Ambulatory activity associations with cardiovascular and metabolic risk factors in smokers

Impact of baseline physical activity and diet behavior on metabolic syndrome in a pharmaceutical trial: results from NAVIGATOR

OBJECTIVE

The cardiometabolic risk cluster metabolic syndrome (MS) includes ≥3 of elevated fasting glucose, hypertension, elevated triglycerides, reduced high-density lipoprotein cholesterol (HDL-c), and increased waist circumference. Each can be affected by physical activity and diet. Our objective was to determine whether determine whether baseline physical activity and/or diet behavior impact MS in the course of a large pharmaceutical trial.

MATERIALS/METHODS

This was an observational study from NAVIGATOR, a double-blind, randomized (nateglinide, valsartan, both, or placebo), controlled trial between 2002 and 2004. We studied data from persons (n=9306) with impaired glucose tolerance and cardiovascular disease (CVD) or CVD risk factors; 7118 with pedometer data were included in this analysis. Physical activity was assessed with 7-day pedometer records; diet behavior was self-reported on a 6-item survey. An MS score (MSSc) was calculated using the sum of each MS component, centered around the Adult Treatment Panel III threshold, and standardized according to sample standard deviation. Excepting HDL-c, assessed at baseline and year 3, MS components were assessed yearly. Follow-up averaged 6 years.

RESULTS

For every 2000-step increase in average daily steps, there was an associated reduction in average MSSc of 0.29 (95% CI (-)0.33 to (-)0.25). For each diet behavior endorsed, there was an associated reduction in average MSSc of 0.05 (95% CI (-)0.08 to (-)0.01). Accounting for the effects of pedometer steps and diet behavior together had minimal impact on parameter estimates with no significant interaction. Relations were independent of age, sex, race, region, smoking, family history of diabetes, and use of nateglinide, valsartan, aspirin, antihypertensive, and lipid-lowering agent.

CONCLUSIONS

Baseline physical activity and diet behavior were associated independently with reductions in MSSc such that increased attention to these lifestyle elements provides cardiometabolic benefits. Thus, given the potential to impact outcomes, assessment of physical activity and diet should be performed in pharmacologic trials targeting cardiometabolic risk.

Steps/day and metabolic syndrome in African American adults: the Jackson Heart Study

OBJECTIVE

To examine the relationship between pedometer-measured step count data and the Metabolic Syndrome (MetS) in African American adults.

METHOD

379 African American adults (mean age 60.1 years; 60% female) enrolled in the Jackson Heart Study (Jackson, MS) from 2000 to 2004 provided sufficient pedometer data for inclusion in this analysis. MetS was classified according to the International Diabetes Federation Task Force on Epidemiology and Prevention.

RESULTS

Using steps/day categorized as tertiles (<3717 (referent), 3717-6238, >6238), participants taking 3717-6238 (Odds Ratio (OR)(95% Confidence Interval (CI))=0.34 (0.19, 0.61)) and >6238 steps/day (OR(95% CI)=0.43 (0.23, 0.78)) had lower odds of having MetS compared to participants in the lowest tertile. Using previously suggested steps/day cut-points (<2500 (referent), 2500-4999, 5000-7499, ≥7500), the odds of having MetS were lower for participants taking 2500-4999 (OR(95% CI)=0.32 (0.14, 0.72)), 5000-7499 (OR(95% CI)=0.22 (0.09, 0.53)), and >7500 (OR(95% CI)=0.26 (0.11, 0.65)) steps/day compared to those taking <2500 steps/day.

CONCLUSION

Compared to lower levels, higher levels of steps/day are associated with a lower prevalence of MetS in this older African American population.