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      Associations of objectively measured moderate-to-vigorous-intensity physical activity and sedentary time with all-cause mortality in a population of adults at high risk of type 2 diabetes mellitus

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          Abstract

          The relationships of physical activity and sedentary time with all-cause mortality in those at high risk of type 2 diabetes mellitus (T2DM) are unexplored. To address this gap in knowledge, we examined the associations of objectively measured moderate-to-vigorous-intensity physical activity (MVPA) and sedentary time with all-cause mortality in a population of adults at high risk of T2DM. In 2010–2011, 712 adults (Leicestershire, U.K.), identified as being at high risk of T2DM, consented to be followed up for mortality. MVPA and sedentary time were assessed by accelerometer; those with valid data (≥ 10 hours of wear-time/day with ≥ 4 days of data) were included. Cox proportional hazards regression models, adjusted for potential confounders, were used to investigate the independent associations of MVPA and sedentary time with all-cause mortality. 683 participants (250 females (36.6%)) were included and during a mean follow-up period of 5.7 years, 26 deaths were registered. Every 10% increase in MVPA time/day was associated with a 5% lower risk of all-cause mortality [Hazard Ratio (HR): 0.95 (95% Confidence Interval (95% CI): 0.91, 0.98); p = 0.004]; indicating that for the average adult in this cohort undertaking approximately 27.5 minutes of MVPA/day, this benefit would be associated with only 2.75 additional minutes of MVPA/day. Conversely, sedentary time showed no association with all-cause mortality [HR (every 10-minute increase in sedentary time/day): 0.99 (95% CI: 0.95, 1.03); p = 0.589]. These data support the importance of MVPA in adults at high risk of T2DM. The association between sedentary time and mortality in this population needs further investigation.

          Highlights

          • Objectively measured MVPA time was strongly associated with all-cause mortality.

          • Objectively measured sedentary time was not associated with all-cause mortality.

          • These data support the importance of MVPA in adults at high risk of T2DM.

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          Regression Models and Life-Tables

          D R Cox (1972)
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            Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants

            Summary Background One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes. Methods We pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence—defined as fasting plasma glucose of 7·0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs—in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue. Findings We used data from 751 studies including 4 372 000 adults from 146 of the 200 countries we make estimates for. Global age-standardised diabetes prevalence increased from 4·3% (95% credible interval 2·4–7·0) in 1980 to 9·0% (7·2–11·1) in 2014 in men, and from 5·0% (2·9–7·9) to 7·9% (6·4–9·7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28·5% due to the rise in prevalence, 39·7% due to population growth and ageing, and 31·8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target. Interpretation Since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults affected, has increased faster in low-income and middle-income countries than in high-income countries. Funding Wellcome Trust.
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              Calibration of the Computer Science and Applications, Inc. accelerometer.

              We established accelerometer count ranges for the Computer Science and Applications, Inc. (CSA) activity monitor corresponding to commonly employed MET categories. Data were obtained from 50 adults (25 males, 25 females) during treadmill exercise at three different speeds (4.8, 6.4, and 9.7 km x h(-1)). Activity counts and steady-state oxygen consumption were highly correlated (r = 0.88), and count ranges corresponding to light, moderate, hard, and very hard intensity levels were or = 9499 cnts x min(-1), respectively. A model to predict energy expenditure from activity counts and body mass was developed using data from a random sample of 35 subjects (r2 = 0.82, SEE = 1.40 kcal x min(-1)). Cross validation with data from the remaining 15 subjects revealed no significant differences between actual and predicted energy expenditure at any treadmill speed (SEE = 0.50-1.40 kcal x min(-1)). These data provide a template on which patterns of activity can be classified into intensity levels using the CSA accelerometer.
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                Author and article information

                Contributors
                Journal
                Prev Med Rep
                Prev Med Rep
                Preventive Medicine Reports
                Elsevier
                2211-3355
                26 January 2017
                March 2017
                26 January 2017
                : 5
                : 285-288
                Affiliations
                [a ]Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom
                [b ]Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom
                [c ]Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom
                [d ]National Institute for Health Research (NIHR) Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Diabetes Research Centre, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom
                [e ]National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care – East Midlands (CLAHRC – EM), Diabetes Research Centre, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom
                [f ]Charles Perkins Center, Prevention Research Collaboration, School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
                [g ]Department of Epidemiology and Public Health, Institute of Epidemiology and Healthcare, University College London, London, WC1E 6BT, United Kingdom
                [h ]School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, United Kingdom
                Author notes
                [* ]Corresponding author at: Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, Leicestershire, LE5 4PW, United Kingdom.Diabetes Research CentreUniversity of LeicesterLeicester General HospitalGwendolen RoadLeicesterLeicestershireLE5 4PWUnited Kingdom kb318@ 123456le.ac.uk
                Article
                S2211-3355(17)30012-8
                10.1016/j.pmedr.2017.01.013
                5279862
                28149710
                2189bcd4-ccef-4270-ab8b-67a5bb651bb4
                © 2017 Published by Elsevier Inc.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 19 September 2016
                : 18 January 2017
                : 22 January 2017
                Categories
                Regular Article

                mortality,physical activity,moderate-to-vigorous-intensity physical activity,sedentary,type 2 diabetes mellitus,cox proportional hazards regression

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