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. Author manuscript; available in PMC: 2016 Mar 8.
Published in final edited form as: Eur J Cardiovasc Prev Rehabil. 2006 Jun;13(3):334–340. doi: 10.1097/01.hjr.0000214614.37232.f0

The impact of 3-year changes in lifestyle habits on metabolic syndrome parameters: the D.E.S.I.R study

Beverley Balkau 1,*, Emilie Vierron 1, Michel Vernay 1, Catherine Born 2, Dominique Arondel 3, Anne Petrella 3, Pierre Ducimetière 1
PMCID: PMC4764669  PMID: 16926661

Abstract

Background

The effect of lifestyle changes in cohorts of free-living populations has been surprisingly little evaluated.

Design

Longitudinal study.

Methods

In the French D.E.S.I.R. study of 1958 men and 2028 women, 30 to 65 years, the impact of 3-year changes in lifestyle habits (sporting activity, physical activity at home and at work, alcohol drinking, smoking) on metabolic syndrome parameters (insulin, glucose, HDL-cholesterol, triglycerides, systolic blood pressure, waist circumference) and on body mass index (BMI) were investigated.

Results

In men, 3-year increases in sporting activity were associated with lowering of insulin, glucose, systolic blood pressure and waist circumference (all p < 0.05). For women, the only effect was on lowering waist circumference (p < 0.03). Increases in physical activity at home were beneficially associated with HDL-cholesterol, triglycerides, waist circumference and BMI changes (all p < 0.05) in men, but had no apparent effect in women. Decreases in alcohol intake only had an effect in men with decreases in HDL-cholesterol and systolic blood pressure (p < 0.05) while decreasing cigarette smoking in men was associated with significant increases in insulin, glucose, triglycerides, waist and BMI (p < 0.001), and in women HDL-cholesterol, waist circumference and BMI increased (p < 0.02). These results were mainly due those who had stopped smoking.

Conclusions

Increases in physical activity over the three-year period were associated with beneficial effects on syndrome parameters, particularly in men. Smoking cessation and alcohol moderation produced mixed effects on these parameters.

Keywords: Adult, Aged, Metabolic Syndrome X, Middle Aged, Sex Factors, Smoking, Alcohol Drinking, Body Mass Index, Exercise, Female, Humans, Life Style, Longitudinal Studies, Male

Introduction

Lifestyle habits play an important role in the incidence of diabetes and cardiovascular disease and in risk factors for these diseases, including factors in the metabolic syndrome. The European Guidelines on cardiovascular disease prevention [1] and the American Diabetes Association [2] have official statements on the benefits of exercise and physical activity. Successful weight loss involves a number of intervention targets, and increasing the level of physical activity is a key element [3]. Many cross-sectional studies have examined the relations of exercise, alcohol drinking, and smoking with cardiovascular and diabetes risk factors [4–6] and of their long-term effects on the incidence of cardiovascular mortality and diabetes [7–12].

Interventions used in randomized controlled trials have been able to delay the incidence of diabetes [13–14] via programs of lifestyle change, centred on increasing physical activity and dietary counselling. The populations in these trials were selected because they were at high risk of diabetes and the great majority had impaired glucose tolerance.

The metabolic syndrome is considered to provide a “common soil” for diabetes and cardiovascular disease [15], and as such the determinants of this syndrome require further study.

We examine, in a free living population, associations between 3-year changes in modifiable lifestyle habits: physical activity, alcohol drinking and smoking and metabolic syndrome parameters: fasting insulin, glucose, HDL-cholesterol, triglycerides concentrations, systolic blood pressure and waist circumference as well as on body mass index (BMI). We have chosen not to look at the syndrome as a whole, because lifestyle habits can have differing effects on the individual syndrome parameters.

Methods

Subjects

The analysis included 1958 men and 2028 women, 30–65 years, insured by the French Social Security and participants in the D.E.S.I.R. (Data from an Epidemiological Study on the Insulin Resistance syndrome) cohort. The study was approved by an ethics committee and participants signed a statement of informed consent. Subjects analyzed had complete data on lifestyle factors and metabolic syndrome parameters at inclusion and at 3 years of follow-up.

