Longitudinal Analysis of Patterns and Correlates of Physical Activity and Sedentary Behavior in Women From Preconception to Postpartum: The Singapore Preconception Study of Long-Term Maternal and Child Outcomes Cohort.

OBJECTIVE: Longitudinal changes in physical activity (PA) and sedentary behavior patterns from preconception to postpartum are not fully characterized. We examined changes and baseline sociodemographic/clinical correlates of PA and sedentary behavior in women from preconception to postpartum. METHODS: The Singapore Preconception Study of Long-Term Maternal and Child Outcomes cohort recruited 1032 women planning pregnancy. Participants completed questionnaires at preconception, 34 to 36 weeks gestation, and 12 months postpartum. Repeated-measures linear regression models were used to analyze changes in walking, moderate to vigorous PA (MVPA), screen time, and total sedentary time, and to identify sociodemographic/clinical correlates associated with these changes. RESULTS: Of the 373 women who delivered singleton live births, 281 provided questionnaires for all time points. Walking time increased from preconception to late pregnancy but decreased postpartum (adjusted means [95% CI]: 454 [333-575], 542 [433-651], and 434 [320-547] min/wk, respectively). Vigorous-intensity PA and MVPA decreased from preconception to late pregnancy but increased postpartum (vigorous-intensity PA: 44 [11-76], 1 [-3-5], and 11 [4-19] min/wk, MVPA: 273 [174-372], 165 [95-234], and 226 [126-325] min/wk, respectively). Screen time and total sedentary time remained consistent from preconception to pregnancy but decreased postpartum (screen: 238 [199-277], 244 [211-277], and 162 [136-189] min/d, total: 552 [506-598], 555 [514-596], and 454 [410-498] min/d, respectively). Individual characteristics of ethnicity, body mass index, employment, parity, and self-rated general health significantly influenced women's activity patterns. CONCLUSION: During late pregnancy, walking time increased, while MVPA declined significantly, and partially returned to preconception levels postpartum. Sedentary time remained stable during pregnancy but decreased postpartum. The identified set of sociodemographic/clinical correlates underscores need for targeted strategies.

Myo-inositol: a potential prophylaxis against premature onset of labour and preterm birth.

The incidence of preterm birth (PTB), delivery before 37 completed weeks of gestation, is rising in most countries. Several recent small clinical trials of myo-inositol supplementation in pregnancy, which were primarily aimed at preventing gestational diabetes, have suggested an effect on reducing the incidence of PTB as a secondary outcome, highlighting the potential role of myo-inositol as a preventive agent. However, the underlying molecular mechanisms by which myo-inositol might be able to do so remain unknown; these may occur through directly influencing the onset and progress of labour, or by suppressing stimuli that trigger or promote labour. This paper presents hypotheses outlining the potential role of uteroplacental myo-inositol in human parturition and explains possible underlying molecular mechanisms by which myo-inositol might modulate the uteroplacental environment and inhibit preterm labour onset. We suggest that a physiological decline in uteroplacental inositol levels to a critical threshold with advancing gestation, in concert with an increasingly pro-inflammatory uteroplacental environment, permits spontaneous membrane rupture and labour onset. A higher uteroplacental inositol level, potentially promoted by maternal myo-inositol supplementation, might affect lipid metabolism, eicosanoid production and secretion of pro-inflammatory chemocytokines that overall dampen the pro-labour uteroplacental environment responsible for labour onset and progress, thus reducing the risk of PTB. Understanding how and when inositol may act to reduce PTB risk would facilitate the design of future clinical trials of maternal myo-inositol supplementation and definitively address the efficacy of myo-inositol prophylaxis against PTB.

Maternal height, gestational diabetes mellitus and pregnancy complications.

AIMS: To explore the glucose-overload hypothesis of artefactual gestational diabetes (GDM) diagnosis in shorter women during oral glucose tolerance testing (OGTT), by investigating associations between height and maternal glycemia; and GDM and pregnancy complications in height-groups. METHODS: Women from GUSTO (n = 1100, 2009-2010) and NUH (n = 4068, 2017-2018) cohorts underwent a mid-gestation two and three time-point 75 g 2-hour OGTT, respectively. GDM-related complications (hypertensive disorders of pregnancy, preterm delivery, emergency cesarean section, neonatal intensive care unit admission, macrosomia, birthweight) were compared within shorter and taller groups, dichotomized by ethnic-specific median height. RESULTS: Using WHO-1999 criteria, 18.8% (GUSTO) to 22.9% (NUH) of women were diagnosed with GDM-1999; and by WHO-2013 criteria, 21.9% (NUH) had GDM-2013. Each 5-cm height increment was inversely associated with GDM-1999 (adjusted odds ratio [aOR, 95% CI] = 0.81 [0.76-0.87], 2-h glycemia (adjusted ß [aß, 95% CI] = -0.171 mmol/L [-0.208, -0.135]) and 1-h glycemia (aß = -0.160 mmol/L [-0.207, -0.112]). The inverse association between height and 2-h glycemia was most marked in "Other" ethnicities (Eurasians/Caucasians/mixed/other Asians) and Indians, followed by Chinese, then Malays. Compared with non-GDM, GDM-1999 was associated with preterm delivery (aOR = 1.76 [1.19-2.61]) and higher birthweight (aß = 57.16 g [20.95, 93.38]) only among taller but not shorter women. CONCLUSIONS: Only taller women had an increased odds of GDM-related pregnancy complications. An artefactual GDM diagnosis due to glucose-overload among shorter women is plausible.

High placental inositol content associated with suppressed pro-adipogenic effects of maternal glycaemia in offspring: the GUSTO cohort.

BACKGROUND/OBJECTIVES: Maternal glycaemia promotes fetal adiposity. Inositol, an insulin sensitizer, has been trialled for gestational diabetes prevention. The placenta has been implicated in how maternal hyperglycaemia generates fetal pathophysiology, but no studies have examined whether placental inositol biology is altered with maternal hyperglycaemia, nor whether such alterations impact fetal physiology. We aimed to investigate whether the effects of maternal glycaemia on offspring birthweight and adiposity at birth differed across placental inositol levels. METHODS: Using longitudinal data from the Growing Up in Singapore Towards healthy Outcomes cohort, maternal fasting glucose (FPG) and 2-hour plasma glucose (2hPG) were obtained in pregnant women by a 75-g oral glucose tolerance test around 26 weeks' gestation. Relative placental inositol was quantified by liquid chromatography-mass spectrometry. Primary outcomes were birthweight (n = 884) and abdominal adipose tissue (AAT) volumes measured by neonatal MRI scanning in a subset (n = 262) of term singleton pregnancies. Multiple linear regression analyses were performed. RESULTS: Placental inositol was lower in those with higher 2hPG, no exposure to tobacco smoke antenatally, with vaginal delivery and shorter gestation. Positive associations of FPG with birthweight (adjusted ß [95% CI] 164.8 g [109.1, 220.5]) and AAT (17.3 ml [11.9, 22.6] per mmol glucose) were observed, with significant interactions between inositol tertiles and FPG in relation to these outcomes (p < 0.05). Stratification by inositol tertiles showed that each mmol/L increase in FPG was associated with increased birthweight and AAT volume among cases within the lowest (birthweight = 174.2 g [81.2, 267.2], AAT = 21.0 ml [13.1, 28.8]) and middle inositol tertiles (birthweight = 202.0 g [103.8, 300.1], AAT = 19.7 ml [9.7, 29.7]). However, no significant association was found among cases within the highest tertile (birthweight = 81.0 g [-21.2, 183.2], AAT = 0.8 ml [-8.4, 10.0]). CONCLUSIONS: High placental inositol may protect the fetus from the pro-adipogenic effects of maternal glycaemia. Studies are warranted to investigate whether prenatal inositol supplementation can increase placental inositol and reduce fetal adiposity.

Accelerometer Profile of Physical Activity and Sedentary Behavior in a Multi-Ethnic Urban Asian Population.

