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Of the 4,685 participants included in the study, 825 (17.6%) had MetS at baseline in 2009 and 1,188 (25.6%) had MetS in 2015. Table 1 shows the baseline characteristics between the MetS group and the non-MetS group in 2009. We found significant differences between the non-MetS group and MetS group in terms of age, gender, region, education, dietary intake, regular drinking, TV time, and MVPA levels. The MetS group was more likely to be older, male, urban residents, primary school or below, regular drinker, TV time ≥ 28 h/w, non-MVPA, and higher protein and Na intake, but less likely to be middle school, TV time < 7 h/w, in the highest tertile of MVPA, and lower carbohydrate intake.
Parameters Total (4,685) Normal (n = 3,860) MetS (n = 825) P Average age (years)* 51.4 ± 13.0 50.6 ± 13.1 55.2 ± 11.7 < 0.001 Age group (n, %) 18−34 4,959 (10.6) 457 (11.8) 38 (4.6) < 0.001 35−44 992 (21.2) 866 (22.4) 126 (15.3) < 0.001 45−54 1,291 (27.6) 1,062 (27.5) 229 (27.8) 0.382 55−64 1,185 (25.3) 926 (24.0) 259 (31.4) < 0.001 65− 722 (15.4) 549 (14.2) 173 (21.0) < 0.001 Gender (n, %) 0.015 Male 2,104 (44.9) 1,694 (43.9) 410 (49.7) Female 2,581 (55.1) 2,166 (56.1) 415 (50.3) Region (n, %) 0.031 City 1,334 (28.5) 1,060 (27.5) 274 (33.2) Country 3,351 (71.5) 2,800 (72.5) 551 (66.8) Education (n, %) Primary school/below 2,153 (46.0) 1,754 (45.4) 399 (48.4) 0.007 Middle school 1,571 (33.5) 1,313 (34.0) 258 (31.3) 0.002 High school/above 961 (20.5) 793 (20.6) 168 (20.4) 0.934 Annual per capital family income (yuan) (n, %) < 10,000 2,295 (49.0) 1,888 (48.9) 407 (49.3) 0.056 10,000−20,000 1,195 (25.5) 1,020 (26.4) 175 (21.2) 0.073 ≥ 20,000 1,195 (25.5) 952 (24.7) 243 (29.5) 0.114 Dietary intake* Carbohydrate (g/day) 298.0 ± 111.1 299.8 ± 109.9 289.8 ± 116.2 0.004 Protein (g/day) 68.1 ± 25.4 67.9 ± 25.2 69.2 ± 26.4 0.011 Fat (g/day) 79.1 ± 41.4 79.2 ± 40.7 78.9 ± 44.4 0.109 Cholesterol (g/day) 263.3 ± 209.9 262.5 ± 209.7 267.0 ± 211.0 0.586 Na (mg/day) 5275.5 ± 4533.8 5184.0 ± 4392.5 5704.3 ± 5125.9 0.047 Kcal (kcal/day) 2234.7 ± 716.1 2,240.8 ± 710.5 2206.1 ± 742.0 0.292 Current smoker (n, %) 1,427 (30.5) 1,160 (30.1) 267 (32.4) 0.201 Regular drinking (n, %) 1,328 (28.4) 1,068 (27.7) 260 (31.5) 0.008 Sleep time (h/day)* 7.7 ± 2.2 7.7 ± 2.2 7.7 ± 2.0 0.566 Leisure ST (h/w) (n, %) TV time < 10.5 1,491 (31.8) 1,263 (32.7) 228 (27.6) 0.012 10.5−17.5 1,666 (35.6) 1,386 (35.9) 280 (33.9) 0.071 17.5−28 889 (19.0) 717 (18.6) 172 (20.9) 1.319 ≥ 28 63 (13.6) 494 (12.8) 145 (17.6) 0.024 Computer time 0.186 < 7 4,280 (91.4) 3,536 (91.6) 744 (90.2) ≥ 7 405 (8.6) 324 (8.4) 81 (9.8) Reading time 0.295 < 7 4,307 (91.9) 3,556 (92.1) 751 (91.0) ≥ 7 378 (8.1) 304 (7.9) 74 (9.0) Total leisure ST < 14 1,474 (31.5) 1,252 (32.4) 222 (26.9) < 0.001 14−21 1,444 (30.8) 1,187 (30.8) 257 (31.2) 0.337 21−35 1,259 (26.9) 1,029 (26.7) 230 (27.9) 0.216 ≥ 35 508 (10.8) 392 (10.2) 116 (14.1) < 0.001 Total time Physical activity (METs.h/w) (n, %) LPA Low (< 18.6) 1,392 (29.7) 1,159 (30.0) 233 (28.2) 0.777 Medium (18.6−53.7) 1,671 (35.7) 1,352 (35.0) 319 (38.7) 0.854 High (≥ 53.7) 1,622 (34.6) 1,349 (35.0) 273 (33.1) 0.71 MVPA Low (= 0) 1,918 (40.9) 1,502 (38.9) 416 (50.4) < 0.001 Medium (0−61.0) 1,048 (22.4) 850 (22.2) 198 (24.0) 0.21 High (≥ 61.0) 1,719 (36.7) 1,508 (39.1) 211 (25.6) < 0.001 Total PA Low (< 46.6) 1,374 (29.3) 1,075 (27.9) 299 (36.2) < 0.001 Medium (46.6−147.2) 1,598 (34.1) 1,286 (33.3) 312 (37.8) 0.54 High (≥ 147.2) 1,713 (36.6) 1,499 (38.8) 214 (25.9) < 0.001 MetS components (n, %) Abnomial obesity 1,634 (34.9) 935 (24.2) 699 (84.7) < 0.001 Hyperglycemia 638 (13.6) 267 (6.9) 371 (45.0) < 0.001 Raised TG 1,507 (32.2) 807 (20.9) 700 (84.9) < 0.001 Reduced HDL_C 618 (13.2) 253 (6.6) 365 (44.2) < 0.001 Raised BP 1,761 (37.6) 1,124 (29.1) 637 (77.2) < 0.001 Note. MetS: metabolic syndrome; PA: physical activity; met: metabolic equivalent; h/w: hours per week; MET: Metabolic equivalent of task; MVPA Moderate-to-vigorous-intensity physical activity; HDL: high-density lipoprotein cholesterol; MET: metabolic equivalent of task; *: means (standard deviations) and conducted an analysis of variance (ANOVA). Table 1. Baseline characteristics of the study populations stratified by MetS in 2009
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Table 2 shows the association between the risks of MetS and its components and the levels of different types of leisure ST and PA at baseline. After adjusting for all covariates, higher levels of TV time were associated with abdominal obesity (OR 1.4, 95% CI 1.1–1.7, Ptrend < 0.001), hyperglycemia (OR 1.3, 95% CI 1.0–1.7, Ptrend = 0.012), elevated TG (OR 1.3, 95% CI 1.1–1.7, Ptrend = 0.006), and MetS (OR 1.3, 95% CI 1.1–1.6, Ptrend < 0.001). The computer time > 7 h/w group had a higher risk of low HDL-C (OR 1.4, 95% CI 1.1–1.7) and MetS (OR 1.5, 95% CI 1.2–1.9) than the computer time < 7 h/w group. A higher level of total leisure ST was associated with abdominal obesity (OR 1.2, 95% CI 1.0–1.5, Ptrend < 0.001), hyperglycemia (OR 1.3, 95% CI 1.0–1.6, P trend < 0.001), elevated TG (OR 1.4, 95% CI 1.2–1.7, Ptrend < 0.001), and MetS (OR 1.4, 95% CI 1.2–1.8, Ptrend < 0.001). The effects of reading level were not significant.
