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Physical Activity and the Metabolic Syndrome in Canada

Physical Activity and the Metabolic Syndrome in Canada. Susan E. Brien, PhD School of Physical and Health Education Queen’s University Kingston, ON. Metabolic Syndrome. National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines* Three or more of:

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Physical Activity and the Metabolic Syndrome in Canada

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  1. Physical Activity and the Metabolic Syndrome in Canada Susan E. Brien, PhD School of Physical and Health Education Queen’s University Kingston, ON

  2. Metabolic Syndrome National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines* Three or more of: • Abdominal obesity • High triglycerides • Low high-density lipoprotein cholesterol • High plasma glucose • High blood pressure Predisposed to type 2 diabetes, CVD, cancer and higher mortality rates *JAMA 2001;285:2486.

  3. Treatment of the Metabolic Syndrome NCEP and AHA recommend therapeutic lifestyle changes as first line therapy Diet modification and increased physical activity! NCEP ATP III Expert Panel, JAMA 2001;285:2486. Pearson et al. Circulation 2002;106:388.

  4. Metabolic Syndrome and Physical Activity Level in Overweight Men and Women (NHANES III) 1.4 1.2 Men * 1 Women * Odds Ratio 0.8 ** 0.6 0.4 0.2 0.36 0.61 0.58 0.79 0 Inactive Moderately Active Active Inactive Moderately Active Active Adjusted for lifestyle, age, race, education, income, menopause, other modifiable factors *p < 0.05; **p<0.001 Zhu et al 2004; Metabolism 53(11): 1503

  5. Fit 28.4 18.9 All-Cause Mortality Among 19,223 Men from the Aerobics Center Longitudinal Study: 10 Years of Follow-up 70 65.3 Unfit 60 50 40 34.6 All-cause death rate per 10 000 man-years 30 20 10 0 Healthy Metabolic Syndrome Katzmarzyk et al. Arch Intern Med 2004;164:1092.

  6. Purpose To determine the relationship between physical activity, metabolic syndrome and component risk factors among Canadian adults.

  7. Methods Sample • Canadian Heart Health Surveys, 1986-92 • 10 provinces • 6406 men and 6475 women (total n = 12 881) • 18-64 y of age; 3 groups: 18-34 y, 35-49 y, 50-64 y • Measured: lipids, blood pressure, height, weight, waist circumference (5 provinces) • Survey: lifestyle, education, income adequacy, physical activity, chronic diseases

  8. Methods Metabolic Syndrome (NCEP ATPIII): Three or more of the following: Waist Circumference: >102 cm (Men), >88 cm (Women) Triglycerides: ≥ 1.69 mM HDL-cholesterol: < 1.04 mM (M), < 1.29 mM (W) Blood Pressure: ≥ 130/85 mm Hg Fasting Glucose: ≥5.6 mM

  9. Methods Metabolic Syndrome (NCEP ATPIII): Three or more of the following: Waist Circumference: >102 cm (Men), >88 cm (Women) Triglycerides: ≥ 1.69 mM HDL-cholesterol: < 1.04 mM (M), < 1.29 mM (W) Blood Pressure: ≥ 130/85 mm Hg Fasting Glucose: ≥5.6 mM • Correlation of WC vs BMI in men and women • Men =0.85 (p<0.0001); Women = 0.88 (p<0.0001) • Regression to determine BMI corresponding to WC cut offs in men and women

  10. Methods Metabolic Syndrome (NCEP ATPIII): Three or more of the following: BMI: >29.2 kg/m2 (Men), >28.4 kg/m2 (Women) Triglycerides: ≥ 1.69 mM HDL-cholesterol: < 1.04 mM (M), < 1.29 mM (W) Blood Pressure: ≥ 130/85 mm Hg Fasting Glucose: ≥5.6 mM • Correlation of WC vs BMI in men and women • Men =0.85 (p<0.0001); Women = 0.88 (p<0.0001) • Regression to determine BMI corresponding to WC cut offs in men and women

  11. Metabolic Syndrome: Body Mass Index vs Waist Circumference

  12. Methods Metabolic Syndrome (NCEP ATPIII): Three or more of the following: BMI: >29.2 kg/m2 (Men), >28.4 kg/m2 (Women) Triglycerides: ≥ 1.69 mM HDL-cholesterol: < 1.04 mM (M), < 1.29 mM (W) Blood Pressure: ≥ 130/85 mm Hg Fasting Glucose: ≥5.6 mM

  13. Methods Metabolic Syndrome (NCEP ATPIII): Three or more of the following: BMI: >29.2 kg/m2 (Men), >28.4 kg/m2 (Women) Triglycerides: ≥ 1.69 mM HDL-cholesterol: < 1.04 mM (M), < 1.29 mM (W) Blood Pressure: ≥ 130/85 mm Hg Insulin Resistance: self-reported diabetes

  14. Methods Physical Activity: Active = 30 minutes of physical activity at least once a week in the past month, with strenuous activity at least some of the time Data Analysis: Logistic regression using STATA to account for complex sampling design of CHHS Covariates: age, smoking, alcohol consumption, income adequacy

