Time-varying association between physical activity and risk of diabetes in the early and late adulthood: A longitudinal study in a West-Asian country

  • Parisa Naseri
    Affiliations
    Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
    Search for articles by this author
  • Parisa Amiri
    Correspondence
    Corresponding author at: Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, Tehran, Iran.
    Affiliations
    Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
    Search for articles by this author
  • Hasti Masihay-Akbar
    Affiliations
    Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
    Search for articles by this author
  • Navideh Sahebi Vaighan
    Affiliations
    Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
    Search for articles by this author
  • Sajad Ahmadizad
    Affiliations
    Department of Biological Sciences in Sport, Faculty of Sports Sciences and Health, Shahid Beheshti University, Tehran, Iran
    Search for articles by this author
  • Arash Ghanbarian
    Affiliations
    Prevention of Metabolic Disease Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
    Search for articles by this author
  • Fereidoun Azizi
    Affiliations
    Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
    Search for articles by this author

      Highlights

      • Assessment the possible changes in PA levels over time as a time-varying covariate.
      • High physical activity can postpone the incidence of T2DM in middle- aged and elderly women.
      • Sex and age groups are important factors in association between physical activity and risk of T2DM.

      Abstract

      Background

      The time-varying association between physical activity (PA) and incidence of type 2 diabetes (T2DM) is still unclear. The present study aimed to investigate this association in the early- and late-adulthood during a 9-year follow-up.

      Methods

      This study was conducted on 3905 participants in early and late adulthood, using the Tehran Lipid and Glucose Study (TLGS) dataset. PA was assessed via the Iranian version of Modified Activity Questionnaire (MAQ). The association between trend of PA and incident T2DM was investigated using time-varying Cox’s proportional hazard model. Variables including job, education, smoking and body mass index (BMI) were adjusted in the final model.

      Results

      The distribution of sex- and age-specific levels of PA changed significantly over time. Compared with physically inactive women, for older women with high level of PA, the risk of T2DM was 0.64 (95% CI: 0.43−0.95, P = 0.02) in adjusted model. Moreover, hazard for low PA group was significantly higher than the moderate group, and for these two groups were significantly higher than high PA level (P < 0.05).

      Conclusion

      High PA level can postpone the incident T2DM in early-aged and elderly women, over time. Therefore, gender and age are of great importance in designing the PA modifying programs to prevent T2DM.