Purpose: Variability in accelerometry-data processing decisions limited data comparability across studies. We aimed to examine different accelerometry-data processing rules: varying bout lengths and allowance of 0- and 2-min interruptions on the total and bout-accumulated time spent in moderate-to-vigorous physical activity (MVPA) and sedentary behavior estimates, and describe the distribution of activity time based on counts per min (CPM) in granular categories. Method: Using the Singapore Health 2 survey, this study included 746 adults (41.8% women, median age 45.0 years) who provided valid ActiGraph GT3X+ accelerometer-data (≥4 valid days with ≥10-h/day). Quantile regression analysis adjusting for accelerometry daily wear time, age, and gender was performed to calculate the median and interquartile range of accelerometry estimates. Results: Median MVPA time accumulated in bouts of 1-min versus bouts of 10-min was 39.2 min/day and 6.0 min/day, respectively. MVPA time was higher when considering a 2-min interruption (range: 1.8-39.2 min/day) compared to 0-min interruption (range: 0-35.5 min/day) across bout lengths of 1- to 15-min. Participants were sedentary (≤100 CPM) for a daily median of 7.6 h/day. Median activities min/day on the lower-intensity activity spectrum (100-2499 CPM) decreased from 63.4 to 4.6 min/day, while on the higher-intensity activity spectrum (≥2500 CPM) was ≤2.9 min/day. Men generally spent more time in MVPA than women. Conclusions: This study highlights the differences in accelerometry estimates based on data processing decisions, and the importance of quantifying accelerometry-based activity time across the granular intensity spectrum. More studies are warranted to understand the determinants and health impact of these behaviors.

Placental Inositol Reduced in Gestational Diabetes as Glucose Alters Inositol Transporters and IMPA1 Enzyme Expression.

CONTEXT: Perturbed inositol physiology in insulin-resistant conditions has led to proposals of inositol supplementation for gestational diabetes (GDM) prevention, but placental inositol biology is poorly understood. OBJECTIVE: Investigate associations of maternal glycemia with placental inositol content, determine glucose effects on placental expression of inositol enzymes and transporters, and examine relations with birthweight. DESIGN AND PARTICIPANTS: Case-control study of placentae from term singleton pregnancies (GDM n = 24, non-GDM n = 26), and culture of another 9 placentae in different concentrations of glucose and myo-inositol for 48 hours. MAIN OUTCOME MEASURES: Placental inositol was quantified by the Megazyme assay. Relative expression of enzymes involved in myo-inositol metabolism and plasma membrane inositol transport was determined by quantitative RT-PCR and immunoblotting. Linear regression analyses were adjusted for maternal age, body mass index, ethnicity, gestational age, and sex. RESULTS: Placental inositol content was 17% lower in GDM compared with non-GDM. Higher maternal mid-gestation glycemia were associated with lower placental inositol. Increasing fasting glycemia was associated with lower protein levels of the myo-inositol synthesis enzyme, IMPA1, and the inositol transporters, SLC5A11 and SLC2A13, the expression of which also correlated with placental inositol content. In vitro, higher glucose concentrations reduced IMPA1 and SLC5A11 mRNA expression. Increasing fasting glycemia positively associated with customized birthweight percentile as expected in cases with low placental inositol, but this association was attenuated with high placental inositol. CONCLUSION: Glycemia-induced dysregulation of placental inositol synthesis and transport may be implicated in reduced placental inositol content in GDM, and this may in turn be permissive to accelerated fetal growth.

Author Correction: Anthropometric measures and HbA1c to detect dysglycemia in young Asian women planning conception: The S-PRESTO cohort.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Anthropometric measures and HbA1c to detect dysglycemia in young Asian women planning conception: The S-PRESTO cohort.

We investigated whether adding anthropometric measures to HbA1c would have stronger discriminative ability over HbA1c alone in detecting dysglycemia (diabetes and prediabetes) among Asian women trying to conceive. Among 971 Singaporean women, multiple regression models and area under receiver-operating characteristic (AUROC) curves were used to analyze associations of anthropometric (weight, height, waist/hip circumferences, 4-site skinfold thicknesses) and HbA1c z-scores with dysglycemia (fasting glucose ≥6.1 mmol/L with 2-hour glucose ≥7.8 mmol/l). The prevalence of dysglycemia was 10.9%. After adjusting for sociodemographic/medical history, BMI (Odds Ratio [OR] = 1.62 [95%CI 1.32-1.99]), waist-to-height ratio (OR = 1.74 [1.39-2.17]) and total skinfolds (OR = 2.02 [1.60-2.55]) showed the strongest associations with dysglycemia but none outperformed HbA1c (OR = 4.09 [2.81-5.94]). After adjustment for history, adding BMI, waist-to-height ratio and total skinfolds (anthropometry trio) as continuous variables to HbA1c (AUROC = 0.80 [95%CI 0.75-0.85]) performed similarly to HbA1c alone (AUROC = 0.79 [0.74-0.84]). However, using clinically-defined thresholds without considering history, as in common clinical practice, BMI ≥ 23 kg/m2 + HbA1c ≥ 5.7% (AUROC = 0.70 [0.64-0.75]) and anthropometry trio + HbA1c ≥ 5.7% (AUROC = 0.71 [0.65-0.76]) both outperformed HbA1c ≥ 5.7% alone (AUROC = 0.61 [0.57-0.65]). In a two-stage strategy, incorporating BMI ≥ 23 kg/m2 alongside HbA1c ≥ 5.7% into first-stage screening to identify high risk women for subsequent oral glucose tolerance testing improves dysglycemia detection in Asian women preconception.