Measures

Participants recorded at inclusion and at the 3-year follow-up their age, education level, any hypoglycaemic, hypolipidaemic or antihypertensive drugs, and:

  1. physical activity:

    1. usual sporting activity [never (score=1), or per week: less than once (2), once to twice (3), more than two times (4)],

    2. daily physical activity at work and at home [light (score=1), moderate (2), sustained (3), intensive (4)],

  2. intake of wine, beer or cider (none, or per day: <1/2, 1/2 to 1, 1 to 2, 2 to 3, >3 litres), intake of spirits (number of glasses/week)

  3. number of cigarettes smoked/day.

To estimate grams of pure alcohol consumed/day, we equated 125ml of wine or 250ml of beer or cider with 10gm, and one glass of spirits (2ml) with 7 gm of pure alcohol.

At inclusion and at 3-years included we measured: systolic blood pressure (mean of two measures after 5 minutes at rest in a supine position), waist circumference (smallest circumference), BMI, serum insulin (centrally measured, specific enzyme-immunoassay (MEIA) with an IMX (Abbott)), plasma glucose (glucose-oxidase-peroxydase method using a Technicon RA 1000 (Bayer) or a Specific, Delta or a LAB 20 (Konelab)), HDL-cholesterol and triglycerides (phosphotungstic precipitation methods and the enzymatic Trinder method (respectively) with a Technicon DAX24 or with a Specific, Delta or a LAB 20). Analyses were performed in one of four laboratories: IRSA (Institut inter Régional pour la Santé) at La Riche and Health Examination Centre laboratories at Blois, Orléans and Chartres which maintained an inter-laboratory quality control program

Statistical analysis

SAS version 8 was used: p<0.05 is described as statistically significant, p-values between 0.05 and 0.1, as trends. Men and women were analyzed separately because of their different drinking and smoking patterns. Insulin and triglycerides concentrations were log-transformed. Descriptive statistics are reported as means (standard deviations) or percentages.

For analyses of insulin and glucose, only subjects not treated by anti-diabetic drugs either at baseline or at 3 years were studied (1917 men, 2006 women); for HDL-cholesterol and triglycerides, only those not treated by lipid lowering drugs (1665 men, 1795 women); for systolic blood pressure, only the 1670 men and 1700 women not treated by anti-hypertensive drugs.

We studied relations between the syndrome parameters at three years and the 3-year averages and the 3-year changes in

  1. classes of physical activity (sport, at home, at work)

    1. average activity: low (average score 1 or 1.5), moderate (2 to 3) or intense (3.5 or 4)

    2. change in activity: large decrease (difference in score −3 or −2), decrease (−1), stable (0), increase (1) or large increase (2 or 3),

  2. quantity of alcohol consumed, gm/day

  3. number of cigarettes smoked, cigarettes/day

  4. weight, kg

using analysis of covariance, adjusting for the baseline value of the parameter concerned [16], age and educational level. In the models with alcohol or smoking, binary variables adjusted for non-drinkers or for non-smokers: these subjects may have differing habits to occasional drinkers or smokers. Trend tests were used across physical activity classes and linearity was checked by likelihood ratio tests. We also tested the effects of 3-year BMI changes.

Syndrome parameters at 3-years were predicted from the average and the change of all lifestyle factors in a multivariate model.

Results

Baseline Characteristics

The mean age was 47 years, and 18% of men and 14% of women had attended university (Table 1). The median daily alcohol intake was 21g for men and 1g for women with respectively, 12% and 37% non-drinkers at inclusion; 10% of men drank more than 62g/day and 10% of women more than 22g/day. More men than women smoked, 25% versus 14% and men were heavier smokers: 11% and 5% respectively smoked more than 15 cigarettes a day. About one in two (47% in men, 52% in women) did not play any sport, but 84% of men and 93% of women had at least a moderate physical activity at home. Mean BMI was 25.4kg/m2 in men and 24.0kg/m2 in women.

Table 1.

