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Abstract：
OBJECTIVE: The associations of sitting, standing, physical activity and sleep with cardiometabolic health and glycaemic control markers are interrelated. We aimed to identify 24 h time-use compositions associated with optimal metabolic and glycaemic control and determine whether these varied by diabetes status.
METHODS: Thigh-worn activPAL data from 2388 participants aged 40-75 years (48.7% female; mean age 60.1 [SD = 8.1] years; n=684 with type 2 diabetes) in The Maastricht Study were examined. Compositional isometric log ratios were generated from mean 24 h time use (sitting, standing, light-intensity physical activity [LPA], moderate-to-vigorous physical activity [MVPA] and sleeping) and regressed with outcomes of waist circumference, fasting plasma glucose (FPG), 2 h plasma glucose, HbA1c, the Matsuda index expressed as z scores, and with a clustered cardiometabolic risk score. Overall analyses were adjusted for demographics, smoking, dietary intake and diabetes status, and interaction by diabetes status was examined separately. The estimated difference when substituting 30 min of one behaviour with another was determined with isotemporal substitution. To identify optimal time use, all combinations of 24 h compositions possible within the study footprint (1st-99th percentile of each behaviour) were investigated to determine those cross-sectionally associated with the most-optimal outcome (top 5%) for each outcome measure.
RESULTS: Compositions lower in sitting time and with greater standing time, physical activity and sleeping had the most beneficial associations with outcomes. Associations were stronger in participants with type 2 diabetes (p<0.05 for interactions), with larger estimated benefits for waist circumference, FPG and HbA1c when sitting was replaced by LPA or MVPA in those with type 2 diabetes vs the overall sample. The mean (range) optimal compositions of 24 h time use, considering all outcomes, were 6 h (range 5 h 40 min-7 h 10 min) for sitting, 5 h 10 min (4 h 10 min-6 h 10 min) for standing, 2 h 10 min (2 h-2 h 20 min) for LPA, 2 h 10 min (1 h 40 min-2 h 20 min) for MVPA and 8 h 20 min (7 h 30 min-9 h) for sleeping.
CONCLUSIONS: Shorter sitting time and more time spent standing, undergoing physical activity and sleeping are associated with preferable cardiometabolic health. The substitutions of behavioural time use were significantly stronger in their associations with glycaemic control in those with type 2 diabetes compared with those with normoglycaemic metabolism, especially when sitting time was balanced with greater physical activity.
METHODS: Thigh-worn activPAL data from 2388 participants aged 40-75 years (48.7% female; mean age 60.1 [SD = 8.1] years; n=684 with type 2 diabetes) in The Maastricht Study were examined. Compositional isometric log ratios were generated from mean 24 h time use (sitting, standing, light-intensity physical activity [LPA], moderate-to-vigorous physical activity [MVPA] and sleeping) and regressed with outcomes of waist circumference, fasting plasma glucose (FPG), 2 h plasma glucose, HbA1c, the Matsuda index expressed as z scores, and with a clustered cardiometabolic risk score. Overall analyses were adjusted for demographics, smoking, dietary intake and diabetes status, and interaction by diabetes status was examined separately. The estimated difference when substituting 30 min of one behaviour with another was determined with isotemporal substitution. To identify optimal time use, all combinations of 24 h compositions possible within the study footprint (1st-99th percentile of each behaviour) were investigated to determine those cross-sectionally associated with the most-optimal outcome (top 5%) for each outcome measure.
RESULTS: Compositions lower in sitting time and with greater standing time, physical activity and sleeping had the most beneficial associations with outcomes. Associations were stronger in participants with type 2 diabetes (p<0.05 for interactions), with larger estimated benefits for waist circumference, FPG and HbA1c when sitting was replaced by LPA or MVPA in those with type 2 diabetes vs the overall sample. The mean (range) optimal compositions of 24 h time use, considering all outcomes, were 6 h (range 5 h 40 min-7 h 10 min) for sitting, 5 h 10 min (4 h 10 min-6 h 10 min) for standing, 2 h 10 min (2 h-2 h 20 min) for LPA, 2 h 10 min (1 h 40 min-2 h 20 min) for MVPA and 8 h 20 min (7 h 30 min-9 h) for sleeping.
CONCLUSIONS: Shorter sitting time and more time spent standing, undergoing physical activity and sleeping are associated with preferable cardiometabolic health. The substitutions of behavioural time use were significantly stronger in their associations with glycaemic control in those with type 2 diabetes compared with those with normoglycaemic metabolism, especially when sitting time was balanced with greater physical activity.
