Page 91 - 《运动与健康科学》(英文)2024年第2期

TaggedAPTARAEndPA and mortality in type 2 diabetes 213
China. 18 The UK Biobank was approved by the Northwest
TaggedAPTARAH11. IntroductionTaggedAPTARAEnd
Multi-Centre Research Ethical Committee (Reference number:
TaggedAPTARAPGlobally, more than 1 in 11 adults have diabetes, of whom
1
more than 90% have type 2 diabetes. Despite an impressive 11/NW/03820). The China Kadoorie Biobank was approved
by the Ethics Committees at Oxford University and the China
reduction in excess mortality among adults with type 2
National Center for Disease Control and from institutional
diabetes from high-income countries during the last 2 research boards at the local Centers for Disease Control in the
4
decades, 2,3 the life expectancy gap remains substantial. The
10 included regions. Participants provided written informed
American Diabetes Association states that caregivers, patients
consent.TaggedAPTARAEnd
and societies should focus on optimizing healthy lifestyle
behaviors, such as physical activity (PA), to improve diabetes
5
care and reduce risk of complications and death. However, TaggedAPTARAH22.2. Study populationTaggedAPTARAEnd
individuals with type 2 diabetes are less physically active than TaggedAPTARAPWe identified adults with prevalent type 2 diabetes in the
6 19
individuals free from chronic diseases. TaggedAPTARAEnd UK Biobank by the Eastwood algorithm and/or from a
TaggedAPTARAPFor adults with type 2 diabetes, contemporary PA guide- measured hemoglobin A1c (HbA1c) 48 mmol/mol. The
lines are quantitatively identical to those given to the general Eastwood algorithm is based on combining several sources of
population (i.e., 150300 min of moderate-to-vigorous PA per information, including diabetes diagnosis, age of diabetes
5,7
week ). Based on limited data, only 40%60% of adults diagnosis, ethnicity and use of medication based on a question-
with type 2 diabetes meet this recommendation in naire and an interview with a trained nurse. We included
8,9
high-income countries. The guidelines, updated by the participants from the UK Biobank baseline examination and
World Health Organization (WHO) in 2020, emphasize that from the repeat assessment conducted from 2012 to 2013 (i.e.,
PA below the recommended level will result in health benefits individuals developing type 2 diabetes since their participation
for all adults because the doseresponse association is highly in the baseline assessment). Data collected at the repeat assess-
curvilinear. 10 Therefore, the largest health gains can be ment was used as baseline for these participants. In China
obtained by moving inactive adults from doing no activity to Kadoorie Biobank, prevalent type 2 diabetes was defined from
doing some PA. This message has substantial clinical implica- self-reported current diabetes with a diagnosis age above
tions as doing a little PA may be a feasible target for many 30 years, a random plasma blood glucose 11.1 mmol/L, or a
patients. Yet, for adults with type 2 diabetes, key issues with
fasting plasma blood glucose 7.0 mmol/L.TaggedAPTARAEnd
respect to the doseresponse relationship between PA and
mortality and cardiovascular disease (CVD), including the
TaggedAPTARAH22.3. Data collectionTaggedAPTARAEnd
minimal effective dose needed to prevent outcomes, are not
7 TaggedAPTARAPIn both studies, sociodemographic, behavioral, and
underpinned by high-quality evidence. TaggedAPTARAEnd
TaggedAPTARAPAnother cause for concern is the lack of evidence from low- health-related information were collected at local assessment
where
and middle-income countries, 1114 which are home to 80% of centers, 20,21 participants also provided biological
the global population of adults with type 2 diabetes. 15 Differ- samples. Information about covariates used for this study
ences in healthcare, economy, culture, genetic predispositions is provided in Supplementary Table 1 of Supplementary File
to type 2 diabetes, and conditions and distributions of PA 1. Body mass index (BMI) was calculated from measured
behaviors mean evidence from high-income countries may not height and weight. Years since diagnosis was used as a proxy
be transferable to other contexts. Concomitantly, consistent of diabetes duration and calculated as age at examination
exposureoutcome associations across different contexts minus self-reported age at diabetes diagnosis. Individuals with
16 undiagnosed type 2 diabetes identified from baseline biochem-
provide greater confidence in the totality of the evidence. TaggedAPTARAEnd
TaggedAPTARAPAccordingly, the aim of this study was to quantify and istry measurement were assigned a diabetes duration of 0.
compare the doseresponse associations of leisure-time PA Prevalent medical conditions at baseline were identified from
with all-cause mortality and CVD in British and Chinese self-report and hospital records in the UK Biobank and from
self-report in the China Kadoorie Biobank.TaggedAPTARAEnd
adults with type 2 diabetes.TaggedAPTARAEnd
TaggedAPTARAH22.4. Assessment of PATaggedAPTARAEnd
TaggedAPTARAH12. MethodsTaggedAPTARAEnd
TaggedAPTARAPPA was self-reported on a touch-screen questionnaire in UK
TaggedAPTARAH22.1. Study design and settingTaggedAPTARAEnd
Biobank and by an interviewer-assisted questionnaire in China
TaggedAPTARAPThe current study is based on the UK Biobank and the Kadoorie Biobank. The questionnaires covered information
China Kadoorie Biobank population-based prospective on the frequency, duration, and type of leisure-time PA.
cohorts. For the UK Biobank study, 502,682 participants Responses were combined to calculate the total volume of
(approximately 5.5% of those invited) aged 3782 years were leisure-time PA in metabolic equivalents of task (MET)-h/week
recruited via 22 assessment centers across England, Wales, (additional details in Supplementary Table 1 of Supplementary
and Scotland between 2006 and 2010. 17 For the China File 1). MET-h/week were classified into 4 mutually exclusive
Kadoorie Biobank study, 512,891 participants (approximately categories based on the WHO and American Diabetes Associa-
30% of those invited) aged 3079 years were recruited tion PA recommendations of 150300 min of aerobic
between 2004 and 2008 from 10 regions of the mainland of moderate-to-vigorous PA per week (assuming 3 METs as