Compositional analysis of the associations between 24-h movement behaviours and cardio-metabolic risk factors in overweight and obese adults with pre-diabetes from the PREVIEW study: cross-sectional baseline analysis

Nils Swindell, Paul Rees, Mikael Fogelholm, Mathijs Drummen, Ian MacDonald, J Alfredo Martinez, Santiago Navas-Carretero, Teodora Handjieva-Darlenska, Nadka Boyadjieva, Georgi Bogdanov, Sally D Poppitt, Nicholas Gant, Marta P Silvestre, Jennie Brand-Miller, Wolfgang Schlicht, Roslyn Muirhead, Shannon Brodie, Heikki Tikkanen, Elli Jalo, Margriet Westerterp-Plantenga, Tanja Adam, Pia Siig Vestentoft, Thomas M Larsen, Anne Raben, Gareth Stratton, Nils Swindell, Paul Rees, Mikael Fogelholm, Mathijs Drummen, Ian MacDonald, J Alfredo Martinez, Santiago Navas-Carretero, Teodora Handjieva-Darlenska, Nadka Boyadjieva, Georgi Bogdanov, Sally D Poppitt, Nicholas Gant, Marta P Silvestre, Jennie Brand-Miller, Wolfgang Schlicht, Roslyn Muirhead, Shannon Brodie, Heikki Tikkanen, Elli Jalo, Margriet Westerterp-Plantenga, Tanja Adam, Pia Siig Vestentoft, Thomas M Larsen, Anne Raben, Gareth Stratton

Abstract

Background: Physical activity, sedentary time and sleep have been shown to be associated with cardio-metabolic health. However, these associations are typically studied in isolation or without accounting for the effect of all movement behaviours and the constrained nature of data that comprise a finite whole such as a 24 h day. The aim of this study was to examine the associations between the composition of daily movement behaviours (including sleep, sedentary time (ST), light intensity physical activity (LIPA) and moderate-to-vigorous activity (MVPA)) and cardio-metabolic health, in a cross-sectional analysis of adults with pre-diabetes. Further, we quantified the predicted differences following reallocation of time between behaviours.

Methods: Accelerometers were used to quantify daily movement behaviours in 1462 adults from eight countries with a body mass index (BMI) ≥25 kg·m- 2, impaired fasting glucose (IFG; 5.6-6.9 mmol·l- 1) and/or impaired glucose tolerance (IGT; 7.8-11.0 mmol•l- 1 2 h following oral glucose tolerance test, OGTT). Compositional isotemporal substitution was used to estimate the association of reallocating time between behaviours.

Results: Replacing MVPA with any other behaviour around the mean composition was associated with a poorer cardio-metabolic risk profile. Conversely, when MVPA was increased, the relationships with cardiometabolic risk markers was favourable but with smaller predicted changes than when MVPA was replaced. Further, substituting ST with LIPA predicted improvements in cardio-metabolic risk markers, most notably insulin and HOMA-IR.

Conclusions: This is the first study to use compositional analysis of the 24 h movement composition in adults with overweight/obesity and pre-diabetes. These findings build on previous literature that suggest replacing ST with LIPA may produce metabolic benefits that contribute to the prevention and management of type 2 diabetes. Furthermore, the asymmetry in the predicted change in risk markers following the reallocation of time to/from MVPA highlights the importance of maintaining existing levels of MVPA.

Trial registration: ClinicalTrials.gov (NCT01777893).

Keywords: Compositional analysis; Physical activity; Pre-diabetes; Sedentary time.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Asymmetry of predicted change in outcome variables with the reallocation of time to and from sedentary time. Figure 1-a shows the predicted change in BMI, with the reallocation of time to/from ST. As MVPA increases at the expense of ST, predicted BMI steadily declines. Conversely, as MVPA is displaced by ST, predicted BMI rises exponentially. Figures 1-a shows that relative to MVPA, displacing ST with sleep or LIPA is associated with only marginal change in BMI. However, figure 1-b suggests that displacing ST with LIPA represents a favourable alternative to ST or sleep. ST sedentary time, LIPA light intensity physical activity, MVPA moderate-to-vigorous physical activity, BMI body mass index, HOMA-IR homeostasis model assessment for insulin resistance, hs-CRP, high sensitivity C-reactive protein

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