Association of Cord Blood Thyroid-Stimulating Hormone Levels with Maternal, Delivery and Infant Factors.

INTRODUCTION: This study examined maternal, delivery and infant factors associated with cord thyroid-stimulating hormone (TSH) concentrations in an Asian population. METHODS: The Growing Up in Singapore Towards healthy Outcomes (GUSTO) study is a mother-offspring birth cohort from 2 major hospitals in Singapore. Cord serum TSH was measured using the Abbott ARCHITECT TSH Chemiluminescent Microparticle Immunoassay and the ADVIA Centaur TSH-3 Immunoassay. After excluding infants with a maternal history of thyroid disease, screening cord TSH results from 604 infants were available for multivariable regression analysis in relation to the factors of interest. RESULTS: Babies born by vaginal delivery had significantly higher cord serum TSH concentrations than babies born by caesarean section. Cord serum TSH concentrations differed significantly by measurement method. There was no association of cord TSH concentrations with ethnicity, sex, birth weight, gestational age, maternal body mass index, gestational weight gain, gestational diabetes mellitus status and other maternal, delivery and infant factors studied. CONCLUSION: Interpretation of cord serum TSH results may need to take into account mode of delivery and measurement method.

Gestational Diabetes Mellitus and Developmental Programming.

During normal pregnancy, increased insulin resistance acts as an adaptation to enhance materno-foetal nutrient transfer and meet the nutritional needs of the developing foetus, particularly in relation to glucose requirements. However, about 1 in 6 pregnancies worldwide is affected by the inability of the mother's metabolism to maintain normoglycaemia, with the combination of insulin resistance and insufficient insulin secretion resulting in gestational diabetes mellitus (GDM). A growing body of epidemiologic work demonstrates long-term implications for adverse offspring health resulting from exposure to GDM in utero. The effect of GDM on offspring obesity and cardiometabolic health may be partly influenced by maternal obesity; this suggests that improving glucose and weight control during early pregnancy, or better still before conception, has the potential to lessen the risk to the offspring. The consequences of GDM for microbiome modification in the offspring and the impact upon offspring immune dysregulation are actively developing research areas. Some studies have suggested that GDM impacts offspring neurodevelopmental and cognitive outcomes; confirmatory studies will need to separate the effect of GDM exposure from the complex interplay of social and environmental factors. Animal and human studies have demonstrated the role of epigenetic modifications in underpinning the predisposition to adverse health in offspring exposed to suboptimal hyperglycaemic in utero environment. To date, several epigenome-wide association studies in human have extended our knowledge on linking maternal diabetes-related DNA methylation marks with childhood adiposity-related outcomes. Identification of such epigenetic marks can help guide future research to develop candidate diagnostic biomarkers and preventive or therapeutic strategies. Longer-term interventions and longitudinal studies will be needed to better understand the causality, underlying mechanisms, or impact of GDM treatments to optimize the health of future generations.

Associations between psychological factors and accelerometer-measured physical activity in urban Asian adults.

OBJECTIVES: Examine the association between psychological variables and accelerometer-measured moderate-to-vigorous physical activity (MVPA) in urban Asians. METHODS: A population-based cross-sectional study was conducted in Singapore. Participants wore an accelerometer for 7 days to measure physical activity (PA). Demographic, anthropometric and psychological data were also collected. Psychological variables included PA guideline knowledge, motivational profile for PA self-regulation (5 subscales), perceived barriers to PA (4 subscales) and perceived social support for PA. Regression models with adjustment for socio-demographic variables were fitted. RESULTS: External regulation (b = - 13.03, 95% CI - 34.55; - 1.50) and perceived daily life barriers (b = - 12.63, 95% CI - 24.95; - 0.32) were significantly associated with fewer weekly MVPA minutes. A significant interaction between perceived social support and age (p = 0.046) was found. Social support was significantly negative associated with MVPA minutes in younger (< 28 years), but not in older participants. CONCLUSIONS: Considering levels of self-determination to engage in PA and perceived daily life barriers may be important for planning PA interventions in urban Asian populations. Caution is required when promoting social support for PA as it was associated with lower MVPA in younger people.

