Effect of the interaction between physical activity and estimated macronutrient intake on HbA1c: population-based cross-sectional and longitudinal studies

Takuma Furukawa, Yuichiro Nishida, Megumi Hara, Chisato Shimanoe, Kayoko Koga, Chiharu Iwasaka, Yasuki Higaki, Keitaro Tanaka, Ryoko Nakashima, Hiroaki Ikezaki, Asahi Hishida, Takashi Tamura, Yasufumi Kato, Yudai Tamada, Keitaro Matsuo, Hidemi Ito, Haruo Mikami, Miho Kusakabe, Rie Ibusuki, Keiichi ShibuyaSadao Suzuki, Hiroko Nakagawa-Senda, Etsuko Ozaki, Daisuke Matsui, Kiyonori Kuriki, Yasuyuki Nakamura, Aya Kadota, Kokichi Arisawa, Sakurako Katsuura-Kamano, Kenji Takeuchi, Kenji Wakai

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2 Citations (Scopus)


Introduction Healthy diet and physical activity (PA) are essential for preventing type 2 diabetes, particularly, a combination of diet and PA. However, reports on interaction between PA and diet, especially from large epidemiological studies, are limited. We investigated the effect of interaction between PA and macronutrient intake on hemoglobin A1c (HbA1c) levels in the general population. Research design and methods We conducted a cross-sectional study of 55 469 men and women without diabetes who participated in the baseline survey of the Japan Multi-Institutional Collaborative Cohort Study. A self-administered questionnaire ascertained PA and macronutrient intake (carbohydrate, fat, and protein). Multiple linear regression analyses were performed to adjust for confounding variables and examine the interactions. In addition, we conducted a longitudinal study during a 5-year period within a subcohort (n=6881) with accelerometer-assessed PA data. Results Overall, PA had a weak inverse association (β=-0.00033, p=0.049) and carbohydrate intake had a strong positive association (β=0.00393, p<0.001) with HbA1c. We observed a tendency of interactions between PA and carbohydrate or fat intake, but not protein intake, on HbA1c levels after adjusting for age, sex, study area, total energy intake, alcohol consumption, smoking, and medication for hypertension or hypercholesterolemia (P interaction =0.054, 0.006, and 0.156, respectively). The inverse associations between PA and HbA1c level were more evident in participants with high-carbohydrate (or low-fat) intake than in participants with low-carbohydrate (or high-fat) intake. Although further adjustment for body mass index slightly attenuated the above interactions (P interaction =0.098 for carbohydrate and 0.068 for fat), the associations between PA and HbA1c level in stratified analyses remained unchanged. Similar associations and interactions were reproduced in the longitudinal study. Conclusions The present results suggest that the effect of PA on HbA1c levels is modified by intake of macronutrient composition.

Original languageEnglish
Article numbere002479
JournalBMJ Open Diabetes Research and Care
Issue number1
Publication statusPublished - 2022 Jan 3


  • Epidemiology
  • Exercise
  • Glycated hemoglobin
  • Nutrients


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