Diurnal timing of physical activity in relation to obesity and diabetes in the German National Cohort (NAKO)

Michael J Stein¹, Andrea Weber², Fabian Bamberg³, Hansjörg Baurecht², Klaus Berger⁴, Patricia Bohmann², Hermann Brenner⁵, Julian Brummer^{6

7}, Marcus Dörr^{8

9}, Beate Fischer², Sylvia Gastell¹⁰, Karin Halina Greiser¹¹, Volker Harth¹², Antje Hebestreit¹³, Jana-Kristin Heise¹⁴, Florian Herbolsheimer⁶, Till Ittermann¹⁵, André Karch⁴, Thomas Keil^{16

17

18}, Alexander Kluttig¹⁹, Lilian Krist¹⁶, Karin B Michels²⁰, Rafael Mikolajczyk¹⁹, Matthias Nauck^{9

21}, Katharina Nimptsch²², Nadia Obi¹², Tobias Pischon^{22

23

24}, Olga Pivovarova-Ramich^{10

25

26}, Tamara Schikowski²⁷, Börge Schmidt²⁸, Matthias B Schulze^{25

29

30}, Karen Steindorf⁶, Stephanie Zylla^{21

22}, Michael F Leitzmann²

Affiliations

¹ Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany. michael.stein@ukr.de.
² Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
³ Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
⁴ Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany.
⁵ Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
⁶ Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany.
⁷ Medical Faculty, Heidelberg University, Heidelberg, Germany.
⁸ Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.
⁹ German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany.
¹⁰ Department of Molecular Metabolism and Precision Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
¹¹ Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
¹² Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹³ Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
¹⁴ Department for Epidemiology, Helmholtz Centre for Infection Research (HZI), Hannover, Germany.
¹⁵ Department SHIP clinical epidemiological research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
¹⁶ Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany.
¹⁷ Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.
¹⁸ State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany.
¹⁹ Institute of Medical Epidemiology, Biometrics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
²⁰ Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
²¹ Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.
²² Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany.
²³ Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin, Germany.
²⁴ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
²⁵ German Center for Diabetes Research (DZD), Neuherberg, Germany.
²⁶ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Endocrinology and Metabolism, Berlin, Germany.
²⁷ Department of Epidemiology, IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany.
²⁸ Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
²⁹ Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
³⁰ Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany.

PMID: 39856244
PMCID: PMC12095084
DOI: 10.1038/s41366-025-01721-9

Diurnal timing of physical activity in relation to obesity and diabetes in the German National Cohort (NAKO)

Michael J Stein et al. Int J Obes (Lond). 2025 May.

. 2025 May;49(5):921-930.

doi: 10.1038/s41366-025-01721-9. Epub 2025 Jan 24.

Authors

Affiliations

¹ Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany. michael.stein@ukr.de.
² Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
³ Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
⁴ Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany.
⁵ Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
⁶ Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany.
⁷ Medical Faculty, Heidelberg University, Heidelberg, Germany.
⁸ Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.
⁹ German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany.
¹⁰ Department of Molecular Metabolism and Precision Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
¹¹ Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
¹² Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹³ Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
¹⁴ Department for Epidemiology, Helmholtz Centre for Infection Research (HZI), Hannover, Germany.
¹⁵ Department SHIP clinical epidemiological research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
¹⁶ Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany.
¹⁷ Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.
¹⁸ State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany.
¹⁹ Institute of Medical Epidemiology, Biometrics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
²⁰ Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
²¹ Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.
²² Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany.
²³ Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin, Germany.
²⁴ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
²⁵ German Center for Diabetes Research (DZD), Neuherberg, Germany.
²⁶ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Endocrinology and Metabolism, Berlin, Germany.
²⁷ Department of Epidemiology, IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany.
²⁸ Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
²⁹ Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
³⁰ Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany.

PMID: 39856244
PMCID: PMC12095084
DOI: 10.1038/s41366-025-01721-9

Abstract

Background: Physical activity supports weight regulation and metabolic health, but its timing in relation to obesity and diabetes remains unclear. We aimed to assess the diurnal timing of physical activity and its association with obesity and diabetes.

Methods: We cross-sectionally analyzed hip-worn accelerometry data from 61,116 participants aged 20-75 in the German National Cohort between 2015 and 2019. We divided physical activity into sex- and age-standardized quartiles of total morning (06:00-11:59), afternoon (12:00-17:59), evening (18:00-23:59), and nighttime (00:00-06:00) physical activity. Using multivariable logistic regression, we estimated associations of physical activity timing with obesity (BMI ≥ 30.0 kg/m²) and diabetes (self-reported or HbA1c ≥ 6.5%). We accounted for sex, age, study region, education, employment, risky alcohol use, smoking, night shift work, and sleep duration.

Results: High afternoon (top vs. bottom quartile, OR: 0.36, 95% CI: 0.33-0.38) and evening physical activity (OR: 0.45, 95% CI: 0.42-0.48) showed lower obesity odds than high morning activity (OR: 0.71, 95% CI: 0.66-0.76), whereas nighttime activity increased obesity odds (OR: 1.58, 95% CI: 1.48-1.68). Associations were similar for diabetes, with the lowest odds for afternoon (OR: 0.47, 95% CI: 0.42-0.53), followed by evening (OR: 0.56, 95% CI: 0.50-0.62) and morning activity (OR: 0.80, 95% CI: 0.71-0.89), and higher odds for nighttime activity (OR: 1.43, 95% CI: 1.29-1.58). Findings were not modified by employment status, night shift work, and sleep duration.

Conclusions: Our cross-sectional findings require longitudinal corroboration but suggest afternoon and evening activity provide greater metabolic health benefits than morning activity, while nighttime activity is discouraged.

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Conflict of interest statement

Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: The NAKO obtained ethics approval from all local committees of the study centers (original ethics approval of the leading ethics committee of the Bayerische Landesaerztekammer with protocol code 13023). All participants provided written informed consent. This study was conducted in line with the Declaration of Helsinki and the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guideline for cross-sectional studies.

Figures

**Fig. 1. Odds ratios and 95% confidence intervals (CI) for timing of physical activity in relation to obesity (left) and diabetes (right).**
Adjusted for sex, age, study region, education, employment status, alcohol use, smoking status, night shift work frequency, and sleep duration.

See this image and copyright information in PMC

References

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Diurnal timing of physical activity in relation to obesity and diabetes in the German National Cohort (NAKO)

Affiliations

Diurnal timing of physical activity in relation to obesity and diabetes in the German National Cohort (NAKO)

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical