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Original Research |

Physical Fitness Among Swedish Military Conscripts and Long-Term Risk for Type 2 Diabetes Mellitus: A Cohort StudyPhysical Fitness and Type 2 Diabetes

Casey Crump, MD, PhD; Jan Sundquist, MD, PhD; Marilyn A. Winkleby, PhD; Weiva Sieh, MD, PhD; and Kristina Sundquist, MD, PhD
[+] Article, Author, and Disclosure Information

This article was published at www.annals.org on 8 March 2016.


From Icahn School of Medicine at Mount Sinai, New York, New York; Stanford Prevention Research Center, Stanford University, Stanford, California, and Center for Primary Health Care Research, Lund University, Malmö, Sweden.

Grant Support: By the National Heart, Lung, and Blood Institute, National Institutes of Health (grant R01 HL116381); the Swedish Research Council; and Region Skåne/Lund University (Avtal om Läkarutbildning och Forskning, or Agreement on Medical Training and Research, project grant).

Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2002.

Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.

Reproducible Research Statement:Study protocol, data set, and statistical code: Not available.

Requests for Single Reprints: Casey Crump, MD, PhD, Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY 10029; e-mail, casey.crump@mssm.edu.

Current Author Addresses: Dr. Crump: Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY 10029.

Drs. Jan and Kristina Sundquist: Clinical Research Centre, Center for Primary Health Care Research, Lund University, Building 28, Floor 11, Jan Waldenströms gata 35, Skåne University Hospital, SE-205 02 Malmö, Sweden.

Dr. Winkleby: Stanford Prevention Research Center, Stanford University, 251 Campus Drive, Medical School Office Building, Room X318, Stanford, CA 94305-5411.

Dr. Sieh: Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY 10029.

Author Contributions: Conception and design: C. Crump, J. Sundquist, M.A. Winkleby, W. Sieh, K. Sundquist.

Analysis and interpretation of the data: C. Crump, J. Sundquist, M.A. Winkleby, W. Sieh, K. Sundquist.

Drafting of the article: C. Crump, M.A. Winkleby.

Critical revision of the article for important intellectual content: C. Crump, J. Sundquist, M.A. Winkleby, W. Sieh, K. Sundquist.

Final approval of the article: C. Crump, J. Sundquist, M.A. Winkleby, W. Sieh, K. Sundquist.

Statistical expertise: C. Crump, J. Sundquist, M.A. Winkleby, W. Sieh.

Obtaining of funding: J. Sundquist, K. Sundquist.

Administrative, technical, or logistic support: J. Sundquist, K. Sundquist.

Collection and assembly of data: J. Sundquist, K. Sundquist.


Ann Intern Med. 2016;164(9):577-584. doi:10.7326/M15-2002
© 2016 American College of Physicians
Text Size: A A A

Background: Early-life physical fitness has rarely been examined in relation to type 2 diabetes mellitus (DM) in adulthood because of the lengthy follow-up required. Elucidation of modifiable risk factors at young ages may help facilitate earlier and more effective interventions.

Objective: To examine aerobic capacity and muscle strength at age 18 years in relation to risk for type 2 DM in adulthood.

Design: National cohort study.

Setting: Sweden.

Participants: 1 534 425 military conscripts from 1969 to 1997 (97% to 98% of all men aged 18 years nationwide) without prior type 2 DM.

Measurements: Aerobic capacity and muscle strength (measured in watts and newtons per kilogram of body weight, respectively) were examined in relation to type 2 DM identified from outpatient and inpatient diagnoses from 1987 to 2012 (maximum age, 62 years).

Results: 34 008 men were diagnosed with type 2 DM in 39.4 million person-years of follow-up. Low aerobic capacity and muscle strength were independently associated with increased risk for type 2 DM. The absolute difference in cumulative incidence of type 2 DM between the lowest and highest tertiles of both aerobic capacity and strength was 0.22% at 20 years of follow-up (95% CI, 0.20% to 0.25%), 0.76% at 30 years (CI, 0.71% to 0.81%), and 3.97% at 40 years (CI, 3.87% to 4.06%). Overall, the combination of low aerobic capacity and muscle strength was associated with a 3-fold risk for type 2 DM (adjusted hazard ratio, 3.07 [CI, 2.88 to 3.27]; P < 0.001), with a positive additive interaction (P < 0.001). These associations were seen even among men with normal body mass index.

Limitation: This cohort did not include women and did not measure physical fitness at older ages.

Conclusion: In this large cohort of Swedish male military conscripts, low aerobic capacity and muscle strength at age 18 years were associated with increased long-term risk for type 2 DM, even among those with normal body mass index.

Primary Funding Source: National Institutes of Health.

Figures

Grahic Jump Location
Figure.

Cumulative incidence of type 2 diabetes mellitus, by aerobic capacity and muscle strength in men aged 18 years with a maximum follow-up of 44 years.

Grahic Jump Location

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