Association between physical activity energy expenditure and cardiometabolic risk factor clustering among Chinese adults in 2015

Abstract

To understand the association between cardiometabolic risk factor (CMRF) clustering and physical activity (PA) levels, we included 86520 Chinese adults aged 18-64 years having at least one CMRF (hypertension, diabetes, dyslipidemia, or obesity) from the China Chronic Disease and Nutrition Surveillance survey in 2015, a nationally and provincially representative investigation with a multistage clustering sampling design. Self-reported PA information was collected with the Global Physical Activity Questionnaire through face-to-face interviews. In view of the obesity epidemic in CMRF patients, PA energy expenditure (PAEE) per kilogram body weight was used, and was defined into four categories: (i) inactivity: 0 ​kJ/kg/day; (ii) low activity: 0-5 ​kJ/kg/day; (iii) moderate activity: 6-11 ​kJ/kg/day; and (iv) vigorous activity: ≥ 12 ​kJ/kg/day. The estimated weighted prevalence (95% confidence interval [CI]) of having 1, 2, 3, and 4 CMRFs was 60.57% (59.48%-61.67%), 28.10% (27.40%-28.79%), 9.82% (9.22%-15.42%) and 1.50% (1.37%-1.63%), respectively. The rate (95%CI) of inactivity, low activity, moderate activity, and vigorous activity was 34.52% (32.69%-36.35%), 22.22% (21.37%-23.37%), 15.98% (15.38%-16.58%) and 27.28% (26.02%-28.53%), respectively. For those having 2, 3 and 4 CMRFs (compared to those having 1 CMRF), the adjusted odds ratio (95%CI) for moderate activity and vigorous activity were 0.91 (0.85-0.98) and 0.92 (0.85-0.99), 0.87 (0.80-0.95) and 0.84 (0.77-0.92), and 0.77 (0.67-0.89) and 0.85 (0.72-1.00), respectively. In conclusion, CMRF clustering was a pandemic among Chinese adults in 2015 and was inversely associated with PA level. PAEE (in kJ/kg/day) may be introduced into PA management practice, especially for populations with high body weight.

Keywords

Physical activity / Energy expenditure / Cardiometabolic risk factors

References

[[1]] GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 396

( 10258 (2020), pp. 1223-1249, DOI: 10.1016/s0140-6736(20 ) 30752-2

[[2]] GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioral, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.

[ published correction appears in Lancet. 2019 Jan 12;393(10167):132 ]

[[3]] D. Gu, A. Gupta, P. Muntner, et al.. Prevalence of cardiovascular disease risk factor clustering among the adult population of China: results from the International Collaborative Study of Cardiovascular Disease in Asia (InterAsia). Circulation, 112 (5) ( 2005), pp. 658-665, DOI: 10.1161/circulationaha.104.515072

[[4]] Z.J. Sun, J.N. Fan, C.Q. Yu, et al.. Prevalence, patterns and long-term changes of multimorbidity in adults from 10 regions of China [in Chinese]. Chinese J Epidemiol, 42 (5) ( 2021), pp. 755-762, DOI: 10.3760/cma.j.cn112338-20200305-00259

[[5]] Y. Wang, H. Wang, A.G. Howard, et al.. Six-year incidence of cardiometabolic risk factors in a population-based cohort of Chinese adults followed from 2009 to 2015. J Am Heart Assoc, 8 (12) ( 2019), Article e011368, DOI: 10.1161/jaha.118.011368

[[6]] C. Hu, W. Jia. Diabetes in China: epidemiology and genetic risk factors and their clinical utility in personalized medication. Diabetes, 67 (1) ( 2018), pp. 3-11, DOI: 10.2337/dbi17-0013

[[7]] L. Pan, Z. Yang, Y. Wu, et al.. The prevalence, awareness, treatment and control of dyslipidemia among adults in China. Atherosclerosis, 248 (5) ( 2016), pp. 2-9, DOI: 10.1016/j.atherosclerosis.2016.02.006

[[8]] X.F. Pan, L. Wang, A. Pan. Epidemiology and determinants of obesity in China. Lancet Diabetes Endocrinol, 9 (6) ( 2021), pp. 373-392, DOI: 10.1016/s2213-8587(21)00045-0

[[9]] Z. Wang, Z. Chen, L. Zhang, et al.. Status of hypertension in China: results from the China hypertension survey, 2012-2015. Circulation, 137 (22) ( 2018), pp. 2344-2356, DOI: 10.1161/circulationaha.117.032380

[[10]] 2018 Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Scientific Report. Department of Health and Human Services, Washington DC ( 2018, 2019).