Characteristics (mean ± SD or percentage) of subjects studied: the D.E.S.I.R. cohort

Men (n = 1958) Women (n = 2028)
Age (years) 47.1 ± 10.0 47.1 ± 10.0
Body mass index (kg/m2) 25.4 ± 3.2 24.0 ± 4.0
Waist circumference (cm) 89.5 ± 9.2 76.9 ± 10.1
Fasting insulin (pmol/l) 47.8 ± 30.4 43.8 ± 24.6
Fasting glucose (mmol/l) 5.56 ± 0.85 5.12 ± 0.70
HDL-Cholesterol (mmol/l) 1.49 ± 0.38 1.78 ± 0.42
Triglycerides (mmol/l) 1.23 ± 0.64 0.94 ± 0.50
Systolic Blood Pressure (mm Hg) 134.3 ± 14.6 127.6 ± 15.5
Educational level (%) < 12 years schooling 67 71
12 years schooling 15 15
University level 18 14
Alcohol consumption (%) Non-drinker 12 37
1 to 19 g/day 18 35
20 to 39 g/day 39 24
> 40 g/day 31 4
Cigarette consumption (%) Non-smoker 75 86
1 to 5 cigarettes/day 7 4
6 to 14 cigarettes/day 7 5
≥ 15 cigarettes/day 11 5
Sporting activity (%) Never 47 52
Less than once per week 20 15
Once to two times per week 23 26
More than two times per week 10 7
Physical activity at home (%) Light 16 7
Moderate 60 60
Sustained 22 30
Intense 2 3
Physical activity at work (%)* Light 26 29
Moderate 42 40
Sustained 27 26
Intense 5 5
Drug treatment (%) Hypo-glycaemic 1.4 0.4
Hypo-lipidaemic 9.0 6.5
Antihypertensive 10.4 11.5
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*

percentages calculated only for those working: men (n=1535) women (n=1384)

Change in lifestyle and weight over three years

More than 60% of men and women maintained their initial level of sporting activity and equal numbers increased and decreased (Fig. 1). Close to 65% of participants maintained their level of physical activity at home, and slightly more subjects decreased than increased this activity. The percentages were similar for physical activity at work.

Fig 1.

Fig 1

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3-year changes in sporting activity, physical activity at home, cigarette smoking (among those who smoked either at inclusion or at follow-up) and alcohol intakes (among those who drank alcohol either at inclusion or at follow-up). Men, white columns, women black columns. The D.E.S.I.R. Study.

Among the 3305 alcohol drinkers (at inclusion or at three years), 25% of men and 13% of women decreased their consumption by a least 2g/day, 25% and 19% increased, and 50% and 68% respectively had a stable intake (Fig 1).

For the 860 subjects who smoked (at baseline or at follow-up), 37% of men and 27% of women reduced their cigarette consumption by at least two cigarettes/day, while 25% and 27% increased by more than two cigarettes over the 3-year follow-up.

Over the three years, 7% of men and 10% of women lost more than 5% of their baseline weight, whereas 16% of men and 25% of women gained more than 5% of their initial weight. This resulted in a change in mean weight of 0.9kg for the men and 1.1kg for the women.

Metabolic syndrome parameters and sporting activity

The 3-year average sporting activity was significantly associated with beneficial effects on syndrome parameters in men, after adjusting on the 3-year change, with the exception of glucose concentrations and systolic blood pressure (Table 2). In women, significant relations were seen with insulin, glucose and triglycerides concentrations with a trend for a decrease in systolic blood pressure and BMI. For example the BMI was 0.31kg/m2 and 0.21kg/m2 lower in the most in comparison to the least sportive groups of men and women respectively, and the triglycerides concentrations were 14% and 4% lower. The results remained unchanged after adjusting for the 3-year change in BMI, except for the association between triglycerides and average activity in women, which became a trend (p<0.1).

Table 2.

Differences of metabolic syndrome parameters, in comparison with a reference group, associated with the 3-year average and the 3-year changes in sporting activity, adjusted for age and educational level, with p-values for the trends across classes: the D.E.S.I.R. cohort

