產後少看電視多運動可避免發生糖尿病


  【24drs.com】研究者報告指出,雖然有妊娠糖尿病的婦女發生第二型糖尿病的風險高,如果她們產後保持運動並儘量少看電視,則罹病風險降低。
  
  在一篇針對有妊娠糖尿病史婦女進行的大型前瞻世代研究中,達到美國聯邦運動指引的婦女,發生第二型糖尿病的風險降低45%,與身體質量指數(BMI)和其他主要風險因素無關。
  
  資深作者、國家健康研究院Eunice Kennedy Shriver國家兒童健康與人類發展研究中心的Cuilin Zhang醫師表示,研究結果指出,這類婦女應規律運動且試著達到美國聯邦指引建議的每週至少150分鐘中等強度運動[例如快走]或每週75分鐘的強度運動,如慢跑。
  
  運動可以幫助這些高風險婦女避免糖尿病,但是,如果老是坐著看電視,則會因為BMI增加而使發生糖尿病風險升高。
  
  Zhang醫師指出,久坐看電視而不運動,會減少能量消耗,且會「不經意」的吃東西,還會被高熱量低營養零食的電視廣告影響。
  
  這篇研究線上登載於5月19日美國醫學會內科醫學期刊,作者是Eunice Kennedy Shriver國家兒童健康與人類發展研究中心的Wei Bao博士等人。
  
  Zhang醫師解釋,約4%至7%孕婦會發生妊娠糖尿病,且常見於肥胖、少數民族與年長婦女。妊娠糖尿病會使未來20年發生第二型糖尿病的風險增加,有多少婦女會發生符合定義之糖尿病的估計則不一,從16%到60%都有。
  
  之前,這個研究團隊報告指出,有妊娠糖尿病史的婦女依循健康飲食可降低發生第二型糖尿病的風險,但是對於可能影響第二型糖尿病的其他風險因素就比較不清楚。
  
  他們希望檢視運動與看電視及其他久坐行為對於發生第二型糖尿病風險的關聯。
  
  在「護士健康研究II」的研究中,4554名婦女有妊娠糖尿病史,於1991至2007年間被追蹤。開始時,這些研究大部份是白人婦女,平均年齡約為38歲且平均BMI約為27,約四分之一有糖尿病家族史。
  
  研究對象在1991、1997、2001和2005年回覆問卷,回覆每週花在走路、慢跑、跑步、騎腳踏車、體操、使用划船機、游泳、或打壁球、短柄牆球、網球的平均時間。根據這些資料,研究者估計每週總運動量、強度運動量、散步量的代謝當量(MET)小時數。
  
  這些婦女也報告她們每週在家看電視、在家坐著做其他事情、坐著工作或開車的時間。
  
  總共有635名婦女發生第二型糖尿病。
  
  每週代謝當量每增加5 MET — 或相當於每週100分鐘中等強度運動或每週50分鐘強度運動—與第二型糖尿病發生風險降低9%有關。
  
  作者們寫道,散步和強度運動與降低第二型糖尿病的風險相當,這是「令人放心的」。
  
  相較於每週看電視時間少於6小時,每週看電視6小時到20小時以上與發生第二型糖尿病風險增加28%-77%有關;校正BMI之後,此風險降低。其他的久坐行為則是和第二型糖尿病風險無關。
  
  北加州Kaiser Permanente中心的Monique Hedderson博士和Assiamira Ferrara博士在編輯評論中寫道,Bao醫師等人的文章為妊娠糖尿病婦女帶來希望,如果她們可以增加運動量,或許可減少或延遲發生第二型糖尿病的風險。
  
  他們強調,多運動的建議也適用所有年輕婦女。醫師必須建議綜合性的生活型態方式,所有婦女都應健康飲食與增加運動 ,特別是計畫懷孕者,以避免肥胖、妊娠糖尿病與糖尿病。
  
  他們結論表示,考慮到解決當前糖尿病和肥胖流行病的緊迫性,該文也呼籲研究者和衛生當局採取行動,發展有效的介入方式增加孕齡婦女運動量。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=7084&x_classno=0&x_chkdelpoint=Y
  

Less TV, More Exercise Wards off Diabetes After Pregnancy

By Marlene Busko
Medscape Medical News

Although women with a history of gestational diabetes are at exceptionally high risk for type 2 diabetes mellitus, if they keep active and minimize the amount of TV they watch, they may lower this risk, researchers report.