[[11]] Joint task force for guideline on the assessment management of cardiovascular risk in China. Guideline on the assessment and management of cardiovascular risk in China. [in Chinese]. Chin J Prev Med, 53 (1) ( 2019), pp. 13-35, DOI: 10.3760/cma.j.issn.0253-9624.2019.01.004

[[12]] F.L.J. Visseren, F. Mach, Y.M. Smulders, et al.. ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J, 42 (34) ( 2021), pp. 3227-3337, DOI: 10.1093/eurheartj/ehab484. 2021

[[13]] S. Fan, J. Chen, J. Huang, et al.. Physical activity level and incident type 2 diabetes among Chinese adults. Med Sci Sports Exerc, 47 (4) ( 2015), pp. 751-756, DOI: 10.1249/mss.0000000000000471

[[14]] X.Q. Lao, H.B. Deng, X. Liu, et al.. Increased leisure-time physical activity associated with lower onset of diabetes in 44 828 adults with impaired fasting glucose: a population-based prospective cohort study. Br J Sports Med, 53 (14) ( 2019), pp. 895-900, DOI: 10.1136/bjsports-2017-098199

[[15]] Q. Zou, H. Wang, C. Su, et al.. Longitudinal association between physical activity and blood pressure, risk of hypertension among Chinese adults: China health and nutrition survey 1991-2015. Eur J Clin Nutr, 75 (2) ( 2021), pp. 274-282, DOI: 10.1038/s41430-020-0653-0

[[16]] Q. Liu, F.C. Liu, K.Y. Huang, et al.. Beneficial effects of moderate to vigorous physical activity on cardiovascular disease among Chinese adults. J Geriatr Cardiol, 17 (2) ( 2020), pp. 85-95, DOI: 10.11909/j.issn.1671-5411.2020.02.001

[[17]] R. Shi, Y. Cai, R. Qin, et al.. Dose-response association between physical activity and clustering of modifiable cardiovascular risk factors among 26,093 Chinese adults. BMC Cardiovasc Disord, 20 (1) ( 2020), p. 347, DOI: 10.1186/s12872-020-01627-6

[[18]] D.A. Bennett, H. Du, F. Bragg, et al.. Physical activity, sedentary leisure-time and risk of incident type 2 diabetes: a prospective study of 512 000 Chinese adults. BMJ Open Diabetes Res Care, 7 (1) ( 2019), p. e000835, DOI: 10.1136/bmjdrc-2019-000835

[[19]] L. Wang, P. Gao, M. Zhang, et al.. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013. JAMA, 317 (24) ( 2017), pp. 2515-2523, DOI: 10.1001/jama.2017.7596

[[20]] Z. Zhao, M. Zhang, J. Wu, et al.. E-cigarette use among adults in China: findings from repeated cross-sectional surveys in 2015-16 and 2018-19. Lancet Public Health, 5 (12) ( 2020), pp. e639-e649, DOI: 10.1016/s2468-2667(20)30145-6

[[21]] M. Zhang, S. Liu, L. Yang, et al.. Prevalence of smoking and knowledge about the hazards of smoking among 170 000 Chinese adults, 2013-2014. Nicotine Tob Res, 21 (12) ( 2019), pp. 1644-1651, DOI: 10.1093/ntr/ntz020

[[22]] T. Armstrong, F. Bull. Development of the world health organization global physical activity questionnaire (GPAQ). J Public Health, 14 (2) ( 2006), pp. 66-70, DOI: 10.1007/s10389-006-0024-x

[[23]] F.C. Bull, T.S. Maslin, T. Armstrong. Global physical activity questionnaire (GPAQ): nine country reliability and validity study. J Phys Activ Health, 6 (6) ( 2009), pp. 790-804, DOI: 10.1123/jpah.6.6.790

[[24]] World Health Organization. Physical activity surveillance.

[[25]] World Health Organization. WHO guidelines on physical activity and sedentary behaviour.

[[26]] B.E. Ainsworth, W.L. Haskell, S.D. Herrmann, et al.. 2011 Compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc, 43 (8) ( 2011), pp. 1575-1581, DOI: 10.1249/mss.0b013e31821ece12

[[27]] S.W. Ng, A.G. Howard, H.J. Wang, et al.. The physical activity transition among adults in China: 1991-2011. Obes Rev, 15 (Suppl 1) ( 2014), pp. 27-36, DOI: 10.1111/obr.12127

[[28]] W. Zhao, G. Ning. Methodology and content of China chronic disease surveillance 2010 [in Chinese]. Chin J Prev Med, 46 (5) ( 2012), pp. 477-479, DOI: 10.3760/cma.j.issn.0253-9624.2012.05.023

[[29]] S.B. Sisson, S.M. Camhi, T.S. Church, et al.. Leisure time sedentary behavior, occupational/domestic physical activity, and metabolic syndrome in U.S. men and women. Metab Syndr Relat Disord, 7 (6) ( 2009), pp. 529-536, DOI: 10.1089/met.2009.0023

[[30]] X. Chen, Z. Pang, K. Li. Dietary fat, sedentary behaviors and the prevalence of the metabolic syndrome among Qingdao adults. Nutr Metabol Cardiovasc Dis, 19 (1) ( 2009), pp. 27-34, DOI: 10.1016/j.numecd.2008.01.010

