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Article(id=1240375113229594761, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202311130, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1699286400000, receivedDateStr=2023-11-07, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773658072048, onlineDateStr=2026-03-16, pubDate=1711296000000, pubDateStr=2024-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773658072048, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773658072048, creator=13701087609, updateTime=1773658072048, updator=13701087609, issue=Issue{id=1240375105386238038, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='6', pageStart='961', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773658070179, creator=13701087609, updateTime=1773658539618, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240377074414833974, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240377074414833975, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1063, endPage=1069, ext={EN=ArticleExt(id=1240375113523196068, articleId=1240375113229594761, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Correlation analyses of sedentary behavior and insulin resistance in middle-aged and elderly non-diabetic population, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the sedentary behavior of middle-aged and elderly non-diabetic population in Lanzhou and explore its correlation with insulin resistance (IR).

Methods

A cluster random sampling method was used to select residents aged 40-75 years from the survey data of the "REACTION Study" conducted between 2014 and 2016 in Lanzhou. A total of 3 609 individuals who met the inclusion criteria were included in this study. The sedentary time was divided into <3 h/d, 3-5 h/d and ≥5 h/d groups. Insulin resistance was diagnosed using the homeostasis model assessment of insulin resistance (HOMA-IR). Multivariate logistic regression analysis was performed to examine the association between sedentary behavior and IR, while subgroup analysis explored this relationship among different population subgroups.

Results

The average daily sedentary time for study population was found to be approximately 4.00±1.92 h/d, with an overall prevalence rate of IR at 25.0%. The prevalence rates of IR for those with a sedentary time <3 h/d, 3-5 h/d and ≥5 h/d were observed as follows: 21.7%, 24.9% and 31%, respectively, with statistically significant differences (χ2=24.447, P<0.05). After adjusting for various confounding factors through logistic regression analysis, it was revealed that compared with sedentary <3 h/d, sedentary ≥5 h/d was a risk factor for the prevalence of IR (OR=1.468, 95% CI:1.168-1.845, P<0.05). Subgroup analysis indicated that only within subgroups consisting of individuals aged≥65 years old (OR=1.060,95% CI:1.005-1.118), insufficient physical activity (OR=1.071, 95% CI:1.017-1.128), hyperlipidemia (OR=1.071,95% CI:1.001-1.145), no hyperuricemia (OR=1.062, 95% CI:1.010-1.117), fatty liver (OR=1.133, 95% CI:1.038-1.237), and WC≥85 cm (OR=1.079, 95% CI:1.017-1.144), increased sedentary time was associated with increased risk of IR (all P<0.05).

Conclusion

Sedentary behavior is positively associated with the occurrence of IR in middle-aged and elderly non-diabetic population.However, the findings may vary across populations with distinct characteristics.

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目的

了解兰州市中老年非糖尿病人群的久坐情况，并探讨久坐行为与胰岛素抵抗（IR）的相关性。

方法

使用兰州市REACTION研究2014—2016年的调查数据，利用整群随机抽样选取年龄为40~75岁的居民，对符合纳入标准的3 609人进行研究，将久坐时间分为<3 h/d、3~5 h/d及>5 h/d三组，依据稳态模型评估胰岛素抵抗指数（HOMA-IR）诊断IR，采用多因素logistic回归模型分析久坐行为与IR的关联，并通过亚组分析探索不同分组下久坐时间与IR的相关性。

结果

研究人群平均久坐时间为4.00±1.92 h/d，总体IR患病率为25.0%，其中<3 h/d、3~5 h/d及>5 h/d人群中IR的患病率分别为21.7%、24.9%及31.0%，差异具有统计学差异（χ2=24.447，P<0.05）。在调整多种混杂因素后，logistic回归分析结果显示，与久坐<3h/d对比，久坐>5 h/d是IR患病的危险因素（OR=1.468，95% CI:1.168~1.845，P<0.05）。亚组分析表明，仅在年龄<65岁（OR=1.060，95% CI:1.005~1.118）、体力活动不足（OR=1.071，95% CI:1.017~1.128）、高血脂（OR=1.071，95% CI:1.001~1.145）、无高尿酸血症（OR=1.062，95% CI:1.010~1.117）、脂肪肝（OR=1.133，95% CI:1.038~1.237）、WC≥85cm（OR=1.079，95% CI:1.017~1.144）的个体亚组中，久坐时间增加与IR患病风险增加相关（均P<0.05）。

结论

中老年非糖尿病人群久坐行为与IR发生呈正相关，但在不同特征人群中结果可能存在差异。

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甄东户，E-mail：
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石兴文（1997—），男，硕士在读，研究方向：糖尿病及相关并发症

