Associations of 24 h time-use compositions of sitting, standing, physical activity and sleeping with optimal cardiometabolic risk and glycaemic control : The Maastricht Study

Journal article


Brakenridge, Christian J., Koster, Annemarie, de Galan, Bastiaan E., Carver, Alison, Dumuid, Dorothea, Dzakpasu, Francis Q. S., Eussen, Simone J. P. M., Savelberg, Hans H. C. M., Bosma, Hans, Owen, Neville, Schaper, Nicholas C., Healy, Genevieve N. and Dunstan, David W.. (2024). Associations of 24 h time-use compositions of sitting, standing, physical activity and sleeping with optimal cardiometabolic risk and glycaemic control : The Maastricht Study. Diabetologia. 67(7), pp. 1356-1367. https://doi.org/10.1007/s00125-024-06145-0
AuthorsBrakenridge, Christian J., Koster, Annemarie, de Galan, Bastiaan E., Carver, Alison, Dumuid, Dorothea, Dzakpasu, Francis Q. S., Eussen, Simone J. P. M., Savelberg, Hans H. C. M., Bosma, Hans, Owen, Neville, Schaper, Nicholas C., Healy, Genevieve N. and Dunstan, David W.
Abstract

Aims/hypothesis
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/interpretation
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.

Keywordscardiometabolic risk; glycaemic control; physical activity; sitting; sleep; time use
Year2024
JournalDiabetologia
Journal citation67 (7), pp. 1356-1367
PublisherSpringer
ISSN0012-186X
Digital Object Identifier (DOI)https://doi.org/10.1007/s00125-024-06145-0
PubMed ID38656371
Scopus EID2-s2.0-85191151463
PubMed Central IDPMC11153304
Open accessPublished as ‘gold’ (paid) open access
Page range1356-1367
FunderEuropean Regional Development Fund (FEDER)
Province of Limburg
Dutch Ministry of Economic Affairs
Stichting De Weijerhorst
Pearl String Initiative Diabetes
Cardiovascular Center
CARIM School for Cardiovascular Diseases
CAPHRI Care and Public Health Research Institute
NUTRIM School for Nutrition and Translational Research in Metabolism
Stichting Annadal
Health Foundation Limburg
Janssen-Cilag
Novo Nordisk Pharmaceuticals
Sanofi-Aventis
Australian Research Council (ARC)
National Health and Medical Research Council (NHMRC)
Operational Infrastructure Support (OIS) Program, Victorian Government
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online24 Apr 2024
Publication process dates
Accepted28 Feb 2024
Deposited02 Jun 2025
Supplemental file
License
File Access Level
Open
ARC Funded ResearchThis output has been funded, wholly or partially, under the Australian Research Council Act 2001
Grant ID31O.041
DE230101174
1193815
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© The Author(s) 2024.

