Protective role of physical activity on type 2 diabetes: Analysis of effect modification by race–ethnicity
体力活动对2型糖尿病的保护作用:根据人种-种族修正的效果分析
Corresponding Author
William R. Boyer
Department of Kinesiology, Recreation and Sports Studies, University of Tennessee, Knoxville, Tennessee, USA
Correspondence
William R. Boyer, Department of Kinesiology, Recreation, and Sports Studies, University of Tennessee, 914 Andy Holt Avenue, Knoxville, TN 37994, USA.
Tel: +1 904 502 3473
Fax: +1 865 974 8981
Email: [email protected]
Search for more papers by this authorJames R. Churilla
Department of Clinical and Applied Movement Sciences, University of North Florida, Jacksonville, Florida, USA
Search for more papers by this authorSamantha F. Ehrlich
Department of Public Health, University of Tennessee, Knoxville, Tennessee, USA
Search for more papers by this authorScott E. Crouter
Department of Kinesiology, Recreation and Sports Studies, University of Tennessee, Knoxville, Tennessee, USA
Search for more papers by this authorLyndsey M. Hornbuckle
Department of Kinesiology, Recreation and Sports Studies, University of Tennessee, Knoxville, Tennessee, USA
Search for more papers by this authorEugene C. Fitzhugh
Department of Kinesiology, Recreation and Sports Studies, University of Tennessee, Knoxville, Tennessee, USA
Search for more papers by this authorCorresponding Author
William R. Boyer
Department of Kinesiology, Recreation and Sports Studies, University of Tennessee, Knoxville, Tennessee, USA
Correspondence
William R. Boyer, Department of Kinesiology, Recreation, and Sports Studies, University of Tennessee, 914 Andy Holt Avenue, Knoxville, TN 37994, USA.
Tel: +1 904 502 3473
Fax: +1 865 974 8981
Email: [email protected]
Search for more papers by this authorJames R. Churilla
Department of Clinical and Applied Movement Sciences, University of North Florida, Jacksonville, Florida, USA
Search for more papers by this authorSamantha F. Ehrlich
Department of Public Health, University of Tennessee, Knoxville, Tennessee, USA
Search for more papers by this authorScott E. Crouter
Department of Kinesiology, Recreation and Sports Studies, University of Tennessee, Knoxville, Tennessee, USA
Search for more papers by this authorLyndsey M. Hornbuckle
Department of Kinesiology, Recreation and Sports Studies, University of Tennessee, Knoxville, Tennessee, USA
Search for more papers by this authorEugene C. Fitzhugh
Department of Kinesiology, Recreation and Sports Studies, University of Tennessee, Knoxville, Tennessee, USA
Search for more papers by this authorAbstract
enBackground
It is well known physical activity (PA) plays a role in the prevention of type 2 diabetes (T2D). However, the extent to which PA may affect T2D risk among different race–ethnic groups is unknown. Therefore, the aim of the present study was to systematically examine the effect modification of race–ethnicity on PA and T2D.
Methods
The PubMed and Embase databases were systematically searched through June 2016. Study assessment for inclusion was conducted in three phases: title review (n = 13 022), abstract review (n = 2200), and full text review (n = 265). In all, 27 studies met the inclusion criteria and were used in the analysis. Relative risks (RRs) and 95% confidence intervals (CIs) were extracted and analyzed using Comprehensive Meta-Analysis software. All analyses used a random-effects model.
Results
A significant protective summary RR, comparing the most active group with the least active PA group, was found for non-Hispanic White (RR 0.71, 95% CI 0.60–0.85), Asians (RR 0.76, 95% CI 0.67–0.85), Hispanics (RR 0.75, 95% CI 0.64–0.89), and American Indians (RR 0.73, 95% CI 0.60–0.88). The summary effect for non-Hispanic Blacks (RR 0.91, 95% CI 0.76–1.08) was not significant.
Conclusions
The results of the present study indicate that PA (comparing most to least active groups) provides significant protection from T2D, with the exception of non-Hispanic Blacks. The results also indicate a need for race–ethnicity-specific reporting of RRs in prospective cohort studies that incorporate multiethnic samples.