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Acta Physiologica, 2023, 237(4): e13945., articleTitle=Physical activity and sedentary behavior show distinct associations with tissue-specific insulin sensitivity in adults with overweight, refAbstract=null)], funds=[Fund(id=1240746304247223152, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113229594761, awardId=23YFFA0032, language=CN, fundingSource=甘肃省重点研发计划(23YFFA0032), fundOrder=null, country=null), Fund(id=1240746304352080755, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113229594761, awardId=I期10研究, language=CN, fundingSource=上海市医药卫生发展基金会糖尿病临床研究项目(I期10研究), fundOrder=null, country=null), Fund(id=1240746304452744055, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113229594761, awardId=2018-mmczxjj-3, language=CN, fundingSource=国家标准化代谢性疾病管理中心专项研究基金(2018-mmczxjj-3), fundOrder=null, country=null), Fund(id=1240746304586961794, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113229594761, awardId=21JR1RA096, language=CN, fundingSource=甘肃省自然科学基金(21JR1RA096), fundOrder=null, country=null), Fund(id=1240746304691819398, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113229594761, awardId=lzuyxcx-2022-112, language=CN, fundingSource=医学院校硕士研究生学位论文质量提升策略研究(lzuyxcx-2022-112), fundOrder=null, country=null), Fund(id=1240746304817648525, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113229594761, awardId=820809036, language=CN, fundingSource=医学院校硕士研究生学位论文质量提升策略研究(820809036), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240746301093106390, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113229594761, xref=1., ext=[AuthorCompanyExt(id=1240746301101494999, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113229594761, companyId=1240746301093106390, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=The First Clinical Medical College of Lanzhou University; Department of Endocrinology, First Hospital of Lanzhou University, Lanzhou, Gansu 730030, China), AuthorCompanyExt(id=1240746301109883609, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113229594761, companyId=1240746301093106390, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.兰州大学第一临床医学院，甘肃 兰州 730030)]), AuthorCompany(id=1240746301210546913, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113229594761, xref=2., ext=[AuthorCompanyExt(id=1240746301218935522, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113229594761, companyId=1240746301210546913, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.兰州大学第一医院内分泌科)])], figs=[ArticleFig(id=1240746303278338878, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113229594761, language=EN, label=Fig.1, caption=Subgroup analysis of sedentary time and IR, figureFileSmall=guP92+tnKy3901wNYRw8LA==, figureFileBig=E/nomwlN8AZ+wValjcINng==, tableContent=null), ArticleFig(id=1240746303374807875, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113229594761, language=CN, label=图1, caption=久坐时间与IR的亚组分析, figureFileSmall=guP92+tnKy3901wNYRw8LA==, figureFileBig=E/nomwlN8AZ+wValjcINng==, tableContent=null), ArticleFig(id=1240746303504831307, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113229594761, language=EN, label=Table 1, caption=

Basic characteristics of the study population under different sedentary time

, figureFileSmall=null, figureFileBig=null, tableContent=
基本特征<3 h/d(n=1 472)3~5 h/d(n=1 314)>5 h/d(n=823)f/z/χ2P值
年龄(岁)60.86±7.6960.11±7.5158.66±8.1020.145<0.001
性别6.5130.039
男338(23.0)332(25.3)228(27.7)
女1 134(77.0)982(74.7)595(72.3)a
总收入(万元/年)1.1460.564
≤3278(19.4)240(18.5)142(17.6)
>31 154(80.6)1 054(81.5)665(82.4)
文化程度31.716<0.001
高中以下657(44.8)506(38.6)271(33.0)
高中及以上809(55.2)804(61.4)a549(67.0)a,b
目前工作180(12.2)192(14.6)203(24.7)a,b63.6560.001
体力活动79.930<0.001
充分546(37.1)440(33.5)159(19.3)
不足926(62.9)874(66.5)655(72.7)a,b
现在吸烟119(8.1)142(10.8)a120(14.6)a,b23.731<0.001
现在饮酒64(4.3)63(4.8)58(7.0)a8.3770.015
打鼾384(26.2)405(30.9)a244(29.6)8.1370.017
睡眠质量0.3820.826
良好1 034(70.3)911(69.4)570(69.3)
较差437(29.7)402(30.6)253(30.7)
食盐摄入量(g/d)0.1240.940
≤5211(14.3)194(14.8)118(14.3)
>51 261(85.7)1 120(85.2)705(85.7)
高血压474(32.2)441(33.6)269(32.7)0.5900.744
高血脂483(32.8)493(37.5)a332(40.3)a14.4020.001
高尿酸血症166(11.3)184(14.0)114(13.9)5.5460.062
脂肪肝278(18.9)274(20.9)180(21.9)3.2560.196
BMI(kg/m2)24.07±3.4324.27±3.4324.61±3.24a6.7690.001
WC(cm)82.42±9.8082.61±9.4684.38±9.86a,b12.002<0.001
HC(cm)95.15±7.0695.50±6.7996.47±7.64a,b8.365<0.001
NC(cm)33.30±3.3433.31±3.0333.75±3.29a,b6.1080.002
HR(次/min)76.77±10.9176.81±10.6477.35±10.810.8670.420
HbA1c(%)5.53±0.355.54±0.355.53±0.340.1260.881
FBG(mmol/L)5.02±0.505.05±0.495.03±0.491.1820.307
2hPG(mmol/L)6.65±1.626.78±1.696.72±1.652.4400.087
FINS(mIU/L)6.70(4.90,9.00)7.20(5.40,9.60)a7.80(5.60,10.20)a,b46.779<0.001
HOMA-IR1.49(1.05,2.09)1.60(2.27,2.20)a1.72(1.24,2.37)a,b41.950<0.001
IR319(21.7)327(24.9)255(31.0)a,b24.447<0.001
), ArticleFig(id=1240746303576134482, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113229594761, language=CN, label=表1, caption=

