (age, 60-97 yr; 54% female): consistently low (9.7%), low-increasing (22.3%), moderate-decreasing (13.5%), moderate-increasing (30.3%), consistently high (18.9%), and high-increasing (5.2%). There were no statistically significant relationships with TUG (P > 0.05). In the fully adjusted model, KES performance was significantly better in the consistently low, low-increasing, and consistently high trajectories, compared with the moderate-increasing trajectory (P < 0.001, R = 0.33).

CONCLUSION

Twelve-year trajectories of TV time were associated with muscle strength in older adults. These findings suggest that patterns of sedentary behavior can be a determinant of muscle strength in later life.

Evidence of increasing sedentarism in Mexico City during the last decade: Sitting time prevalence, trends, and associations with obesity and diabetes

INTRODUCTION

Sedentary behaviors such as sitting time are associated with obesity and diabetes independently of total reported physical activity. This study aimed to describe the current sitting time/day prevalence and trends and to examine the association of sitting time with sociodemographic and clinical variables in Mexico City.

METHODS

Two cross-sectional representative surveys in Mexico City were used for this analysis (2006: n = 1148 and 2015: n = 1329). Sedentary behavior questions from the International Physical Activity Questionnaire included time spent sitting on a weekday in the last week or on a Wednesday. Sitting time /day was divided into deciles, and participants in the highest decile (≥ 420 minutes/day) were classified within the high sitting category; others were classified in the low sitting time category. Multivariate logistic regression was used to evaluate the associations of sitting time with sociodemographic and clinical indicators, controlling for confounders and testing for potential interactions.

RESULTS

A total of 13.7% (2006) and 14.8% (2015) adults were classified in the highest sitting time category (≥ 420 minutes/day). There was a significant increase in the average sitting time/day between the surveys (216.0 minutes in 2006 vs. 233.3 minutes in 2015, p < 0.001). In 2015, men, those aged 20-49 years, those in low-intensity jobs, students, and those with a high socioeconomic level were more likely to be in the highest sitting time category. Participants with overweight/obesity (OR = 2.37, 95% CI: 1.11, 5.09) and those with high glucose levels (survey finding) (OR = 2.34, 95% CI: 1.04, 5.25) were more likely to report sitting time in the highest category.

DISCUSSION

Sitting time/day prevalence increased 8%, and average daily sitting minutes significantly increased by 8.2% (18 minutes) in the nine-year study period (2006-2015). Current public health policies should consider strategies not only for increasing physical activity levels, but also for reducing sitting time/day among the population as a measure to fight the growing epidemic of obesity and diabetes in Mexico.

Sitting Time and Obesity or Abdominal Obesity in Older South Koreans: Korean National Health and Nutrition Examination Survey 2013

We examined relationships between sitting time and obesity or abdominal obesity according to sex and socioeconomic status in elderly people. We analyzed data from the Korean National Health and Nutrition Examination Survey 2013, and 1565 participants were included in the study. Multivariate logistic regression analysis was used to examine relationships between sitting time and obesity or abdominal obesity according to sex and socioeconomic status. Sitting time was positively correlated with body mass index in men and women and waist circumference in men. When considering socioeconomic factors, men who sat for 5 hours or longer and fell within the lowest income were more likely to have obesity and abdominal obesity relative to men who sat for 5 hours or shorter and earned higher incomes (odds ratio [95% confidence interval] = 1.80 [1.14-2.84] and 1.63 [1.02-2.61] respectively), and women who sat for 5 hours or longer and fell within the lowest educational level were more likely to have obesity relative to women who sat for 5 hours or less and were educated to a higher level (1.24 [1.01-1.85]). Strategies to reduce sedentary behavior would help to prevent obesity in older men who earn low incomes and women with lower levels of educational attainment.

