Research Article: Associations of sitting accumulation patterns with cardio-metabolic risk biomarkers in Australian adults

Date Published: June 29, 2017

Publisher: Public Library of Science

Author(s): John Bellettiere, Elisabeth A. H. Winkler, Sebastien F. M. Chastin, Jacqueline Kerr, Neville Owen, David W. Dunstan, Genevieve N. Healy, Cheng Hu.


High amounts of time spent sitting can increase cardiovascular disease risk and are deleteriously associated cardio-metabolic risk biomarkers. Though evidence suggests that accruing sitting time in prolonged periods may convey additional risk, verification using high-quality measures is needed. We examined this issue in adults from the Australian Diabetes, Obesity and Lifestyle Study, using accurate measures of sitting accumulation.

In 2011/12, 739 adults aged 36 to 89 years (mean±SD 58±10 years) wore activPAL3™ monitors (which provide accurate objective measures of sitting); 678 provided ≥4 valid days of monitor data and complete cardio-metabolic biomarker and confounder data. Multivariable linear regression models examined associations of sitting time, sitting time accrued in ≥30 minute bouts (prolonged sitting time), and three measures of sitting accumulation patterns with cardio-metabolic risk markers: body mass index (BMI), waist circumference, blood pressure, high- and low- density lipoprotein (HDL and LDL) cholesterol, triglycerides, glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and 2-hour post-load glucose (PLG). Interactions tests examined whether associations of sitting time with biomarkers varied by usual sitting bout duration.

Adjusted for potential confounders, greater amounts of sitting time and prolonged sitting time were significantly (p<0.05) deleteriously associated with BMI, waist circumference, HDL cholesterol, and triglycerides. Total sitting time was also significantly associated with higher PLG. Sitting accumulation patterns of frequently interrupted sitting (compared to patterns with relatively more prolonged sitting) were significantly beneficially associated with BMI, waist circumference, HDL cholesterol, triglycerides, PLG, and with FPG. Effect sizes were typically larger for accumulation patterns than for sitting time. Significant interactions (p<0.05) showed that associations of sitting time with HDL, triglycerides and PLG became more deleterious the longer at a time sitting was usually accumulated. Adding to previous evidence reliant on low-quality measures, our study showed that accumulating sitting in patterns where sitting was most frequently interrupted had significant beneficial associations with several cardio-metabolic biomarkers and that sitting for prolonged periods at a time may exacerbate some of the effects of sitting time. The findings support sedentary behavior guidelines that promote reducing and regularly interrupting sitting.

Partial Text

Diabetes mellitus and cardiovascular disease (CVD), on a global scale, account for more than one in four deaths annually [1]. In addition to lack of physical activity, sedentary behaviors—defined as time spent sitting or reclining while awake with low energy expenditure [2]—have emerged as a new risk factor [3–5]. Moreover, time spent sedentary has also been shown to be detrimentally associated with key biomarkers pertinent to both type 2 diabetes mellitus and CVD, notably excess adiposity and disordered lipid and glucose metabolism [6,7].

The analytic sample included 678 adults (n = 639 for analyses of PLG) with a mean age (± SD) of 57.8±9.8 years, after excluding participants who were pregnant or had any missing data (Table 1). Additional participant characteristics are described in Table 1 and S3 Table.

This study evaluated sedentary accumulation in relation to cardio-metabolic biomarkers in a large, general population sample of adults. To our knowledge, this study is among the first to examine this topic with accurate measures of sitting accumulation [37,38]. Many of the previous findings concerning sedentary accumulation that had been established with low-validity measures were corroborated. Although sitting many times per day and accumulating sitting time in long bouts were both relevant in terms of how much sitting time adults ultimately accrued, additional time spent sitting did not appear to be the only relevant correlate of prolonged accumulation patterns.




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