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Preventive Medicine
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a b s t r a c t
Objective. The aim of this study is to investigate the association between ve-year changes in occupational sitting and body mass index (BMI) in working adults.
Methods. We analyzed data from The Danish Work Environment Cohort Study (2005 and 2010, n = 3.482).
Data on occupational sitting, weight, height and several potential confounders were self-reported. The association between change in occupational sitting (hours) (categorized as large decrease b7.5, moderate decrease
7.5 to b 2.5, no change 2.5 to 2.5, moderate increase N2.5 to 7.5 and large increase N7.5) and change in
BMI was explored by multiple linear regression analyses.
Results. 43.0% men and 36.1% women had high occupational sitting time (25 h per week) at baseline. 31.8%
men and 27.2% women decreased while 30.0% men and 33.0% women increased occupational sitting. The proportion of obese (BMI 30) increased almost 3% for both genders. BMI changed 0.13 (CI: 0.06; 0.20, p = 0.0003), per
category of change in occupational sitting in women, but no association was found in men.
Conclusion. In women, there is a positive association between ve-year changes in occupational sitting and
BMI.
2015 Elsevier Inc. All rights reserved.
Introduction
The prevalence of overweight and obesity has been strongly increasing the last decades (Haslam and James, 2005; Kelly et al., 2008). Because overweight and obesity increase the risk for several diseases
such as diabetes, cancer and cardiovascular disease, it is considered to
be among the largest challenges for public health worldwide (Haslam
and James, 2005; Kelly et al., 2008). A contributing factor for the obesity
epidemic could be, that work has changed from mainly involving different forms of physical activity to becoming mainly sedentary for a high
proportion of the working population (Stamatakis et al., 2007; Juneau
and Potvin, 2010; Allman-Farinelli et al., 2010; Church et al., 2011). Because adults often spend more than half of their waking hours at work
(Tudor-Locke et al., 2011), and sedentary behavior is characterized by
a low energy expenditure, this change has potential effects on obesity
(Pate et al., 2008; Church et al., 2011), and, more documentation for
changes in body weight from changes in occupational sitting is needed
(Hamilton et al., 2007). One prospective study found a positive association between sedentary work and body mass index (BMI) (Hu et al.,
2003). However, other prospective studies found no associations
Corresponding author at: National Research Centre for the Working Environment,
Lers Parkall 105, DK-2100 Copenhagen , Denmark.
E-mail address: dorte.eriksen@yahoo.com (D. Eriksen).
http://dx.doi.org/10.1016/j.ypmed.2014.12.038
0091-7435/ 2015 Elsevier Inc. All rights reserved.
between sedentary work and BMI (van Uffelen et al., 2010). The strongest epidemiological evidence for the positive health effects of physical
activity is based on studies investigating associations between changes
in physical activity and risk for impaired health and diseases (Bravata
et al., 2007). However, no previous studies have to our knowledge investigated if changes in sedentary working time are associated with
changes in BMI. The main aim of this study was to investigate the association between changes in occupational sitting time and BMI in a representative sample of the working population in Denmark, testing the
a priori hypothesis of a positive association between these variables.
Methods
Participants/study population
This study used data from The Danish Work Environment Cohort Study
(DWECS), consisting of a representative sample of the Danish working population aged 1859 years at entry. In 2005 the survey used a combination of (postalor internet based) questionnaire (90%) and telephone interview (10%) among a
representative sample of 20,000 workers with a response rate of 63%. In 2010 the
survey was conducted using (postal- or internet based) questionnaire only, and
achieved a response rate of 53% of a representative sample of 30,000 workers.
This study includes data from the 4732 working respondents who participated
in both 2005 and 2010.
Occupational sitting
Participants reported their amount of occupational sitting time by answering the question Does your work imply sitting? with six response categories
(Almost all the time, approximately of the time, approximately of the
time, approximately of the time, rarely/very little or never). Similar categorical measures of occupational sitting have been used previously (Choi et al.,
2010; Stock et al., 2005). Accounting for participants having varying number
of working hours, the categories of sitting time were calculated into sitting
hours, based on self-reported weekly working hours achieved by response to
the questions How many hours a week do you work in your main job, including
possible extra hours? and How many hours a week do you normally work in
your secondary job? The total amount of working hours per week was then
multiplied by the constant for occupational sitting, corresponding to the previously mentioned categorical occupational sitting time (0.875, 0.750, 0.500,
0.250, 0.125 and 0.000). The change in occupational sitting time from 2005 to
2010 was calculated by subtracting occupational sitting in 2005 from occupational sitting in 2010, and dened on an ordinal scale with ve categories of
weekly change (hours) (large decrease b7.5, moderate decrease = 7.5 to
b 2.5, no change = 2.5 to 2.5, moderate increase N2.5 to 7.5 and large increase N7.5). Moreover, the baseline weekly occupational sitting hours was dened on an ordinal scale with three categories (low: 10, moderate: N 10 to b 25
and high: 25).
Table 1
Characteristics of the study population for each sex separately, numbers (n), percent (%).
N = 3482. The Danish Work Environment Cohort (NAK), 2005.