A pilot study of physical activity and sedentary behavior distribution patterns in older women

The study aims were to investigate free-living physical activity and sedentary behavior distribution patterns in a group of older women, and assess the cross-sectional associations with body mass index (BMI). Eleven older women (mean (SD) age: 77 (9) yrs) wore custom-built activity monitors, each containing a tri-axial accelerometer (±16g, 100Hz), on the waist and ankle for lab-based walking trials and 4 days in free-living. Daily active time, step counts, cadence, and sedentary break number were estimated from acceleration data. The sedentary bout length distribution and sedentary time accumulation pattern, using the Gini index, were investigated. Associations of the parameters' total daily values and coefficients of variation (CVs) of their hourly values with BMI were assessed using linear regression. The algorithm demonstrated median sensitivity, positive predictive value, and agreement values >98% and <1% mean error in cadence calculations with video identification during lab trials. Participants' sedentary bouts were found to be power law distributed with 56% of their sedentary time occurring in 20min bouts or longer. Meaningful associations were detectable in the relationships of total active time, step count, sedentary break number and their CVs with BMI. Active time and step counts had moderate negative associations with BMI while sedentary break number had a strong negative association. Active time, step count and sedentary break number CVs also had strong positive associations with BMI. The results highlight the importance of measuring sedentary behavior and suggest a more even distribution of physical activity throughout the day is associated with lower BMI.

Work-related correlates of occupational sitting in a diverse sample of employees in Midwest metropolitan cities

The worksite serves as an ideal setting to reduce sedentary time. Yet little research has focused on occupational sitting, and few have considered factors beyond the personal or socio-demographic level. The current study i) examined variation in occupational sitting across different occupations, ii) explored whether worksite level factors (e.g., employer size, worksite supports and policies) may be associated with occupational sitting. Between 2012 and 2013, participants residing in four Missouri metropolitan areas were interviewed via telephone and provided information on socio-demographic characteristics, schedule flexibility, occupation, work related factors, and worksite supports and policies. Occupational sitting was self-reported (daily minutes spent sitting at work), and dichotomized. Occupation-stratified analyses were conducted to identify correlates of occupational sitting using multiple logistic regressions. A total of 1668 participants provided completed data. Those employed in business and office/administrative support spent more daily occupational sitting time (median 330 min) compared to service and blue collar employees (median 30 min). Few worksite supports and policies were sitting specific, yet factors such as having a full-time job, larger employer size, schedule flexibility, and stair prompt signage were associated with occupational sitting. For example, larger employer size was associated with higher occupational sitting in health care, education/professional, and service occupations. Work-related factors, worksite supports and policies are associated with occupational sitting. The pattern of association varies among different occupation groups. This exploratory work adds to the body of research on worksite level correlates of occupational sitting. This may provide information on priority venues for targeting highly sedentary occupation groups.

Clinical utility of metabolic syndrome severity scores: considerations for practitioners

The metabolic syndrome (MetS) is marked by abnormalities in central obesity, high blood pressure, high triglycerides, low high-density lipoprotein-cholesterol, and high fasting glucose and appears to be produced by underlying processes of inflammation, oxidative stress, and adipocyte dysfunction. MetS has traditionally been classified based on dichotomous criteria that deny that MetS-related risk likely exists as a spectrum. Continuous MetS scores provide a way to track MetS-related risk over time. We generated MetS severity scores that are sex- and race/ethnicity-specific, acknowledging that the way MetS is manifested may be different by sex and racial/ethnic subgroup. These scores are correlated with long-term risk for type 2 diabetes mellitus and cardiovascular disease. Clinical use of scores like these provide a potential opportunity to identify patients at highest risk, motivate patients toward lifestyle change, and follow treatment progress over time.

Does a peer-led exercise intervention affect sedentary behavior among breast cancer survivors?

OBJECTIVE

Sedentary behavior is recognized as an independent risk factor for chronic diseases. Cancer survivors report high levels of sedentary behavior. In secondary analyses, we examined the effects of an exercise intervention on sedentary behavior (sitting time) among breast cancer survivors.

METHODS

Seventy-six breast cancer survivors (mean age = 55.62 y, mean 1.1 y since diagnosis) were randomized to receive either a 12-week telephone-delivered exercise intervention from peer volunteers or a contact control condition. The intervention did not specifically address sitting time. Participants' sedentary behavior was assessed for 7 days at baseline, 12 weeks, and 24 weeks via self-report and objective measurement (accelerometer).

