Cross-sectional associations between 24-hour movement behaviors and cardiometabolic health among adults with chronic diseases: insights in compositional data analysis and time reallocations

Objectives: Adults with chronic diseases (i.e. type 2 diabetes mellitus (T2DM), overweight, obesity) have a higher risk of health complications and mortality. Evidence suggests that 24-hour movement behaviors (24 h-MBs; i.e., physical activity, sedentary behavior and sleep) play a crucial role in managing cardiometabolic health. Therefore, it is of interest to explore the 24 h-MBs among adults with chronic diseases and how 24 h-MBs are associated with their cardiometabolic health. Methods: 24 h-MBs were collected via an accelerometer (Actigraph wGT3x+BT) in combination with a diary. Accelerometer data were analyzed using raw data processing techniques, i.e. the R package GGIR. The following cardiometabolic variables were considered: Body Mass Index (BMI), waist circumference (WC), HbA1c, fasting glucose, triglycerides, total-cholesterol, HDL-cholesterol, LDL-cholesterol, blood pressure. Regression models using compositional data analysis explored associations with cardiometabolic variables. If the overall composition (ILR coordinates) was significantly associated with a cardiometabolic health outcome, theoretical time reallocation model predictions were conducted to quantify the associations in meaningful terms. Results: The study revealed variations in time estimates of 24 h-MBs based on the data processing methods used. Among adults with T2DM, differences in 24h-MBs were observed across various weight categories. Specifically, the 24h composition of adults with T2DM being obese consisted of less sleep, light physical activity (LPA) and moderate to vigorous physical activity (MVPA) and more sedentary time (ST) per day as compared to adults with T2DM being overweight or normal weight (p < 0.001). Regardless of weight category, the largest associations were found when reallocating 20 minutes a day from ST into MVPA for BMI (−0.32 kg/m2 ; [−0.55; −0.09], −1.09 %), WC (−1.44 cm, [−2.26; −0.62], −1.35 %) and HDL-cholesterol (0.02 mmol/l, [0.01, 0.02], +1.59 %), as well as from ST into LPA for triglycerides (−0.04 ...