title: Replacement Effects of Sedentary Time on Metabolic Outcomes: The Maastricht Study.
abstract: Sedentary time has been associated with detrimental health effects, so in some countries, guidelines to reduce sedentary time have been developed. As reducing sedentary time inevitably results in more nonsedentary time, effects of this reduction may depend on the activity with which it is replaced.
  
  
  
  This study aimed to examine associations of theoretical reallocations of sedentary time to standing or stepping with cardiometabolic outcomes and type 2 diabetes.
  
  
  
  We included 2213 participants (51% men, mean ± SD age = 60.0 ± 8.1 yr) of the Maastricht Study who were asked to wear an accelerometer 24 h·d for a week. We calculated daily sedentary, standing, and stepping time. An isotemporal substitution modeling approach was applied to examine effects on waist circumference; body mass index; cholesterol, triacylglycerol, glucose, and insulin levels; metabolic syndrome; and type 2 diabetes.
  
  
  
  Replacement of sedentary time (30 min·d) with stepping was associated with lower odds for metabolic syndrome (odds ratio [OR] = 0.72, 95% confidence interval [CI] = 0.66-0.78) and type 2 diabetes (OR = 0.79, 95% CI = 0.72-0.87), more favorable waist circumference (B = -1.42, 95% CI = -1.78 to -1.06), and body mass index (B = -0.48, 95% CI = -0.62 to -0.35) and improved cholesterol, triacylglycerol, glucose, and insulin levels. Replacing sedentary time with standing was associated with lower odds for metabolic syndrome and type 2 diabetes and favorable outcomes in waist circumference, cholesterol, triacylglycerol, and insulin levels.
  
  
  
  Theoretical replacements of sedentary time with nonsedentary time (both standing and stepping) were associated with lower odds for metabolic syndrome, type 2 diabetes, and beneficial metabolic outcomes. These results could be important for the general population, including those who cannot meet physical activity guidelines. Consideration should be given to developing recommendations for daily reallocating sedentary time.
authors.affiliation: 1Department of Social Medicine, Maastricht University, Maastricht, THE NETHERLANDS; 2CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, THE NETHERLANDS; 3Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, THE NETHERLANDS; 4Department of Human Movement Sciences, Maastricht University, Maastricht, THE NETHERLANDS; 5NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, THE NETHERLANDS; 6Department of Internal Medicine, Maastricht University Medical Center, Maastricht, THE NETHERLANDS; 7CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, THE NETHERLANDS; 8Biomedical Research Institute, University of Hasselt, Diepenbeek, BELGIUM; 9Department of Internal Medicine, VieCuri Medical Centre, Venlo, THE NETHERLANDS; 10Department of Epidemiology, Maastricht University, Maastricht, THE NETHERLANDS; 11Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, THE NETHERLANDS; and 12MHeNS School for Mental Health and Neuroscience, Maastricht University, Maastricht, THE NETHERLANDS.
authors.forename: Julianne D
authors.initials: JD
authors.lastname: VAN DER Berg
authors.forename: Jeroen H P M
authors.initials: JHPM
authors.lastname: VAN DER Velde
authors.forename: Ellis A C
authors.initials: EAC
authors.lastname: DE Waard
authors.forename: Hans
authors.initials: H
authors.lastname: Bosma
authors.forename: Hans H C M
authors.initials: HHCM
authors.lastname: Savelberg
authors.forename: Nicolaas C
authors.initials: NC
authors.lastname: Schaper
authors.forename: Joop P W
authors.initials: JPW
authors.lastname: VAN DEN Bergh
authors.forename: Piet P M M
authors.initials: PPMM
authors.lastname: Geusens
authors.forename: Miranda T
authors.initials: MT
authors.lastname: Schram
authors.forename: Simone J S
authors.initials: SJS
authors.lastname: Sep
authors.forename: Carla J H
authors.initials: CJH
authors.lastname: VAN DER Kallen
authors.forename: Ronald M A
authors.initials: RMA
authors.lastname: Henry
authors.forename: Pieter C
authors.initials: PC
authors.lastname: Dagnelie
authors.forename: Simone J P M
authors.initials: SJPM
authors.lastname: Eussen
authors.forename: Martien C J M
authors.initials: MCJM
authors.lastname: VAN Dongen
authors.forename: Sebastian
authors.initials: S
authors.lastname: Köhler
authors.forename: Abraham A
authors.initials: AA
authors.lastname: Kroon
authors.forename: Coen D A
authors.initials: CDA
authors.lastname: Stehouwer
authors.forename: Annemarie
authors.initials: A
authors.lastname: Koster
mesh_terms: D061725:Accelerometry; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000517:prevention & control*; D008875:Middle Aged; D011187:Posture / Q000502:physiology*; D011446:Prospective Studies; D057185:Sedentary Behavior; D000072799:Stair Climbing / Q000502:physiology*; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference
chemical_list: D001786:Blood Glucose; D007328:Insulin; D014280:Triglycerides; D002784:Cholesterol