RESULTS

At baseline, our sample reported sitting for 7.75 hours/day (10.98 h/d by accelerometer data). Spearman rank correlations showed significant positive correlations at baseline between sitting time measured by self-report and accelerometer (ρ = 0.37; P = .002) in the entire sample. There were no significant changes over time within group nor were there any significant intervention effects on sitting time (self-report and objective) at 12 and 24 weeks (all P's > .05).

CONCLUSIONS

An exercise intervention that did not focus specifically on sitting time did not affect sedentary behavior among breast cancer survivors. Intervention components that specifically target sitting behavior are needed to reduce this risk behavior among survivors.

Exercise and diet in the management of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver condition worldwide, and is projected to become the leading cause for liver transplantation in the United States as early as 2020. The mainstay of treatment remains lifestyle modification with diet and exercise recommendations, as although some pharmacological treatments such as glitazones and Vitamin E have shown benefit, there are concerns regarding long term safety. The evidence base for dietary interventions in NAFLD such as the Mediterranean diet, omega-3 polyunsaturated fatty acids and coffee is mainly derived from observational data with questionable validity. Where trials exist, they have shown benefit for surrogate outcomes such as hepatic steatosis and insulin resistance, but no trials have been conducted with salient clinical outcomes such as reduction in progression to chronic liver disease. Benefit in surrogate outcomes has also been seen for aerobic, anaerobic and combined modality exercise but it remains unclear if one type is superior. Furthermore, a reduction in sedentary time appears equally important. To provide a sound evidence base for lifestyle recommendations to people with NAFLD, longer duration trials of standardized dietary or exercise interventions, and testing various doses, types and with liver related outcomes, are essential.

Independent Associations between Sedentary Time, Moderate-To-Vigorous Physical Activity, Cardiorespiratory Fitness and Cardio-Metabolic Health: A Cross-Sectional Study

We aimed to study the independent associations of sedentary time (ST), moderate-to-vigorous physical activity (MVPA), and objectively measured cardiorespiratory fitness (CRF) with clustered cardio-metabolic risk and its individual components (waist circumference, fasting glucose, HDL-cholesterol, triglycerides and blood pressure). We also investigated whether any associations between MVPA or ST and clustered cardio-metabolic risk were mediated by CRF. MVPA, ST, CRF and individual cardio-metabolic components were measured in a population-based sample of 341 adults (age 53.8 ± 8.9 years; 61% men) between 2012 and 2014. MVPA and ST were measured with the SenseWear pro 3 Armband and CRF was measured with a maximal exercise test. Multiple linear regression models and the product of coefficients method were used to examine independent associations and mediation effects, respectively. Results showed that low MVPA and low CRF were associated with a higher clustered cardio-metabolic risk (β = -0.26 and β = -0.43, both p<0.001, respectively). CRF explained 73% of the variance in the association between MVPA and clustered cardio-metabolic risk and attenuated this association to non-significance. After mutual adjustment for MVPA and ST, CRF was the most important risk factor for a higher clustered cardio-metabolic risk (β = -0.39, p<0.001). In conclusion, because of the mediating role of CRF, lifestyle-interventions need to be feasible yet challenging enough to lead to increases in CRF to improve someone’s cardio-metabolic health.

Physical Activity and Sedentary Behavior in Metabolically Healthy versus Unhealthy Obese and Non-Obese Individuals - The Maastricht Study

Background

Both obesity and the metabolic syndrome are associated with increased risk of cardiovascular diseases and type 2 diabetes. Although both frequently occur together in the same individual, obesity and the metabolic syndrome can also develop independently from each other. The (patho)physiology of “metabolically healthy obese” (i.e. obese without metabolic syndrome) and “metabolically unhealthy non-obese” phenotypes (i.e. non-obese with metabolic syndrome) is not fully understood, but physical activity and sedentary behavior may play a role.

Objective

To examine objectively measured physical activity and sedentary behavior across four groups: I) “metabolically healthy obese” (MHO); II) “metabolically unhealthy obese” (MUO); III)”metabolically healthy non-obese” (MHNO); and IV) “metabolically unhealthy non-obese” (MUNO).

Methods

Data were available from 2,449 men and women aged 40–75 years who participated in The Maastricht Study from 2010 to 2013. Participants were classified into the four groups according to obesity (BMI≥30kg/m²) and metabolic syndrome (ATPIII definition). Daily activity was measured for 7 days with the activPAL physical activity monitor and classified as time spent sitting, standing, and stepping.

