CoChat
Sign Up
Cited by 72Physical Activity and HealthDiabetes, Cardiovascular Risks, and LipoproteinsObesity, Physical Activity, Diet

Independent and combined effects of physical activity and body mass index on the development of Type 2 Diabetes – a meta-analysis of 9 prospective cohort studies

Open access
Cloostermans, Laura, Wendel-Vos, Wanda, Doornbos, Gerda, Howard, Bethany, Craig, Cora Lynn, Kivimäki, Mika, Tabak, Adam G., Jefferis, Barbara J. +7 more·2015·International Journal of Behavioral Nutrition and Physical Activity
DOI 10.1186/s12966-015-0304-3PMC PMC4666059
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: The aim of this harmonized meta-analysis was to examine the independent and combined effects of physical activity and BMI on the incidence of type 2 diabetes. METHODS: Our systematic literature review in 2011 identified 127 potentially relevant prospective studies of which 9 fulfilled the inclusion criteria (total N = 117,878, 56.2 % female, mean age = 50.0 years, range = 25-65 years). Measures of baseline physical activity (low, intermediate, high), BMI-category [BMI < 18.4 (underweight), 18.5-24.9 (normal weight), 25.0-29.9 (overweight), 30+ (obese)] and incident type 2 diabetes were harmonized across studies. The associations between physical activity, BMI and incident type 2 diabetes were analyzed using Cox regression with a standardized analysis protocol including adjustments for age, gender, educational level, and smoking. Hazard ratios from individual studies were combined in a random-effects meta-analysis. RESULTS: Mean follow-up time was 9.1 years. A total of 11,237 incident type 2 diabetes cases were recorded. In mutually adjusted models, being overweight or obese (compared with normal weight) and having low physical activity (compared with high physical activity) were associated with an increased risk of incident type 2 diabetes (hazard ratios 2.33, 95 % CI 1.95-2.78; 6.10, 95 % CI: 4.63-8.04, and 1.23, 95 % CI: 1.09-1.39, respectively). Individuals who were both obese and had low physical activity had 7.4-fold (95 % CI 3.47-15.89) increased risk of type 2 diabetes compared with normal weight, high physically active participants. CONCLUSIONS: This harmonized meta-analysis shows the importance of maintaining a healthy weight and being physically active in diabetes prevention.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1186/s12966-015-0304-3

Cites

3 of 3 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Weight loss is a strong diabetes risk factor.

    “a strong diabetes risk factor (12,13)”

    From Global diabetes prevention interventions: A systematic review and network meta-analysis of the real-world impact on incidence, weight, and glucose (2018) · cites this paper as [13]

    The Discussion (page not available) identifies being overweight or obese—not losing weight—as associated with increased type 2 diabetes risk. The paper compares BMI categories rather than measuring weight loss, so it does not support calling weight loss a strong risk factor. (LLM, conf=0.78)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

  • Weight loss is important for diabetes prevention.

    “We also found that every additional kilogram of weight lost was associated with lower diabetes incidence, supporting the premise that weight loss is important for diabetes prevention (12,13).”

    From Global diabetes prevention interventions: A systematic review and network meta-analysis of the real-world impact on incidence, weight, and glucose (2018) · cites this paper as [13]

    The Conclusions say that maintaining a healthy weight is important for reducing type 2 diabetes risk. However, the Methods assess baseline BMI rather than weight loss, so this paper supports the importance of healthy weight but does not directly establish that losing weight prevents diabetes. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 22