Domain-Specific Adult Sedentary Behaviour Questionnaire (ASBQ) and the GPAQ Single-Item Question: A Reliability and Validity Study in an Asian Population.

This study examined the validity and reliability of a domain-specific Adult Sedentary Behaviour Questionnaire (ASBQ) and the Global Physical Activity Questionnaire (GPAQ) single-item sitting question using self- and interviewer-administered modes of administration against the triaxial ActiGraph wGT3X-BT accelerometer. The ASBQ and the GPAQ were administered twice, seven days apart. Participants were asked to put on the waist-worn accelerometer for seven days. Convergent validity was assessed using Spearman's rho, mean absolute error (MAE), and Bland-Altman analysis (n = 78). Reliability was assessed using the Spearman's rho and intraclass correlation coefficient (ICC) (n = 84). Participants were adults aged 20-65 years and identifying as Chinese, Malay, or Indian. Only the self-administered GPAQ was significantly correlated with accelerometry-based measures (rho: 0.46), but not the interviewer-administered version (rho: 0.12). MAE for GPAQ was 207.5-218.3 min/day in relation to the accelerometer and for ASBQ was 154.7-174.6 min/day. Bland-Altman plots demonstrated large limits of agreement between questionnaire and accelerometry-based measures. While the self-administered GPAQ demonstrated a moderate correlation with accelerometry, the mean bias and the limits of agreement were large. The GPAQ (rho: 0.68-0.79; ICC: 0.68-0.78) and the ASBQ (rho: 0.53-0.64; ICC: 0.66-0.74) showed moderate-to-good reliability for total sedentary time using either self- or interviewer-administration. Future research should incorporate accelerometers to generate useful sedentary behaviour measures.

Comparison of wrist-worn Fitbit Flex and waist-worn ActiGraph for measuring steps in free-living adults.

INTRODUCTION: Accelerometers are commonly used to assess physical activity. Consumer activity trackers have become increasingly popular today, such as the Fitbit. This study aimed to compare the average number of steps per day using the wrist-worn Fitbit Flex and waist-worn ActiGraph (wGT3X-BT) in free-living conditions. METHODS: 104 adult participants (n = 35 males; n = 69 females) were asked to wear a Fitbit Flex and an ActiGraph concurrently for 7 days. Daily step counts were used to classify inactive (<10,000 steps) and active (≥10,000 steps) days, which is one of the commonly used physical activity guidelines to maintain health. Proportion of agreement between physical activity categorizations from ActiGraph and Fitbit Flex was assessed. Statistical analyses included Spearman's rho, intraclass correlation (ICC), median absolute percentage error (MAPE), Kappa statistics, and Bland-Altman plots. Analyses were performed among all participants, by each step-defined daily physical activity category and gender. RESULTS: The median average steps/day recorded by Fitbit Flex and ActiGraph were 10193 and 8812, respectively. Strong positive correlations and agreement were found for all participants, both genders, as well as daily physical activity categories (Spearman's rho: 0.76-0.91; ICC: 0.73-0.87). The MAPE was: 15.5% (95% confidence interval [CI]: 5.8-28.1%) for overall steps, 16.9% (6.8-30.3%) vs. 15.1% (4.5-27.3%) in males and females, and 20.4% (8.7-35.9%) vs. 9.6% (1.0-18.4%) during inactive days and active days. Bland-Altman plot indicated a median overestimation of 1300 steps/day by the Fitbit Flex in all participants. Fitbit Flex and ActiGraph respectively classified 51.5% and 37.5% of the days as active (Kappa: 0.66). CONCLUSIONS: There were high correlations and agreement in steps between Fitbit Flex and ActiGraph. However, findings suggested discrepancies in steps between devices. This imposed a challenge that needs to be considered when using Fibit Flex in research and health promotion programs.

Assessing and understanding sedentary behaviour in office-based working adults: a mixed-method approach.