不同久坐时间下研究人群的基本特征

, figureFileSmall=null, figureFileBig=null, tableContent=
基本特征<3 h/d(n=1 472)3~5 h/d(n=1 314)>5 h/d(n=823)f/z/χ2P值
年龄(岁)60.86±7.6960.11±7.5158.66±8.1020.145<0.001
性别6.5130.039
男338(23.0)332(25.3)228(27.7)
女1 134(77.0)982(74.7)595(72.3)a
总收入(万元/年)1.1460.564
≤3278(19.4)240(18.5)142(17.6)
>31 154(80.6)1 054(81.5)665(82.4)
文化程度31.716<0.001
高中以下657(44.8)506(38.6)271(33.0)
高中及以上809(55.2)804(61.4)a549(67.0)a,b
目前工作180(12.2)192(14.6)203(24.7)a,b63.6560.001
体力活动79.930<0.001
充分546(37.1)440(33.5)159(19.3)
不足926(62.9)874(66.5)655(72.7)a,b
现在吸烟119(8.1)142(10.8)a120(14.6)a,b23.731<0.001
现在饮酒64(4.3)63(4.8)58(7.0)a8.3770.015
打鼾384(26.2)405(30.9)a244(29.6)8.1370.017
睡眠质量0.3820.826
良好1 034(70.3)911(69.4)570(69.3)
较差437(29.7)402(30.6)253(30.7)
食盐摄入量(g/d)0.1240.940
≤5211(14.3)194(14.8)118(14.3)
>51 261(85.7)1 120(85.2)705(85.7)
高血压474(32.2)441(33.6)269(32.7)0.5900.744
高血脂483(32.8)493(37.5)a332(40.3)a14.4020.001
高尿酸血症166(11.3)184(14.0)114(13.9)5.5460.062
脂肪肝278(18.9)274(20.9)180(21.9)3.2560.196
BMI(kg/m2)24.07±3.4324.27±3.4324.61±3.24a6.7690.001
WC(cm)82.42±9.8082.61±9.4684.38±9.86a,b12.002<0.001
HC(cm)95.15±7.0695.50±6.7996.47±7.64a,b8.365<0.001
NC(cm)33.30±3.3433.31±3.0333.75±3.29a,b6.1080.002
HR(次/min)76.77±10.9176.81±10.6477.35±10.810.8670.420
HbA1c(%)5.53±0.355.54±0.355.53±0.340.1260.881
FBG(mmol/L)5.02±0.505.05±0.495.03±0.491.1820.307
2hPG(mmol/L)6.65±1.626.78±1.696.72±1.652.4400.087
FINS(mIU/L)6.70(4.90,9.00)7.20(5.40,9.60)a7.80(5.60,10.20)a,b46.779<0.001
HOMA-IR1.49(1.05,2.09)1.60(2.27,2.20)a1.72(1.24,2.37)a,b41.950<0.001
IR319(21.7)327(24.9)255(31.0)a,b24.447<0.001
), ArticleFig(id=1240746303697769301, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113229594761, language=EN, label=Table 2, caption=

Basic characteristics of the non-IR and IR groups

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基本特征非IR组(n=2 708)IR组(n=901)t/z/χ2P值
年龄(岁)59.89±7.7960.67±7.65-2.5930.010
性别0.0000.987
男674(24.9)224(24.9)
女2 034(75.1)677(75.1)
总收入(万元/年)1.7150.190
≤3508(19.2)152(17.2)
>32 141(80.8)732(82.8)
文化程度4.6780.031
高中以下1 048(38.9)386(42.9)
高中及以上1 649(61.1)513(57.1)
目前工作453(16.7)122(13.5)5.1290.024
体力活动10.8460.001
充分899(33.2)246(27.3)
不足1 809(66.8)655(72.7)
现在吸烟293(10.8)88(9.8)0.7940.373
现在饮酒134(4.9)51(5.7)0.7050.401
打鼾678(25.1)355(39.6)69.494<0.001
睡眠质量1.1430.285
良好1 874(69.3)641(71.1)
较差832(30.7)260(28.9)
食盐摄入量(g/d)0.0710.791
≤5390(14.4)133(14.8)
>52 318(85.6)768(85.2)
高血压765(28.2)419(46.5)102.194<0.001
高血脂827(30.5)481(53.4)152.706<0.001
高尿酸血症270(10.0)194(21.5)80.654<0.001
脂肪肝391(14.4)341(37.8)228.764<0.001
久坐时间(h/d)3.91±1.894.24±2.00-4.327<0.001
BMI(kg/m2)23.59±3.0926.29±3.46-22.019<0.001
WC(cm)81.23±9.3488.05±9.03-19.136<0.001
HC(cm)94.47±6.6098.92±7.57-15.761<0.001
NC(cm)33.05±3.1434.48±3.23-11.759<0.001
HR(次/min)76.11±10.5778.34±9.57-7.857<0.001
HbA1c(%)5.50±0.345.64±0.36-10.754<0.001
FBG(mmol/L)4.93±0.455.34±0.50-21.649<0.001
2hPG(mmol/L)6.47±1.577.44±1.68-15.339<0.001
FINS(mIU/L)6.10(4.80,7.60)11.90(10.40,14.20)-44.116<0.001
HOMA-IR1.34(1.02,1.72)2.78(2.43,3.32)-45.029<0.001
), ArticleFig(id=1240746303794238298, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113229594761, language=CN, label=表2, caption=

