Association between walking pace and incident type 2 diabetes by adiposity level: A prospective cohort study from the UK Biobank

Abstract

Aims: To investigate the combined association of adiposity and walking pace with incident type 2 diabetes.

Methods: We undertook a prospective cohort study in 194 304 White-European participants (mean age 56.5 years, 55.9% women). Participants' walking pace was self-reported as brisk, average or slow. Adiposity measures included body mass index (BMI), waist circumference (WC) and body fat percentage (BF%). Associations were investigated using Cox proportional hazard models, with a 2-year landmark analysis. A four-way decomposition analysis was used for mediation and additive interaction.

Results: The median (interquartile range) follow-up was 5.4 (4.8-6.3) years. During the follow-up period, 4564 participants developed type 2 diabetes. Compared to brisk-walking participants with normal BMI, those with obesity who walked briskly were at an approximately 10- to 12-fold higher risk of type 2 diabetes (hazard ratio [HR] 9.64, 95% confidence interval [CI] 7.24-12.84, in women; HR 11.91, 95% CI 8.80-16.12, in men), whereas those with obesity and walked slowly had an approximately 12- to 15-fold higher risk (HR 12.68, 95% CI 9.62-16.71, in women; HR 15.41, 95% CI 11.27-21.06, in men). There was evidence of an additive interaction between WC and BF% and walking pace among women, explaining 17.8% and 47.9% excess risk respectively. Obesity mediated the association in women and men, accounting for 60.1% and 44.9%, respectively.

Conclusions: Slow walking pace is a risk factor for type 2 diabetes independent of adiposity. Promoting brisk walking as well as weight management might be an effective type 2 diabetes prevention strategy given their synergistic effects.

Keywords: body fat; gait; mediation; obesity; type 2 diabetes mellitus.

FIGURE 1

Combined association between adiposity and walking pace and incident type 2 diabetes. Data are presented as hazard ratio (HR) and 95% confidence interval (CI). Analyses were adjusted for age, deprivation index, education, smoking status, fruit and vegetable intake, red meat intake, processed meat intake, alcohol consumption, total sedentary time, sleep duration and multimorbidity. All analyses were conducted using 2‐year landmark analyses and excluding participants with type 1, type 2 diabetes, unknown diabetes and non‐White ethnic background. A, Combined association between body mass index and walking pace and incident type 2 diabetes. B, Combined association between waist circumference (WC) and walking pace and incident type 2 diabetes. C, Combined association between body fat percentage and walking pace and incident type 2 diabetes

FIGURE 2

Penalized cubic splines for the association between walking pace, adiposity and incident type 2 diabetes. Data are presented as hazard ratios and their 95% confidence interval (CI). Analyses were adjusted for age, deprivation index, education, smoking status, fruit and vegetable intake, red meat intake, processed meat intake, alcohol consumption, total sedentary time, sleep duration and multimorbidity. All analyses were conducted using 2‐year landmark analyses and excluding participants with type 1, type 2 diabetes, unknown diabetes and non‐white ethnic background. BF%, body fat percentage; BMI, body mass index; WC, waist circumference