Daily step count and incident diabetes in community-dwelling 70-year-olds: a prospective cohort study

dc.contributor.authorBallin, Marcel
dc.contributor.authorNordström, Peter
dc.contributor.authorNiklasson, Johan
dc.contributor.authorAlamäki, Antti
dc.contributor.authorCondell, Joan
dc.contributor.authorTedesco, Salvatore
dc.contributor.authorNordström, Anna
dc.contributor.funderVetenskapsrådeten
dc.contributor.funderUmeå Universiteten
dc.date.accessioned2021-02-09T10:57:44Z
dc.date.available2021-02-09T10:57:44Z
dc.date.issued2020-11-30
dc.date.updated2021-02-08T14:51:32Z
dc.description.abstractBackground: Older adults with diabetes take fewer steps per day than those without diabetes. The purpose of the present study was to investigate the association of daily step count with incident diabetes in community-dwelling 70-year-olds. Methods: This prospective cohort study included N = 3055 community-dwelling 70-year-olds (52% women) who participated in a health examination in Umeå, Sweden during 2012–2017, and who were free from diabetes at baseline. Daily step count was measured for 1 week using Actigraph GT3X+ accelerometers. Cases of diabetes were collected from the Swedish National Patient Register. The dose-response association was evaluated graphically using a flexible parametric model, and hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Cox regressions. Results: During a mean follow-up of 2.6 years, diabetes was diagnosed in 81 participants. There was an inverse nonlinear dose-response association between daily step count and incident diabetes, with a steep decline in risk of diabetes from a higher daily step count until around 6000 steps/day. From there, the risk decreased at a slower rate until it leveled off at around 8000 steps/day. A threshold of 4500 steps/day was found to best distinguish participants with the lowest risk of diabetes, where those taking ≥ 4500 steps/day, had 59% lower risk of diabetes, compared to those taking fewer steps (HR, 0.41, 95% CI, 0.25–0.66). Adjusting for visceral adipose tissue (VAT) attenuated the association (HR, 0.64, 95% CI, 0.38–1.06), which was marginally altered after further adjusting for sedentary time, education and other cardiometabolic risk factors and diseases (HR, 0.58, 95% CI, 0.32–1.05). Conclusions: A higher daily step count is associated with lower risk of incident diabetes in community-dwelling 70-year-olds. The greatest benefits occur at the lower end of the activity range, and much earlier than 10,000 steps/day. With the limitation of being an observational study, these findings suggest that promoting even a modest increase in daily step count may help to reduce the risk of diabetes in older adults. Because VAT appears to partly mediate the association, lifestyle interventions targeting diabetes should apart from promoting physical activity also aim to prevent and reduce central obesity.en
dc.description.sponsorshipVetenskapsrådet (Swedish Research Council (grant nr 2016-02589); University of Umea (Open Access funding)en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.articleid1830en
dc.identifier.citationBallin, M., Nordström, P., Niklasson, J., Alamäki, A., Condell, J., Tedesco, S. and Nordström, A. (2020) 'Daily step count and incident diabetes in community-dwelling 70-year-olds: a prospective cohort study', BMC Public Health, 20(1), 1830, (10 pp). doi: 10.1186/s12889-020-09929-2en
dc.identifier.doi10.1186/s12889-020-09929-2en
dc.identifier.endpage10en
dc.identifier.issn1471-2458
dc.identifier.journaltitleBMC Public Healthen
dc.identifier.startpage1en
dc.identifier.urihttps://hdl.handle.net/10468/11050
dc.identifier.volume20en
dc.language.isoenen
dc.publisherMDPIen
dc.relation.urihttps://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09929-2
dc.rights© The Author(s). 2020 Open Access. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.subjectPhysical activityen
dc.subjectWalkingen
dc.subjectAccelerometryen
dc.subjectMetabolic syndromeen
dc.subjectNon-communicable diseaseen
dc.subjectVisceral adipose tissueen
dc.subjectObesityen
dc.titleDaily step count and incident diabetes in community-dwelling 70-year-olds: a prospective cohort studyen
dc.typeArticle (peer-reviewed)en
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