Associations of steps per day and step intensity with the risk of diabetes: the Hispanic Community Health Study / Study of Latinos (HCHS/SOL)

Abstract

Background Higher levels of moderate-to-vigorous physical activity have been associated with a lower risk of diabetes, but less is known about how daily step counts (steps/day) are associated with diabetes risk. Therefore, we examined the association of steps/day and step intensity with incident diabetes. Methods We included 6634 adults from the population-based prospective cohort Hispanic Community Health Study/Study of Latinos (HCHS/SOL) (2008–2017). Cox proportional hazard models that accounted for complex survey design and sampling weights were used to estimate the association of baseline accelerometer-assessed steps/day and step intensity with 6-year risk of incident diabetes as hazard ratios (HR) and 95% confidence intervals (CI). We further examined whether the percent of intense steps at a given accumulation of steps/day was associated with diabetes risk, and if associations were modified by specific cohort characteristics. Results The average age of cohort members was 39 years and 52% were female. Adults had an average of 8164 steps/day and spent 12 min/day in brisk ambulation (> 100 steps/min). Over 6 years of follow-up, there were 1115 cases of diabetes. There was a suggestive lower risk of diabetes with more steps/day– adults had a 2% lower risk per 1000 steps/day (HR = 0.98 (95% CI 0.95, 1.00)). Inverse associations between average steps/day and diabetes incidence were observed across many cohort characteristics, but most importantly among adults at high risk for diabetes – those who were older, or had obesity or prediabetes. Adults who accumulated 17 min/day in brisk ambulation compared to < 2 min/day had a 31% lower risk of diabetes (HR = 0.69 (95% CI 0.53, 0.89)). A greater percent of intense steps for a given accumulation of steps/day was associated with further risk reduction. Conclusion Adults who accumulate more daily steps may have a lower risk of diabetes. Accumulating more steps/day and greater step intensity appear to be important targets for preventing diabetes.

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

“…Among Hispanic adults in the HCHS/SOL, there was a 2% (HR, 0.98 [95% CI, 0.95–1.00]) lower risk of diabetes per 1000 steps/d over the next 6 years. 80…”

Quantifying the Relationship Between Physical Activity Energy Expenditure and Incident Type 2 Diabetes: A Prospective Cohort Study of Device-Measured Activity in 90,096 Adults

“…Both Cuthbertson et al. ( 21 ) and Garduno et al. ( 19 ) found the relationship to be approximately linear, while Ballin et al.…”

“…( 19 ) found the relationship to be approximately linear, while Ballin et al. ( 22 ) observed a nonlinear dose-response relationship typically observed between physical activity and other chronic health outcomes ( 19 , 21 , 22 ). Cuthbertson et al.…”

“…In a cohort of 16,415 Hispanic/Latino adults, Cuthbertson et al. ( 21 ) estimated a 2% (0–5) lower hazard of incident diabetes per 1,000 steps/day, with the association fully attenuated after adjustment for BMI. Similarly, Garduno et al.…”

Comparative Analysis of ActiGraph Step Counting Methods in Adults: A Systematic Literature Review and Meta-Analysis

“…Both researchers and the public are interested in steps because they are more easily understood than other units representing the volume of physical activity, such as minutes of moderate-to-vigorous physical activity or total activity counts. Moreover, steps per day are inversely related to adiposity (3), metabolic disease (i.e., type 2 diabetes) (4,5), cardiovascular events (6), and all-cause mortality (7,8).…”