Parameters N Abdominal obesity Hyperglycemia Raised TG Reduced HDL_C Raised BP MetS subjects Model 1 Model 2 Model 1 Model 2 Model 1 Model 2 Model 1 Model 2 Model 1 Model 2 Model 1 Model 2 Leisure ST (h/w) TV time < 10.5 1,491 ref ref ref ref ref ref ref ref ref ref ref ref 10.5−17.5 1,666 1.1
(0.9, 1.3)1.1
(0.9, 1.3)1.0
(0.8, 1.3)1.0
(0.8, 1.3)1.0
(0.8, 1.2)1.1
(1.0, 1.2)*0.9
(0.7, 1.1)1.0
(0.8, 1.2)1.3
(0.9, 1.6)1.3
(0.9, 1.6)1.0
(0.9, 1.2)1.0
(0.9, 1.2)17.5−28 889 1.2
(1.0, 1.4)*1.2
(1.0, 1.5)*1.1
(0.9, 1.3)1.1
(1.0, 1.3)*1.2
(1.0, 1.4)1.2
(1.0, 1.4)*1.0
(0.8, 1.2)1.0
(0.8, 1.2)1.2
(0.9, 1.4)1.2
(0.9, 1.5)1.3
(1.1, 1.5)**1.2
(1.1, 1.5)**≥ 28 639 1.3
(1.1, 1.6)**1.4
(1.1, 1.7)**1.4
(1.1, 1.8)**1.3
(1.0, 1.7)**1.4
(1.1, 1.7)**1.3
(1.1, 1.7)**1.1
(0.9, 1.4)1.0
(0.8, 1.3)1.0
(0.9, 1.3)1.1
(0.9, 1.3)1.4
(1.2, 1.7)**1.3
(1.1, 1.6)**Ptrend < 0.001 < 0.001 0.001 0.012 < 0.001 0.006 0.347 0.992 0.429 0.566 < 0.001 < 0.001 Computer time < 7 4,280 ref ref ref ref ref ref ref ref ref ref ref ref ≥ 7 405 1.2
(1.0, 1.4)1.2
(1.0, 1.4)1.2
(0.9, 1.5)1.1
(0.9, 1.4)1.7
(1.4, 2.0)**1.5
(0.9, 1.8)1.4
(1.2, 1.7)**1.4
(1.1, 1.7)**1.0
(0.8, 1.2)1.1
(0.9, 1.3)1.6
(1.3, 2.0)**1.5
(1.2, 1.9)**Reading time < 7 4,307 ref ref ≥ 7 378 1.1
(0.9, 1.4)1.1
(0.9, 1.4)1.0
(0.8, 1.3)1.0
(0.7, 1.2)1.1
(0.9, 1.3)0.8
(0.7, 1.0)1.2
(0.9, 1.5)1.0
(0.8, 1.3)0.9
(0.8, 1.1)1.0
(0.8, 1.3)1.1
(0.9, 1.4)1.0
(0.8, 1.2)Total leisure ST < 14 1,474 ref ref ref ref ref ref ref ref ref ref ref ref 14−21 1,444 1.2
(1.0, 1.3)*1.2
(1.0, 1.3)*1.1
(0.9, 1.3)1.0
(0.9, 1.2)1.2
(1.1, 1.4)**1.2
(1.1, 1.4)**1.1
(0.9, 1.3)1.1
(0.9, 1.3)1.0
(0.9, 1.1)1.0
(0.9, 1.1)1.2
(1.0, 1.4)*1.1
(0.9, 1.3)21−35 1,259 1.2
(1.0, 1.3)*1.2
(1.0, 1.4)*1.2
(1.0, 1.5)*1.2
(0.9, 1.4)1.2
(1.1, 1.4)**1.2
(1.1, 1.5)**1.1
(0.9, 1.3)1.1
(0.9, 1.2)1.0
(0.9, 1.2)1.0
(0.9, 1.1)1.3
(1.1, 1.5)**1.2
(1.0, 1.4)*≥ 35 508 1.4
(1.2, 1.7)**1.2
(1.0, 1.5)**1.4
(1.1, 1.8)**1.3
(1.0, 1.6)*1.6
(1.3, 1.9)**1.4
(1.2, 1.7)**1.4
(1.1, 1.7)**1.2
(0.9, 1.4)0.9
(0.7, 1.1)0.9
(0.7, 1.1)1.7
(1.4, 2.0)**1.4
(1.2, 1.8)**Ptrend < 0.001 0.008 < 0.001 < 0.001 < 0.001 < 0.001 0.014 0.853 0.744 0.639 < 0.001 < 0.001 Note. The model 1 adjusted only for baselined gender, age, region, education, income and wave; the model 2 full adjusted the covariates including baselined carbohydrate, protein, fat, cholesterol, Na, kcal, regular drinking, current smoking, sleep time, total PA besides those in model 1, and when each type of ST was studied, the other types of sedentary excluding the total ST were acted as covariates. *P < 0.05; **P < 0.001. Table 2. Prospective associations of risk of MetS and its components with levels of leisure ST at baseline, OR (95%) CI
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Table 3 shows the association between MetS risk and the levels of different types of baseline PA time. After adjusting for all covariates, higher levels of MVPA time were associated with a lower risk of abdominal obesity (OR 0.8, 95% CI 0.7–0.9, Ptrend = 0.008), elevated TG (OR 0.7, 95% CI 0.6–0.8, Ptrend = 0.011), lower HDL-C (OR 0.8, 95% CI 0.7–0.9, Ptrend = 0.031), elevated BP (OR 0.8, 95% CI 0.7–0.9, Ptrend = 0.031), and MetS (OR 0.7, 95% CI 0.6–0.9, Ptrend < 0.001). Higher levels of total PA time were associated with a lower risk of abdominal obesity (OR 0.8, 95% CI 0.7–0.9, Ptrend = 0.003), elevated TG (OR 0.8, 95% CI 0.7–0.9, Ptrend = 0.020), and MetS (OR 0.8, 95% CI 0.7–0.9, Ptrend < 0.001).
