Lower physical activity, but not excessive calorie intake, is associated with metabolic syndrome in elderly with type 2 diabetes mellitus: The Japanese elderly diabetes intervention trial

Abstract

A decline in physical activity has been shown to be associated with metabolic syndrome (MetS), leading to cardiovascular events. However, this is difficult to manage well in the elderly with multiple atherosclerotic risk factors. In this study, we investigated the correlation between physical activity and clinical parameters in the presence and absence of MetS in Japanese elderly subjects with type 2 diabetes mellitus (T2DM). In addition, we determined which factor, calorie intake or physical activity, mainly contributes to the prevalence of MetS. Cross-sectional analysis of 846 consecutive Japanese elderly (408 men and 438 women, mean age 68.7 years) was carried out at the time of enrolment (2000-2002) in the Japanese Elderly Diabetes Intervention Trial. Their level of physical activity was evaluated using the Baecke questionnaire, consisting of three components: work, sports and leisure. Total activity score (TAS) as the sum of each activity score was divided into four quartiles (Q1 to Q4). After adjustment for age and sex, there was a positive association of TAS with high-density lipoprotein cholesterol, although no significant correlation between other lipid parameters and TAS was found. In addition, fasting plasma glucose, insulin level and physical measurements, such as waist circumference, waist/hip ratio and body mass index, were inversely associated with TAS. Although no correlation between TAS and cognitive function Mini-Mental State Examination was found, TAS was positively associated with instrumental ADL and negatively associated with geriatric depression score (GDS), suggesting that a decline in physical activity in the elderly is associated with depressed mood rather than a decline of cognitive function. Total calorie intake appeared to increase according to TAS; however, this did not reach statistical significance. In a subanalysis comparing the presence and absence of MetS, the TAS grade in the MetS group was significantly lower than that in the non-MetS group, although there was no significant difference in total calorie intake between the groups. These results showed that lower physical activity, but not excessive calorie intake, is independently associated with the prevalence of MetS in the elderly with T2DM. In our routine work, encouraging physical activity might contribute to preventing MetS and subsequent atherosclerotic disease in the elderly, rather than strict management of abnormal laboratory parameters using multiple drugs.