Page 84 - 《运动与健康科学》(英文)2024年第2期

TaggedAPTARAEnd206 K. Shi et al.
In the present study, we identified CKD cases with major TaggedAPTARAPSensitivity analyses excluded participants who had CKD in
subtypes (DKD and HTN) according to China Kidney Disease the first 2 years and 5 years of follow-up as well as those who
3
Network and added CKD (International Classification of had respiratory diseases or diabetes at baseline. We addition-
Disease, 10th Revision: N18) without unspecified subtypes as ally adjusted for waist circumference or self-rated health status
other CKD 20 (Supplementary Table 2). Participants were at baseline. We further regrouped PA categories using quan-
followed from the date of baseline questionnaire completion to tiles by sex. In addition, we conducted a competing risk analy-
the date of diagnosis of CKD, death, loss to follow-up, or sis defining mortality as the competing risk.TaggedAPTARAEnd
TaggedAPTARAPThe statistical analyses were conducted using Stata 15.0
December 31, 2018, whichever came first.TaggedAPTARAEnd
(StataCorp., College Station, TX, USA). Statistical signifi-
cance was set at 2-tailed p trend < 0.05.TaggedAPTARAEnd
TaggedAPTARAH22.5. Statistical analysisTaggedAPTARAEnd
TaggedAPTARAPThe exposure, which included total, domain-specific, and
intensity-specific PA, was categorized into 4 groups based on TaggedAPTARAH13. ResultsTaggedAPTARAEnd
their quartiles. Means or percentages of baseline characteris-
TaggedAPTARAH23.1. Baseline characteristics of participants by total PATaggedAPTARAEnd
tics were calculated across total PA categories using linear
TaggedAPTARAPAmong all 475,376 participants, 40.62% were men, 43.12%
regressions for continuous variables or logistic regressions for
categorical variables and adjusting for age, sex, and study area resided in urban areas, and the age at baseline was 51.47 §
10.51 years (mean § SD). The baseline total PA was 21.70 §
as appropriate.TaggedAPTARAEnd
13.75 MET-h/day. The mean values in the lowest (Q1), second
TaggedAPTARAPCox proportional hazards models were used to estimate the
HRs and 95%CIs for the associations between PA and CKD inci- (Q2), third (Q3), and highest (Q4) quartiles were 7.09, 14.31,
24.12, and 41.30 MET-h/day, respectively. Participants who
dence, with age as the underlying time scale and stratified by age
were more physically active were more likely to be young,
at baseline (in 5-year intervals) and 10 study areas. Multivariate
rural residents, agricultural and industrial workers, current
models were adjusted for age at baseline; sex; education (primary
daily smokers, and to have lower sedentary leisure time, BMI,
school and below, middle school and high school, or college and
above); occupation (manual, non-manual, or not working); and prevalence of hypertension and diabetes (Table 1).TaggedAPTARAEnd
annual household income (<RMB10,000; RMB10,00019,999;
>RMB19,999); marital status (married or unmarried); smoking
TaggedAPTARAH23.2. Association of total PA with CKD incidenceTaggedAPTARAEnd
status (never or occasional, ex-regular, and among current daily
smokers (cigarettes/day)): <15, 1524, >24); alcohol consump- TaggedAPTARAPDuring a median of 12.1 years (interquartile range = 1.95
tion (never or occasional, ex-regular, weekly, and among daily years; 5.6 million person-years) of follow-up, we documented
drinkers (g/day): <15, 1529, >2959, >59); consumption 5415 incident CKD cases, including 1159 DKD cases, 362
frequencies of red meat, fresh vegetables, and fresh fruits (0, 0.5, HTN cases, and 4280 other CKD cases. Upon multivariate
2.0, 5.0, 7.0 days/week, continuous); sedentary leisure time adjustment, total PA was inversely associated with the risk of
(continuous); BMI (continuous); prevalent hypertension and incident CKD in a doseresponse manner (Fig. 1 and Supple-
diabetes (presence or absence). For domain-specific (occupational mentary Table 3). Compared with participants in Q1 of total
or nonoccupational) and intensity-specific (LPA or MVPA) PA PA, the adjusted HRs (95%CIs) for incident CKD in Q2Q4
analysis, these domains or intensities were included in the were 0.87 (0.810.94), 0.86 (0.790.95), and 0.83
adjusted models. In addition, to examine the linear trend of the (0.750.92), respectively (p for trend = 0.005). Similarly, the
association, the median of each category of PA was included in adjusted HRs (95%CIs) in Q4 were 0.75 (0.580.97) for DKD
(p for trend = 0.037) and 0.56 (0.370.85) for HTN (p for
the model as a continuous variable.TaggedAPTARAEnd
TaggedAPTARAPA single measurement of PA tends to underestimate the trend = 0.010).TaggedAPTARAEnd
actual association of the usual PA with CKD risk because of TaggedAPTARAPThe associations of total PA with incident CKD and its
within-person variation or measurement error. 21 Repeat subtypes remained stable after exclusions, additional adjust-
measurement of PA at the second resurvey among approxi- ments to covariates, and categorizing the PA levels by sex.
mately 20,000 participants was used to correct for regression The results did not differ substantially after a competing risk
dilution bias. The mean usual PA in each baseline category analysis defining mortality as the competing risk (Supplemen-
was assigned as the mean PA of the second resurvey in the tary Table 4).TaggedAPTARAEnd
22
corresponding category. TaggedAPTARAEnd
TaggedAPTARAPSubgroup analysis was conducted to examine whether the
TaggedAPTARAH23.3. Association of domain-specific PA with CKD incidenceTaggedAPTARAEnd
association differed by age (<60 or 60 years), sex (male or
female), region (rural or urban), tobacco smoking (current TaggedAPTARAPFor occupational PA, only participants in Q4 had a lower
daily, or not current daily), alcohol consumption (current risk of incident HTN (HR = 0.42, 95%CI: 0.210.84), whereas
2
weekly or not current weekly), BMI (<24.0 or 24.0 kg/m ), increased nonoccupational PA was significantly associated
sedentary leisure time (<3hor 3 h), or prevalence of hyper- with a decreased risk of CKD, DKD, and HTN incidence, with
tension (no or yes) and diabetes (no or yes) at baseline. The p an HR (95%CI) of 0.80 (0.730.88) for CKD, 0.76
values for interaction were corrected using the false discovery (0.630.93) for DKD, and 0.69 (0.480.99) for HTN in Q4 as
rate.TaggedAPTARAEnd compared to Q1 (Fig. 2 and Supplementary Table 5).TaggedAPTARAEnd