非IR组与IR组的基本特征

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基本特征非IR组(n=2 708)IR组(n=901)t/z/χ2P值
年龄(岁)59.89±7.7960.67±7.65-2.5930.010
性别0.0000.987
男674(24.9)224(24.9)
女2 034(75.1)677(75.1)
总收入(万元/年)1.7150.190
≤3508(19.2)152(17.2)
>32 141(80.8)732(82.8)
文化程度4.6780.031
高中以下1 048(38.9)386(42.9)
高中及以上1 649(61.1)513(57.1)
目前工作453(16.7)122(13.5)5.1290.024
体力活动10.8460.001
充分899(33.2)246(27.3)
不足1 809(66.8)655(72.7)
现在吸烟293(10.8)88(9.8)0.7940.373
现在饮酒134(4.9)51(5.7)0.7050.401
打鼾678(25.1)355(39.6)69.494<0.001
睡眠质量1.1430.285
良好1 874(69.3)641(71.1)
较差832(30.7)260(28.9)
食盐摄入量(g/d)0.0710.791
≤5390(14.4)133(14.8)
>52 318(85.6)768(85.2)
高血压765(28.2)419(46.5)102.194<0.001
高血脂827(30.5)481(53.4)152.706<0.001
高尿酸血症270(10.0)194(21.5)80.654<0.001
脂肪肝391(14.4)341(37.8)228.764<0.001
久坐时间(h/d)3.91±1.894.24±2.00-4.327<0.001
BMI(kg/m2)23.59±3.0926.29±3.46-22.019<0.001
WC(cm)81.23±9.3488.05±9.03-19.136<0.001
HC(cm)94.47±6.6098.92±7.57-15.761<0.001
NC(cm)33.05±3.1434.48±3.23-11.759<0.001
HR(次/min)76.11±10.5778.34±9.57-7.857<0.001
HbA1c(%)5.50±0.345.64±0.36-10.754<0.001
FBG(mmol/L)4.93±0.455.34±0.50-21.649<0.001
2hPG(mmol/L)6.47±1.577.44±1.68-15.339<0.001
FINS(mIU/L)6.10(4.80,7.60)11.90(10.40,14.20)-44.116<0.001
HOMA-IR1.34(1.02,1.72)2.78(2.43,3.32)-45.029<0.001
), ArticleFig(id=1240746303945233246, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113229594761, language=EN, label=Table 3, caption=

Association of sedentary time with IR

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久坐时间模型1模型2模型3
OR95% CIP值OR95% CIP值OR95% CIP值
<3 h/d1.000<0.0011.000<0.0011.0000.002
3~5 h/d1.2001.005~1.4320.0441.1020.911~1.3330.2811.1020.899~1.3490.351
>5 h/d1.6311.344~1.980<0.0011.5471.249~1.914<0.0011.4681.168~1.845<0.001
), ArticleFig(id=1240746304066868071, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113229594761, language=CN, label=表3, caption=

久坐时间与IR的相关性

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久坐时间模型1模型2模型3
OR95% CIP值OR95% CIP值OR95% CIP值
<3 h/d1.000<0.0011.000<0.0011.0000.002
3~5 h/d1.2001.005~1.4320.0441.1020.911~1.3330.2811.1020.899~1.3490.351
>5 h/d1.6311.344~1.980<0.0011.5471.249~1.914<0.0011.4681.168~1.845<0.001
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中老年非糖尿病人群久坐行为与胰岛素抵抗的相关性分析
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石兴文 1, 2 , 尹鸿涛 2 , 田高鹏 1, 2 , 甄东户 2
现代预防医学 | 健康与社会行为 2024,51(6): 1063-1069
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现代预防医学 | 健康与社会行为 2024, 51(6): 1063-1069
中老年非糖尿病人群久坐行为与胰岛素抵抗的相关性分析
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石兴文1, 2, 尹鸿涛2, 田高鹏1, 2, 甄东户2
作者信息
  • 1.兰州大学第一临床医学院，甘肃 兰州 730030
  • 2.兰州大学第一医院内分泌科

    • 石兴文（1997—），男，硕士在读，研究方向：糖尿病及相关并发症

通讯作者:

甄东户，E-mail：
Correlation analyses of sedentary behavior and insulin resistance in middle-aged and elderly non-diabetic population
Xing-wen SHI1, 2, Hong-tao YIN2, Gao-peng TIAN1, 2, Dong-hu ZHEN2
Affiliations
  • The First Clinical Medical College of Lanzhou University; Department of Endocrinology, First Hospital of Lanzhou University, Lanzhou, Gansu 730030, China
出版时间: 2024-03-25 doi: 10.20043/j.cnki.MPM.202311130
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摘要
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目的

了解兰州市中老年非糖尿病人群的久坐情况，并探讨久坐行为与胰岛素抵抗（IR）的相关性。

方法

使用兰州市REACTION研究2014—2016年的调查数据，利用整群随机抽样选取年龄为40~75岁的居民，对符合纳入标准的3 609人进行研究，将久坐时间分为<3 h/d、3~5 h/d及>5 h/d三组，依据稳态模型评估胰岛素抵抗指数（HOMA-IR）诊断IR，采用多因素logistic回归模型分析久坐行为与IR的关联，并通过亚组分析探索不同分组下久坐时间与IR的相关性。