摘要
zh背景
众所周知, 体力活动(physical activity, PA)在预防2型糖尿病(T2D)中发挥作用。然而, 目前尚未明确的是在不同的人种-种族群体中, 哪一种PA在什么程度上可以预防T2D的风险。因此, 本研究的目的是系统调查按照人种-种族修正的PA对T2D具有何种影响。
方法
对截至2016年6月的PubMed与EMBASE数据库进行系统检索。将纳入的研究进行3个阶段的评估:标题评估(n=13022)、摘要评估(n=2200)以及全文评估(n=265)。在这项分析中总共有27个研究达到了入选标准并用于后续分析。使用综合性的meta分析软件来提取与分析相对风险(relative risks, RRs)与95%置信区间(CIs)。所有的分析都使用随机效应模型。
结果
将PA最活跃组与最不活跃组进行比较后发现, 在非西班牙裔白人(RR为0.71, 95% CI为0.60-0.85)、亚裔(RR为0.76, 95% CI为0.67-0.85)、西班牙裔(RR为0.75, 95% CI为0.64-0.89)以及美国印第安人(RR为0.73, 95% CI为0.60-0.88)中, PA对总体RR都具有显著保护作用。在非西班牙裔黑人中没有显著的总体保护效应(RR为0.91, 95% CI为0.76-1.08)。
结论
本研究结果表明, 除了对非西班牙裔黑人外, PA都具有显著的预防T2D作用(PA最活跃组与最不活跃组相比)。研究结果还表明在包括多种族样本的前瞻性队列研究中, 报告RRs时需要按照人种-种族进行分组。
Supporting Information
Filename | Description |
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jdb12574-sup-0001-FigureS1.jpgJPEG image, 62.8 KB | Figure S1. Funnel plot assessing publication bias within prospective cohort studies examining physical activity and type 2 diabetes risk. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
References
- 1 Centers for Disease Control and Prevention. 2014 National Diabetes Statistics Report. 2014. Available from: http://www.cdc.gov/diabetes/data/statistics/2014StatisticsReport.html (accessed 10 October 2016).
- 2 Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and trends in diabetes among adults in the United States, 1988–2012. JAMA. 2015; 314: 1021–1029.
- 3 Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: Dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr. 2010; 8: 29.
- 4 Honeycutt AA, Boyle JP, Broglio KR et al. A dynamic Markov model for forecasting diabetes prevalence in the United States through 2050. Health Care Manag Sci. 2003; 6: 155–164.
- 5 Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346: 393–403.
- 6 Aune D, Norat T, Leitzmann M, Tonstad S, Vatten LJ. Physical activity and the risk of type 2 diabetes: A systematic review and dose-response meta-analysis. Eur J Epidemiol. 2015; 30: 529–542.
- 7 Gill JM, Celis-Morales CA, Ghouri N. Physical activity, ethnicity and cardio-metabolic health: Does one size fit all? Atherosclerosis. 2014; 232: 319–333.
- 8 US Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. 2008. Available from: https://health.gov/paguidelines/pdf/paguide.pdf (accessed 10 October 2016).
- 9 Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Report. 2008. Available from: https://health.gov/paguidelines/report/pdf/committeereport.pdf (accessed 8 October 2016).
- 10 Jeon CY, Lokken RP, Hu FB, van Dam RM. Physical activity of moderate intensity and risk of type 2 diabetes: A systematic review. Diabetes Care. 2007; 30: 744–752.
- 11 Stroup DF, Berlin JA, Morton SC et al. Meta-analysis of observational studies in epidemiology: A proposal for reporting. JAMA. 2000; 283: 2008–2012.
- 12 Burchfiel CM, Sharp DS, Curb JD et al. Physical activity and incidence of diabetes: The Honolulu Heart Program. Am J Epidemiol. 1995; 141: 360–368.
- 13 Burke V, Zhao Y, Lee AH et al. Predictors of type 2 diabetes and diabetes-related hospitalisation in an Australian Aboriginal cohort. Diabetes Res Clin Pract. 2007; 78: 360–368.
- 14 Fan S, Chen J, Huang J et al. Physical activity level and incident type 2 diabetes among Chinese adults. Med Sci Sports Exerc. 2015; 47: 751–756.
