title: Joint associations of physical activity and hypertension with the development of type 2 diabetes among urban men and women in Mainland China.
abstract: BACKGROUND
  Physical activity (PA) and hypertension (HTN) are important influences on the development of type 2 diabetes (T2D). However, the joint impact of PA and HTN on T2D development is unknown.
  
  
  METHODS
  Two community-based prospective cohort studies, with the same protocols, instruments and questionnaires, were conducted among adults in urban areas of Nanjing, China, during 2004-2007 and 2007-2010. T2D was defined using World Health Organization criteria based on physicians' diagnosis and fasting blood glucose concentration. PA level (sufficient/insufficient) and blood pressure status (hypertensive/normotensive) were assessed at baseline and the third year of follow-up. We pooled and analyzed data from these two studies.
  
  
  RESULTS
  Among 4550 participants aged 35 years or older, the three-year cumulative incidence of T2D was 5.1%. After adjusting for potential confounders, participants with sufficient PA were less likely to develop T2D than those with insufficient PA (OR = 0.43, 95%CI = 0.27, 0.68) and those who were normotensive were less likely to develop T2D than those who were hypertensive (OR = 0.39, 95%CI = 0.29, 0.51). Compared to participants with insufficient PA and who were hypertensive, those with sufficient PA and hypertension were at lower risk of developing T2D (OR = 0.36, 95%CI = 0.19, 0.69), as were those with insufficient PA who were normotensive (OR = 0.37, 95%CI = 0.28, 0.50) and those with sufficient PA who were normotensive (OR = 0.19, 95%CI = 0.10, 0.37).
  
  
  CONCLUSIONS
  Insufficient PA was found to be associated with the development of T2D among adults with and without hypertension. These findings support a role for promoting higher physical activity levels to lower T2D risk in both hypertensive and non-hypertensive individuals.
authors.affiliation: Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Xu
authors.affiliation: School of Population Health, The University of Queensland, Brisbane, Australia.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Ware
authors.affiliation: JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Lap Ah
authors.initials: LA
authors.lastname: Tse
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, University, Baltimore, Maryland, United States of America.
authors.forename: YouFa
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.
authors.forename: ZhiYong
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Hong
authors.affiliation: JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Emily Ying Yang
authors.initials: EY
authors.lastname: Chan
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
authors.forename: David W
authors.initials: DW
authors.lastname: Dunstan
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
authors.forename: Neville
authors.initials: N
authors.lastname: Owen
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D002681:China / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology* / Q000517:prevention & control*; D005215:Fasting; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000503:physiopathology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose