Ethnic variation in the contribution of Cardiorespiratory ... · Valencia Spain, 2015 . ... To...
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Ethnic variation in the contribution of Cardiorespiratory fitness and muscular strength to diabetes: crossectional study of 68,116 UK Biobank participants Uduakobong Ntuk, Institute of Health and Wellbeing ,University of Glasgow International Conference on Epidemiology & Public Health Valencia Spain, 2015
Transcript of Ethnic variation in the contribution of Cardiorespiratory ... · Valencia Spain, 2015 . ... To...
Ethnic variation in the contribution of
Cardiorespiratory fitness and muscular strength to
diabetes: crossectional study of 68,116 UK
Biobank participants
Uduakobong Ntuk,
Institute of Health and Wellbeing ,University of Glasgow
International Conference on Epidemiology & Public Health
Valencia Spain, 2015
Outline
Background
Study Aims
Methods
Result
Discussion
Strengths and Limitations
Conclusion
Background Type 2 diabetes is a major public health problem
Diabetes prevalence
◦ Black (2x White European)
◦ South Asian (4x White European)
Background (cont’d) • Low cardiorespiratory fitness
• involved in the progression from normal glucose metabolism to type 2 diabetes
(T2D);
• predictors of cardiovascular events and premature mortality in T2D individuals.
• Muscular strength is a predictor of all-cause mortality, as well as
disability.
No epidemiological studies on ethnic variation and diabetes
prevalence
Rantanen T, et al; Sayer AA, et al; Ghouri N, et al; Wander PL, et al
Study Aims To determine the associations of (a) cardiorespiratory fitness (b)
muscular strength on diabetes risk in White European, Black and South
Asian.
To determine the extent to which ethnic differences in fitness and muscle
strength might account for observed differences in diabetes prevalence
Whether the strength of these relationships similar across ethnic groups
Methods Data Source UK Biobank
◦ Large sample size data >500,000
◦ Aged between 40 and 70 years
◦ Representative of the UK population in terms of age-band, sex and ethnic structure
◦ Self-identified as White, South Asian or black background living in the UK
Data Analysis ◦ Multivariate logistic regression model
◦ Adjusting for : Age, Sex ,Deprivation quintile , Smoking , Alcohol consumption, BMI and Percentage
body fat
Results
Table 1.Characteristics of study participants by ethnic group and sex
Men Women
White
N=28,402
Black
N=904
South Asian
N=1,066
White N=35,367 Black
N=1,293
South Asian
N=1,086
Age(years) 59 (51-64) 51 (45-59)
54 (45-61) 58 (51-63) 51 (46-58) 53 (46-60)
BMI (kg/m2) 27.2
(25.0-29.9)
28.2
(25.9-30.9)
26.5
(24.4-29.0)
25.9
(23.3-29.4)
29.5
(26.0-33.6)
26.3
(23.6-29.3
Hand grip strength
(kg/kg body weight) 0.45
(0.28-0.53)
0.47
(0.37-0.55)
0.43
(0.35-0.50)
0.33
(0.26-0.39)
0.32
(0.25-0.38)
0.29
(0.23-0.36)
CRF (METS)
10.02
(8.14-11.92)
8.65
(6.85-10.27)
9.20
(7.65-10.73)
7.65
(6.09-9.31)
6.49
(4.75-7.98)
6.82
(5.31-8.21)
N (%) N (%) N (%) N (%) N (%) N (%)
Diabetes
1,604 (5.64) 134 (14.77) 189 (17.68) 1,122 (3.17) 108 (8.34) 126 (11.60)
High fitness
Moderate fitness
Low fitness
0
1
2
3
4
5
6
7
8
Highstrength
Moderatestrength
Lowstrength
1.88
3.65 4.78
2.49
3.76
5.02
2.70
3.90
5.86
Dia
bete
s o
dd
s ra
tio
Black men
High fitnessModerate fitness
Low fitness
012345678
1.00 1.06 1.64
1.00 1.24 1.76
1.32 1.94 2.41
Dia
bete
s o
dd
s ra
tio
White men
High fitness
Moderate fitness
Low fitness
0
1
2
3
4
5
6
7
8
3.02 3.94 4.54 3.43 4.04
6.29
3.49
6.51 6.72
Dia
bete
s o
dd
s ra