Parameters N Abdominal obesity Hyperglycemia Raised TG Reduced HDL_C Raised BP MetS subjects Model 1 Model 2 Model 1 Model 2 Model 1 Model 2 Model 1 Model 2 Model 1 Model 2 Model 1 Model 2 Total time Physical activity (METs-h/w) LPA Low 1,392 ref ref ref ref ref ref ref ref ref ref ref ref Medium 1,671 1.2
(1.0, 1.4)**1.1
(0.9, 1.3)1.0
(0.9, 1.2)1.0
(0.9, 1.2)1.2
(0.9, 1.3)1.1
(0.9, 1.3)1.2
(1.0, 1.4)*1.2
(0.9, 1.4)1.2
(1.0, 1.3)*1.1
(0.9, 1.3)1.2
(1.0, 1.4)*1.2
(0.9, 1.4)High 1,622 1.2
(0.9, 1.4)1.1
(0.9, 1.3)1.2
(0.9, 1.4)1.1
(0.9, 1.4)1.0
(0.9, 1.2)1.0
(0.9, 1.2)1.1
(0.9, 1.3)1.1
(0.9, 1.3)1.2
(0.9, 1.3)1.2
(0.9, 1.4)1.2
(0.9, 1.5)1.1
(0.9, 1.4)Ptrend 0.085 0.548 0.125 0.294 0.491 0.914 0.1 0.165 0.087 0.054 0.051 0.123 MVPA Low 1,918 ref ref ref ref ref ref ref ref ref ref ref ref Medium 1,048 1.0
(0.9, 1.1)0.9
(0.8, 1.1)0.9
(0.8, 1.1)0.9
(0.7, 1.0)1.0
(0.9, 1.1)1.0
(0.8, 1.1)0.9
(0.8, 1.0)0.9
(0.8, 1.1)0.9
(0.8, 1.0)0.9
(0.7, 1.0)*1.0
(0.8, 1.1)0.9
(0.8, 1.1)High 1,719 0.8
(0.7, 0.9)**0.8
(0.7, 0.9)**0.9
(0.7, 1.0)0.9
(0.8, 1.0)0.7
(0.6, 0.8)**0.7
(0.6, 0.8)**0.7
(0.6, 0.8)**0.8
(0.7, 0.9)**0.9
(0.8, 1.0)*0.8
(0.7, 0.9)**0.7
(0.6, 0.8)**0.7
(0.6, 0.9)**Ptrend 0.02 0.008 0.015 0.03 0.002 0.011 0.02 0.085 0.045 0.031 < 0.001 < 0.001 Total PA Low 1,374 ref ref ref ref ref ref ref ref ref ref ref ref Medium 1,598 1.0
(0.9, 1.1)1.0
(0.9, 1.1)1.0
(0.8, 1.1)0.9
(0.8, 1.1)1.0
(0.9, 1.2)1.0
(0.9, 1.2)1.0
(0.9, 1.1)1.0
(0.9, 1.2)1.0
(0.9, 1.1)1.0
(0.9, 1.1)1.0
(0.9, 1.2)1.0
(0.9, 1.2)High 1,713 0.8
(0.7, 0.9)**0.8
(0.7, 0.9)**0.9
(0.8, 1.0)0.9
(0.8, 1.0)0.7
(0.6, 0.8)**0.8
(0.7, 0.9)**0.8
(0.7, 0.9)**0.9
(0.8, 1.1)1.0
(0.8, 1.1)0.9
(0.8, 1.0)0.7
(0.6, 0.8)**0.8
(0.7, 0.9)**Ptrend 0.003 0.003 0.158 0.356 0.019 0.020 0.022 0.096 0.765 0.774 < 0.001 < 0.001 Note. The model 1 adjusted only for baselined gender, age, region, education, income and wave, and the model 2 full adjusted the covariates besides those in model 1, including baselined, carbohydrate, protein, fat, cholesterol, Na, kcal, regular drinking, current smoking, sleep time, total leisure ST, and when each type of PA was studied, the other types of PA excluding the total PA were acted as covariates. Classification of LPA, MVPA and total PA were based on the tertiles of the amounts per week (MET-h/w), there were LPA: low level (_ 18.6 MET-h/w), medium level (18.6–53.7 MET-h/w), and high level (≥ 53.7 MET-h/w); MVPA: low level (0 MET-h/w), medium level (0–61.0 MET-h/w), and high level (≥ 61.0 MET-h/w); total PA: low level (46.6 MET-h/w), medium level (46.6–147.2 MET-h/w), and high level (≥ 147.2 MET-h/w). Table 3. Prospective associations of risk of MetS and its components with levels of Physical activity at baseline, OR (95%) CI
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Figure 1A shows the joint association between total ST and MVPA and MetS. Those reporting the highest total leisure ST (≥ 35 h/w) and the lowest levels of MVPA (0 MET-h/w) had a twofold higher odds of MetS (OR 2.0, 95% CI 1.4–2.7) than the reference group (those reporting the lowest level of total leisure ST (< 14 h/w) and the highest tertile of MVPA (≥ 61.0 MET-h/w). Those reporting the highest total leisure ST (≥ 35 h/w) with a medium level of MVPA (0–61.0 MET-h/w) had a 70% higher odds (OR 1.7, 95% CI 1.2–2.4), and those reporting the highest total leisure ST with the highest tertile of MVPA also had a 70% higher odds (OR 1.7, 95% CI 1.1–2.6) than the reference group. Except for those reporting ST (14–21 h/w) within the highest tertile of MVPA (≥ 61.0 MET-h/w), the other groups had significantly higher odds of MetS, which showed a curved acceleration with increased TV time.
