Promoting exercise, reducing sedentarism or both for diabetes prevention: The Seguimiento Universidad De Navarra (SUN) cohort

Background and aim: Both physical activity (PA) and sedentary behaviors have demonstrated independent associations with the development of type 2 diabetes mellitus (T2DM). However, the combination of both, has been less explored. We aimed to compare the associations of PA-only versus the simultaneous effect of PA and sedentary behaviors on T2DM in a Mediterranean cohort. Methods and results: Participants (n = 19,524) initially free of T2DM from the SUN Project were followed-up for a median of 10.4 years. Analyses were conducted in 2018. PA and sedentary parameters (TV viewing time and sitting time) were assessed through a validated questionnaire. The amount of each PA was expressed in METs-h/wk. After that, a previously developed 8-item active + sedentary lifestyle score was computed. T2DM was defined according to ADA criteria. To adjust for potential confounders, Cox regression models were adjusted. Among 19,524 participants, 175 cases of new-onset T2DM were observed during follow-up. After multivariable adjustment, higher PA was strongly inversely associated with T2DM, showing highly significant differences between extreme quartiles (HR = 0.51; 95% CI 0.32-0.79 p for trend<0.001). When considering not only PA, but also the more comprehensive active + sedentary lifestyle combined score, even stronger differences were found between the lowest and the highest categories (HR = 0.40; 95%CI 0.20-0.80; p for trend<0.001). Conclusion: Sedentary lifestyles, in addition to PA patterns, should be included in the assessment of T2DM risk. Promoting PA should be coupled with the avoidance of a sedentary lifestyle to lower the risk of T2DM. (C) 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Automated summary

The study found that both physical activity and sedentary behaviors are associated with the development of type 2 diabetes mellitus. The research showed significant differences in the impact on T2DM between solely engaging in physical activity and combining physical activity with sedentary behaviors. Therefore, it is important to focus on promoting physical activity while also avoiding a sedentary lifestyle to reduce the risk of T2DM.