- 15 Fretts AM, Howard BV, Kriska AM et al. Physical activity and incident diabetes in American Indians: The Strong Heart Study. Am J Epidemiol. 2009; 170: 632–639.
- 16 Fretts AM, Howard BV, McKnight B et al. Life's simple 7 and incidence of diabetes among American Indians: The Strong Heart Family Study. Diabetes Care. 2014; 37: 2240–2245.
- 17 Honda T, Kuwahara K, Nakagawa T, Yamamoto S, Hayashi T, Mizoue T. Leisure-time, occupational, and commuting physical activity and risk of type 2 diabetes in Japanese workers: A cohort study. BMC Public Health. 2015; 15: 1004.
- 18 Hsia J, Wu L, Allen C et al. Physical activity and diabetes risk in postmenopausal women. Am J Prev Med. 2005; 28: 19–25.
- 19 Hu G, Lindstrom J, Valle TT et al. Physical activity, body mass index, and risk of type 2 diabetes in patients with normal or impaired glucose regulation. Arch Intern Med. 2004; 164: 892–896.
- 20 James SAP, Jamjoum LMPH, Raghunathan TEP, Strogatz DSP, Furth EDMD, Khazanie PGP. Physical activity and NIDDM in African-Americans: The Pitt County Study. Diabetes Care. 1998; 21: 555–562.
- 21 Joseph JJ, Echouffo-Tcheugui JB, Carnethon MR et al. The association of ideal cardiovascular health with incident type 2 diabetes mellitus: The Multi-Ethnic Study of Atherosclerosis. Diabetologia. 2016; 9: 1893–1903.
- 22 Koloverou E, Panagiotakos DB, Pitsavos C et al. 10-year incidence of diabetes and associated risk factors in Greece: The ATTICA study (2002–2012). Rev Diabet Stud. 2014; 11: 181–189.
- 23 Kriska AM, Saremi A, Hanson RL et al. Physical activity, obesity, and the incidence of type 2 diabetes in a high-risk population. Am J Epidemiol. 2003; 158: 669–675.
- 24 Lee DC, Park I, Jun TW et al. Physical activity and body mass index and their associations with the development of type 2 diabetes in Korean men. Am J Epidemiol. 2012; 176: 43–51.
- 25 Ma Y, Hebert JR, Manson JE et al. Determinants of racial/ethnic disparities in incidence of diabetes in postmenopausal women in the U.S.: The Women's Health Initiative 1993–2009. Diabetes Care. 2012; 35: 2226–2234.
- 26 Nakanishi N, Takatorige T, Suzuki K. Daily life activity and risk of developing impaired fasting glucose or type 2 diabetes in middle-aged Japanese men. Diabetologia. 2004; 47: 1768–1775.
- 27 Okada K, Hayashi T, Tsumura K, Suematsu C, Endo G, Fujii S. Leisure-time physical activity at weekends and the risk of type 2 diabetes mellitus in Japanese men: The Osaka Health Survey. Diabet Med. 2000; 17: 53–58.
- 28 Panagiotakos DB, Pitsavos C, Skoumas Y, Lentzas Y, Stefanadis C. Five-year incidence of type 2 diabetes mellitus among cardiovascular disease-free Greek adults: Findings from the ATTICA study. Vasc Health Risk Manag. 2008; 4: 691–698.
- 29 Shi L, Shu XO, Li H et al. Physical activity, smoking, and alcohol consumption in association with incidence of type 2 diabetes among middle-aged and elderly Chinese men. PLoS ONE. 2013; 8: e77919.
- 30 Tonstad S, Stewart K, Oda K, Batech M, Herring RP, Fraser GE. Vegetarian diets and incidence of diabetes in the Adventist Health Study-2. Nutr Metab Cardiovasc Dis. 2013; 23: 292–299.
- 31 Tsai AC, Lee SH. Determinants of new-onset diabetes in older adults: Results of a national cohort study. Clin Nutr. 2015; 34: 937–942.
- 32 Villegas R, Shu XO, Li H et al. Physical activity and the incidence of type 2 diabetes in the Shanghai Women's Health Study. Int J Epidemiol. 2006; 35: 1553–1562.
