Abstract
This cross-sectional investigation studied differences in insulin resistance across levels of physical activity in 6,500 US adults who were randomly selected as part of the National Health and Nutrition Examination Survey (NHANES). Another important objective was to determine the influence of abdominal obesity on the physical activity and insulin resistance relationship. MET-minutes were utilized to quantify total activity based on participation in 48 different physical activities. Two strategies were employed to categorize levels of physical activity: one was based on relative MET-minutes (quartiles), and the other approach was based on the US physical activity guidelines. Insulin resistance was indexed using the homeostatic model assessment (HOMA). Abdominal obesity was indexed using waist circumference. Effect modification was tested by dividing waist circumferences into sex-specific quartiles and then evaluating the relationship between physical activity and HOMA-IR within each quartile separately. Results showed that relative physical activity level was associated with HOMA-IR after controlling for demographic and demographic and lifestyle covariates (F = 11.5, P < 0.0001 and F = 6.0, P=0.0012, respectively). Adjusting for demographic and demographic and lifestyle covariates also resulted in significant relationships between guideline-based activity and HOMA-IR (F = 8.0, P < 0.0001 and F = 4.9, P=0.0017, respectively). However, statistically controlling for differences in waist circumference with the other covariates nullified the relationship between total physical activity and HOMA-IR. Effect modification testing showed that when the sample was delimited to adults with abdominal obesity (Quartile 4), relative (F = 5.6, P=0.0019) and guideline-based physical activity (F = 3.7, P=0.0098) and HOMA-IR were significantly associated. Physical activity and HOMA-IR were not related within the other three quartiles. In conclusion, it appears that differences in physical activity may play a meaningful role in insulin resistance in those with abdominal obesity, but total activity does not seem to account for differences in insulin resistance among US adults with smaller waists.
Highlights
Type 2 diabetes is a serious disease
To examine the potential modifying effect of waist circumference more comprehensively, the relationship between total MET-minutes of physical activity and insulin resistance was studied across four sex-specific quartiles based on waist circumference. e sex-specific quartiles were labeled small, medium, large, and abdominal obesity, with precisely 25% of the sample in each quartile. e abdominal obesity quartile represented adults ≥75th percentile
In a random sample of 6,500 US adults, total MET-minutes of physical activity accounted for significant differences in measured insulin resistance
Summary
Type 2 diabetes is a serious disease. It is associated with increases in an array of comorbidities, including hypertension, depression, coronary heart disease, and obesity [1]. E 2017 National Diabetes Statistics Report estimated that another 84.1 million US adults had prediabetes in 2015, based on fasting glucose or A1C levels indicative of insulin resistance [3]. In 2016, 21 million US adults had diagnosed type 2 diabetes, mostly caused by insulin resistance [2]. Combined estimates of those with diagnosed, undiagnosed, or prediabetes show that these conditions affect an alarming 43.3% of US adults [3]. Several factors increase the likelihood of becoming insulin resistant, including obesity, especially abdominal obesity, and physical inactivity [6,7,8]
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