Fasting insulin* (pmol/l) Fasting glucose (mmol/l) HDL-cholest (mmol/l) Triglycerides* (mmol/l) Systolic BP (mmHg) Waist (cm) BMI (kg/m2)
MEN n=1917 n=1917 n=1665 n=1665 n=1670 n=1958 n=1958
3-year average low 0.151 0.034 −0.087 0.141 0.887 1.324 0.312
moderate 0.132 0.015 −0.056 0.051 −0.052 1.130 0.314
intense (ref) 0 0 0 0 0 0 0
p-value for trend ≤0.0001 0.5 ≤0.0001 ≤0.0001 0.1 0.0002 0.01
3-year change large decrease 0.049 0.198 −0.047 0.015 3.315 0.285 0.209
decrease 0.027 −0.015 −0.034 −0.010 −0.140 0.047 −0.024
stable (ref) 0 0 0 0 0 0 0
increase 0.010 −0.029 −0.012 0.023 −0.139 −0.066 −0.045
large increase −0.145 −0.047 −0.036 0.025 −2.921 −1.818 −0.208
p-value for trend 0.005 0.02 0.4 0.4 0.006 0.005 0.09
WOMEN n=2006 n=2006 n=1795 n=1795 n=1700 n=2028 n=2028
3-year average low 0.088 0.045 0.005 0.038 1.703 0.244 0.210
moderate −0.004 −0.044 0.010 −0.014 1.043 −0.045 0.078
intense (ref) 0 0 0 0 0 0 0
p-value for trend 0.0002 0.003 0.8 0.05 0.1 0.2 0.06
3-year change large decrease 0.103 0.024 0.000 0.044 0.989 0.614 0.137
decrease −0.004 −0.034 −0.008 0.025 −0.131 −0.093 −0.121
stable (ref) 0 0 0 0 0 0 0
increase −0.006 0.003 −0.012 −0.029 0.020 −0.128 −0.029
large increases 0.027 0.055 −0.042 0.040 0.001 −0.965 −0.004
p-value for trend 0.3 0.3 0.2 0.4 0.7 0.03 0.8
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*

log transformed

After adjusting for the 3-year average sporting activity, a 3-year increase in sporting activity had a beneficial and significant effect on insulin, glucose, systolic blood pressure and waist circumference in men with a trend for a decrease in BMI. In women, only waist circumference was significantly reduced. Men with a large increase in sporting activity decreased their waist circumference on average by 1.82cm and women by 0.96cm. The lowering of insulin, glucose and systolic blood pressure in men and of waist circumference in both men and women were not just due to a decrease in weight as they were independent of changes in BMI.

Metabolic syndrome parameters and physical activity at home

Higher average levels of activity at home, adjusted for change in this activity, were related to higher HDL-cholesterol in men with trends for a larger waist and higher systolic blood pressure and in women with lower insulin and triglyceride concentrations (Table 3).

Table 3.

Differences of metabolic syndrome parameters in comparison with a reference group, associated with the 3-year average and the 3-year changes in physical activity at home, adjusted for age and educational level, with p-values for the trends across classes: the D.E.S.I.R. cohort

Fasting insulin* (pmol/l) Fasting glucose (mmol/l) HDL-cholest (mmol/l) Triglycerides* (mmol/l) Systolic BP (mmHg) Waist (cm) BMI (kg/m2)
MEN n=1917 n=1917 n=1665 n=1665 n=1670 n=1958 n=1958
3-year average low 0.015 −0.134 −0.055 −0.101 −1.441 0.331 −0.160
moderate −0.012 −0.163 −0.024 −0.126 −0.413 −0.315 −0.281
intense (ref) 0 0 0 0 0 0 0
p-value for trend 0.3 0.8 0.02 0.8 0.09 0.08 0.3
3-year change large decrease 0.113 −0.032 −0.062 0.217 3.064 1.288 −0.024
decrease 0.011 −0.043 −0.005 0.056 0.273 −0.112 0.157
stable (ref) 0 0 0 0 0 0 0
increase −0.006 −0.020 0.028 −0.015 −0.490 −0.705 −0.111
large increase −0.090 0.006 0.004 −0.002 −2.932 −0.798 0.141
p-value for trend 0.2 0.5 0.04 0.004 0. 1 0.03 0.02
WOMEN n=2006 n=2006 n=1795 n=1795 n=1700 n=2028 n=2028
3-year average low 0.078 0.027 −0.029 0.115 −0.653 0.137 0.035
moderate 0.014 −0.002 −0.034 0.073 1.267 0.512 0.094
intense (ref) 0 0 0 0 0 0 0
p-value for trend 0.04 0.6 0. 7 0.02 0. 2 0.8 0.9
3-year change large decrease −0.110 −0.135 −0.006 −0.018 −3.078 −0.738 −0.156
decrease 0.018 −0.003 −0.005 0.022 0.330 0.129 0.173
stable (ref) 0 0 0 0 0 0 0
increase −0.033 −0.074 0.003 0.006 0.789 0.025 −0.013
large increase −0.068 0.126 −0.039 0.047 0.016 −1.424 −0.050
p-value for trend 0.3 0.4 0.8 0.7 0.4 0.8 0.2
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*