- 33 Villegas R, Shu XO, Yang G et al. Energy balance and type 2 diabetes: A report from the Shanghai Women's Health Study. Nutr Metab Cardiovasc Dis. 2009; 19: 190–197.
- 34 Waki K, Noda M, Sasaki S et al. Alcohol consumption and other risk factors for self-reported diabetes among middle-aged Japanese: A population-based prospective study in the JPHC study cohort I. Diabet Med. 2005; 22: 323–331.
- 35 Waller K, Kaprio J, Lehtovirta M, Silventoinen K, Koskenvuo M, Kujala UM. Leisure-time physical activity and type 2 diabetes during a 28 year follow-up in twins. Diabetologia. 2010; 53: 2531–2537.
- 36 Wang H, Shara NM, Calhoun D, Umans JG, Lee ET, Howard BV. Incidence rates and predictors of diabetes in those with prediabetes: The Strong Heart Study. Diabetes Metab Res Rev. 2010; 26: 378–385.
- 37 Xu F, Wang Y, Ware RS et al. Physical activity, family history of diabetes and risk of developing hyperglycaemia and diabetes among adults in Mainland China. Diabet Med. 2012; 29: 593–599.
- 38 Xu F, Wang Y, Ware RS et al. Joint impact of physical activity and family history on the development of diabetes among urban adults in Mainland China: A pooled analysis of community-based prospective cohort studies. Asia Pac J Public Health. 2015; 27: NP372–NP381.
- 39
Bornstein M, Hedges L, Higgins J, Rothstein H. Introduction to Meta-Analysis. John Wiley & Sons, West Sussex, 2009.
10.1002/9780470743386 Google Scholar
- 40 National Heart Lung and Blood Institute. Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. 2014. Available from: https://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/cohort (accessed 15 November 2016).
- 41 Celis-Morales CA, Ghouri N, Bailey MES, Sattar N, Gill JMR. Should physical activity recommendations be ethnicity-specific? Evidence from a cross-sectional study of South Asian and European men. PLoS ONE. 2013; 8: e82568.
- 42 Steinbrecher A, Erber E, Grandinetti A, Nigg C, Kolonel LN, Maskarinec G. Physical activity and risk of type 2 diabetes among Native Hawaiians, Japanese Americans, and Caucasians: The Multiethnic Cohort. J Phys Act Health. 2012; 9: 634–641.
- 43 DeLany JP, Dube JJ, Standley RA et al. Racial differences in peripheral insulin sensitivity and mitochondrial capacity in the absence of obesity. J Clin Endocrinol Metab. 2014; 99: 4307–4314.
- 44 Bonora E, Kiechl S, Willeit J et al. Population-based incidence rates and risk factors for type 2 diabetes in white individuals: The Bruneck study. Diabetes. 2004; 53: 1782–1789.
- 45 Boden G. Pathogenesis of type 2 diabetes. Insulin resistance. Endocrinol Metab Clin North Am. 2001; 30: 801–815.
- 46 Lakoski SG, Kozlitina J. Ethnic differences in physical activity and metabolic risk: The Dallas Heart Study. Med Sci Sports Exerc. 2014; 46: 1124–1132.
- 47 Irwin ML, Mayer-Davis EJ, Addy CL et al. Moderate-intensity physical activity and fasting insulin levels in women: The Cross-Cultural Activity Participation Study. Diabetes Care. 2000; 23: 449–454.
- 48 Hasson RE, Granados K, Chipkin S, Freedson PS, Braun B. Effects of a single exercise bout on insulin sensitivity in black and white individuals. J Clin Endocrinol Metab. 2010; 95: E219–E223.
- 49 Palaniappan LP, Carnethon MR, Fortmann SP. Heterogeneity in the relationship between ethnicity, BMI, and fasting insulin. Diabetes Care. 2002; 25: 1351–1357.
- 50 Kodama K, Tojjar D, Yamada S, Toda K, Patel CJ, Butte AJ. Ethnic differences in the relationship between insulin sensitivity and insulin response: A systematic review and meta-analysis. Diabetes Care. 2013; 36: 1789–1796.