BACKGROUND: Sedentary behaviours (SB) can be characterized by low energy expenditure in a reclining position (e.g., sitting) often associated with work and transport. Prolonged SB is associated with increased risk for chronic conditions, and due to technological advances, the working population is in office settings with high occupational exposure to SB. This study aims to assess SB among office workers, as well as barriers and strategies towards reducing SB in the work setting. METHODS: Using a mixed-methods approach guided by the socio-ecological framework, non-academic office workers from a professional school in a large public university were recruited. Of 180 eligible office workers, 40 enrolled and completed all assessments. Self-reported and objectively measured SB and activity levels were captured. Focus group discussion (FGD) were conducted to further understand perceptions, barriers, and strategies to reducing workplace SB. Environmental factors were systematically evaluated by trained research staff using an adapted version of the Checklist for Health Promotion Environments at Worksites (CHEW). Thematic analysis of FGD was conducted and descriptive analysis of quantitative data was performed. RESULTS: The sample was mostly Chinese (n = 33, 80 %) with a total of 24 (60 %) female participants. Most participants worked five days a week for about 9.5(0.5) hrs/day. Accelerometer data show that participants spend the majority of their days in sedentary activities both on workdays (76.9 %) and non-workdays (69.5 %). Self-report data confirm these findings with median sitting time of 420(180) minutes at work. From qualitative analyses, major barriers to reducing SB emerged, including the following themes: workplace social and cultural norms, personal factors, job scope, and physical building/office infrastructure. CHEW results confirm a lack of support from the physical infrastructure and information environment to reducing SB. CONCLUSIONS: There is high SB among office workers in this sample. We identified multiple levels of influence for prolonged occupational SB, with a particular emphasis on workplace norms and infrastructure as important barriers to reducing SB and increasing PA. A larger, representative sample of the Singaporean population is needed to confirm our findings but it seems that any intervention aimed at reducing SB in the workplace should target individual, environmental, and organizational levels.

Reliability and Validity of the Self- and Interviewer-Administered Versions of the Global Physical Activity Questionnaire (GPAQ).

OBJECTIVE: The Global Physical Activity Questionnaire (GPAQ) was originally designed to be interviewer-administered by the World Health Organization in assessing physical activity. The main aim of this study was to compare the psychometric properties of a self-administered GPAQ with the original interviewer-administered approach. Additionally, this study explored whether using different accelerometry-based physical activity bout definitions might affect the questionnaire's validity. METHODS: A total of 110 participants were recruited and randomly allocated to an interviewer- (n = 56) or a self-administered (n = 54) group for test-retest reliability, of which 108 participants who met the wear time criteria were included in the validity study. Reliability was assessed by administration of questionnaires twice with a one-week interval. Criterion validity was assessed by comparing against seven-day accelerometer measures. Two definitions for accelerometry-data scoring were employed: (1) total-min of activity, and (2) 10-min bout. RESULTS: Participants had similar baseline characteristics in both administration groups and no significant difference was found between the two formats in terms of validity (correlations between the GPAQ and accelerometer). For validity, the GPAQ demonstrated fair-to-moderate correlations for moderate-to-vigorous physical activity (MVPA) for self-administration (rs = 0.30) and interviewer-administration (rs = 0.46). Findings were similar when considering 10-min activity bouts in the accelerometer analysis for MVPA (rs = 0.29 vs. 0.42 for self vs. interviewer). Within each mode of administration, the strongest correlations were observed for vigorous-intensity activity. However, Bland-Altman plots illustrated bias toward overestimation for higher levels of MVPA, vigorous- and moderate-intensity activities, and underestimation for lower levels of these measures. Reliability for MVPA revealed moderate correlations (rs = 0.61 vs. 0.63 for self vs. interviewer). CONCLUSIONS: Our findings showed comparability between both self- and interviewer-administration modes of the GPAQ. The GPAQ in general but especially the self-administered version may offer a relatively inexpensive method for measuring physical activity of various types and at different domains. However, there may be bias in the GPAQ measurements depending on the overall physical activity. It is advisable to incorporate accelerometers in future studies, particularly when measuring different intensities of physical activity.

Association between physical activity and metabolic syndrome among Malay adults in a developing country, Malaysia.