  15. 25.8 (0.16) 24.6 (0.36) 25.2 (0.24) Descriptive statistics Men (n=6406) Women (n=6475) All 18-34 35-49 50-64 total 18-34 35-49 50-64 total (n=12 881) BMI [kg/m2, mean (SE)] 24.6 (0.12) 26.4 (0.38) 26.7 (0.14) 23.4 (0.16) 24.7 (0.58) 26.8 (0.57) Physically Active (%) 46.3 32.6 22.7 36.2 36.8 29.9 22.2 30.9 33.6 Metabolic Syndrome (%)

  16. 25.8 (0.16) 24.6 (0.36) 25.2 (0.24) Descriptive statistics Men (n=6406) Women (n=6475) All 18-34 35-49 50-64 total 18-34 35-49 50-64 total (n=12 881) BMI [kg/m2, mean (SE)] 24.6 (0.12) 26.4 (0.38) 26.7 (0.14) 23.4 (0.16) 24.7 (0.58) 26.8 (0.57) Physically Active (%) 46.3 32.6 22.7 36.2 36.8 29.9 22.2 30.9 33.6 Metabolic Syndrome (%) 8.7 21.3 27.1 17.5 4.6 11.7 23.8 11.0 14.4

  17. Physically Inactive Physically Active Prevalence of Metabolic Syndrome and component risk factors in Physically Active vs Inactive Men and Women, combined 45 38.8 40 35 31.2 31 30 26.7 23.1 25 22.8 Percent (%) 21.1 20 17.4 15 12.3 8.4 10 4.4 5 2 0 Metabolic Syndrome High Triglycerides Low HDL- Cholesterol High Blood Pressure Type 2 Diabetes High BMI

  18. Physically Inactive Physically Active Prevalence of Metabolic Syndrome and component risk factors in Physically Active vs Inactive Men 45 40.8 40.4 40 37.7 35 30.2 28.5 30 25.5 25 22.1 Percent (%) 20 20 15 11.8 9.4 10 5.2 5 1.5 0 Metabolic Syndrome High Triglycerides Low HDL- Cholesterol High Blood Pressure Type 2 Diabetes High BMI

  19. Physically Inactive Physically Active Prevalence of Metabolic Syndrome and component risk factors in Physically Active vs Inactive Women 45 39.8 40 35 28.2 30 22 25 21.6 22.4 Percent (%) 20 15.7 14.5 12.9 13 15 10 7.4 3.7 5 2.7 0 Metabolic Syndrome High Triglycerides Low HDL- Cholesterol High Blood Pressure Type 2 Diabetes High BMI

  20. 0.67 Risk of Metabolic Syndrome in Physically Active vs Inactive Men and Women, separately 1.2 Men Women 1.0 0.8 ** Odds Ratio 0.6 0.4 0.2 0.45 0.0 Active Inactive Inactive Active Odds ratios are adjusted for age, alcohol consumption, smoking and annual income. Error bars indicate 95% confidence intervals; **p<0.001

  21. Risk of Metabolic Syndrome in Physically Active vs Inactive Men, by age 18-34 y 35-49 y 50-64 y 1.2 1 * * 0.8 ** Odds Ratio 0.6 0.4 0.2 0.68 0.38 0.32 0 Inactive Active Inactive Active Inactive Active Odds ratios are adjusted for alcohol consumption, smoking and annual income. Error bars indicate 95% confidence intervals; **p<0.001; *p<0.05

  22. Risk of Metabolic Syndrome in Physically Active vs Inactive Women, by age 50-64 y 18-34 y 35-49 y 2.5 2 1.5 Odds Ratio * 1 0.5 0.69 0.44 1.07 0 Inactive Active Inactive Active Inactive Active Odds ratios are adjusted for alcohol consumption, smoking and annual income. Error bars indicate 95% confidence intervals. *p<0.05

  23. Inactive Active Risk of Metabolic Syndrome or component risk factors in Physically Active vs Inactive Men and Women, combined 1.2 1 * * * 1 ** 0.8 ** ** Odds Ratio 0.6 0.4 0.2 0.73 0.78 0.62 0.80 0.55 0.62 0 Physically Inactive Metabolic Syndrome High Triglycerides Low HDL- Cholesterol High Blood Pressure Type 2 Diabetes High BMI Odds ratios are adjusted for age, sex, alcohol consumption, smoking and annual income. Error bars indicate 95% confidence intervals. *p<0.05; **p<0.001

  24. Men 0.84 Women 0.67 0.80 0.79 0.61 ** Risk of Metabolic Syndrome or component risk factors in Physically Active vs Inactive men and women, separately 1.8 1.6 1.4 1.2 ** ** ** ** Odds Ratio 1.0 0.74 0.72 0.64 ** 0.63 1 0.8 0.45 ** 0.40 0.6 0.4 0.2 Physically Inactive Metabolic Syndrome High Triglycerides Low HDL- Cholesterol High Blood Pressure Type 2 Diabetes High BMI Odds ratios are adjusted for age, alcohol consumption, smoking and annual income. Error bars indicate 95% confidence intervals. *p<0.05; **p<0.001

  25. Conclusions • Physical activity is associated with lower risk of Metabolic Syndrome and risk factors • Stronger relationship in men than women • Further research is necessary to determine the effectiveness of physical activity in the treatment of the metabolic syndrome.

  26. The Canadian Heart Health Surveys Follow-up Study is a New Emerging Team, funded by the Canadian Institutes for Health Research and the Heart and Stroke Foundation of Canada www.chhsnet.ca

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