Physical Activity and the Metabolic Syndrome in Canada

1
Physical Activity and the Metabolic Syndrome in
Canada
Susan E. Brien, PhD School of Physical and
Health Education Queens 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 20012852486.
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
20012852486. Pearson et al. Circulation
2002106388.
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 lt
0.05 plt0.001
Zhu et al 2004 Metabolism 53(11) 1503
5
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 20041641092.
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 gt102 cm
(Men), gt88 cm (Women) Triglycerides 1.69
mM HDL-cholesterol lt 1.04 mM (M), lt 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 gt102 cm
(Men), gt88 cm (Women) Triglycerides 1.69
mM HDL-cholesterol lt 1.04 mM (M), lt 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 (plt0.0001) Women 0.88 (plt0.0001)
• 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 gt29.2 kg/m2 (Men), gt28.4
kg/m2 (Women) Triglycerides 1.69
mM HDL-cholesterol lt 1.04 mM (M), lt 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 (plt0.0001) Women 0.88 (plt0.0001)
• 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 gt29.2 kg/m2 (Men), gt28.4
kg/m2 (Women) Triglycerides 1.69
mM HDL-cholesterol lt 1.04 mM (M), lt 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 gt29.2 kg/m2 (Men), gt28.4
kg/m2 (Women) Triglycerides 1.69
mM HDL-cholesterol lt 1.04 mM (M), lt 1.29 mM
(W) Blood Pressure 130/85 mm Hg Insulin
Resistance self-reported diabetes
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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
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Descriptive statistics
All
Women (n6475)
Men (n6406)
18-34
35-49
50-64
35-49
50-64
18-34
(n12 881)
total
total
23.4 (0.16)
24.7 (0.58)
26.8 (0.57)
26.4 (0.38)
26.7 (0.14)
24.6 (0.12)
BMI kg/m2, mean (SE)
36.8
29.9
22.2
32.6
22.7
46.3
33.6
30.9
36.2
Physically Active ()
Metabolic Syndrome ()
16
Descriptive statistics
All
Women (n6475)
Men (n6406)
18-34
35-49
50-64
35-49
50-64
18-34
(n12 881)
total
total
23.4 (0.16)
24.7 (0.58)
26.8 (0.57)
26.4 (0.38)
26.7 (0.14)
24.6 (0.12)
BMI kg/m2, mean (SE)
36.8
29.9
22.2
32.6
22.7
46.3
33.6
30.9
36.2
Physically Active ()
4.6
11.7
23.8
21.3
27.1
8.7
14.4
11.0
17.5
Metabolic Syndrome ()
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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
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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
Prevalence of Metabolic Syndrome and component
risk factors in Physically Active vs Inactive
Women
45
39.8
40
35
28.2
30
22
25
22.4
21.6
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
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 plt0.001
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
0.32
0.38
0
Inactive
Active
Inactive
Active
Inactive
Active
Odds ratios are adjusted for alcohol consumption,
smoking and annual income. Error bars indicate
95 confidence intervals plt0.001 plt0.05
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
Inactive
Inactive
Active
Active
Active
Odds ratios are adjusted for alcohol consumption,
smoking and annual income. Error bars indicate
95 confidence intervals. plt0.05
23
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
Metabolic Syndrome
High Triglycerides
Low HDL- Cholesterol
High Blood Pressure
Type 2 Diabetes
Physically Inactive
High BMI
Odds ratios are adjusted for age, sex, alcohol
consumption, smoking and annual income. Error
bars indicate 95 confidence intervals. plt0.05
plt0.001
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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
Metabolic Syndrome
High Triglycerides
Low HDL- Cholesterol
High Blood Pressure
Type 2 Diabetes
Physically Inactive
High BMI
Odds ratios are adjusted for age, alcohol
consumption, smoking and annual income. Error
bars indicate 95 confidence intervals. plt0.05
plt0.001
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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.

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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