log transformed

In men, a 3-year change in this activity was associated positively with HDL-cholesterol and negatively with triglycerides, waist circumference and BMI, after adjusting for mean activity. HDL-cholesterol and triglycerides were still associated with the change in physical activity after adjusting for the 3-year change in BMI, but waist circumference was no longer significant. In contrast, there were no significant effects in women with changes in physical activity.

Metabolic syndrome parameters and physical activity at work

This activity was not related to the parameters studied, neither in men nor in women, and neither to the mean nor to the change in this activity (data not shown).

Metabolic syndrome parameters and alcohol

In women, glucose was 0.06mmol/l higher (p<0.02) in those who drank alcohol in comparison to non-drinkers whereas there were no relations with metabolic syndrome parameters in men (Table 4).

Table 4.

Regression coefficients of metabolic syndrome parameters associated with the 3-year average and the 3-year changes in alcohol (gram per day of pure alcohol) and cigarette (number per day) consumption and the 3-year average and 3-year change in weight, adjusted for age and educational level, with p-values for trends: The D.E.S.I.R. cohort

Fasting insulin* (pmol/l) Fasting glucose (mmol/l) HDL-cholest (mmol/l) Triglycerides** (mmol/l) Systolic BP (mmHg) Waist (cm) BMI (kg/m2)
Alcohol drinking (g/day)
MEN n=1917 n=1917 n=1665 n=1665 n=1670 n=1958 n=1958
 Drinker 0.052 0.2 0.048 0.3 −0.002 0.9 0.058 0.1 0.637 0.5 −0.473 0.2 −0.048 0.7
 3 yr average 0.000 0.5 0.002 0.001 0.001 0.006 −0.000 0.9 0.027 0.05 0.019 0.0005 0.006 0.0003
 3 yr change −0.001 0.2 0.001 0.4 0.001 0.01 −0.000 0.4 0.029 0.04 0.005 0.4 0.002 0.3
WOMEN n=2006 n=2006 n=1795 n=1795 n=1700 n=2028 n=2028
 Drinker −0.005 0.8 0.061 0.02 −0.016 0.3 0.003 0.9 0.340 0.6 0.373 0.2 0.147 0.1
 3 yr average 0.000 0.8 0.001 0.2 0.001 0.3 0.001 0.9 0.034 0.3 0.007 0.6 −0.003 0.4
 3 yr change −0.001 0.6 −0.001 0.5 0.000 0.5 −0.017 0.7 −0.045 0.1 0.008 0.6 −0.003 0.5
Cigarette smoking (number/day)
MEN n=1917 n=1917 n=1665 n=1665 n=1670 n=1958 n=1958
 Smoker 0.010 08 0.086 0.03 0.019 0.3 0.035 0.3 −0.092 0.9 0.619 0.08 0.201 0.04
 3 yr average 0.001 0.7 −0.002 0.4 −0.001 0.2 0.002 0.3 0.012 0.8 −0.017 0.5 −0.004 0.5
 3 yr change −0.007 0.001 −0.011 0.0001 0.001 0.3 −0.008 0.0002 −0.036 0.6 −0.097 0.0001 −0.031 0.0001
WOMEN n=2006 n=2006 n=1795 n=1795 n=1700 n=2028 n=2028
 Smoker −0.044 0.3 −0.049 0.3 0.012 0.6 0.052 0.2 −1.536 0.2 −0.162 0.8 −0.271 0.09
 3 yr average 0.005 0.1 0.009 0.007 −0.001 0.7 0.000 0.9 0.016 0.8 −0.002 0.9 0.024 0.05
 3 yr change −0.002 0.5 −0.003 0.4 −0.006 0.01 −0.003 0.35 0.019 0.8 −0.108 0.02 −0.059 0.0001
Weight (kg)
MEN n=1917 n=1917 n=1665 n=1665 n=1670 n=1958
 3 yr average 0.009 0.0001 0.006 0.0001 −0.002 0.0001 0.004 0.0001 0.128 0.0001 0.191 0.0001
 3 yr change 0.029 0.0001 0.017 0.0001 −0.008 0.0001 0.023 0.0001 0.433 0.0001 0.638 0.0001
WOMEN n=2006 n=2006 n=1795 n=1795 n=1700 n=2028
 3 yr average 0.010 0.0001 0.007 0.0001 −0.005 0.0001 0.005 0.0001 0.114 0.0001 0.255 0.0001 -
 3 yr change 0.021 0.0001 0.012 0.0001 −0.006 0.0001 0.015 0.0001 0.348 0.0001 0.636 0.0001
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*