结果

研究人群平均久坐时间为4.00±1.92 h/d，总体IR患病率为25.0%，其中<3 h/d、3~5 h/d及>5 h/d人群中IR的患病率分别为21.7%、24.9%及31.0%，差异具有统计学差异（χ2=24.447，P<0.05）。在调整多种混杂因素后，logistic回归分析结果显示，与久坐<3h/d对比，久坐>5 h/d是IR患病的危险因素（OR=1.468，95% CI:1.168~1.845，P<0.05）。亚组分析表明，仅在年龄<65岁（OR=1.060，95% CI:1.005~1.118）、体力活动不足（OR=1.071，95% CI:1.017~1.128）、高血脂（OR=1.071，95% CI:1.001~1.145）、无高尿酸血症（OR=1.062，95% CI:1.010~1.117）、脂肪肝（OR=1.133，95% CI:1.038~1.237）、WC≥85cm（OR=1.079，95% CI:1.017~1.144）的个体亚组中，久坐时间增加与IR患病风险增加相关（均P<0.05）。

结论

中老年非糖尿病人群久坐行为与IR发生呈正相关，但在不同特征人群中结果可能存在差异。

久坐  /  胰岛素抵抗  /  中老年人
Objective

To investigate the sedentary behavior of middle-aged and elderly non-diabetic population in Lanzhou and explore its correlation with insulin resistance (IR).

Methods

A cluster random sampling method was used to select residents aged 40-75 years from the survey data of the "REACTION Study" conducted between 2014 and 2016 in Lanzhou. A total of 3 609 individuals who met the inclusion criteria were included in this study. The sedentary time was divided into <3 h/d, 3-5 h/d and ≥5 h/d groups. Insulin resistance was diagnosed using the homeostasis model assessment of insulin resistance (HOMA-IR). Multivariate logistic regression analysis was performed to examine the association between sedentary behavior and IR, while subgroup analysis explored this relationship among different population subgroups.

Results

The average daily sedentary time for study population was found to be approximately 4.00±1.92 h/d, with an overall prevalence rate of IR at 25.0%. The prevalence rates of IR for those with a sedentary time <3 h/d, 3-5 h/d and ≥5 h/d were observed as follows: 21.7%, 24.9% and 31%, respectively, with statistically significant differences (χ2=24.447, P<0.05). After adjusting for various confounding factors through logistic regression analysis, it was revealed that compared with sedentary <3 h/d, sedentary ≥5 h/d was a risk factor for the prevalence of IR (OR=1.468, 95% CI:1.168-1.845, P<0.05). Subgroup analysis indicated that only within subgroups consisting of individuals aged≥65 years old (OR=1.060,95% CI:1.005-1.118), insufficient physical activity (OR=1.071, 95% CI:1.017-1.128), hyperlipidemia (OR=1.071,95% CI:1.001-1.145), no hyperuricemia (OR=1.062, 95% CI:1.010-1.117), fatty liver (OR=1.133, 95% CI:1.038-1.237), and WC≥85 cm (OR=1.079, 95% CI:1.017-1.144), increased sedentary time was associated with increased risk of IR (all P<0.05).

Conclusion

Sedentary behavior is positively associated with the occurrence of IR in middle-aged and elderly non-diabetic population.However, the findings may vary across populations with distinct characteristics.