Results

In our study population, 562 individuals were obese. 19.4% of the obese individuals and 72.7% of the non-obese individuals was metabolically healthy. After adjustments for age, sex, educational level, smoking, alcohol use, waking time, T2DM, history of CVD and mobility limitation, MHO (n = 107) spent, per day, more time stepping (118.2 versus 105.2 min; p<0.01) and less time sedentary (563.5 versus 593.0 min., p = 0.02) than MUO (n = 440). In parallel, MHNO (n = 1384) spent more time stepping (125.0 versus 115.4 min; p<0.01) and less time sedentary (553.3 versus 576.6 min., p<0.01) than MUNO (n = 518).

Conclusion

Overall, the metabolically healthy groups were less sedentary and more physically active than the metabolically unhealthy groups. Therefore, physical activity and sedentary time may partly explain the presence of the metabolic syndrome in obese as well as non-obese individuals.

Physical activity and non-movement behaviours: their independent and combined associations with metabolic syndrome

BACKGROUND

Metabolic syndrome (MetS) is a prevalent risk condition associated with a higher risk of chronic conditions, including diabetes and cardiovascular diseases. Physical activity and non-movement behaviours (NMB), including sleep, screen time and sedentary activity, have been associated with MetS. In light of the increasing prevalence of NMBs, and the moderate rates of physical activity guideline adherence in Canada, this analysis examines the independent and combined associations of NMB and physical activity with MetS.

METHODS

Data on Canadians 18 years and older from the Canadian Health Measures Survey (n = 2901) were used to examine the moderating effect of moderate-to-vigorous physical activity (MVPA) guideline adherence (150 minutes or more of MVPA/week, based on accelerometer) on the association of NMBs (sleep based on self-report, screen time based on self-report, and sedentary time based on accelerometer) with MetS. Logistic regression analyses were conducted and sampling weights were applied to represent the Canadian adult population.

RESULTS

A graded association between PA and MetS was observed, with those achieving less MVPA than guidelines having a higher odds of MetS (OR 2.9, 95 % CI: 1.9-4.5 for < 75 mins/week of MVPA, and OR 1.8, 95 % CI: 1.2-2.8 for 75-150 mins/week, as compared to those accumulating 150 mins/week or more). When examining the moderating effect of PA on the association between NMBs and MetS, we found that (1) for participants who met guidelines, no level of any NMB was significantly associated with MetS and (2) for those who did not achieve guidelines, there was an increased odds of MetS based on excess NMB time(OR 3.2, 95 % CI: 1.5-6.8 for 1.4-2.1 h/day and OR 4.4, 95 % CI: 2.5-7.9 for ≥2.1 h/day of screen time and 75-150 mins/week of MVPA, OR 1.7, 95 % CI: 1.1-2.5 for ≥8 h/day of sleep time and <75 mins/week of MVPA, and OR 2.2, 95 % CI: 1.3-3.8 for 9.2-10.3 h/day of sedentary time and <75 mins/week of MVPA).

CONCLUSIONS

Adhering to physical activity guidelines may mitigate the associations of NMBs with MetS. Given the novel findings that associations between NMBs and MetS were not significant among Canadians meeting PA guidelines, these results suggest the beneficial role of physical activity to prevent chronic disease risk.

The association between time spent in sedentary behaviors and blood pressure: a systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

Sedentary behaviors, defined as waking behaviors with low energy expenditure while sitting, are positively associated with several adverse health outcomes. However, the association between sedentary behaviors and blood pressure (BP) is inconclusive. This study aimed to conduct a systematic review and meta-analysis on the association between time spent in sedentary behaviors and BP.

METHODS

We searched PubMed, MEDLINE, and Web of Science for papers published before August 2014 that assessed the association between time spent in sedentary behaviors and BP. Studies on both adults and children were included. Only good quality studies were included. The pooled estimates of systolic BP (SBP) and diastolic BP (DBP) increase per hour of time spent in sedentary behaviors a day were computed using a fixed-effects model and a random-effects model, respectively. Another pooled estimate of odds ratio per hour of time spent in sedentary behaviors a day on having high BP was computed using a fixed-effects model. A sub-group analysis was conducted for studies using self-reported and objectively assessed time spent in sedentary behaviors separately.