      Keywords

      To read this article in full you will need to make a payment
      Subscribe to Primary Care Diabetes
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Al Busaidi N.
        • Shanmugam P.
        • Manoharan D.
        Diabetes in the Middle East: government health care policies and strategies that address the growing diabetes prevalence in the Middle East.
        Curr. Diab. Rep. 2019; 19: 8
        • Shi L.
        • Shu X.-O.
        • Li H.
        • Cai H.
        • Liu Q.
        • Zheng W.
        • Xiang Y.-B.
        • Villegas R.
        Physical activity, smoking, and alcohol consumption in association with incidence of type 2 diabetes among middle-aged and elderly Chinese men.
        PLoS One. 2013; 8e77919
        • Tuomilehto J.
        • Lindström J.
        • Eriksson J.G.
        • Valle T.T.
        • Hämäläinen H.
        • Ilanne-Parikka P.
        • Keinänen-Kiukaanniemi S.
        • Laakso M.
        • Louheranta A.
        • Rastas M.
        Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.
        N. Engl. J. Med. 2001; 344: 1343-1350
        • Javanbakht M.
        • Mashayekhi A.
        • Baradaran H.R.
        • Haghdoost A.
        • Afshin A.
        Projection of diabetes population size and associated economic burden through 2030 in Iran: evidence from micro-simulation Markov model and Bayesian meta-analysis.
        PLoS One. 2015; 10e0132505
        • Smith A.D.
        • Crippa A.
        • Woodcock J.
        • Brage S.
        Physical Activity and Incident Type 2 Diabetes Mellitus: A Systematic Review and Dose–Response Meta-Analysis of Prospective Cohort Studies.
        Springer, 2016
        • Davidson M.B.
        The effect of aging on carbohydrate metabolism: a review of the English literature and a practical approach to the diagnosis of diabetes mellitus in the elderly.
        Metabolism. 1979; 28: 688-705
        • Roglic G.
        WHO Global report on diabetes: a summary.
        Int. J. Noncommun. Dis. 2016; 1: 3
        • Abdelhafiz A.H.
        • Sinclair A.J.
        Diabetes in the elderly.
        Medicine. 2019; 47: 119-122
        • Noroozian M.
        The elderly population in Iran: an ever growing concern in the health system.
        Iran. J. Psychiatry Behav. Sci. 2012; 6: 1
        • Sharifi F.
        • Fakhrzadeh H.
        • Vannaghani M.
        • Arzaghi S.M.
        • Khoei M.A.
        • Farzadfar F.
        • Tanjani P.T.
        Prevalence of dementia and associated factors among older adults in Iran: national elderly health survey (NEHS).
        Arch Iran Med (AIM). 2016; 19
        • Nejhad Z.H.
        • Vardanjani H.M.
        • Abolhasani F.
        • Hadipour M.
        • Sheikhzadeh K.
        Relative effect of socio-economic status on the health-related quality of life in type 2 diabetic patients in Iran.
        Diabetes Metab. Syndr. Clin. Res. Rev. 2013; 7: 187-190
        • Hu F.B.
        • Manson J.E.
        • Stampfer M.J.
        • Colditz G.
        • Liu S.
        • Solomon C.G.
        • Willett W.C.
        Diet, lifestyle, and the risk of type 2 diabetes mellitus in women.
        N. Engl. J. Med. 2001; 345: 790-797
        • Hu F.B.
        Physical activity, sedentary behaviors, and obesity.
        Obesity Epidemiology. Oxford University Press, Inc, New York (NY)2008: 301-319
        • Henriksson J.
        Influence of exercise on insulin sensitivity.
        J. Cardiovasc. Risk. 1995; 2: 303-309
        • Saad M.F.
        • Knowler W.C.
        • Pettitt D.J.
        • Nelson R.G.
        • Charles M.A.
        • Bennett P.H.
        A two-step model for development of non-insulin-dependent diabetes.
        Am. J. Med. 1991; 90: 229-235
        • Hallal P.C.
        • Andersen L.B.
        • Bull F.C.
        • Guthold R.
        • Haskell W.
        • Ekelund U.
        • Group LPASW
        Global physical activity levels: surveillance progress, pitfalls, and prospects.
        Lancet. 2012; 380: 247-257
        • Esteghamati A.
        • Khalilzadeh O.
        • Rashidi A.
        • Kamgar M.
        • Meysamie A.
        • Abbasi M.
        Physical activity in Iran: results of the third national surveillance of risk factors of non-communicable diseases (SuRFNCD-2007).
        J. Phys. Act. Health. 2011; 8: 27-35
        • Didarloo A.
        • Shojaeizadeh D.
        • Ardebili H.E.
        • Niknami S.
        • Hajizadeh E.
        • Alizadeh M.
        Factors influencing physical activity behavior among Iranian women with type 2 diabetes using the extended theory of reasoned action.
        Diabetes Metab. J. 2011; 35: 513-522
        • King A.C.
        • Castro C.
        • Wilcox S.
        • Eyler A.A.
        • Sallis J.F.
