Relative importance and conjoint effects of obesity and physical inactivity for the development of insulin resistance

Abstract

Background

Obesity and physical inactivity are related to the development of insulin resistance, but their relative importance and conjoint effects are unclear.

Methods

We related body mass index (BMI) and self-reported leisure-time physical activity (PA) at the age of 50 years to insulin sensitivity measured with euglycemic insulin clamp technique and the presence of metabolic syndrome (MetS) at a subsequent examination, 20 years later, in 862 men free from diabetes and MetS at baseline.

Results

In a multivariable model including BMI, PA, homeostasis model assessment insulin resistance index, erythrocyte sedimentation rate, and all components of MetS at baseline, both BMI (β, −0.19 mg/kg bodyweight/min per 1 kg/m²; P < 0.0001) and PA (adjusted least square means, 5.1, 5.2, 5.4, and 6.2 mg/kg bodyweight/min in individuals with sedentary, moderate, regular, and athletic PA, respectively; P = 0.0035) were significant predictors of insulin sensitivity at age 70. When categorizing individuals into four groups by BMI and PA at baseline, insulin sensitivity at the age of 70 years decreased significantly over the following categories: multivariable-adjusted least square means, 5.8 (low BMI/high PA); 5.6 (low BMI/low PA); 5.1 (high BMI/high PA); and 4.6 (high BMI/low PA) mg/kg bodyweight/min, respectively; P value of less than 0.0001.

Conclusion

In our community-based sample of middle-aged men, BMI and PA were independent predictors of insulin resistance after 20 years of follow-up. Our results imply that obesity and physical inactivity may increase insulin resistance and metabolic risk by partly independent pathways, and emphasize the importance of strategies that address both obesity and physical inactivity to achieve increased public health. Eur J Cardiovasc Prev Rehabil 16:28-33 © 2009 The European Society of Cardiology

Keywords

body mass index insulin resistance metabolic syndrome X obesity physical activity

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References

Rydén

Standi

Bartnik

Van den Berghe

Betteridge

de Boer

Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. The task force on diabetes and cardiovascular diseases of the European society of cardiology (ESC) and of the European association for the study of diabetes (EASD). Eur Heart J 2007; 28: 88–136.

Grundy

Cleeman

Daniels

Donato

Eckel

Franklin

Diagnosis and management of the metabolic syndrome: an American heart association/national heart, lung, and blood institute scientific statement. Circulation 2005; 112:2735–2752.

3 Reilly

Wolfe

Rhodes

Girman

Mehta

Rader

. Measures of insulin resistance add incremental value to the clinical diagnosis of metabolic syndrome in association with coronary atherosclerosis. Circulation 2004; 110:803–809.

4 Meigs

Rutter

Sullivan

Fox

DÄgostino

Sr Wilson

. Impact of insulin resistance on risk of type 2 diabetes and cardiovascular disease in people with metabolic syndrome. Diabetes Care 2007; 30: 1219–1225.

5 Racette

Evans

Weiss

Hagberg

Holloszy

. Abdominal adiposity is a stronger predictor of insulin resistance than fitness among 50–95 year olds. Diabetes Care 2006; 29:673–678.

6 Eisenmann

DuBose

Donnelly

. Fatness, fitness, and insulin sensitivity among 7–9-year-old children. Obesity (Silver Spring) 2007; 15:2135–2144.

7 Ruiz

Rizzo

Ortega

Loit

Veidebaum

Sjostrom

. Markers of insulin resistance are associated with fatness and fitness in school-aged children: the European Youth Heart Study. Diabetologia 2007; 50: 1401–1408.

Holt

Wild

Wareham

Ekelund

Umpleby

Shojaee-Moradie

Differential effects of fatness, fitness and physical activity energy expenditure on whole-body, liver and fat insulin sensitivity. Diabetologia 2007; 50:1698–1706.

9 Snitker

Hager

Caballero

Black

. Association of physical activity and body composition with insulin sensitivity in a community sample of adolescents. Arch Pediatr Adolesc Med 2007; 161:677–683.

10.

Kavouras

Panagiotakos

Pitsavos

Chrysohoou

Anastasiou

Lentzas

Physical activity, obesity status, and glycemic control: the ATTICA study. Med Sci Sports Exerc 2007; 39:606–611.

11.

11 Ekelund

Brage

Franks

Hennings

Emms

Wareham

. Physical activity energy expenditure predicts progression toward the metabolic syndrome independently of aerobic fitness in middle-aged healthy Caucasians: the Medical Research Council Ely Study. Diabetes Care 2005; 28:1195–1200.