RESULTS

A total of 31 papers of good quality were included in the systematic review, 18 of which found no association between time spent in sedentary behaviors and BP (58.1%). A total of 28 papers were included in the meta-analysis. Pooled effects showed that an additional hour of time spent in sedentary behaviors per day was associated with an increase of 0.06 mmHg (108,228 participants, 95% CI 0.01-0.11, p = 0.01) of SBP and 0.20 mmHg (107,791 participants, 95% CI 0.10-0.29, p < 0.001) of DBP. Accelerometer-assessed time spent in sedentary behaviors was not associated with either SBP (p = 0.06) or DBP (p = 0.33). The odds ratio (OR) of having high BP with an additional hour of time spent in sedentary behaviors per day was 1.02 (98,798 participants, 95% CI 1.003-1.03, p = 0.02).

CONCLUSIONS

Self-reported but not accelerometer-assessed time spent in sedentary behaviors was associated with BP. Further studies are warranted to determine the preventive effect of reducing sedentary behaviors on high BP.

Adverse associations of car time with markers of cardio-metabolic risk

OBJECTIVE

To examine associations of time spent sitting in cars with markers of cardio-metabolic risk in Australian adults.

METHOD

Data were from 2800 participants (age range: 34-65) in the 2011-12 Australian Diabetes, Obesity and Lifestyle Study. Self-reported time spent in cars was categorized into four groups: ≤15min/day; >15 to ≤30min/day; >30 to ≤60min/day; and >60min/day. Markers of cardio-metabolic risk were body mass index (BMI), waist circumference, systolic and diastolic blood pressure, triglycerides, HDL (high-density lipoprotein)-cholesterol, fasting plasma glucose, 2-h plasma glucose, a clustered cardio-metabolic risk score, and having the metabolic syndrome or not. Multilevel linear and logistic regression analyses examined associations of car time with each cardio-metabolic risk outcome, adjusting for socio-demographic and behavioral variables and medication use for blood pressure and cholesterol/triglycerides.

RESULTS

Compared to spending 15min/day or less in cars, spending more than 1h/day in cars was significantly associated with higher BMI, waist circumference, fasting plasma glucose, and clustered cardio-metabolic risk, after adjusting for socio-demographic attributes and potentially relevant behaviors including leisure-time physical activity and dietary intake. Gender interactions showed car time to be associated with higher BMI in men only.

CONCLUSIONS

Prolonged time spent sitting in cars, in particular over 1h/day, was associated with higher total and central adiposity and a more-adverse cardio-metabolic risk profile. Further studies, ideally using objective measures of sitting time in cars and prospective designs, are needed to confirm the impact of car use on cardio-metabolic disease risk.

Associations of Reducing Sedentary Time With Vascular Function and Insulin Sensitivity in Older Sedentary Adults

BACKGROUND

We previously reported increased moderate-intensity (3-6 metabolic equivalents (METs)) physical activity (PA) reverses aging-associated vascular endothelial dysfunction, a surrogate marker of cardiovascular risk. Whether reductions in sedentary time alone contribute to this improvement is unknown.

METHODS

Data from 96 adults (aged ≥50 years) enrolled in a randomized control trial evaluating a 12-week intervention to increase PA in sedentary individuals were analyzed. Amount and intensity of activity were measured pre- and post-intervention by step count and accelerometry. Subjects were divided into 3 categories based on change in sedentary activity (<1. 5 METs): (i) ≥5% reduction in sedentary time, (ii) 0-4.99% reduction, and (iii) increase sedentary time. Vascular endothelial function was measured by brachial artery flow-mediated dilation (FMD%) pre- and post-intervention.

RESULTS

Sedentary time decreased overall (P = 0.001), with a 101-minute decrease in category 1 (N = 27, P < 0.001), a 42-minute decrease in category 2 (N = 29, P = 0.003), and a 44-minute increase in category 3 (N = 40, P = 0.02). While FMD% increased in the entire study population (P = 0.008) over 12 weeks, no differences were observed between the categories (P = 0.73). In category 1, FMD% improvement was associated achievement of ≥20 minutes/day of moderate intensity PA in bouts ≥ 10 minutes in length.

