Physical Activity and the Metabolic Syndrome in Canada

Susan E. Brien, PhD

School of Physical and Health EducationQueen’s University

Kingston, ON

Metabolic Syndrome

Predisposed to type 2 diabetes, CVD, cancer and higher mortality rates

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

*JAMA 2001;285:2486.

NCEP and AHA recommend

therapeutic lifestyle changes

as first line therapy

Treatment of the Metabolic Syndrome

NCEP ATP III Expert Panel, JAMA 2001;285:2486.Pearson et al. Circulation 2002;106:388.

Diet modification and increased physical activity!

Metabolic Syndrome and Physical Activity Level in Overweight Men and Women (NHANES III)

Zhu et al 2004; Metabolism 53(11): 1503

0

0.2

0.4

0.6

0.8

1

1.2

1.4

Od

ds

Rat

io

Inactive Moderately Active

Active

**

Adjusted for lifestyle, age, race, education, income, menopause, other modifiable factors*p < 0.05; **p<0.001

**

Inactive Moderately Active

Active

Men

Women

0.360.58 0.610.79

Healthy Metabolic Syndrome

All

-cau

se d

eath

rat

e p

er 1

0 0

00 m

an-y

ears

Unfit

Katzmarzyk et al. Arch Intern Med 2004;164:1092.

All-Cause Mortality Among 19,223 Men from the Aerobics Center Longitudinal Study: 10 Years of Follow-up

34.6

65.3

Fit

18.9

28.4

0

10

20

30

40

50

60

70

Purpose

To determine the relationship between physical activity, metabolic syndrome and component

risk factors among Canadian adults.

MethodsSample- 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

Methods

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

Methods

Metabolic Syndrome (NCEP ATPIII):Three or more of the following:Waist Circumference: >102 cm (Men), >88 cm (Women) Triglycerides: ≥ 1.69 mMHDL-cholesterol: < 1.04 mM (M), < 1.29 mM (W)Blood Pressure: ≥ 130/85 mm HgFasting 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

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 mMHDL-cholesterol: < 1.04 mM (M), < 1.29 mM (W)Blood Pressure: ≥ 130/85 mm HgFasting 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

Metabolic Syndrome: Body Mass Index vs Waist Circumference

Men Women Total

5 provinces (n=6602)

MetS by WC % 16.8 11.7 14.2

MetS by BMI % 17.8 10.5 14.3

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 mMHDL-cholesterol: < 1.04 mM (M), < 1.29 mM (W)Blood Pressure: ≥ 130/85 mm HgFasting Glucose: ≥ 5.6 mM

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 mMHDL-cholesterol: < 1.04 mM (M), < 1.29 mM (W)Blood Pressure: ≥ 130/85 mm HgInsulin Resistance: self-reported diabetes

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

36.8

18-34

29.9

35-49

22.2

50-64

32.6

35-49

22.7

50-64

46.3

18-34 (n=12 881)totaltotal

Metabolic Syndrome (%)

33.630.936.2Physically Active (%)

23.4

(0.16)

24.7

(0.58)

26.8

(0.57)

26.4

(0.38)

26.7

(0.14)

24.6

(0.12)

25.2 (0.24)

24.6 (0.36)

25.8 (0.16)

BMI [kg/m2, mean (SE)]

All Women (n=6475)Men (n=6406)

Descriptive statistics

4.6

36.8

18-34

11.7

29.9

35-49

23.8

22.2

50-64

21.3

32.6

35-49

27.1

22.7

50-64

8.7

46.3

18-34 (n=12 881)totaltotal

14.411.017.5Metabolic

Syndrome (%)

33.630.936.2Physically Active (%)

23.4

(0.16)

24.7

(0.58)

26.8

(0.57)

26.4

(0.38)

26.7

(0.14)

24.6

(0.12)

25.2 (0.24)

24.6 (0.36)

25.8 (0.16)

BMI [kg/m2, mean (SE)]

All Women (n=6475)Men (n=6406)

Descriptive statistics

Prevalence of Metabolic Syndrome and component risk factors in Physically Active vs Inactive Men and Women, combined

17.4

8.4

31.2

22.8

38.8

26.7

31

23.1

4.42

21.1

12.3

0

5

10

15

20

25

30

35

40

45

Per

cen

t (%

)

MetabolicSyndrome

High Triglycerides

Low HDL-Cholesterol

High BloodPressure

Type 2Diabetes

HighBMI

Physically Inactive

Physically Active

22.1

9.4

40.4

28.5

37.7

25.5

40.8

30.2

5.2

1.5

20

11.8

0

5

10

15

20

25

30

35

40

45

Prevalence of Metabolic Syndrome and component risk factors in Physically Active vs Inactive Men

MetabolicSyndrome

High Triglycerides

Low HDL-Cholesterol

High BloodPressure

Type 2Diabetes

HighBMI

Per

cen

t (%

)

Physically Inactive

Physically Active

13

7.4

22.4

15.7

39.8

28.2

21.6

14.5

3.7 2.7

22

12.9

0

5

10

15

20

25

30

35

40

45

Prevalence of Metabolic Syndrome and component risk factors in Physically Active vs Inactive Women

MetabolicSyndrome

High Triglycerides

Low HDL-Cholesterol

High BloodPressure

Type 2Diabetes

HighBMI

Per

cen

t (%

)

Physically Inactive

Physically Active

Men Women

Odds ratios are adjusted for age, alcohol consumption, smoking and annual income.Error bars indicate 95% confidence intervals; **p<0.001

Inactive Inactive

Risk of Metabolic Syndrome in Physically Active vs Inactive Men and Women, separately

0.0

0.2

0.4

0.6

0.8

1.0

1.2

Od

ds

Rat

io

Active

**

0.45

Active

0.67

Odds ratios are adjusted for alcohol consumption, smoking and annual income.Error bars indicate 95% confidence intervals; **p<0.001; *p<0.05

Inactive Active

18-34 y 35-49 y 50-64 y

Risk of Metabolic Syndrome in Physically Active vs Inactive Men, by age

0

0.2

0.4

0.6

0.8

1

1.2

Od

ds

Rat

io

Inactive Active Inactive Active

**

0.320.38

*

0.68

*

Odds ratios are adjusted for alcohol consumption, smoking and annual income.Error bars indicate 95% confidence intervals. *p<0.05

Inactive Inactive InactiveActive Active Active

18-34 y 35-49 y 50-64 y

0

0.5

1

1.5

2

2.5

Od

ds

Rat

io

0.69

*

0.44 1.07

Risk of Metabolic Syndrome in Physically Active vs Inactive Women, by age

Risk of Metabolic Syndrome or component risk factors in Physically Active vs Inactive Men and Women, combined

1

0.73 0.78 0.62 0.80 0.55 0.620

0.2

0.4

0.6

0.8

1

1.2

MetabolicSyndrome

Od

ds

Rat

io

High Triglycerides

Low HDL-Cholesterol

High BloodPressure

Type 2Diabetes

PhysicallyInactive

HighBMI

*

**

**

****

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

InactiveActive

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

Risk of Metabolic Syndrome or component risk factors in Physically Active vs Inactive men and women, separately

MetabolicSyndrome

High Triglycerides

Low HDL-Cholesterol

High BloodPressure

Type 2Diabetes

PhysicallyInactive

HighBMI

Od

ds

Rat

io

1 0.45

0.72

0.40

0.640.740.63

0.80 0.790.67

0.84

0.61**

**

** ****

**

**

MenWomen

Odds ratios are adjusted for age, alcohol consumption, smoking and annual income.Error bars indicate 95% confidence intervals. *p<0.05; **p<0.001

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.

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