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      Physical activity, sedentary leisure-time and risk of incident type 2 diabetes: a prospective study of 512 000 Chinese adults


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          Aim to examine the independent and joint associations of physical activity (PA) and sedentary leisure-time (SLT) with risk of diabetes and assess the extent to which these associations were mediated by adiposity.

          Research design and methods

          The prospective China Kadoorie Biobank recruited ~512 000 adults from 10 diverse areas across China. Self-reported PA was estimated based on type, frequency and duration of specific types of PA, covering four domains (occupation, leisure, household and commuting). SLT was defined as hours per day spent watching television, reading or playing card games. Stratified Cox proportional hazards models were used to estimate adjusted HRs (aHRs) for PA and SLT associated with incident diabetes. Analyses were stratified by age-at-risk (5-year intervals), sex and region and adjusted for household income, education, alcohol consumption, smoking, fresh fruit intake, self-reported general health status, family history of diabetes and body mass index (BMI) status. Analyses of total PA, occupational and non-occupational PA and SLT were mutually adjusted for each other, as appropriate.


          After ~9 years of follow-up, there were 14 940 incident diabetes cases among 460 736 participants without prior diabetes or cardiovascular diseases at baseline. The mean (SD) age at baseline was 51 (10.6) years, 59% were women and 43% resided in urban areas. Overall, the mean BMI was 23.5 (3.3) kg/m 2, which differed by ~0.5 kg/m 2 among individuals in the highest compared with the lowest PA and SLT groups. PA was inversely associated the risk of diabetes 16% (aHR: 0.84, 95% CI 0.81 to 0.88) lower in top than bottom fifth. After further adjustment for BMI this was attenuated to 0.99 (95% CI 0.98 to 1.00). SLT was positively associated with diabetes and each 1 hour per day higher usual level was associated with aHR of 1.13 (95% CI 1.09 to 1.17) for diabetes, attenuated to 1.05 (95% CI 1.01 to 1.09) after further adjustment for BMI.


          Among Chinese adults, higher levels of PA and lower levels of SLT were associated with lower risks of diabetes with no evidence of effect modification by each other. These associations appeared to arise mainly through adiposity.

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          Most cited references23

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          Exercise and Type 2 Diabetes

          Although physical activity (PA) is a key element in the prevention and management of type 2 diabetes, many with this chronic disease do not become or remain regularly active. High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently, but it is now well established that participation in regular PA improves blood glucose control and can prevent or delay type 2 diabetes, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. Structured interventions combining PA and modest weight loss have been shown to lower type 2 diabetes risk by up to 58% in high-risk populations. Most benefits of PA on diabetes management are realized through acute and chronic improvements in insulin action, accomplished with both aerobic and resistance training. The benefits of physical training are discussed, along with recommendations for varying activities, PA-associated blood glucose management, diabetes prevention, gestational diabetes mellitus, and safe and effective practices for PA with diabetes-related complications.
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              Association Between Diabetes and Cause-Specific Mortality in Rural and Urban Areas of China.

              In China, diabetes prevalence has increased substantially in recent decades, but there are no reliable estimates of the excess mortality currently associated with diabetes.

                Author and article information

                BMJ Open Diabetes Res Care
                BMJ Open Diabetes Res Care
                BMJ Open Diabetes Research & Care
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                18 December 2019
                : 7
                : 1
                [1 ] departmentClinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health , University of Oxford , Oxford, UK
                [2 ] departmentMedical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health , University of Oxford , Oxford, UK
                [3 ] Chinese Academy of Medical Sciences , Beijing, China
                [4 ] departmentDepartment of Epidemiology and Biostatistics, School of Public Health , Peking University Health Science Center , Beijing, China
                [5 ] Non-Communicable Disease Prevention and Control Department, Liuzhou CDC , Liuzhou, Guangxi, China
                [6 ] China National Center for Food Safety Risk Assessment (CFSA) , Beijing, China
                Author notes
                [Correspondence to ] Dr Derrick A Bennett; derrick.bennett@ 123456ndph.ox.ac.uk ; Dr Zhengming Chen; zhengming.chen@ 123456ndph.ox.ac.uk
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/.

                Funded by: FundRef http://dx.doi.org/10.13039/100004440, Wellcome Trust;
                Award ID: 088158/Z/09/Z
                Award ID: 104085/Z/14/Z
                Award ID: 202922/Z/16/Z
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 81390540
                Award ID: 81390541
                Award ID: 81390544
                Funded by: National Key Research and Development Program of China;
                Award ID: 2016YFC0900500
                Award ID: 2016YFC1303904
                Award ID: 2016YFC900501
                Award ID: 2016YFC900504
                Epidemiology/Health Services Research
                Custom metadata

                physical activity,sedentary leisure-time,adiposity,type 2 diabetes


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