Sedentary  /  Insulin resistance  /  Middle-aged and elderly people
石兴文, 尹鸿涛, 田高鹏, 甄东户. 中老年非糖尿病人群久坐行为与胰岛素抵抗的相关性分析. 现代预防医学, 2024 , 51 (6) : 1063 -1069 . DOI: 10.20043/j.cnki.MPM.202311130
Xing-wen SHI, Hong-tao YIN, Gao-peng TIAN, Dong-hu ZHEN. Correlation analyses of sedentary behavior and insulin resistance in middle-aged and elderly non-diabetic population[J]. Modern Preventive Medicine, 2024 , 51 (6) : 1063 -1069 . DOI: 10.20043/j.cnki.MPM.202311130
正文
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久坐行为是以坐着、斜倚或躺着时能量消耗低于1.5 MET为特征的清醒行为[1]。据统计，2008—2018年全球成年人平均每日久坐时间为7.3 h[2]。久坐行为对身体健康的负担已被证实，研究表明长时间久坐会增加全因、癌症和心血管疾病的死亡风险[1]。胰岛素抵抗（Insulin resistance, IR）为肝脏、肌肉及脂肪组织等胰岛素靶向器官对胰岛素敏感性降低和（或）胰岛素反应性下降的状态[3]。临床研究提出，IR是肥胖、2型糖尿病、代谢综合征、非酒精性脂肪肝、动脉粥样硬化心血管疾病重要的致病驱动因素，而久坐行为可能会通过影响IR从而促进以上慢性代谢性疾病的发生[4-5]。众多研究表明久坐时间增加与IR风险增加呈正相关[6-8]，但美国最新的一项横断面研究并未发现久坐行为与IR的关联[9]。除研究结论存在差异外，国外的研究大多都聚焦于久坐行为对儿童或青少年IR的影响[10-11]，很少关注与成年人IR间的关系，且国内相关研究少见，因此本研究以稳态模型评估胰岛素抵抗指数（Homeostasis model assessment of insulin resistance, HOMA-IR）作为IR的评价指标，探索久坐行为与中老年非糖尿病人群IR的相关性，为IR及相关疾病的预防和机制研究提供新的科学依据。
1 对象与方法
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1.1 研究对象
本研究采用REACTION研究2014—2016年的随访资料，研究对象来自兰州市城关区3个不同社区中40~75岁的自然人群（居住时间≥5年），共招募了5 074名符合条件的居民进行流行病学调查。本研究的纳入标准为能独立完成调查问卷并且资料完整的非糖尿病人群，因此首先需剔除既往有糖尿病病史以及新诊断的糖尿病患者，其他排除标准如下：血样缺失、严重肝肾功能不全、体力活动资料不全或异常、有胰腺疾病及胰腺手术史、有恶性肿瘤病史。最终纳入3 609例研究对象进行横断面分析。本研究已获上海交通大学瑞金医院医学伦理委员会批准[2014临伦审第(52)号]，所有参与者均获得书面知情同意。
1.2 研究方法
1.2.1 问卷调查
问卷共分为两个部分，第一部分内容包括：基本信息（性别、年龄、文化程度、年总收入、工作情况）；生活方式（吸烟史、饮酒史、睡眠和打鼾情况、每天的盐摄入量）；疾病及手术史（糖尿病、高血压、高血脂、高尿酸血症、脂肪肝、胰腺疾病及恶性肿瘤）。第二部分内容参考中文版国际体力活动短问卷[12]所设计，问卷包含：过去7天的久坐情况（包含工作日及周末每天坐着时间，例如办公桌工作、开车、看手机、电视及电脑等）；过去7天工作以外时间中等和剧烈强度体力活动的频率和持续时间：（1）剧烈体力活动（觉得呼吸吃力的活动，例如举重物、打篮球、游泳、跑步等）；（2）中等强度体力活动（觉得呼吸稍比正常吃力的活动，例如缓步跑、打乒乓球、耍太极等），只统计每次持续10分钟及以上的活动。所有研究人员均经过标准化和规范化的培训。
1.2.2 体格检查
对静坐5分钟后的研究人群进行血压即收缩压（SBP）和舒张压（DBP）以及心率（HR）的测量（欧姆龙电子血压计），以测量3次后（每隔1分钟1次）的平均值为最终结果。随后完成对身高（HT）、体重（WT）、腰围（WC）、臀围（HC）及颈围（NC）的测量。
1.2.3 血样检测
对所有研究对象进行口服葡萄糖耐量实验（OGTT），分别采集指尖全血、空腹及餐后2小时静脉血，使用全自动生化免疫分析仪architect ci16200（雅培公司）对静脉血液指标进行检测，包括空腹血糖（FBG）、OGTT2h血糖（2hPG）、空腹胰岛素（FINS）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、尿酸（UA）。使用Variant Ⅱ糖化血红高蛋白检测仪（美国伯乐公司）对指尖全血进行糖化血红蛋白（HbA1c）检测。
1.2.4 参数计算
（1）体质指数（BMI）=WT/HT2(kg/m2)；（2）HOMA-IR=FBG×FINS/22.5[3]。
1.3 分组及诊断标准