- 51 Williams SK, Fiscella K, Winters P, Martins D, Ogedegbe G. Association of racial disparities in the prevalence of insulin resistance with racial disparities in vitamin D levels: National Health and Nutrition Examination Survey (2001–2006). Nutr Res. 2013; 33: 266–271.
- 52 Albu JB, Kovera AJ, Allen L et al. Independent association of insulin resistance with larger amounts of intermuscular adipose tissue and a greater acute insulin response to glucose in African American than in white nondiabetic women. Am J Clin Nutr. 2005; 82: 1210–1217.
- 53 Wilcox G. Insulin and insulin resistance. Clin Biochem Rev. 2005; 26: 19–39.
- 54 Girard J. The inhibitory effects of insulin on hepatic glucose production are both direct and indirect. Diabetes. 2006; 55 (Suppl.): S65–S69.
- 55 Bavenholm PN, Pigon J, Ostenson CG, Efendic S. Insulin sensitivity of suppression of endogenous glucose production is the single most important determinant of glucose tolerance. Diabetes. 2001; 50: 1449–1454.
- 56 Consoli A. Role of liver in pathophysiology of NIDDM. Diabetes Care. 1992; 15: 430–441.
- 57 Gaillard TR, Osei K. Racial disparities in the pathogenesis of type 2 diabetes and its subtypes in the African diaspora: A new paradigm. J Racial Ethn Health Disparities. 2016; 3: 117–128.
- 58 Haffner SM, D’Agostino R, Saad MF et al. Increased insulin resistance and insulin secretion in nondiabetic African-Americans and Hispanics compared with non-Hispanic whites: The insulin resistance atherosclerosis study. Diabetes. 1996; 45: 742–748.
- 59 Lorenzo C, Hanley AJG, Wagenknecht LE et al. Relationship of insulin sensitivity, insulin secretion, and adiposity with insulin clearance in a multiethnic population: The Insulin Resistance Atherosclerosis Study. Diabetes Care. 2013; 36: 101–103.
- 60 Turcotte LP, Fisher JS. Skeletal muscle insulin resistance: Roles of fatty acid metabolism and exercise. Phys Ther. 2008; 88: 1279–1296.
- 61 Goedecke JH, Keswell D, Weinreich C et al. Ethnic differences in hepatic and systemic insulin sensitivity and their associated determinants in obese black and white South African women. Diabetologia. 2015; 58: 2647–2652.
- 62 Ingram KH, Lara-Castro C, Gower BA et al. Intramyocellular lipid and insulin resistance: Differential relationships in European and African Americans. Obesity. 2011; 19: 1469–1475.
- 63 Staiano AE, Harrington DM, Johannsen NM et al. Uncovering physiological mechanisms for health disparities in type 2 diabetes. Ethn Dis. 2015; 25: 31–37.
- 64 Ceaser T, Hunter G. Black and white race differences in aerobic capacity, muscle fiber type, and their influence on metabolic processes. Sports Med. 2015; 45: 615–623.
- 65 Albers PH, Pedersen AJT, Birk JB et al. Human muscle fiber type-specific insulin signaling: Impact of obesity and type 2 diabetes. Diabetes. 2015; 64: 485–497.
- 66 Daugaard JR, Nielsen JN, Kristiansen S, Andersen JL, Hargreaves M, Richter EA. Fiber type-specific expression of GLUT4 in human skeletal muscle: Influence of exercise training. Diabetes. 2000; 49: 1092–1095.
- 67 Sallis JF, Saelens BE. Assessment of physical activity by self-report: Status, limitations, and future directions. Res Q Exerc Sport. 2000; 71: 1–14.
- 68 Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008; 40: 181–188.
- 69 Bhopal R, Donaldson L. White, European, Western, Caucasian, or what? Inappropriate labeling in research on race, ethnicity, and health. Am J Public Health. 1998; 88: 1303–1307.
- 70 Executive Office of the President; Office of Management and Budget; Office of Information and Regulatory Affairs. Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity. 1997. Available from: https://obamawhitehouse.archives.gov/omb/fedreg_1997standards (accessed 1 November 2016).