log transformed

Adjusted for change in alcohol consumption, and drinker status, the average alcohol intake was related positively and significantly to glucose, HDL-cholesterol, systolic blood pressure, waist circumference and BMI in men. In women, there were no relations, and no parameter showed even a trend toward significance.

Three-year decreases in daily alcohol intake were associated, in men, with lower HDL-cholesterol and systolic blood pressure, after adjusting for average consumption and drinker status. For a 10gm decrease in pure alcohol intake, or one glass of wine, HDL-cholesterol decreased by 0.01mmol/l on average and systolic blood pressure by 0.29mmHg. All these relations remained after adjusting for change in BMI, except for average alcohol consumption and systolic blood pressure in men, which became a trend. In women, a 3-year change in alcohol intake had no significant effect on the parameters studied.

Metabolic syndrome parameters and cigarette smoking

Male smokers had on average a 0.20kg/m2 higher BMI than non-smokers (p<0.04), a higher glucose concentration (0.09mmol/l, p<0.03), and a trend to have a larger waist (Table 4). In contrast, women smokers tended to have a 0.27kg/m2 lower BMI.

There was no significant relation in men between the average number of cigarettes smoked and the parameters studied, after adjusting for change in tobacco consumption and smoking status. In women the fewer cigarettes smoked on average, the lower the glucose and the BMI.

A 10 cigarettes/day decrease over the 3-year period was associated in men with a significant increase in insulin (7%), glucose (0.11mmol/l), triglycerides (8%), waist (0.97cm) and BMI (0.31kg/m2), adjusted on average tobacco intake and smoker/non-smoker status, and these relations remained significant for insulin, glucose and triglycerides after adjusting for the 3-year change in BMI, with a trend for the waist circumference. These associations were mainly due to the 81 men who had decreased their cigarette intake by more than 10 cigarettes/day, including 51 men who had stopped smoking. For women, a 10 cigarettes/day decrease in smoking over the 3-year period corresponded to a 3-year increase of HDL-cholesterol (0.06mmol/l), waist circumference (1.1cm) and BMI (0.59kg/m2), but only the relation with HDL-cholesterol remained after adjusting for the 3-year change in BMI.

Metabolic parameters and all lifestyle habits

Each metabolic syndrome parameter was predicted from the 3-year average and the 3-year change in all above lifestyle factors (excepting physical activity at work), adjusting for age, education, drinking and smoking status. The significance of the above results was generally not altered, indicating the independence of the effects of these lifestyle habits (p-value>0.05 in only 2 of 140 tests). Additionally, after accounting for the 3-year change in BMI none of the previously described significant results were altered.

Metabolic parameters and weight

As might be expected, mean weight and weight change had highly statistically significant associations with all syndrome parameters (p<0.0001) (Table 4).

Discussion

This is one of the few studies that investigates the effect of changes in lifestyle habits in a free-living general population, over a moderately long period of time, three years. In men, all syndrome parameters were improved by either an increase in sport or physical activity in the home or both. For women, only the waist circumference decreased in those who increased their sporting activity. A 3-year decrease in alcohol consumption was associated with a decrease in both the HDL-cholesterol and the systolic blood pressure in men, but had no effect in women. A decrease in cigarette smoking had a detrimental effect on men for insulin, glucose, triglycerides, waist circumference and BMI, and these results were independent of the 3-year change in BMI. In women, those who decreased their smoking increased their HDL-cholesterol, waist and BMI. An increase in smoking appeared beneficial and quitting detrimental over this 3-year period; over a longer period, these effects may be reversed: ex-smokers and never-smokers might be similar. Quitting is beneficial for longevity [10].