Figure 1. The ORs for the joint associations of total leisure sedentary time and MVPA/total PA with MetS. Note: The ORs for the joint associations of total leisure ST and MVPA with MetS are showed in Figure 1A, and the ORs for the joint associations of total leisure ST and total PA with MetS are showed in Figure 1B. Both models were adjusted the covariates including baselined gender, age, region, education, income, carbohydrate, protein, fat, cholesterol, Na, kcal, regular drinking, current smoking, sleep time, and wave, besides LPA were adjusted in Figure 1A. Classification of LPA, MVPA and total PA were based on the tertiles of the amounts per week (MET-h/w), there were LPA: low level (< 18.6 MET-h/w), medium level (18.6−53.7 MET-h/w), and high level (≥ 53.7 MET-h/w); MVPA: low level (0 MET-h/w), medium level (0−61.0 MET-h/w), and high level (≥ 61.0 MET-h/w); total PA: low level (46.6 MET-h/w), medium level (46.6−147.2 MET-h/w), and high level (≥ 147.2 MET-h/w).
When we repeated these analyses using total leisure ST and total PA, the results were similar but weaker (Figure 1B). Compared with the reference group (those reporting the lowest level of total leisure ST (< 14 h/w) and the highest tertile of total PA (≥ 147.2 MET-h/w), those reporting the highest leisure ST (≥ 35 h/w) and the lowest levels of total PA (< 46.6 MET-h/w) had a twofold higher odds of MetS (OR 1.9, 95% CI 1.4–2.5), and those reporting the highest leisure ST (≥ 35 h/w) and the second tertile of total PA (46.6–147.2 MET-h/w) had a 60% higher odds (OR 1.6, 95% CI 1.2–2.1), while those reporting the highest level of leisure ST (≥ 35 h/w) and the highest tertile of total PA (≥ 147.2 MET-h/w) did not have a significantly higher odds. In addition, within those reporting the highest tertile of total PA (≥ 147.2 MET-h/w), the levels of total leisure ST had no significant effects on MetS. Within those reporting the second (46.6–147.2 MET-h/w) and the first (< 46.6 MET-h/w) tertile of total PA, except that the lowest level of total leisure ST (< 14 h/w) had no significant effects on MetS, the other higher levels of total leisure ST significantly increased the odds of MetS.
Associations of Sedentary Time and Physical Activity with Metabolic Syndrome among Chinese Adults: Results from the China Health and Nutrition Survey
doi: 10.3967/bes2021.132
- Received Date: 2021-07-07
- Accepted Date: 2021-10-28
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Key words:
- Sedentary time /
- Physical activity /
- Metabolic syndrome /
- Adults
Abstract:
Citation: | BAI Jing, WANG Yun, ZHANG Xian Fan, OUYANG Yi Fei, ZHANG Bing, WANG Zhi Hong, DU Shu Fa, WANG Hui Jun. Associations of Sedentary Time and Physical Activity with Metabolic Syndrome among Chinese Adults: Results from the China Health and Nutrition Survey[J]. Biomedical and Environmental Sciences, 2021, 34(12): 963-975. doi: 10.3967/bes2021.132 |