OBJECTIVES: Metabolic syndrome is a highly prevalent health problem within the adult population in developing countries. We aimed to study the association of physical activity levels and metabolic risk factors among Malay adults in Malaysia. DESIGN: Cross-sectional. METHODS: Body mass index, waist circumference, and systolic/diastolic blood pressure, fasting blood glucose, fasting triglyceride and high-density lipoprotein cholesterol levels were measured in 686 Malay participants (aged 35-74 years). Self-reported physical activity was obtained with the validated International Physical Activity Questionnaire (Malay version) and categorized into low, moderate or high activity levels. RESULTS: Individuals who were classified as overweight and obese predominated (65.6%). On the basis of the modified NCEP ATP III criteria, metabolic syndrome was diagnosed in 31.9% of all participants, of whom 46.1% were men and 53.9% were women. The prevalence of metabolic syndrome among participants with low, moderate or high activity levels was 13.3%, 11.7% and 7.0%, respectively (p<0.001). Statistically significant negative associations were found between a number of metabolic risk factors and activity categories (p<0.05). The odds ratios for metabolic syndrome in the moderate and high activity categories were 0.42 (95% CI: 0.27-0.65) and 0.52 (95% CI: 0.35-0.76), respectively, adjusted for gender. CONCLUSIONS: Moderate and high activity levels were each associated with reduced odds for metabolic syndrome independent of gender. Although a slightly lower prevalence of metabolic syndrome was associated with high activity than with moderate activity, potential health benefits were observed when moderate activity was performed.

Joint association of sitting time and physical activity with metabolic risk factors among middle-aged Malays in a developing country: a cross-sectional study.

BACKGROUND: Prolonged sitting is associated with increased weight and higher risks for abdominal obesity, dyslipidaemia, hyperglycaemia and hypertension among the adult population. This has been well documented in the West, but studies on these associations are lacking in developing countries, including Malaysia. OBJECTIVE: This cross-sectional study aimed to examine the joint association of sitting time and physical activity with metabolic risk factors among middle-aged working adults. METHODOLOGY: A total of 686 Malay men and women participated (mean age 45.9 ± 6.5 years). Metabolic syndrome was diagnosed from the modified NCEP ATP III criteria. Self-reported sitting time was obtained with the validated Malay version of the International Physical Activity Questionnaire. Participants were asked about their time spent sitting during travel in a motor vehicle, e.g., car, motorcycle or bus, over the preceding 7 days. Logistic regression was used to estimate the odds ratio with the confidence interval for the combined effects of sitting quartiles and physical activity categories with metabolic risk factors. RESULTS/SIGNIFICANCE: The prevalence of metabolic syndrome among our participants was 31.9%. Their average total sitting time (including transportation) was 7.6 ± 2.4 h/day. After we adjusted for gender and educational level, higher sitting quartiles and physically inactive groups were associated with higher odds for metabolic syndrome compared with the referent group (sitting <6 h/day and physically active). In the physically active stratum, the odds for metabolic syndrome in participants who sat ≥ 9.3 h/day was 3.8 times that of participants who sat <6 h/day. Both higher sitting quartiles and insufficient physical activity were associated with adverse effects on abdominal obesity, hypertriglyceridemia and hyperglycaemia. CONCLUSION: In joint analyses of sitting time and physical activity, higher sitting time and insufficient physical activity were deleteriously associated with odds for metabolic risk factors in middle-aged Malay men and women.

Associations of occupational, transportation, household and leisure-time physical activity patterns with metabolic risk factors among middle-aged adults in a middle-income country.

OBJECTIVE: This study investigates physical activity in different domains and its association with metabolic risk factors among middle-aged adults. METHOD: The study was performed in Kuala Lumpur, Malaysia from August 2010-August 2011. Body mass index (BMI), waist circumference, systolic/diastolic blood pressure, and fasting blood glucose/lipid profile were measured in 686 Malay participants (mean age 45.9 ± 6.5 years). Self-reported physical activity was obtained with the validated IPAQ (Malay version) and categorized into low-, moderate- and high-activity levels across occupational, transportation, household and leisure-time domains. RESULTS: Participants spent most of their time on household (567.5, 95% CI: 510-630 MET-minutes/week) and occupational activities (297, 95% CI: 245-330 MET-minutes/week). After adjusted for gender and smoking, participants with low-activity levels in occupational, transport and household domains were associated with significantly higher odds for metabolic syndrome (2.02, 95% CI: 1.33-3.05; 1.49, 95% CI: 1.01-2.21; 1.96, 95% CI: 1.33-2.91). Significantly higher odds for obesity and abdominal obesity were consistently reported among those with low-activity levels across all four domains. CONCLUSION: High-activity levels in occupational, transportation and household domains were each negatively associated with metabolic syndrome among our cohort. Increase participation of physical activity across all four domains (including leisure-time activity) should be encouraged.