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Association of Sedentary Behavior and Metabolic Syndrome

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Association of Sedentary Behavior and Metabolic Syndrome public health 167 (2019) 96e102 Available online at www.sciencedirect.com Public Health journal homepage: www.elsevier.com/puhe Original Research Association of sedentary behavior and metabolic syndrome * I.R. Lemes a, , X. Sui b, R.A. Fernandes c, S.N. Blair b, B.C. Turi-Lynch d, J.S. Codogno c, H.L. Monteiro e a Department of Physiotherapy, School of Sciences and Technology, Sao~ Paulo State University e UNESP, 305 Roberto Simonsen Street, 19060-900, Presidente Prudente, Brazil b Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Public Health Research Center 229, 921 Assembly Street, 29208, Columbia, USA c Department of Physical Education, School of Sciences and Technology, Sao~ Paulo State University e UNESP, 305 Roberto Simonsen Street, 19060-900, Presidente Prudente, Brazil d Department of Physical Education, Faculty of Dracena e UNIFADRA, 332 Bahia Street, 17900-000, Dracena, Brazil e Department of Physical Education, School of Sciences, Sao~ Paulo State University e UNESP. 14-01 Luiz Edmundo Carrijo Coube Av., 17033-360, Bauru, Brazil article info abstract Article history: Objectives: To examine the association of sedentary behavior (SB) with metabolic syndrome Received 8 August 2018 (MetS) in adults, as well as to identify the impact of physical inactivity and economic Received in revised form condition on such association. 6 November 2018 Study design: This is a cross-sectional study. Accepted 8 November 2018 Methods: This study was conducted in the city of Bauru, Sao~ Paulo State, Brazil (n ¼ 970). Available online 12 January 2019 Television (TV) viewing and physical activity (PA) were assessed by questionnaire. MetS was assessed via medical records. Descriptive statistics and binary logistic regression were Keywords: used in data analyses. Brazil Results: Participants with moderate TV viewing were associated with MetS when compared Sedentary lifestyle with low TV viewing group, even after adjustments for age, sex, economic status, smoking, Physical activity and PA (odds ratio [OR] ¼ 1.49 [95% confidence interval {CI}: 1.01e2.20]). The fully adjusted Public health model showed an association between high exposure to TV viewing with MetS (OR ¼ 1.77 TV viewing [95%CI: 1.11e2.82]). The combination of physical inactivity and high TV viewing boosted the likelihood of having MetS (OR ¼ 1.89 [95%CI: 1.08e3.29]). Conclusion: The results of the present study suggest that moderate and high TV viewing time is associated with the presence of MetS, mainly in insufficiently active adults and those living in lower economic condition. © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved. * Corresponding author. Department of Physiotherapy, Sao~ Paulo State University (UNESP), 305, Roberto Simonsen Street, Presidente Prudente, SP, 19060-900, Brazil. Tel.: þ55 18 3229 5527. E-mail address: [email protected] (I.R. Lemes). https://doi.org/10.1016/j.puhe.2018.11.007 0033-3506/© 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved. public health 167 (2019) 96e102 97 Each BHU keeps records of all patients throughout the Introduction years, and based on these records, the researchers randomly selected 970 adults in five BHUs (194 in each BHU). The biggest Metabolic syndrome (MetS) is a cluster of cardiovascular risk BHU in each geographical region of the city (north, south, factors, including abdominal obesity, dyslipidemia, elevated west, east, and downtown) was selected. Researchers con- blood pressure, and impaired glucose metabolism or insulin tacted these adults by telephone to verify inclusion criteria: (i) 1 resistance. It has been associated with cardiovascular disease age 50 years; (ii) registered for at least one year at the BHU; (CVD), type 2 diabetes mellitus (T2DM), and mortality for and (iii) active healthcare service registration (at least one 1e4 several causes. Because of the high prevalence worldwide, medical visit in the previous 6 months). Participants who 5 MetS is considered a major public health problem. fulfilled the inclusion criteria were invited to a face-to-face The benefits of physical activity (PA) on cardiovascular and interview and physical examination at the BHU of origin. 6e9 metabolic risk factors are well established. On the other The study protocol was reviewed and approved by the hand, sedentary behavior (SB), defined as any waking behavior Ethics Committee from Sao~ Paulo State University, Bauru, characterized by an energy expenditure 1.5 metabolic Brazil, and all participants provided written consent to 10 equivalents while in a sitting or reclining posture, has been participate in the study. associated with deleterious health outcomes, such as CVD,11 12,13 14 15 T2DM, depression, some types of cancer, and specific Metabolic syndrome and all-cause mortality.12 The association of SB with MetS has been investigated in MetS was defined according to the criteria established by the previous studies. In a cross-sectional analysis, Wijndaele National Cholesterol Education Program