This study is limited by self-reported lifestyle habits and thus there will be some imprecision in the responses according to how the questions were interpreted, to an individual’s recall of his usual habits, perhaps with an underestimation for both alcohol and cigarette intake and an over-estimation of physical activity. Further, for physical activity there was only one question for each of the aspects, physical activity in the home, at work and sporting activity. There was no question about commuting to work or shopping. For sporting activity, the duration and intensity were not evaluated. These should serve to reduce, not to enhance, the significant relations that are able to be shown. There were more results evident in the men than in the women, while the changes in the lifestyle habits were similar in the two sexes.

The only longitudinal study that we have identified, analyzed the 20-year changes in leisure time physical activity in men initially aged 50 years [18]. Beneficial effects were seen on glucose, HDL-cholesterol, triglycerides and weight, and the effects were maintained after adjusting on change in weight. This is similar to our study as it is a non-interventional, observational study.

Intervention studies have shown the benefits of increasing physical activity. In the Finnish Diabetes Prevention Study [13,19], over one year, the intervention group, in comparison to the control group, decreased significantly their weight, waist circumference, fasting and 2-hour glucose, triglycerides, and both systolic and diastolic blood pressure, but not fasting insulin along with a significantly increased moderate-to-vigorous activity. The body weight of 43% of the subjects in the intervention group and 13% in the control group was decreased to the target level of more than 5% in comparison to 7% of men and 10% of women in this French study. However, at baseline the mean BMI was 31kg/m2 in the Finnish study in comparison to under 25kg/m2 in our study.

Lifestyle factors cluster and individuals with a healthy lifestyle are often physically active, with a healthy diet and they do not smoke. In our study an increase in sporting activity or physical activity at home had a beneficial effect on the syndrome parameters, whereas decreasing alcohol intake only had the beneficial effect on systolic blood pressure and only in men, and decreasing cigarette smoking had deleterious effects on these parameters, mainly due to those who stopped smoking. It is appropriate that physical activity is being targeted not only in intervention studies, but in the general counseling advice given for public education.

Acknowledgments

The D.E.S.I.R. Study Group:

  • INSERM U870: B. Balkau, P. Ducimetière, E. Eschwège;

  • INSERM U367: F. Alhenc-Gelas;

  • CHU d’Angers: Y. Gallois, A. Girault;

  • Hôpital Bichat: F. Fumeron, M. Marre

  • Centres d’Examens de Sante du Reseau 9: Alençon, Angers, Blois, Caen, Chartres, Chateauroux, Cholet, Le Mans, Orléans, Tours

  • Institut de Recherche en Medecine Generale: J. Cogneau;

  • Medecins Generalistes des Départements;

  • Institut inter Regional pour la Sante: C. Born, E. Cacès, M. Cailleau, JG. Moreau, F. Rakotozafy, J. Tichet, S. Vol.

Research supported by co-operative contracts between INSERM and CNAMTS (contract 3AM004), Novartis Pharma (convention 98297), by INSERM contracts (494003, 4R001C, 4D002D), Association Diabète Risque Vasculaire, Fédération Française de Cardiologie, La Fondation de France, ALFEDIAM, ONIVINS; Ardix Medical, Bayer Diagnostics, Becton Dickinson, Cardionics, Lilly, Lipha Pharmaceuticals, Merck Santé, Novo Nordisk, Pierre Fabre, Roche, Topcon.