In new research — a large prospective cohort study of women with a history of gestational diabetes — those who met US federal guidelines for physical activity had a 45% lower risk of developing type 2 diabetes, independent of body mass index (BMI) and other major risk factors.

The results indicate that such women "should exercise regularly and try to comply with the US federal guidance of at least 150 minutes/week of moderate-intensity exercise [such as brisk walking] or 75 minutes/week of vigorous exercise, such as jogging," senior author Cuilin Zhang, MD, from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, in Rockville, MD, told Medscape Medical News in an email.

While upping exercise appeared to ward off diabetes in these high-risk women, the opposite habit — sitting transfixed in front of a television — was associated with an increased risk of developing diabetes, largely due to increased BMI.

"TV watching typically acts as a sedentary replacement for physical activity, leading to a reduction in energy expenditure," Dr. Zhang noted. It "is associated with 'mindless' eating, [and viewers] may be influenced by commercial food advertisements for nutrient-poor, high-calorie foods."

The study was published online May 19 in JAMA Internal Medicine, by Wei Bao, MD, PhD, also of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and colleagues.

High-Risk Women

Gestational diabetes occurs in 4% to 7% of pregnancies and is more common among the obese, minorities, and older women, Dr. Zhang explained. Gestational diabetes increases the risk of developing type 2 diabetes within the next 20 years, although estimates vary widely as to the number of women who will go on to develop full-blown diabetes, ranging from 16% to 60%.

Previously, the same research group reported that women with a history of gestational diabetes who followed a healthy diet had a lower risk of developing type 2 diabetes. But little is known about other risk factors that might affect progression to type 2 diabetes, they explain.

They set out to examine the association between physical activity and TV watching and other sedentary behavior with risk of developing type 2 diabetes.

In the Nurses' Health Study II, 4554 women who had a history of gestational diabetes were identified and followed from 1991 to 2007. At baseline, the women, who were mostly white, had an average age of about 38 and an average BMI of around 27, and about a quarter had a family history of diabetes.

The participants filled in questionnaires in 1991, 1997, 2001, and 2005 in which they reported the average time they spent each week walking, jogging, running, bicycling, doing calisthenics, using a rowing machine, swimming, or playing squash, racquetball, or tennis. From this, the researchers determined the metabolic equivalent (MET) hours per week that were expended in total physical activity, vigorous physical activity, or walking.

The women also reported the average time they spent each week at home watching television, sitting at home doing other things, or sitting at work or driving.

A total of 635 women developed type 2 diabetes.

Each incremental increase of 5 MET/week — or about 100 minutes per week of moderate-intensity physical activity or 50 minutes per week of vigorous-intensity activity — was associated with a 9% lower risk of developing type 2 diabetes.

Both walking and vigorous activity were associated with a similar lower risk of type 2 diabetes mellitus, which is "reassuring," the authors write.

And compared with watching less than 6 hours of television a week, watching 6 to more than 20 hours a week was associated with a 28% to 77% increased risk of developing type 2 diabetes. The risk was lower after adjustment for BMI. Other sedentary behaviors were not linked with risk of type 2 diabetes.

"Hopeful Message," "Call to Action"

"The article by Dr. Bao et al provides evidence of a hopeful message for women with gestational diabetes mellitus, that if they can increase their physical activity, they may potentially reduce or delay their risk of developing [type 2] diabetes," Monique Hedderson, PhD, and Assiamira Ferrara, MD, PhD, of Kaiser Permanente Northern California, in Oakland, California, write in an accompanying editorial.

And the advice to up exercise applies to all young women, they stress. "Clinicians should recommend a comprehensive lifestyle approach, including healthful diet and increasing physical activity for all women, especially those who are planning to become pregnant, in an effort to prevent obesity, gestational diabetes, and diabetes," they note.

"Considering the urgency of addressing the current diabetes and obesity epidemics, [the] article is also a call to action for researchers and health systems to develop successful interventions to increase physical activity among women of reproductive age," they conclude.

The authors and editorialists have reported no relevant financial relationships.

JAMA Intern Med. Published online May 19, 2014.

    
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