[[31]] Writing Group of 2018. Chinese guidelines for the management of hypertension, Chinese society of cardiology, Chinese medical doctor association hypertension committee, branch of China international exchange and promotive association for medical and health care, association HBoCGM. 2018 Chinese guidelines for the management of hypertgension.[in Chinese]. Chin J Cardiovasc Med, 24 (1) ( 2019), pp. 24-56, DOI: 10.3969/j.issn.1007-5410.2019.01.002

[[32]] Beijing Writing Group for Guideline for the Prevention and Control of Overweight and Obesity in Chinese Adults. Guideline for the Prevention and Control of Overweight and Obesity in Chinese Adults. [in Chinese], People’s Medical Publishing House, Beijing ( 2006)

[[33]] S.P. Zhao. Key points and comments on the 2016 Chinese guideline for the management of dyslipidemia in adults. [in Chinese]. Chin J Cardiol, 44 (10) ( 2016), pp. 827-829, DOI: 10.3760/cma.j.issn.0253-3758.2016.10.003

[[34]] Chinese Diabetes Society. Chinese guideline for the prevention and treatment of type 2 diabetes mellitus (2017 edition). [in Chinese]. Chinese Journal of Practical Internal Medicine, 34 (4) ( 2018), pp. 292-344, DOI: 10.19538/j.nk2018040108

[[35]] N. Hu, Y. Jiang, Y. Li, et al.. Data weighting methods for China chronic disease surveillance ( 2010). [in Chinese]. Chin J Health Statistics, 29 (3) ( 2012), pp. 424-426, DOI: 10.3969/j.issn.1002-3674.2012.03.045

[[36]] K.R. Westerterp.Physical activity and physical activity induced energy expenditure in humans: measurement, determinants, and effects. Front Physiol, 4 ( 2013), p. 90, DOI: 10.3389/fphys.2013.00090

[[37]] A. Mok, K.T. Khaw, R. Luben, et al.. Physical activity trajectories and mortality: population based cohort study. BMJ, 365 ( 2019), p. l2323, DOI: 10.1136/bmj.l2323

[[38]] M. Fan, J. Lv, C. Yu, et al.. Association between active commuting and incident cardiovascular diseases in Chinese: a prospective cohort study. J Am Heart Assoc, 8 (20) ( 2019), Article e012556, DOI: 10.1161/JAHA.119.012556

[[39]] C.P. Wen, J.P. Wai, M.K. Tsai, et al.. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet, 378 (9798) ( 2011), pp. 1244-1253, DOI: 10.1016/s0140-6736(11)60749-6

[[40]] Y. Liu, W. Wen, Y.T. Gao, et al.. Level of moderate-intensity leisure-time physical activity and reduced mortality in middle-aged and elderly Chinese. Epidemiol Community Health, 72 (1) ( 2018), pp. 13-20, DOI: 10.1136/jech-2017-209903

[[41]] X.R. Chen, Y. Jiang, L.M. Wang, et al.. Leisure time physical activity and sedentary behaviors among Chinese adults in 2010. [in Chinese]. Chin J Prev Med, 46 (5) ( 2012), pp. 399-403, DOI: 10.3760/cma.j.issn.0253-9624.2012.05.005

[[42]] X. Li, C. Wu, J. Lu, et al.. Cardiovascular risk factors in China: a nationwide population-based cohort study. Lancet Public Health, 5 (12) ( 2020), pp. e672-e681, DOI: 10.1016/s2468-2667(20)30191-2

[[43]] H. Du, D. Bennett, L. Li, et al.. Physical activity and sedentary leisure time and their associations with BMI, waist circumference, and percentage body fat in 0.5 million adults: the China Kadoorie biobank study. Am J Clin Nutr, 97 (3) ( 2013), pp. 487-496, DOI: 10.3945/ajcn.112.046854

[[44]] T. Wang, Z. Zhao, X. Yu, et al.. Age-specific modifiable risk factor profiles for cardiovascular disease and all-cause mortality: a nationwide, population-based, prospective cohort study. The Lancet Regional Health-Western Pacific, 17 ( 2021), p. 100277, DOI: 10.1016/j.lanwpc.2021.100277

[[45]] C. Li, L. Wang, X. Zhang, et al.. Leisure-time physical activity among Chinese adults - China 2015. China CDC Weekly, 2 (35) ( 2020), pp. 671-677, DOI: 10.46234/ccdcw2020.187

[[46]] L.Z. Kong.China's medium-to-long term plan for the prevention and treatment of chronic diseases ( 2017-2025) under the healthy China initiative. Chronic Dis Transl Med, 3 (3) ( 2017), pp. 135-137, DOI: 10.1016/j.cdtm.2017.06.004

The funding resources for surveillance were provided by the Chinese Central Government (Key Project of Public Health Program), and the National Key Research and Development Program of China (grant numbers 2018YFC1311700, 2018YFC1311701, 2018YFC1311702, 2018YFC1311703). We thank all more than 6000 research staffs from 31 provincial Centres for Disease Control and Prevention and 298 local Centres for Disease Control and Prevention for their collection of data and their efforts in quality control. We would like to extend our sincere thanks to all the study participants for their contribution.