Leisure-time physical activity and all-cause mortality and cardiovascular disease in adults with type 2 diabetes:Cross-country comparison of cohort studies

Purpose:This study aimed to quantify the dose-response association and the minimal effective dose of leisure-time physical activity(PA)to prevent mortality and cardiovascular disease in adults with type 2 diabetes.Methods:Cross-country comparison of 2 prospective cohort studies including 14,913 and 17,457 population-based adults with type 2 diabetes from the UK and China.Baseline leisure-time PA was self-reported and categorized by metabolic equivalent hours per week(MET-h/week)according to World Health Organization recommendations:none,below recommendation(>0-7.49 MET-h/week);at recommended level(7.5-14.9 MET-h/week);above recommendation(>15 MET-h/week).Mortality and cardiovascular disease data were obtained from national registries.Results:During a median follow-up of 12.4 and 9.7 years,in the UK and China cohorts,repectively,higher levels of leisure-time PA were inversely associated with all-cause(1571 and 2351 events)and cardiovascular mortality(392 and 1060 events),mostly consistent with a linear dose-response relationship.PA below,at,and above recommendations,compared with no activity,yielded all-cause mortality hazard ratios of0.94(95%confidence interval(95%CI):0.79-1.12),0.90(95%CI:0.74-1.10),and 0.85(95%CI:0.70-1.02)in British adults and 0.87(95%CI:0.68-1.10),0.88(95%CI:0.74-1.03),and 0.77(95%CI:0.70-0.85)in Chinese adults.Associations with cardiovascular mortality were more pronounced in British adults(0.80(95%CI:0.58-1.11),0.75(95%CI:0.52-1.09),and 0.69(95%CI:0.48-0.97))but less pronounced in Chinese adults(1.06(95%CI:0.76-1.47),1.01(95%CI:0.80-1.28),and 0.79(95%CI:0.69-0.92)).PA at recommended levels was not associated with lower rates of major adverse cardiovascular events(2345 and 4458 events).Conclusion:Leisure-time PA at the recommended levels was not convincingly associated with lower mortality and had no association with risk of major adverse cardiovascular events in British or Chinese adults with type 2 diabetes.Leisure-time PA above current recommendations may be needed to prevent cardiovascular disease and premature mortality in adults with type 2 diabetes.

Dose-response associations,physical activity intensity and mortality risk:A narrative review

Physical activity is consistently associated with reduced mortality,decreased risk for non-communicable diseases,and improved mental health in observational studies.Randomized controlled trials and observational Mendelian randomization studies support causal links between physical activity and health outcomes.However,the scarcity of evidence from randomized controlled trials,along with their inherent challenges like exposure contrasts,healthy volunteer biases,loss to follow-up,and limited real-world dose-response data,warrants a comprehensive approach.This review advocates synthesizing insights from diverse study designs to better understand the causal relationship between physical activity,mortality risk,and other health outcomes.Additionally,it summarizes recent research since the publication of current physical activity recommendations.Novel observational studies utilizing device-measured physical activity underscore the importance of every minute of activity and suggest that all intensity levels confer health benefits,with vigorous-intensity potentially requiring lower volumes for substantial benefits.Future guidelines,informed by device-measured physical activity studies,may offer refined age-specific recommendations,emphasize vigorous-intensity physical activity,and include daily step counts as a simple,easily assessable metric using commercial wearables.

Punctual mutations in 23S rRNA gene of clarithromycinresistant Helicobacter pylori in Colombian populations

AIM To characterize punctual mutations in 23S rRNA gene of clarithromycin-resistant Helicobacter pylori(H. pylori) and determine their association with therapeutic failure.METHODS PCR products of 23S rRNA gene V domain of 74 H. pylori isolates; 34 resistant to clarithromycin(29 from a low-risk gastric cancer(GC) population: TumacoColombia, and 5 from a high-risk population: TuquerresColombia) and 40 from a susceptible population(28 from Tumaco and 12 from Túquerres) were sequenced using capillary electrophoresis. The concordance between mutations of V domain 23S rRNA gene of H. pylori and therapeutic failure was determined using the Kappa coefficient and Mc Nemar's test was performed to determine the relationship between H. pylori mutationsand clarithromycin resistance.RESULTS23S rRNA gene from H. pylori was amplified in 56/74 isolates, of which 25 were resistant to clarithromycin(20 from Tumaco and 5 from Túquerres, respectively). In 17 resistant isolates(13 from Tumaco and 4 from Túquerres) the following mutations were found: A1593 T1, A1653 G2, C1770 T, C1954 T1, and G1827 C in isolates from Tumaco, and A2144 G from Túquerres. The mutations T2183 C, A2144 G and C2196 T in H. pylori isolates resistant to clarithromycin from Colombia are reported for the first time. No association between the H. pylori mutations and in vitro clarithromycin resistance was found. However, therapeutic failure of eradication treatment was associated with mutations of 23S rRNA gene in clarithromycin-resistant H. pylori(κ = 0.71).CONCLUSION The therapeutic failure of eradication treatment in the two populations from Colombia was associated with mutations of the 23S rRNA gene in clarithromycinresistant H. pylori.