        • Brownson R.C.
        Personal and environmental factors associated with physical inactivity among different racial–ethnic groups of US middle-aged and older-aged women.
        Health Psychol. 2000; 19: 354
        • Health UDo
        • Services H
        Physical Activity Fundamental to Preventing Disease.
        US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation 2002, 2002
        • Davis M.A.
        • Neuhaus J.M.
        • Moritz D.J.
        • Lein D.
        • Barclay J.D.
        • Murphy S.P.
        Health behaviors and survival among middle aged and older men and women in the NHANES I epidemiologic follow-up study.
        Prev. Med. 1994; 23: 369-376
        • Rakhshani T.
        • Shojaiezadeh D.
        • Lankarani K.B.
        • Rakhshani F.
        • Kaveh M.H.
        • Zare N.
        The association of health-promoting lifestyle with quality of life among the Iranian elderly.
        Iran. Red Crescent Med. J. 2014; 16
        • Lao X.Q.
        • Deng H.-B.
        • Liu X.
        • Chan T.-C.
        • Zhang Z.
        • Chang L-y
        • Yeoh E.-K.
        • Tam T.
        • Wong M.C.S.
        • Thomas G.N.
        Increased leisure-time physical activity associated with lower onset of diabetes in 44 828 adults with impaired fasting glucose: a population-based prospective cohort study.
        Br. J. Sports Med. 2019; 53: 895-900
        • Wang Y.
        • Lee D.-c
        • Brellenthin A.G.
        • Eijsvogels T.M.
        • Sui X.
        • Church T.S.
        • Lavie C.J.
        • Blair S.N.
        Leisure-time running reduces the risk of incident type 2 diabetes.
        Am. J. Med. 2019; 132: 1225-1232
        • Wahid A.
        • Manek N.
        • Nichols M.
        • Kelly P.
        • Foster C.
        • Webster P.
        • Kaur A.
        • Friedemann Smith C.
        • Wilkins E.
        • Rayner M.
        Quantifying the association between physical activity and cardiovascular disease and diabetes: a systematic review and meta‐analysis.
        J. Am. Heart Assoc. 2016; 5e002495
        • Tonstad S.
        • Stewart K.
        • Oda K.
        • Batech M.
        • Herring R.
        • Fraser G.
        Vegetarian diets and incidence of diabetes in the Adventist Health Study-2.
        Nutr. Metab. Cardiovasc. Dis. 2013; 23: 292-299
        • Hsia J.
        • Wu L.
        • Allen C.
        • Oberman A.
        • Lawson W.E.
        • Torréns J.
        • Safford M.
        • Limacher M.C.
        • Howard B.V.
        Physical activity and diabetes risk in postmenopausal women.
        Am. J. Prev. Med. 2005; 28: 19-25
        • Picavet H.S.J.
        • Wendel-Vos G.W.
        • Vreeken H.L.
        • Schuit A.J.
        • Verschuren W.M.M.
        How stable are physical activity habits among adults? The Doetinchem cohort study.
        Med. Sci. Sports Exerc. 2011; 43: 74-79
        • Rolando L.
        • Byrne D.W.
        • McGown P.W.
        • Goetzel R.Z.
        • Elasy T.
        • Yarbrough M.I.
        Health risk factor modification predicts incidence of diabetes in an employee population: results of an 8-year longitudinal cohort study.
        J Occup Environ Med/Am Coll Occup Environ Med. 2013; 55: 410
        • Delshad M.
        • Ghanbarian A.
        • Ghaleh N.R.
        • Amirshekari G.
        • Askari S.
        • Azizi F.
        Reliability and validity of the modifiable activity questionnaire for an Iranian urban adolescent population.
        Int. J. Prev. Med. 2015; 6
        • Department of Health and Human Services U.
        Physical Activity and Health: A Report of the Surgeon General.
        US Department of Health and Human Services, Centers for Disease Control and…, 1996
        • Gavin III, J.R.
        • Alberti K.
        • Davidson M.B.
        • DeFronzo R.A.
        Report of the expert committee on the diagnosis and classification of diabetes mellitus.
        Diabetes Care. 1997; 20: 1183
        • Guthold R.
        • Stevens G.A.
        • Riley L.M.
        • Bull F.C.
        Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1· 9 million participants.
        Lancet Glob. Health. 2018; 6: e1077-e1086
        • Afghan M.
        • Ghasemi A.
        • Azizi F.
        Seven-year changes of leisure-time and occupational physical activity among iranian adults (Tehran lipid and glucose study).
        Iran. J. Public Health. 2016; 45: 41-47
        • Koohpayehzadeh J.
        • Etemad K.
        • Abbasi M.
        • Meysamie A.
        • Sheikhbahaei S.
        • Asgari F.
        • Noshad S.
        • Hafezi-Nejad N.
        • Rafei A.
        • Mousavizadeh M.
        • Khajeh E.
        • Ebadi M.
        • Nakhjavani M.
        • Esteghamati A.