  1. [1]Wild S Roglic G Green A Sicree R King H Global prevalence of diabetes: estimates for the year 2000 and projections for 2030 Diabetes Care 2004 27 5 1047 53 10.2337/diacare.27.5.1047 15111519 · DOI · Paper page
  2. [2]International Diabetes Federation IDF Diabetes Atlas 2013 6 Brussels International Diabetes Federation 35914061
  3. [4]Manini TM Lamonte MJ Seguin RA Manson JE Hingle M Garcia L Modifying effect of obesity on the association between sitting and incident diabetes in post-menopausal women Obesity (Silver Spring) 2014 22 4 1133 41 10.1002/oby.20620 24123945 PMC3968183 · DOI
  4. [5]Siegel LC Sesso HD Bowman TS Lee IM Manson JE Gaziano JM Physical activity, body mass index, and diabetes risk in men: a prospective study Am J Med 2009 122 12 1115 21 10.1016/j.amjmed.2009.02.008 19958889 PMC2789347 · DOI
  5. [6]Hu G Lindstrom J Valle TT Eriksson JG Jousilahti P Silventoinen K Physical activity, body mass index, and risk of type 2 diabetes in patients with normal or impaired glucose regulation Arch Intern Med 2004 164 8 892 6 10.1001/archinte.164.8.892 15111376 · DOI
  6. [7]Rana JS Li TY Manson JE Hu FB Adiposity compared with physical inactivity and risk of type 2 diabetes in women Diabetes Care 2007 30 1 53 8 10.2337/dc06-1456 17192333 · DOI
  7. [8]Weinstein AR Sesso HD Lee IM Cook NR Manson JE Buring JE Relationship of physical activity vs body mass index with type 2 diabetes in women JAMA 2004 292 10 1188 94 10.1001/jama.292.10.1188 15353531 · DOI
  8. [9]Hu G Qiao Q Tuomilehto J Balkau B Borch-Johnsen K Pyorala K Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women Arch Intern Med 2004 164 10 1066 76 10.1001/archinte.164.10.1066 15159263 · DOI · Paper page
  9. [10]The InterAct Consortium Physical activity reduces the risk of incident type 2 diabetes in general and in abdominally lean and obese men and women: the EPIC-InterAct Study Diabetologia 2012 55 7 1944 52 10.1007/s00125-012-2532-2 22526603 PMC3369127 · DOI
  10. [11]Global Recommendations on Physical Activity for Health. WHO Guidelines Approved by the Guidelines Review Committee. Geneva: World Health Organization; 2010. 26180873
  11. [12]WHO Obesity: preventing and managing the global epidemic. Report of a WHO Consultation 2000 Geneva World Health Organization 11234459
  12. [14]Lin DYWL Ying Z Checking the Cox model with cumulative sums of martingale-based residuals Biometrika 1993 80 573 81 10.1093/biomet/80.3.573 · DOI
  13. [15]Stijnen T Hamza TH Özdemir P Random effects meta-analysis of event outcome in the framework of the generalized linear mixed model with applications in sparse data Stat Med 2010 29 29 3046 67 10.1002/sim.4040 20827667 · DOI · Paper page
  14. [16]Walker M Whincup PH Shaper AG The British Regional Heart Study 1975–2004 Int J Epidemiology 2004 33 6 1185 92 10.1093/ije/dyh295 15319395 · DOI
  15. [17]The Caerphilly and Speedwell Collaborative Group Caerphilly and Speedwell collaborative heart disease studies J Epidemiol Community Health 1984 38 259 62 10.1136/jech.38.3.259 6332166 PMC1052363 · DOI
  16. [18]Brown WJ Bryson L Byles JE Dobson AJ Lee C Mishra G Women’s Health Australia: recruitment for a national longitudinal cohort study Women & health 1999 28 1 23 40 10.1300/J013v28n01_03 10022055 · DOI
  17. [20]Jeon CY Lokken RP Hu FB van Dam RM Physical activity of moderate intensity and risk of type 2 diabetes: a systematic review Diabetes Care 2007 30 3 744 52 10.2337/dc06-1842 17327354 · DOI · Paper page
  18. [21]Aune D Norat T Leitzmann M Tonstad S Vatten LJ Physical activity and the risk of type 2 diabetes: a systematic review and dose–response meta-analysis Eur J Epidemiol 2015 30 7 529 42 10.1007/s10654-015-0056-z 26092138 · DOI · Paper page
  19. [22]Abdullah A Peeters A de Courten M Stoelwinder J The magnitude of association between overweight and obesity and the risk of diabetes: a meta-analysis of prospective cohort studies Diabetes Res Clin Pract 2010 89 3 309 19 10.1016/j.diabres.2010.04.012 20493574 · DOI · Paper page
  20. [24]Dunstan DW Zimmet PZ Welborn TA Cameron AJ Shaw J de Courten M The Australian Diabetes, Obesity and Lifestyle Study (AusDiab)—methods and response rates Diabetes Res Clin Pract 2002 57 2 119 29 10.1016/S0168-8227(02)00025-6 12062857 · DOI
  21. [25]Verschuren WM Blokstra A Picavet HS Smit HA Cohort profile: the Doetinchem cohort study Int J Epidemiol 2008 37 6 1236 41 10.1093/ije/dym292 18238821 · DOI
  22. [26]Marmot M Brunner E Cohort Profile: the Whitehall II study Int J Epidemiol 2005 34 2 251 6 10.1093/ije/dyh372 15576467 · DOI

Cited by

Sorted by citations

Authors
Cloostermans, L., Wendel-Vos, W., Doornbos, G., Howard, B., Craig, C. L., Kivimäki, M., Tabak, A. G., Jefferis, B. J., Ronkainen, K., Brown, W. J., Picavet, S. H. S. J., Ben-Shlomo, Y., Laukkanen, J. A., Kauhanen, J., & Bemelmans, W. J. E.
Affiliations
  • National Institute for Public Health and the Environment (NL)
  • Baker Heart and Diabetes Institute (AU)
  • Canadian Fitness and Lifestyle Research Institute (CA)
  • University College London (GB)
  • University of Eastern Finland (FI)
  • The University of Queensland (AU)
ORCID
Venue
International Journal of Behavioral Nutrition and Physical Activity
Publisher
Springer Science and Business Media LLC
Published
2015-12
Volume
12
Issue
1
Pages
147-147
ISSN
1479-5868 (ISSN-L)
DOI
10.1186/s12966-015-0304-3
PMC
PMC4666059
OpenAlex
W2183892633
Cited by
72
References
3
Citations by year
2026: 6 · 2025: 5 · 2024: 4 · 2023: 3 · 2022: 9 · 2021: 7 · 2020: 7 · 2019: 8 · 2018: 11 · 2017: 10 · 2016: 2
FWCI
0.94
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • International Journal of Behavioral Nutrition and Physical Activity (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • Bristol Research (University of Bristol) (submittedVersion)
  • Rivm Repository (Netherlands National Institute for Public Health and the Environment) (submittedVersion)
Funders
  • American Cancer Society
  • Australian Government
  • National Institute for Health and Care Research (PDF-2010-03-23)
  • British Heart Foundation (RG/08/013/25942, RG/13/16/30528, K013351)
  • National Institutes of Health
  • Medical Research Council (MR/K013351/1, K013351, RG/13/16/30528)
  • Economic and Social Research Council (ES/J023299/1)
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords
type 2 diabetes, physical activity, body mass index, obesity, overweight, diabetes incidence, diabetes prevention, combined risk factors, healthy weight
MeSH terms
Adult, Aged, Body Weight, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Humans, Male, Middle Aged, Obesity, Prospective Studies, Risk, Thinness, Cohort Studies, Exercise, Body Mass Index, Incidence, Proportional Hazards Models, Internationality, Overweight

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review