CONCLUSIONS

Reductions of up to 100 minutes of sedentary time per day over 12 weeks was not significantly associated with improved vascular endothelial function in older adults. FMD% was significantly higher among those with lower sedentary behavior and concomitant moderate-intensity PA of ≥20 minutes/day in bouts.

Neighbourhood urban form and individual-level correlates of leisure-based screen time in Canadian adults

OBJECTIVES

Despite evidence for an association between the built environment and physical activity, less evidence exists regarding relations between the built environment and sedentary behaviour. This study investigated the extent to which objectively assessed and self-reported neighbourhood walkability, in addition to individual-level characteristics, were associated with leisure-based screen time in adults. We hypothesised that leisure-based screen time would be lower among adults residing in objectively assessed and self-reported 'high walkable' versus 'low walkable' neighbourhoods.

SETTING

The study was undertaken in Calgary, Alberta, Canada in 2007/2008.

PARTICIPANTS

A random cross-section of adults who provided complete telephone interview and postal survey data (n=1906) was included. Captured information included leisure-based screen time, moderate-intensity and vigorous-intensity physical activity, perceived neighbourhood walkability, sociodemographic characteristics, self-reported health status, and self-reported height and weight. Based on objectively assessed built characteristics, participant's neighbourhoods were identified as being low, medium or high walkable.

PRIMARY AND SECONDARY OUTCOME MEASURES

Using multiple linear regression, hours of leisure-based screen time per day was regressed on self-reported and objectively assessed walkability adjusting for sociodemographic and health-related covariates.

RESULTS

Compared to others, residing in an objectively assessed high walkable neighbourhood, women, having a college education, at least one child at home, a household income ≥$120 000/year, and a registered motor vehicle at home, reporting very good-to-excellent health and healthy weight, and achieving 60 min/week of vigorous-intensity physical activity were associated (p<0.05) with less leisure-based screen time. Marital status, dog ownership, season, self-reported walkability and achieving 210 min of moderate-intensity physical activity were not significantly associated with leisure-based screen time.

CONCLUSIONS

Improving neighbourhood walkability could decrease leisure-based television and computer screen time. Programmes aimed at reducing sedentary behaviour may want to consider an individual's sociodemographic characteristics, physical activity level, health status and weight status, in addition to the walkability of their neighbourhood as these factors were found to be important independent correlates of leisure-based screen time.

Genetic association of APOA5 and APOE with metabolic syndrome and their interaction with health-related behavior in Korean men

BACKGROUND

Genome-wide association studies have been used extensively to identify genetic variants linked to metabolic syndrome (MetS), but most of them have been conducted in non-Asian populations. This study aimed to evaluate the association between MetS and previously studied single nucleotide polymorphisms (SNPs), and their interaction with health-related behavior in Korean men.

METHODS

Seventeen SNPs were genotyped and their association with MetS and its components was tested in 1193 men who enrolled in the study at Seoul National University Hospital.

RESULTS

We found that rs662799 near APOA5 and rs769450 in APOE had significant association with MetS and its components. The SNP rs662799 was associated with increased risk of MetS, elevated triglyceride (TG) and low levels of high-density lipoprotein, while rs769450 was associated with a decreased risk of TG. The SNPs showed interactions between alcohol drinking and physical activity, and TG levels in Korean men.

CONCLUSIONS

We have identified the genetic association and environmental interaction for MetS in Korean men. These results suggest that a strategy of prevention and treatment should be tailored to personal genotype and the population.

Effects of a 12-Week Hatha Yoga Intervention on Metabolic Risk and Quality of Life in Hong Kong Chinese Adults with and without Metabolic Syndrome

Objective

To determine the efficacy of a 12-week Hatha yoga intervention to improve metabolic risk profiles and health-related quality of life (HRQoL) in Chinese adults with and without metabolic syndrome (MetS).

Methods

We conducted a controlled trial within an university-affiliated hospital. 173 Chinese men and women aged 18 or above were assigned to either the yoga intervention group (n = 87) or the control group (n = 86). Primary outcomes included 12-week change in metabolic risk factors and MetS z score. Secondary outcome was HRQoL (Medical Outcomes Short Form Survey at 12 weeks).