流行病学调查及临床实践中评估非糖尿病人群IR最常用的方法为HOMA-IR，该指标已被证实与诊断IR的金标准高胰岛素正常血糖钳夹技术（Hyper insulinemic euglycemic clamp, HEC）密切相关[13]。在本研究中IR定义为高于HOMA-IR的第75百分位数（2.20）[3]；依据久坐时间的三分位数将其分为<3 h/d、3~5 h/d及>5 h/d三组；将进行≥150分钟/周的中等强度体力活动和（或）≥75分钟/周的剧烈体力活动和（或）二者的同等组合（剧烈体力活动的代谢当量相当于2倍的中等强度体力活动）定义为活动充分，否则定义为活动不足[1]；高血压诊断标准：既往诊断为高血压且近1月在服用降压药物和（或）SBP≥140 mmHg和(或)DBP≥90 mmHg[14]；高血脂诊断标准：既往诊断为高血脂且近1月在服用降脂药物和（或）TC≥6.22 mmol/L和（或）TG≥2.26 mmo/L和（或）LDL-C≥4.14 mmol/L和（或）HDL-C<1.04 mmol/L[15]；高尿酸血症诊断标准：既往诊断为高尿酸血症且近1月在服用降尿酸药物和（或）UA≥420 mmo/L[16]。现在吸烟定义为现在每天吸卷烟≥1支或烟叶≥1 g，并至少持续6个月；现在饮酒定义为现在每周饮酒≥1次，乙醇量≥50 g/次，并至少持续1年。
1.4 统计分析
本研究采用软件SPSS 26.0对数据进行统计分析。服从正态分布的计量资料以均数±标准差表示，两组和多组间分别采用独立样本t检验和单因素方差分析进行比较。符合偏态分布的连续性变量采用中位数（四分位间距）表示，两组和多组间比较分别采用Mann-Whitney U检验和Kruskal-Wallis H检验。计数资料以n(%)表示，采用卡方检验或Fisher精确检验进行组间比较。采用logistic回归分析久坐行为与IR的相关性，并通过亚组分析进一步探讨在不同基本特征下久坐时间与IR的关联。检验水准α=0.05（双侧）。
2 统计学结果
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2.1 不同久坐时间下研究人群的基本特征
本研究共纳入了3 609名研究人群，其中男性898人，占24.9%，女性2 711人，占75.1%，平均年龄为60.09±7.76岁，平均久坐时间为4.00±1.92 h/d。久坐时间<3 h/d、3~5 h/d及>5h/d的人群比例分别占40.8%、36.4%及22.8%。共有901例IR患者，患病率为25.0%，久坐时间<3 h/d、3~5 h/d及>5 h/d人群中IR的患病率分别为21.7%、24.9%及31.0%。对比久坐时间<3 h/d和3~5 h/d，久坐时间>5 h/d高中及以上文化程度、目前工作、体力活动不足、现在吸烟、IR的比例明显升高（均P<0.05）；WC、HC、NC、FINS及HOMA-IR水平增加（均P<0.05）。此外，久坐时间>5 h/d人群男性、现在饮酒、高血脂、BMI也均高于久坐时间<3 h/d（均P<0.05）。见表1。
2.2 非IR组与IR组的基本特征对比
与非IR组对比，IR组体力活动不足、打鼾、高血压、高血脂、高尿酸血症及脂肪肝的比例更高（均P<0.05），此外IR组的年龄、久坐时间、BMI、WC、HC、NC、HR、HbA1c、FBG、2hPG、FINS及HOMA-IR水平也均高于非IR组（均P<0.05），而高中及以上文化程度和目前工作的比例低于非IR组（均P<0.05）。见表2。
2.3 久坐时间与IR的相关性分析
采用多因素logistic回归模型分析久坐时间与IR的相关性，未调整混杂因素时，与久坐时间<3 h/d相比，久坐3~5 h/d和>5 h/d与IR的患病风险呈正相关（均P<0.05）；在进一步调整年龄、性别、文化程度、目前工作、体力活动、现在吸烟、现在饮酒、打鼾、高血压、高血脂、高尿酸血症及脂肪肝，久坐3~5 h/d与IR的关联消失，久坐>5 h/d与IR的患病风险仍呈正相关（P<0.05）；在上述基础上调整HR、BMI、WC、HC、NC、HbA1c及2hPG，久坐>5 h/d仍然是IR患病的危险因素（OR=1.468，95% CI:1.168~1.845，P<0.05）。见表3。
2.4 久坐时间与IR的亚组分析
进一步分析久坐时间对IR的影响，我们根据年龄，性别，体力活动是否充足，有无高血压、高血脂、高尿酸血症及脂肪肝，BMI及WC水平进行亚组分析，采用森林图表示每个亚组中久坐时间和IR患病率之间的关系，结果发现当年龄<65岁、体力活动不足、高血脂、无高尿酸血症、脂肪肝、WC≥85 cm的个体亚组中，久坐时间增加与IR患病风险增加相关（均P<0.05）。见图1。
3 讨论
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由于社会、经济和环境的快速转型，导致人们花费在办公桌工作、计算机使用和屏幕的时间逐渐增加，久坐行为也变得越来越普遍。本研究人群平均每日久坐时间约为4 h，高于2005—2007年中国35~70岁人群的久坐时间（3.3 h/d）[17]，但低于2016—2018年日本成年人的久坐时间（5.3 h/d）[18]。我国的一项流行病学调查表明当成年人日静坐时长超过3 h消化系统疾病、糖尿病及高血压的患病率将会明显增加[19]，然而IR作为多种慢性疾病的发病基础与久坐行为的关系尚不清楚。本研究以HOMA-IR>2.20作为IR的诊断标准，对3 609名非糖尿病中老年人群研究发现，久坐时间>5 h/d将会显著增加IR的患病风险。