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Ghekiere, Ariane, Cauwenberg, Jelle Van, Carver, Alison, Mertens, Lieze, de Geus, Bas, Clarys, Peter, Cardon, Greet, De Bourdeaudhuij, Ilse and Deforche, Benedicte. (2016). Psychosocial factors associated with children's cycling for transport: A cross-sectional moderation study. Preventive Medicine. 86, pp. 141 - 146. https://doi.org/10.1016/j.ypmed.2016.03.001
Objectively measured sedentary behaviour and health and development in children and adolescents: Systematic review and meta-analysis
Cliff, Dylan P., Hesketh, Kylie D., Vella, S. A., Hinkley, T., Tsiros, Margarita D., Ridgers, Nicola D., Carver, Alison, Veitch, Jenny, Parrish, A.-M., Hardy, L. L., Plotnikoff, Ron C., Okely, A. D., Salmon, Jo and Lubans, David R.. (2016). Objectively measured sedentary behaviour and health and development in children and adolescents: Systematic review and meta-analysis. Obesity Reviews. 17(4), pp. 330 - 344. https://doi.org/10.1111/obr.12371
Objectively measured sedentary behaviour and health and development in children and adolescents: Systematic review and meta-analysis
Cliff, Dylan, Hesketh, Kylie, Vella, S. A., Hinkley, T., Tsiros, Margarita D., Ridgers, Nicola D., Carver, Alison, Veitch, Jenny, Parrish, A. M., Hardy, L. L., Plotnikoff, Ron C., Okely, A. D., Salmon, Jo and Lubans, David. (2016). Objectively measured sedentary behaviour and health and development in children and adolescents: Systematic review and meta-analysis. Obesity Reviews. 17(4), pp. 330 - 344. https://doi.org/10.1111/obr.12371
Australian children's independent mobility levels: Secondary analyses of cross-sectional data between 1991 and 2012
Schoeppe, Stephanie, Tranter, Paul, Duncan, Mitch J., Curtis, Carey, Carver, Alison and Malone, Karen. (2016). Australian children's independent mobility levels: Secondary analyses of cross-sectional data between 1991 and 2012. Children's Geographies. 14(4), pp. 408 - 421. https://doi.org/10.1080/14733285.2015.1082083
Pyschosocial factors associated with children's cycling for transport: A cross-sectional moderation study
Ghekiere, Ariane, Van Cauwenberg, Jelle, Carver, Alison, Mertens, Lieze, de Geus, Bas, Clarys, Peter, Cardon, Greet, De Bourdeaudhuij, Ilse and Deforche, Benedicte. (2016). Pyschosocial factors associated with children's cycling for transport: A cross-sectional moderation study. Preventive Medicine. 86, pp. 141 - 146. https://doi.org/10.1016/j.ypmed.2016.03.001
Addressing the social determinants of inequities in physical activity and sedentary behaviours
Ball, Kylie, Carver, Alison, Downing, Katherine, Jackson, Michelle and O'Rourke, Kerryn. (2015). Addressing the social determinants of inequities in physical activity and sedentary behaviours. Health Promotion International. 30(S2), pp. ii8 - ii19. https://doi.org/10.1093/heapro/dav022
Addressing the social determinants of inequities in physical activity and sedentary behaviours
Ball, Kylie, Carver, Alison, Downing, Katherine, Jackson, Michelle and O'Rourke, Kerryn. (2015). Addressing the social determinants of inequities in physical activity and sedentary behaviours. Health Promotion International. 30, pp. ii8 - ii19. https://doi.org/10.1093/heapro/dav022
How active are people in metropolitan parks? An observational study of park visitation in Australia
Veitch, Jenny, Carver, Alison, Abbott, Gavin, Giles-Corti, Billie, Timperio, Anna and Salmon, Jo. (2015). How active are people in metropolitan parks? An observational study of park visitation in Australia. BMC Public Health. 15(610), pp. 1 - 8. https://doi.org/10.1186/s12889-015-1960-6
Bicycles gathering dust rather than raising dust - Prevalence and predictors of cycling among Australian schoolchildren
Carver, Alison, Timperio, Anna F. and Crawford, David A.. (2015). Bicycles gathering dust rather than raising dust - Prevalence and predictors of cycling among Australian schoolchildren. Journal of Science and Medicine in Sport. 18(5), pp. 540 - 544. https://doi.org/10.1016/j.jsams.2014.07.004
Safety in numbers: Does perceived safety mediate associations between the neighborhood social environment and physical activity among women living in disadvantaged neighborhoods?
Timperio, Anna, Veitch, Jenny and Carver, Alison. (2015). Safety in numbers: Does perceived safety mediate associations between the neighborhood social environment and physical activity among women living in disadvantaged neighborhoods? Preventive Medicine. 74, pp. 49 - 54. https://doi.org/10.1016/j.ypmed.2015.02.012
Safety in numbers: Does perceived safety mediate associations between the neighborhood social environment and physical activity among women living in disadvantaged neighborhoods?
Timperio, Anna, Veitch, Jenny and Carver, Alison. (2015). Safety in numbers: Does perceived safety mediate associations between the neighborhood social environment and physical activity among women living in disadvantaged neighborhoods? Preventive Medicine. 74, pp. 49 - 54. https://doi.org/10.1016/j.ypmed.2015.02.012
How active are people in metropolitan parks? An observational study of park visitation in Australia
Veitch, Jenny, Carver, Alison, Abbott, Gavin, Giles-Corti, Billie, Timperio, Anna and Salmon, Jo. (2015). How active are people in metropolitan parks? An observational study of park visitation in Australia. BMC Public Health. 15(610), pp. 1 - 8. https://doi.org/10.1186/s12889-015-1960-6
Bicycles gathering dust rather than raising dust - Prevalence and predictors of cycling among Australian schoolchildren
