Twenty-four-hour movement guidelines during middle adolescence and their association with glucose outcomes and type 2 diabetes mellitus in adulthood

Abstract

Purpose: The aim of the present study was to determine the association between adherence to the 24-h movement guidelines during middle adolescence and glucose outcomes (glycated hemoglobin and fasting glucose) and type 2 diabetes mellitus (T2DM) in adulthood, 14 and 22 years later.

Methods: We analyzed data from apparently healthy adolescents aged 12-18 years who participated in Waves I and II (1994-1996, n = 14,738), Wave IV (2008-2009, n = 8913), and Wave V (2016-2018, n = 3457) of the National Longitudinal Study of Adolescent to Adult Health (Add Health) in the United States. Physical activity, screen time, and sleep duration were measured using questionnaires, and the 24-h guidelines were defined as: 5 or more times moderate-to-vigorous physical activity per week, ≤2 h per day of screen time, and 9-11 h of sleep for 12-13 years and 8-10 h for 14-17 years. Capillary and venous whole blood was collected and analyzed to determine glycated hemoglobin and fasting glucose for Waves IV and V, respectively.

Results: Only 2.1% of the adolescents met all the 3 guidelines, and 37.8% met none of them. In both waves IV and V, adolescents who met physical activity and screen time guidelines had lower odds of T2DM in adulthood than those who did not meet any of these guidelines (Wave IV; prevalence ratio (PR) = 0.57, 95% confidence interval (95%CI): 0.21-0.89; Wave V: PR = 0.43, 95%CI: 0.32-0.74). Only for Wave V did adolescents who met all 3 guidelines have lower odds of T2DM at follow-up compared with those who did not meet any of these guidelines (PR = 0.47, 95%CI: 0.24-0.91). Also, for each increase in meeting one of the 24-h recommendations, the odds of T2DM decreased by 18% (PR = 0.82, 95%CI: 0.61-0.99) and 15% (PR = 0.85, 95%CI: 0.65-0.98) in adulthood for Waves IV and V, respectively.

Conclusion: Promoting all 24-h movement guidelines in adolescence, especially physical activity and screen time, is important for lowering the potential risk of T2DM in adulthood.

Keywords: Glucose metabolism; Glycated hemoglobin; Physical activity; Screen time; Sleep duration.

Graphical abstract

Fig. 1

Differences between adolescents who met none, 1, 2, or 3 guidelines and log₁₀ glycated hemoglobin (%) ((A) Wave IV and (B) Wave V) and fasting glucose (mg/dL) ((C) Wave IV and (D) Wave V) in adulthood. Covariates included sex, age at follow-up, highest education achieved, race/ethnicity, alcohol consumption at follow-up, smoking habit at follow-up, hsCRP, WC at follow-up, and hypertension. To aid interpretation, data were back-transformed from the log scale for presentation in the results. hsCRP = high sensitivity C-reactive protein; WC = waist circumference.

Fig. 2

PRs for diagnosis of type 2 diabetes mellitus at Waves IV and V associated with meeting vs. not meeting physical activity, screen time, and sleep duration guidelines and combinations among them during adolescence. Analysis was adjusted by biological sex, race/ethnicity, age at follow-up, higher education achieved, alcohol consumption at follow-up, smoking habit at follow-up, hsCRP, WC at follow-up, and hypertension. ^a Mutual adjustments between physical activity, screen time, and sleep duration. 95%CI = 95% confidence interval; hsCRP = high sensitivity C-reactive protein; PA = physical activity; PR = prevalence ratio; WC = waist circumference.