Adult Treatment 16 et al. found a positive association between time spent in Panel III : three or more of the following risk factors such as sedentary activities and MetS risk score. Total and average high blood pressure 130 mmHg systolic or 85 mmHg dia- time spent in SB were also positively associated with MetS and stolic; central obesity (waist circumference > 102 cm for men 17 its individual components. On the other hand, studies have and >88 cm for women); high triglycerides (150 mg/dL); low shown that PA can attenuate or even eliminate, the detri- high-density lipoprotein (HDL) cholesterol (<40 mg/dL for men 18,19 mental effects of too much sitting. In addition, socio- and <50 mg/dL for women); and high fasting plasma glucose demographic characteristics, such as economic status, may (100 mg/dL) or drug treatment for these conditions. 20 play an important role in this association. Blood pressure was measured using a standard mercury Although evidence of the association of SB with MetS has brachial artery sphygmomanometer and stethoscope. Waist been increasing recently, there are no data from developing circumference was measured with the subject standing and at countries, as well as it is not clear if the association between the maximum point of normal expiration. Results of HDL- SB and MetS would be boosted by variables such as insuffi- cholesterol, fasting glucose, and triglycerides, or its respec- cient PA and low economic condition. Therefore, the aim of tive chronic condition diagnosis (dyslipidemia, diabetes, and this study is to examine the association of SB with MetS in hypertension) were obtained from medical records. All blood adults, as well as to identify the impact of physical inactivity exams scheduled by the BHUs were analyzed in a private and economic condition on this association. laboratory following standard procedures. All the assess- ments (blood pressure, waist circumference, and medical re- cords analysis) were performed by the researchers. Methods PA and television viewing assessment Sample Information regarding PA and television (TV) viewing were The present study uses baseline measurements of an ongoing assessed by the Baecke questionnaire,21 which comprises 16 cohort study carried out with adults from the Brazilian Na- questions scored on a 5-point Likert scale, ranging from never tional Health System (NHS). This cross-sectional study was to always/very often, and addresses three domains of PA: conducted from August to December 2010 in Bauru, a Brazilian occupational, sports participation, and leisure-time. Overall city (366,992 inhabitants and human development index of PA score was calculated following the questionnaire in- 0.801) located in the central region of Sao~ Paulo State, the most structions and taking into account the three domains. Par- industrialized state in Brazil. The Department of Health of ticipants classified in the top quartile (25% more active) of e Bauru (subordinated to the NHS) administrates primary care overall PA were identified as ‘physically active’.22 24 services in the city, which is composed of 17 basic healthcare We assessed TV viewing time using one question in the units (BHU). BHUs are small primary healthcare centers, in leisure-time section of the questionnaire: ‘During leisure time which a wide variety of health professionals (e.g. general I watch television’, with the following possibilities of answers: practitioners, gynecologists, obstetricians, psychiatrists, den- ‘never’, ‘seldom’, ‘sometimes’, ‘often’, or ‘very often’. tists, and nurses) offer health services of low complexity (e.g. Although the questionnaire provides five options of answers, medical consultations, medicine prescription, and vaccina- we opted to categorize as three variables because of the few tions) to the population of a specific region of the city. All cases in some of the groups (e.g. never and very often). services are free of charge, characterized as primary health Therefore, the following categories were created: ‘never and care (more complex cases are directed to hospitals linked to seldom’ (low TV viewing), ‘sometimes’ (moderate TV viewing), the NHS). and ‘often and very often’ (high TV viewing).25,26 98 public health 167 (2019) 96e102 Covariates Results In the present study, health status and sociodemographic and behavioral covariates were considered potential confounders Characteristics of the sample according to categories of TV (used to adjust the multivariable models). Sociodemographic viewing are described in Table 1. High frequency of TV viewing variables were sex (male or female), chronological age, and was reported by 21.6% of the participants, which was associ- ¼ economic status. Health status variables were composed of ated with age (P-value 0.025), economic status (P- ¼ ¼ body mass index (BMI) and history of arrhythmia and value 0.003), hypertension (P-value 0.001), MetS (P- ¼ ¼ myocardial infarction. BMI was calculated using measure- value 0.004), male sex (P-value 0.034), and lower PA score ¼ ments of weight and height collected during the face-to-face (P-value 0.001). interview and physical examination.
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