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  • Associations of moderate-to-vigorous-intensity physical activity and body mass index with glycated haemoglobin within the general population: a cross-sectional analysis of the 2008 Health Survey for England

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Diabetes and endocrinology
Research
Associations of moderate-to-vigorous-intensity physical activity and body mass index with glycated haemoglobin within the general population: a cross-sectional analysis of the 2008 Health Survey for England
  1. Kishan Bakrania1,2,3,4,
  2. Thomas Yates2,3,
  3. Charlotte L Edwardson2,3,
  4. Danielle H Bodicoat2,4,
  5. Dale W Esliger3,5,
  6. Jason M R Gill6,
  7. Aadil Kazi2,3,
  8. Latha Velayudhan7,8,
  9. Alan J Sinclair9,
  10. Naveed Sattar6,
  11. Stuart J H Biddle10,
  12. Mark Hamer3,5,
  13. Melanie J Davies2,3,
  14. Kamlesh Khunti2,4
  1. 1Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester, Leicestershire, UK
  2. 2Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, Leicestershire, UK
  3. 3Lifestyle and Physical Activity Biomedical Research Unit (BRU), National Institute for Health Research (NIHR) Leicester-Loughborough Diet, Diabetes Research Centre, Leicester General Hospital, Leicester, Leicestershire, UK
  4. 4National 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, UK
  5. 5School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
  6. 6British Heart Foundation Glasgow Cardiovascular Research Centre (BHF GCRC), Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
  7. 7Psychiatry for the Elderly, Department of Health Sciences, University of Leicester, Leicester, Leicestershire, UK
  8. 8Department of Older People's Mental Health, Oxleas National Health Service (NHS) Foundation Trust, Bromley, UK
  9. 9Diabetes Frail Ltd, Aston University, Birmingham, UK
  10. 10Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Victoria, Australia
  1. Correspondence to Dr Charlotte L Edwardson; ce95{at}le.ac.uk

Abstract

Objectives To investigate the associations of objectively measured moderate-to-vigorous-intensity physical activity (MVPA) and body mass index (BMI) with glycated haemoglobin (HbA1c) in a national sample of English adults.

Methods The 2008 Health Survey for England data were used with 1109 participants aged ≥18 providing complete data. MVPA time was assessed using an accelerometer. Weighted linear regression models, adjusted for several confounders, quantified the associations between continuous measures of MVPA and BMI with HbA1c. Interaction analyses were implemented to observe whether the association of MVPA with HbA1c was modified by BMI or vice versa. Further weighted linear regression models examined the differences in HbA1c across four mutually exclusive categories of MVPA and BMI: (1) ‘physically active and non-obese’, (2) ‘physically active and obese’, (3) ‘physically inactive and non-obese’ and (4) ‘physically inactive and obese’. ‘Physically active’ was defined as: ≥150 min/week of MVPA. ‘Obese’ was defined as: BMI ≥30.0 kg/m2. A wide range of sensitivity analyses were also implemented.

Results Every 30 min/day increment in MVPA was associated with a 0.7 mmol/mol (0.07% (p<0.001)) lower HbA1c level. Each 1 kg/m2 increment in BMI was associated with a 0.2 mmol/mol (0.02% (p<0.001)) higher HbA1c level. The association of MVPA with HbA1c was stronger in obese individuals (−1.5 mmol/mol (−0.13% (p<0.001))) than non-obese individuals (−0.7 mmol/mol (−0.06% (p<0.001))); p=0.004 for interaction. The association of BMI with HbA1c remained stable across MVPA categories. Compared with individuals categorised as ‘physically inactive and obese’, only those categorised as ‘physically active and obese’ or ‘physically active and non-obese’ had lower HbA1c levels by 2.1 mmol/mol (0.19% (p=0.005)) and 3.5 mmol/mol (0.32% (p<0.001)), respectively. Sensitivity analyses indicated robustness and stability.

Conclusions This study emphasises the importance of physical activity as a determinant of HbA1c, and suggests that the associations may be stronger in obese adults.

  • Type 2 Diabetes Mellitus
  • Glycated Haemoglobin
  • Body Mass Index
  • Obesity
  • Moderate-to-Vigorous-Intensity Physical Activity
  • EPIDEMIOLOGY

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-014456

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    Footnotes

    • KB, TY joint first authors.

    • Contributors TY had the original idea for the analysis, which was further developed and refined by KB, CLE, DHB, DWE, JMRG, AK, LV, AJS, NS, SJHB, MH, MJD and KK. CLE processed the 2008 Health Survey for England accelerometer data. KB carried out the statistical analysis and worked with TY to write the first and revised drafts of the manuscript. KB, TY, CLE, DHB, DWE, JMRG, AK, LV, AJS, NS, SJHB, MH, MJD and KK edited and reviewed the manuscript drafts. KB, TY, CLE, DHB, DWE, JMRG, AK, LV, AJS, NS, SJHB, MH, MJD and KK approved the final version of the manuscript.

    • Funding This work was supported by the UK Research Councils' Lifelong Health and Wellbeing Initiative in partnership with the Department of Health (grant number: MR/K025090/1).

    • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health (DoH).

    • Competing interests SJHB: Funding has been received since 2012 for consultancy work from Fitness First, Nuffield Health, Unilever and Weight Watchers, and for travel from The Coca-Cola Foundation. None of these are currently active. Funding was received in 2016 for consultancy work for Halpern Limited. A sit-to-stand desk was kindly provided by Ergotron from 2012 to 2014. Advice has been requested by and offered to Active Working and Get Britain Standing. TY, MJD and KK: Developed a prevention programme, Let's Prevent Diabetes, selected to be part of Healthier You: The NHS Diabetes Prevention Programme in collaboration with Ingeus UK Limited. KK also chaired National Institute of Clinical Excellence (NICE) guidance for the prevention of type 2 diabetes mellitus Public Health Guideline 38 [PH 38], with TY and MJD part of the committee.

    • Patient consent Obtained.

    • Ethics approval Ethical approval for the 2008 Health Survey for England study was obtained from the Oxford A-Research Ethics Committee (reference number: 07/H0604/102). Participants provided written informed consent.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Permission to use the 2008 Health Survey for England accelerometer data files can be obtained from the National Centre for Social Research (NatCen) (http://www.natcen.ac.uk/). All other data are openly available to download from the UK Data Archive (https://discover.ukdataservice.ac.uk/series/?sn=2000021).