tio
South Asian men
Impact of fitness & strength on risk of diabetes (Men)
High fitnessModerate fitness
Low fitness
012345678
1.14 2.11 2.62 1.27
3.31 2.96
3.52
5.88
4.05
Dia
bete
s o
dd
s ra
tio
Black women
High fitnessModerate fitness
Low fitness
0
2
4
6
8
1.00 1.03 1.33
1.09 1.04 1.68
1.36 1.31 2.10
Dia
bete
s o
dd
s ra
tio
White women
High fitness
Moderate fitness
Low fitness
0
1
2
3
4
5
6
7
8
High
strengthModerate
strengthLow
strength
2.53
3.73
5.37 3.54
4.59
6.22
3.90
5.28
6.45
Dia
bete
s o
dd
s ra
tio
South Asian women
Impact of fitness & strength on risk of diabetes (Women)
Breakdown of participantsby fitness & strength (men)
High fitnessModerate fitness
Low fitness
0
5
10
15
20
25
30
35
40
3.8 10.8
15.7 3.5
8.1
17.4 2.1
9.6
29.1
Pro
po
rtio
n o
f p
op
ula
tio
n
in c
ate
go
ry (
%)
Black men
High fitnessModerate fitness
Low fitness
0
10
20
30
40
12.4 9.4
6.1
12.3 11.9 9.9
10.1 12.1 15.7
Pro
po
rtio
n o
f p
op
ula
tio
n
in c
ate
go
ry (
%)
White
High fitness
Moderate fitness
Low fitness
0
5
10
15
20
25
30
35
40
3.0 5.2 4.5
7.5 10.7 13.7 6.1
15.0
34.3
Pro
po
rtio
n o
f p
op
ula
tio
n
in c
ate
go
ry (
%)
South Asian
Breakdown of participantsby fitness & strength (women)
High fitness
Moderate fitness
Low fitness
0
5
10
15
20
25
30
35
40
4.4 6.2 7.1
4.9 11.1 14.0 6.3
15.8
30.2
Pro
po
rtio
n o
f p
op
ula
tio
n
in c
ate
go
ry (
%)
South Asian
High fitness
Moderate fitness
Low fitness
0
5
10
15
20
25
30
35
40
3.9 2.7 3.1
7.3 8.9 8.1
10.1
19.9
36.0
Pro
po
rtio
n o
f p
op
ula
tio
n
in c
ate
go
ry (
%)
Black women
High fitnessModerate fitness
Low fitness
0
5
10
15
20
25
30
35
40
14.2 12.2
8.4
9.5 12.4 11.8
5.9 9.7 15.9
Pro
po
rtio
n o
f p
op
ula
tio
n
in c
ate
go
ry (
%)
White women
Table 2. Attributable risk and attributable fraction of low-to-moderate cardiorespiratory fitness and low-
to-moderate muscular strength for diabetes in White, Black and South Asian men and women
Men Women
White Black South Asian White Black South Asian
Attributable risk
(diabetes cases per
100 people) 1.4 (0.5-2.3) 4.1 (3.5-10.9) 8.2 (2.3-18.6) 1.0 (0.5-1.5) 4.3 (2.2-7.8) 5.0 (2.8-12.5)
Attributable fraction
for diabetes risk (%) 24.5 (6.3-39.1) 28.1 (22.5-60.4) 45.7 (18.8-81.2) 27.3 (5.1-44.3) 42.6 (20.1-79.9) 47.2 (20.8-86.6)
Discussion Findings suggest a graded association between weaker muscular strength,
low cardiorespiratory fitness and diabetes risk, particularly in South Asian
and Black ethnic groups.
◦ remained significant after adjustment for adiposity (BMI and %body fat).
Need to include strength-training exercises, as well as aerobic physical
activity, in future lifestyle interventions trials for diabetes prevention.
Need to target black and south Asian adults for interventions to increase
strength and fitness.
Result (contd)
Strengths and Limitations
Strength of study:
– Primary predictors objectively measured
– Large sample size
– Ethnic diversity
Limitations:
– Cross sectional study
– Can not determine causal association
– Selection bias?
Conclusion
Independent associations between fitness and muscular strength on
diabetes risk in white European, south Asian and black adults
Low-to-moderate fitness and strength could importantly contribute to a
disproportionately large proportion of diabetes cases in the south Asian
and black groups
A clear case for future randomised controlled trials of interventions to
improve both strength and fitness in non-white populations
Translating research into practice ……
The rest of the team …..
Jason M.R. Gill,
Daniel F. Mackay,
Naveed Sattar,
Jill P. Pell