References

  • 1.De Backer G, Ambrosioni E, Borch-Johnsen K, Brotons C, Cifkova R, Dallongeville J, et al. European guidelines on cardiovascular disease prevention in clinical practice: third joint task force of European and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of eight societies and by invited experts) Eur J Cardiovasc Prev Rehabil. 2003;10:S1–S10. doi: 10.1097/01.hjr.0000087913.96265.e2. [DOI] [PubMed] [Google Scholar]
  • 2.Sherwin RS, Anderson RM, Buse JB, Chin MH, Eddy D, Fradkin J, et al. Prevention or delay of type 2 diabetes. Diabetes Care. 2004;27(Suppl 1):S47–S54. doi: 10.2337/diacare.27.2007.s47. [DOI] [PubMed] [Google Scholar]
  • 3.Wing RR, Hill JO. Successful weight loss maintenance. Annu Rev Nutr. 2001;21:323–341. doi: 10.1146/annurev.nutr.21.1.323. [DOI] [PubMed] [Google Scholar]
  • 4.Godsland IF, Leyva F, Walton C, Worthington M, Stevenson JC. Associations of smoking, alcohol and physical activity with risk factors for coronary heart disease and diabetes in the first follow-up cohort of the Heart Disease and Diabetes Risk Indicators in a Screened Cohort study (HDDRISC-1) J Intern Med. 1998;244:33–41. doi: 10.1046/j.1365-2796.1998.00312.x. [DOI] [PubMed] [Google Scholar]
  • 5.Konrat C, Mennen LI, Caces E, Lepinay P, Rakotozafy F, Forhan A, Balkau B D.E.S.I.R. Study Group. Alcohol intake and fasting insulin in French men and women. The D.E.S.I.R. Study. Diabetes Metab. 2002;28:116–123. [PubMed] [Google Scholar]
  • 6.Rennie KL, McCarthy N, Yazdgerdi S, Marmot M, Brunner E. Association of the metabolic syndrome with both vigorous and moderate physical activity. Int J Epidemiol. 2003;32:600–606. doi: 10.1093/ije/dyg179. [DOI] [PubMed] [Google Scholar]
  • 7.Rimm E, Klatsky A, Grobbee D, Stampfer M. Review of moderate alcohol consumption and reduced risk of coronary heart disease: is the effect due to beer, wine, or spirits? BMJ. 1996;312:731–736. doi: 10.1136/bmj.312.7033.731. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Conigrave KM, Hu BF, Camargo CA, Jr, Stampfer MJ, Willett WC, Rimm EB. A prospective study of drinking patterns in relation to risk of type 2 diabetes among men. Diabetes. 2001;50:2390–2395. doi: 10.2337/diabetes.50.10.2390. [DOI] [PubMed] [Google Scholar]
  • 9.Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ. 2004;328:1519–1528. doi: 10.1136/bmj.38142.554479.AE. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Sairenchi T, Iso H, Nishimura A, Hosoda T, Irie F, Saito Y, Murakami A, Fukutomi H. Cigarette smoking and risk of type 2 diabetes mellitus among middle-aged and elderly Japanese men and women. Am J Epidemiol. 2004;160:158–162. doi: 10.1093/aje/kwh183. [DOI] [PubMed] [Google Scholar]
  • 11.Hu F, Manson J, Stampfer M, Colditz G, Liu S, Solomon C, Willet W. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345:790–797. doi: 10.1056/NEJMoa010492. [DOI] [PubMed] [Google Scholar]
  • 12.Blair SN, Kohl HW, 3rd, Barlow CE, Paffenbarger RS, Jr, Gibbons LW, Macera CA. Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA. 1995;273:1093–1098. [PubMed] [Google Scholar]
  • 13.Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344:1343–1350. doi: 10.1056/NEJM200105033441801. [DOI] [PubMed] [Google Scholar]
  • 14.Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM Diabetes Prevention Program. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2003;346:393–403. doi: 10.1056/NEJMoa012512. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Stern M. Diabetes and cardiovascular disease. The “common soil” hypothesis. Diabetes. 1995;44:369–374. doi: 10.2337/diab.44.4.369. [DOI] [PubMed] [Google Scholar]
  • 16.Vickers AJ, Altman DG. Statistics notes: Analysing controlled trials with baseline and follow up measurements. BMJ. 2001;323:1123–1124. doi: 10.1136/bmj.323.7321.1123. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III) JAMA. 2001;285:2486–2497. doi: 10.1001/jama.285.19.2486. [DOI] [PubMed] [Google Scholar]
  • 18.Byberg L, Zethelius B, McKeigue PM, Lithell HO. Changes in physical activity are associated with changes in metabolic cardiovascular risk factors. Diabetologia. 2001;44:2134–2139. doi: 10.1007/s001250100022. [DOI] [PubMed] [Google Scholar]
  • 19.Lindstrom J, Louheranta A, Mannelin M, Rastas M, Salminen V, Eriksson J, et al. The Finnish Diabetes Prevention Study (DPS). Lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care. 2003;26:3230–3236. doi: 10.2337/diacare.26.12.3230. [DOI] [PubMed] [Google Scholar]

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