12.

12 Gustat

Srinivasan

Elkasabany

Berenson

. Relation of self-rated measures of physical activity to multiple risk factors of insulin resistance syndrome in young adults: the Bogalusa Heart Study. J Clin Epidemiol 2002; 55:997–1006.

13.

13 The World Health Report 2002 Reducing risks, promoting healthy life. Geneva: World Health Organization; 2002.

14.

14 Hedstrand

. A study of middle-aged men with particular reference to risk factors for cardiovascular disease. Ups J Med Sci Suppl 1975; 19:1–61.

15.

15 Byberg

Zethelius

McKeigue

Lithell

. Changes in physical activity are associated with changes in metabolic cardiovascular risk factors. Diabetologia 2001; 44:2134–2139.

16.

16 Lochen

Rasmussen

. The Tromso study: physical fitness, self-reported physical activity, and their relationship to other coronary risk factors. J Epidemiol Community Health 1992; 46:103–107.

17.

17 Rosengren

Wilhelmsen

. Physical activity protects against coronary death and deaths from all causes in middle-aged men. Evidence from a 20-year follow-up of the primary prevention study in Goteborg. Ann Epidemiol 1997; 7:69–75.

18.

18 Matthews

Hosker

Rudenski

Naylor

Treacher

Turner

. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28:412–419.

19.

19 Sundström

Riserus

Byberg

Zethelius

Lithell

Lind

. Clinical value of the metabolic syndrome for long term prediction of total and cardiovascular mortality: prospective, population based cohort study. Br Med J 2006; 332:878–882.

20.

Sattar

Gaw

Scherbakova

Ford

O'Reilly

Haffner

Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the west of Scotland Coronary Prevention Study. Circulation 2003; 108:414–419.

21.

21 Ridker

Buring

Cook

Rifai

. C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14719 initially healthy American women. Circulation 2003; 107:391–397.

22.

22 Ingelsson

Sundström

Ärnlöv

Zethelius

Lind

. Insulin resistance and risk of congestive heart failure. J Am Med Assoc 2005; 294:334–341.

23.

23 DeFronzo

Tobin

Andres

. Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol 1979; 237: E214–E223.

24.

24 Pollare

Vessby

Lithell

. Lipoprotein lipase activity in skeletal muscle is related to insulin sensitivity. Arterioscler Thromb 1991; 11:1192–1203.

25.

25 Royston

Sauerbrei

. Multivariable modeling with cubic regression splines: a principled approach. Stata J 2007; 7:45–70.

26.

26 Rothman

Greenland

. Modern epidemiology. Philadelphia: Lippincott-Raven; 1998.

27.

27 Andersson

Alfredsson

Källberg

Zdravkovic

Ahlbom

. Calculating measures of biological interaction. Eur J Epidemiol 2005; 20:575–579.

28.

28 Risérus

Ärnlöv

Berglund

. Long-term predictors of insulin resistance: role of lifestyle and metabolic factors in middle-aged men. Diabetes Care 2007; 30:2928–2933.

29.

29 Hu

Willett

Stampfer

Colditz

Manson

. Adiposity as compared with physical activity in predicting mortality among women. N Engl J Med 2004; 351:2694–2703.

30.

Rana

Manson

Willett

Stampfer

Colditz

Obesity as compared with physical activity in predicting risk of coronary heart disease in women. Circulation 2006; 113:499–506.

31.

Wei

Kampert

Barlow

Nichaman

Gibbons

Paffenbarger

Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. J Am Med Assoc 1999; 282:1547–1553.

32.

32 Church

LaMonte

Barlow

Blair

. Cardiorespiratory fitness and body mass index as predictors of cardiovascular disease mortality among men with diabetes. Arch Intern Med 2005; 165:2114–2120.

33.

Wessel

Arant

Olson

Johnson

Reis

Sharaf

Relationship of physical fitness vs. body mass index with coronary artery disease and cardiovascular events in women. J Am Med Assoc 2004; 292:1179–1187.

34.

Michaëlsson

Olofsson

Jensevik

Larsson

Mallmin

Berglund

Leisure physical activity and the risk of fracture in men. PLoS Med 2007; 4:e199.

35.

Graham

Atar

Borch-Johnsen

Boysen

Burell

Cifkova

European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Fourth joint task force of the European society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts)

Eur J Cardiovasc Prev Rehabil 2007; 14 (Suppl 2): E1–E40.

36.

36 Rydén

Martin

Volqvartz

. The European heart health charter: towards a healthier Europe. Eur J Cardiovasc Prev Rehabil 2007; 14:355–356.