摘要：
目标：坐姿的关联，站立,身体活动和睡眠与心脏代谢健康和血糖控制指标是相互关联的。我们旨在确定与最佳代谢和血糖控制相关的24小时时间使用成分，并确定这些成分是否因糖尿病状态而变化。
方法：检查了马斯特里赫特研究中2388名年龄在40-75岁的参与者（48.7%为女性；平均年龄60.1[SD=8.1]岁；n=684名2型糖尿病患者）的大腿穿着activPAL数据。组成等距对数比是从平均24小时使用时间生成的(坐，站立,光强度体力活动[LPA]，中等至剧烈的身体活动[MVPA]和睡眠），并随着腰围的结果而消退，空腹血糖（FPG），2h血浆葡萄糖，HbA1c,以z分数表示的松田指数，和聚集的心脏代谢风险评分。总体分析根据人口统计学进行了调整，吸烟,饮食摄入和糖尿病状态，和糖尿病状态的相互作用进行了单独检查。用等时取代确定用另一种行为代替30分钟时的估计差异。为了确定最佳时间使用，对研究足迹范围内所有可能的24h组合物组合(每种行为的第1-第99百分位数)进行了调查,以确定与每种结局指标的最佳结局(前5%)横断面相关的组合.
结果：组合物的久坐时间较低，站立时间较长，体力活动和睡眠与结局有最有益的关联.2型糖尿病参与者的关联更强(相互作用p<0.05)，对腰围有更大的估计好处，2型糖尿病患者的FPG和HbA1c在坐位时被LPA或MVPA取代，与整体样本相比。24小时使用的平均(范围)最佳组成，考虑到所有结果，坐着6小时(范围5小时40分钟-7小时10分钟)，5h10min（4h10min-6h10min）静置，LPA为2小时10分钟（2小时-2小时20分钟），2小时10分钟（1小时40分钟-2小时20分钟）的MVPA和8小时20分钟（7小时30分钟-9小时）的睡眠。
结论：坐着的时间更短，站立的时间更多，进行体力活动和睡眠与较好的心脏代谢健康相关。与正常血糖代谢的患者相比，2型糖尿病患者的行为时间使用替代与血糖控制的相关性明显更强。尤其是当坐着的时间与更多的体力活动平衡时。
方法：检查了马斯特里赫特研究中2388名年龄在40-75岁的参与者（48.7%为女性；平均年龄60.1[SD=8.1]岁；n=684名2型糖尿病患者）的大腿穿着activPAL数据。组成等距对数比是从平均24小时使用时间生成的(坐，站立,光强度体力活动[LPA]，中等至剧烈的身体活动[MVPA]和睡眠），并随着腰围的结果而消退，空腹血糖（FPG），2h血浆葡萄糖，HbA1c,以z分数表示的松田指数，和聚集的心脏代谢风险评分。总体分析根据人口统计学进行了调整，吸烟,饮食摄入和糖尿病状态，和糖尿病状态的相互作用进行了单独检查。用等时取代确定用另一种行为代替30分钟时的估计差异。为了确定最佳时间使用，对研究足迹范围内所有可能的24h组合物组合(每种行为的第1-第99百分位数)进行了调查,以确定与每种结局指标的最佳结局(前5%)横断面相关的组合.
结果：组合物的久坐时间较低，站立时间较长，体力活动和睡眠与结局有最有益的关联.2型糖尿病参与者的关联更强(相互作用p<0.05)，对腰围有更大的估计好处，2型糖尿病患者的FPG和HbA1c在坐位时被LPA或MVPA取代，与整体样本相比。24小时使用的平均(范围)最佳组成，考虑到所有结果，坐着6小时(范围5小时40分钟-7小时10分钟)，5h10min（4h10min-6h10min）静置，LPA为2小时10分钟（2小时-2小时20分钟），2小时10分钟（1小时40分钟-2小时20分钟）的MVPA和8小时20分钟（7小时30分钟-9小时）的睡眠。
结论：坐着的时间更短，站立的时间更多，进行体力活动和睡眠与较好的心脏代谢健康相关。与正常血糖代谢的患者相比，2型糖尿病患者的行为时间使用替代与血糖控制的相关性明显更强。尤其是当坐着的时间与更多的体力活动平衡时。