Kim等[20]对2 573名韩国非糖尿病人群研究发现，与久坐时间<5 h/d对比，久坐时间>10 h/d与高IR值（HOMA-IR>1.6）显著相关（OR=1.40，95% CI: 1.060~1.838）。一项关于年轻男性久坐时间与心血管代谢危险因素的横断面研究也表明坐着时间与HOMA-IR呈线性正相关[21]。久坐行为会增加腰围和内脏脂肪堆积[7]，腹型肥胖又是引起IR最常见的原因[3]，遗憾的是，上述研究并没有关注腰围对结局的影响，所以最终的结果可能存在偏倚。久坐时间和IR之间的关联是否通过BMI或腰围作用尚不清楚，为验证这一假设，Parker等[9]将每日坐着时间依据三分位数进行分组（低、中和高），探讨其与HOMA-IR对数值（L-HOMA-IR）的相关性，通过线性回归分析发现随着坐着时间的增加，L-HOMA-IR均值呈上升趋势（0.37±0.008, 0.40±0.012及0.43±0.012），在调整BMI后削弱了这种关系，而调整腰围后这种关联则不再显著，进一步分析也证明腰围是久坐时间与IR间重要的中介变量。但本研究在控制体力活动、BMI及腰围等混杂因素后，久坐时间与IR的相关性虽然降低但仍然存在。日本的一项临床研究也可验证我们的研究结果，该研究对758名成年人佩戴加速计并测量过去7天的久坐时间，在调整BMI和内脏脂肪面积后久坐时间与HOMA-IR水平仍呈正相关（P<0.05）[7]。这表明肥胖虽然和IR密切相关，但并不是IR发生的决定性因素，所以无论BMI和腰围如何，仍需要考虑其他因素对IR的影响[22]。
目前已经有一些机制研究来阐明久坐行为与IR间的关联。有研究发现，长时间久坐行为可导致骨骼肌线粒体含量减少和功能下降，减弱β氧化功能，导致脂肪酸不完全氧化产物增加，进而会引起胰岛素抵抗或敏感性降低[8]。最新一项的研究结果显示久坐行为对脂肪细胞IR也有影响，通过观察204名久坐受试者和336名运动受试者其皮下脂肪细胞中胰岛素对甘油三酯水解和生成的抑制作用，发现久坐者胰岛素受体及其底物的mRNA表达降低，抗脂质作用的敏感性降低[8]。此外，久坐行为可通过降低能量消耗，脂质稳态失调以及增加脂质含量和体重破坏胰岛素通路，导致外周组织胰岛素敏感性受损[24]，本研究通过亚组分析发现，当高脂血症和腰围≥85 cm时久坐时间与IR呈正相关，而在无血脂异常和腰围<85 cm的人群中这种相关性则消失，因此我们也可以通过改善内脏型肥胖和血脂谱进而降低久坐行为对胰岛素敏感性的损害[25]。
久坐行为并不等同于体力活动缺乏，二者对健康的影响是独立相关的[1]，众多研究也开始关注久坐行为与体力活动对机体代谢的综合影响。本研究行亚组分析发现，当体力活动充足的情况下久坐时间与IR的相关性不再显著，这说明体力活动与久坐行为在IR的发生上可能存在拮抗作用。Kullmann等[26]对21名久坐不动的超重和肥胖受试者进行为期8周的有氧运动，发现脑胰岛素敏感性可恢复至正常体重人群水平。芬兰的一项研究依据髋关节加速计所记录的久坐和久坐期间体力活动时间的积累模式将研究人群分为四组，结果发现与长时间久坐无体力活动的人群对比，久坐期间进行体力活动可以明显降低肥胖、血脂和HOMA-IR水平[27]。Cheng等[28]等采用等时替代模型将每日久坐时间重新分配到中高强度和轻度体力活动中研究与心血管代谢标志物的关联，结果发现用不同体力活动替代久坐行为均与HOMA-IR呈负相关。结合以上研究，进行适当的体力活动或者用不同类型活动中断久坐行为在改善IR的同时还可提高胰岛素敏感性。
本研究是首次分析久坐行为与兰州市无糖尿病人群IR之间关联的一项大型横断面研究，结果明确了久坐行为是IR患病的危险因素，并通过亚组分析探讨了在不同特征人群中久坐行为与IR的相关性，为科学预防IR提供了新的临床证据。但本研究也存在一定局限性：首先本研究的久坐和体力活动情况是通过问卷调查获得的，可能存在回忆偏倚，而利用加速计等设备能更准确地测量人群的身体活动；其次本研究只关注了每日的总坐着时间以及全身IR，但不同领域或类型的久坐行为以及IR发生部位的不同（肝脏或肌肉）可能会导致最终的结果存在差异[29]；最后本研究是横向研究，不能推断久坐行为与IR的因果关系，未来需要更多的前瞻性研究或分子机制研究来阐明二者之间的关系。
综上，当每日久坐时间超过5 h，兰州市中老年非糖尿病人群IR的发生风险将会明显增加，除了避免或减少久坐不动，优化其他生活方式例如定期进行体育锻炼、适当减重及改善饮食等也应全程贯彻到IR管理的始终。
基金
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  • 甘肃省重点研发计划(23YFFA0032)
  • 上海市医药卫生发展基金会糖尿病临床研究项目(I期10研究)
  • 国家标准化代谢性疾病管理中心专项研究基金(2018-mmczxjj-3)
  • 甘肃省自然科学基金(21JR1RA096)
  • 医学院校硕士研究生学位论文质量提升策略研究(lzuyxcx-2022-112)
  • 医学院校硕士研究生学位论文质量提升策略研究(820809036)
文献
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2024年第51卷第6期
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文章信息
doi: 10.20043/j.cnki.MPM.202311130
  • 接收时间：2023-11-07
  • 首发时间：2026-03-16
  • 出版时间：2024-03-25
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出版历史
  • 收稿日期：2023-11-07
基金
甘肃省重点研发计划(23YFFA0032)
上海市医药卫生发展基金会糖尿病临床研究项目(I期10研究)
国家标准化代谢性疾病管理中心专项研究基金(2018-mmczxjj-3)
甘肃省自然科学基金(21JR1RA096)
医学院校硕士研究生学位论文质量提升策略研究(lzuyxcx-2022-112)
医学院校硕士研究生学位论文质量提升策略研究(820809036)
作者信息
    1.兰州大学第一临床医学院，甘肃 兰州 730030
    2.兰州大学第一医院内分泌科

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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