Results

The mean age of participants was 52.0 (SD 7.4, range 31-71) years. Analysis involving the entire study population revealed that the yoga group achieved greater decline in waist circumference (p<0.001), fasting glucose (p<0.01), triglycerides (p<0.05), and MetS z score (p<0.01). Yoga training also improved general health perceptions (p<0.01), physical component score (p<0.01), and social functioning (p<0.01) domains score of HRQoL. However, no significant differences between groups were observed in the mean change of systolic/diastolic blood pressures or high-density lipid protein cholesterol (all p>0.05). There were no significant differences in the intervention effects on waist circumference and MetS z score between the MetS subgroups (both p>0.05).

Conclusion

A 12-week Hatha yoga intervention improves metabolic risk profiles and HRQoL in Chinese adults with and without MetS.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12613000816752

Do sedentary behaviors mediate associations between socio-demographic characteristics and BMI in women living in socio-economically disadvantaged neighborhoods?

BACKGROUND

Women living in deprived neighborhoods are a risk group for overweight and obesity, particularly during the childbearing years. Several socio-demographic characteristics may compound this risk, but little is known about why this might be the case. Sedentary behaviors are emerging as a socio-demographically patterned risk factor for obesity. The purpose of the present study was to assess socio-demographic differences in sedentary behaviors, and to examine whether these behaviors could explain the relation between socio-demographic variables and BMI (BMI) in this risk group.

METHODS

Women aged 18-46 years were recruited from 40 urban and 40 rural deprived neighborhoods in Victoria, Australia. In total, 3879 women reported socio-demographic variables (age, educational level, employment status, marital status, number of children, residential location and country of birth), sedentary behaviors (television time, computer time, total screen time and total sedentary time), physical activity, and height and weight, which were used to calculate BMI. For each socio-demographic variable, four single mediation models were conducted using two-level mixed-models regression analyses. Mediating effects were examined using the MacKinnon product-of-coefficients procedure and the Sobel test.

RESULTS

All socio-demographic variables were significantly associated with sedentary behaviors. Single mediation analyses revealed that television time (αβ = 0.017, 95% CI = 0.000, 0.030) and total screen time (αβ = 0.006, 95% CI = 0.000, 0.012) mediated 14.1% and 4.9% of the relationship between educational level and BMI, respectively. Total screen time mediated 45.1% of the relationship between employment status and BMI (αβ = -0.020, 95% CI = -0.033, -0.006), and television time mediated 8.2% of the relationship between country of birth and BMI (αβ = -0.008, 95% CI = -0.016, -0.001).

CONCLUSION

Sedentary behaviors differed depending on socio-demographic characteristics, and partly explained the relationship between socio-demographic factors and BMI in this sample of women. Both television time and total screen time are potential behaviors to target in future programs aimed at reducing socio-demographic disparities in overweight and obesity.

Associations of television viewing time with adults' well-being and vitality

OBJECTIVE

Television (TV) viewing, a common leisure-time sedentary behaviour, is associated adversely with cardio-metabolic health, fatigue, depression and mental health. However, associations of TV viewing time with health-related quality of life attributes are less well understood. We examined associations of TV viewing time with physical well-being, mental well-being and vitality in a large population-based sample of Australian adults.

METHOD

The study sample comprised 4,483 men and 5,424 women (mean age 51±14years) from the Australian Diabetes, Obesity and Lifestyle study (1999-2000). Multiple linear regressions examined associations of TV viewing time (h/day) with the SF-36v1 physical and mental health component summary scores and the vitality sub-score, adjusting for leisure-time physical activity and waist circumference.

RESULTS

Each 1-h/day increment in TV viewing time was associated with lower physical (-0.56 [95% CI: -0.77, -0.34]) and mental (-0.41 [-0.70, -0.12]) component summary scores and vitality (-0.51 [-0.81, -0.21]). Associations remained significant after adjustment for leisure-time physical activity and waist circumference. There was a gender interaction for the association of TV viewing time with vitality (significant in men only).

CONCLUSIONS

TV viewing time is associated adversely with physical well-being, mental well-being and vitality. Further studies are required to better understand potential causal relationships and variations by gender and leisure-time physical activity.