        Gender-specific changes in physical activity pattern in Iran: national surveillance of risk factors of non-communicable diseases (2007-2011).
        Int. J. Public Health. 2014; 59: 231-241https://doi.org/10.1007/s00038-013-0529-3
        • Aune D.
        • Norat T.
        • Leitzmann M.
        • Tonstad S.
        • Vatten L.J.
        Physical Activity and the Risk of Type 2 Diabetes: A Systematic Review and Dose–Response Meta-Analysis.
        Springer, 2015
        • LaMonte M.J.
        • Blair S.N.
        • Church T.S.
        Physical activity and diabetes prevention.
        J Appl Physiol (1985). 2005; 99: 1205-1213https://doi.org/10.1152/japplphysiol.00193.2005
        • Jefferis B.J.
        • Whincup P.H.
        • Lennon L.
        • Wannamethee S.G.
        Longitudinal associations between changes in physical activity and onset of type 2 diabetes in older British men: the influence of adiposity.
        Diabetes Care. 2012; 35: 1876-1883
        • Meisinger C.
        • Löwel H.
        • Thorand B.
        • Döring A.
        Leisure time physical activity and the risk of type 2 diabetes in men and women from the general population.
        Diabetologia. 2005; 48: 27-34
        • Meisinger C.
        • Thorand B.
        • Schneider A.
        • Stieber J.
        • Döring A.
        • Löwel H.
        Sex differences in risk factors for incident type 2 diabetes mellitus: the MONICA Augsburg cohort study.
        Arch. Intern. Med. 2002; 162: 82-89
        • Helmrich S.P.
        • Ragland D.R.
        • Leung R.W.
        • Paffenbarger Jr., R.S.
        Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus.
        N. Engl. J. Med. 1991; 325: 147-152
        • Manson J.E.
        • Nathan D.M.
        • Krolewski A.S.
        • Stampfer M.J.
        • Willett W.C.
        • Hennekens C.H.
        A prospective study of exercise and incidence of diabetes among US male physicians.
        JAMA. 1992; 268: 63-67
        • Tsenkova V.K.
        Leisure-time, occupational, household physical activity and insulin resistance (HOMAIR) in the Midlife in the United States (MIDUS) national study of adults.
        Prev. Med. Rep. 2017; 5: 224-227https://doi.org/10.1016/j.pmedr.2016.12.025
        • Mohebi F.
        • Mohajer B.
        • Yoosefi M.
        • Sheidaei A.
        • Zokaei H.
        • Damerchilu B.
        • Mehregan A.
        • Shahbal N.
        • Rezaee K.
        • Khezrian M.
        • Nematollahi Dehmoosa A.
        • Momen Nia Rankohi E.
        • Darman M.
        • Moghisi A.
        • Farzadfar F.
        Physical activity profile of the Iranian population: STEPS survey, 2016.
        BMC Public Health. 2019; 19: 1266https://doi.org/10.1186/s12889-019-7592-5
        • Momenan A.A.
        • Delshad M.
        • Mirmiran P.
        • Ghanbarian A.
        • Azizi F.
        Leisure time physical activity and its determinants among adults in Tehran: Tehran lipid and glucose study.
        Int. J. Prev. Med. 2011; 2: 243-251
        • Demakakos P.
        • Hamer M.
        • Stamatakis E.
        • Steptoe A.
        Low-intensity physical activity is associated with reduced risk of incident type 2 diabetes in older adults: evidence from the English Longitudinal Study of Ageing.
        Diabetologia. 2010; 53: 1877-1885
        • Mandrup C.M.
        • Egelund J.
        • Nyberg M.
        • Lundberg Slingsby M.H.
        • Andersen C.B.
        • Løgstrup S.
        • Bangsbo J.
        • Suetta C.
        • Stallknecht B.
        • Hellsten Y.
        Effects of high-intensity training on cardiovascular risk factors in premenopausal and postmenopausal women.
        Am. J. Obstet. Gynecol. 2017; 216 (384.e381–384.e311)https://doi.org/10.1016/j.ajog.2016.12.017
        • Helmrich S.P.
        • Ragland D.R.
        • Leung R.W.
        • Paffenbarger Jr., R.S.
        Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus.
        N. Engl. J. Med. 1991; 325: 147-152https://doi.org/10.1056/nejm199107183250302
        • Mirmiran P.
        • Hosseini-Esfahanil F.
        • Jessri M.
        • Mahan L.K.
        • Shiva N.
        • Azizis F.
        Does dietary intake by Tehranian adults align with the 2005 dietary guidelines for Americans? Observations from the Tehran lipid and glucose study.
        J. Health Popul. Nutr. 2011; 29: 39-52https://doi.org/10.3329/jhpn.v29i1.7564
        • Silva-Costa A.
        • Rotenberg L.
        • Nobre A.A.
        • Schmidt M.I.
        • Chor D.
        • Griep R.H.
        Gender-specific association between night-work exposure and type-2 diabetes: results from longitudinal study of adult health, ELSA-Brasil.
        Scand. J. Work Environ. Health. 2015; 41: 569-578https://doi.org/10.5271/sjweh.3520