Carver, Alison, Timperio, Anna F. and Crawford, David A.. (2015). Bicycles gathering dust rather than raising dust - Prevalence and predictors of cycling among Australian schoolchildren. Journal of Science and Medicine in Sport. 18(5), pp. 540 - 544. https://doi.org/10.1016/j.jsams.2014.07.004
Exploring associations between parental and peer variables, personal variables and physical activity among adolescents: A mediation analysis
Verloigne, Maïté, Veitch, Jenny, Carver, Alison, Salmon, Jo, Cardon, Greet, De Bourdeaudhuij, Ilse and Timperio, Anna. (2014). Exploring associations between parental and peer variables, personal variables and physical activity among adolescents: A mediation analysis. BMC Public Health. 14(966), pp. 1 - 11. https://doi.org/10.1186/1471-2458-14-966
Are independent mobility and territorial range associated with park visitation among youth?
Veitch, Jenny, Carver, Alison, Hume, Clare, Crawford, David, Timperio, Anna, Ball, Kylie and Salmon, Jo. (2014). Are independent mobility and territorial range associated with park visitation among youth? International Journal of Behavioral Nutrition and Physical Activity. 11(1), pp. 1 - 6. https://doi.org/10.1186/1479-5868-11-73
Independent mobility on the journey to school: A joint cross-sectional and prospective exploration of social and physical environmental influences
Carver, Alison, Panter, Jenna R., Jones, Andrew P. and Van Sluijs, Esther. (2014). Independent mobility on the journey to school: A joint cross-sectional and prospective exploration of social and physical environmental influences. Journal of Transport and Health. 1(1), pp. 25 - 32. https://doi.org/10.1016/j.jth.2013.12.003
Exploring associations between parental and peer variables, personal variables and physical activity among adolescents: A mediation analysis
Verloigne, Maïté, Veitch, Jenny, Carver, Alison, Salmon, Jo, Cardon, Greet, De Bourdeaudhuij, Ilse and Timperio, Anna. (2014). Exploring associations between parental and peer variables, personal variables and physical activity among adolescents: A mediation analysis. BMC Public Health. 14(1), pp. 1 - 11. https://doi.org/10.1186/1471-2458-14-966
Active transport, independent mobility and territorial range among children residing in disadvantaged areas
Carver, Alison, Veitch, Jenny, Sahlqvist, Shannon, Crawford, David and Hume, Clare. (2014). Active transport, independent mobility and territorial range among children residing in disadvantaged areas. Journal of Transport and Health. 1(4), pp. 267 - 273. https://doi.org/10.1016/j.jth.2014.01.004
A natural experiment to examine the impact of park renewal on park-use and park-based physical activity in a disadvantaged neighbourhood: The REVAMP study methods
Veitch, Jenny, Salmon, Jo, Carver, Alison, Timperio, Anna, Crawford, David, Fletcher, Elly and Giles-Corti, Billie. (2014). A natural experiment to examine the impact of park renewal on park-use and park-based physical activity in a disadvantaged neighbourhood: The REVAMP study methods. BMC Public Health. 14(600), pp. 1 - 9. https://doi.org/10.1186/1471-2458-14-600
Effective recruitment and retention strategies in community health programs
McCann, Jennifer, Ridgers, Nicola D., Carver, Alison, Thornton, Lukar E. and Teychenne, Megan. (2013). Effective recruitment and retention strategies in community health programs. Health Promotion Journal of Australia. 24(2), pp. 104 - 110. https://doi.org/10.1071/HE13042
Parental chauffeurs: What drives their transport choice?
Carver, Alison, Timperio, Anna and Crawford, David. (2013). Parental chauffeurs: What drives their transport choice? Journal of Transport Geography. 26, pp. 72 - 77. https://doi.org/10.1016/j.jtrangeo.2012.08.017
A comparison study of children's independent mobility in England and Australia
Carver, Alison, Watson, Ben, Shaw, Ben and Hillman, Mayer. (2013). A comparison study of children's independent mobility in England and Australia. Children's Geographies. 11(4), pp. 461 - 475. https://doi.org/10.1080/14733285.2013.812303
Maternal Misconceptions of Weight Status among Nepean Adolescents
Shrewsbury, Vanessa A., Garnett, S. P., Campbell, Karen, Carver, Alison, Torvaldsen, Siranda, Steinbeck, Katharine S., Cowell, Chris T. and Baur, Louise A.. (2012). Maternal Misconceptions of Weight Status among Nepean Adolescents. Journal of the Academy of Nutrition and Dietetics. 112(12), pp. 2007 - 2013. https://doi.org/10.1016/j.jand.2012.08.024
How does perceived risk mediate associations between perceived safety and parental restriction of adolescents' physical activity in their neighborhood?
Carver, Alison, Timperio, Anna, Hesketh, Kylie and Crawford, David. (2012). How does perceived risk mediate associations between perceived safety and parental restriction of adolescents' physical activity in their neighborhood? International Journal of Behavioral Nutrition and Physical Activity. 9(1), pp. 1 - 7. https://doi.org/10.1186/1479-5868-9-57
Young and free? A study of independent mobility among urban and rural dwelling Australian children
Carver, Alison, Timperio, Anna F. and Crawford, David A.. (2012). Young and free? A study of independent mobility among urban and rural dwelling Australian children. Journal of Science and Medicine in Sport. 15(6), pp. 505 - 510. https://doi.org/10.1016/j.jsams.2012.03.005
How is active transport associated with children's and adolescents' physical activity over time?
Carver, Alison, Timperio, Anna F., Hesketh, Kylie D., Ridgers, Nicola D., Salmon, Jo L. and Crawford, David A.. (2011). How is active transport associated with children's and adolescents' physical activity over time? International Journal of Behavioral Nutrition and Physical Activity. 8(126), p. 6. https://doi.org/10.1186/1479-5868-8-126