Males
Females
(n = 1679,
48.2%)
(n = 1803,
51.8%)
Confounders
Age (years)
1829
3039
4049
5059
60
164
429
587
470
29
9.8
25.6
35.0
28.0
1.7
143
497
693
459
11
7.9
27.6
38.4
25.5
0.6
Baseline BMI
Underweight (b18.5)
Normal weight (18.5b25)
Overweight (25b30)
Obesity (30)
5
781
715
178
0.3
46.5
42.6
10.6
51
1198
416
138
2.8
66.4
23.1
7.7
61
437
928
253
3.6
26.0
55.3
15.1
27
360
1182
234
1.5
20.0
65.6
13.0
Smoking status
Smoker
Ex-smoker
Never
430
464
785
25.6
27.6
46.8
457
514
832
25.4
28.5
46.2
455
391
441
392
27.1
23.3
26.3
23.4
452
416
514
421
25.1
23.1
28.7
23.4
Questionnaire method
Postal or internet based questionnaire
Telephone interview
1347
332
80.2
19.8
1493
310
82.8
17.2
184
796
354
345
11.0
47.4
21.1
20.6
149
789
659
206
8.3
43.8
36.6
11.4
607
350
722
36.2
20.9
43.0
683
469
651
37.9
26.0
36.1
sitting in 2005 and BMI for both genders as in the primary analyses (results not shown).
Table 2
Characteristics of the study population stratied by BMI and sex, number (n) and percent (%).
N = 3482. The Danish Work Environment Cohort (NAK), 2005 to 2010.
Males (n = 1679;
48.2%)
Females (n = 1803;
51.8%)
Discussion
2005
2005
2010
2010
BMI
Underweight (b18.5)
Normal weight (18.5b25)
Overweight (25b30)
Obesity (30)
5
781
715
178
0.3
46.5
42.6
10.6
4
683
772
220
0.2
40.7
46.0
13.1
51
1198
416
138
2.8
66.4
23.1
7.7
41
1079
493
190
2.3
60.0
27.3
10.5
Results
Table 1 presents an overview of baseline characteristics of the study
population stratied by sex. Men generally have a higher prevalence of
high occupational sitting (25 h/week), overweight and obesity than
women.
Table 2 shows the distribution of the participants in the four BMIcategories in 2005 and 2010, stratied by sex. The prevalence of overweight and obesity increased among both sexes.
Table 3 presents the results for men and women based on the linear
regression analysis on the association between changes in occupational
sitting time and change in BMI. For men, no tendency for an association
between category of change in occupational sitting and BMI was observed. For women, a signicant positive trend was seen between
change in occupational sitting and BMI. Compared to the group with
large increase in sitting time (reference), a positive association with
BMI was found in the groups with large decrease and moderate decrease in occupational sitting. Correcting the results by the Sidk procedure did not alter this nding.
Moreover, a positive association between occupational sitting time
as a quantitative variable and BMI was found in women. Each unit of increase in occupational sitting category was associated with an increase
in BMI. Change in BMI (CI) = 0.13 (0.06; 0.20), p = 0.0003 in model 3
(results not shown). No associations were found between categories
of occupational sitting time in 2005 and both baseline BMI (not
shown) and change in BMI from 2005 to 2010 for men and women respectively (Table 4).
Sensitivity analyses excluding respondents with self-reported height
difference greater than 5 cm showed similar results (Tables 3 and 4).
The additional analyses involving all study participants, independent
of numbers of working hours, found a similar pattern both between
changes in occupational sitting from 2005 to 2010, and occupational
Table 3
Association between change in occupational sitting time and change in BMI (BMI). N = 3482. The Danish Work Environment Cohort (NAK), 2005 to 2010.
Crude (Model 1)a
BMI
Males
Large decrease
Moderate decrease
No change
Moderate increase
Large increase
Females
Large decrease
Moderate decrease
No change
Moderate increase
Large increase
CI
BMI
CI
0.9342
0.04
0.00
0.04
0.06
0
0.27
0.31
0.22
0.27
0.27
0.19
0.27
0.21
Reference
0.7563
0.9750
0.7177
0.6685
0.46
0.50
0.24
0.06
0
0.80
0.12
0.80
0.19
0.50
0.01
0.36
0.25
Reference
0.0077
0.0016
0.0629
0.7092
BMI
CI
0.04
0.02
0.05
0.07
0
0.22
0.31
0.25
0.28
0.27
0.18
0.34
0.20
Reference
0.7446
0.9088
0.6724
0.6013
0.43
0.50
0.25
0.10
0
0.77
0.10
0.81
0.20
0.51
0.00
0.40
0.20
Reference
0.0108
0.0010
0.0502
0.4961
0.9169
0.04
0.01
0.04
0.07
0
0.22
0.31
0.25
0.28
0.26
0.19
0.34
0.20
Reference
0.7415
0.9137
0.7574
0.6166
0.46
0.48
0.23
0.08
0
0.79
0.12
0.79
0.18
0.48
0.03
0.38
0.22
Reference
0.0073
0.0018
0.0811
0.0671
0.0038
*
0.8839
0.0054
0.0058
BMI: Change in BMI from 2005 to 2010. CI: 95% condence interval. P: Signicance level. Bold writing: P b 0.05. *Overall signicance level. Large decrease: b7.5 h. Moderate decrease:
7.5 h to b2.5 h. No change: 2.5 h to 2.5 h. Moderate increase: N2.5 h to 7.5 h. Large increase: N7.5 h.
a
Crude analysis: Adjusted for age.
b
Adjusted for age + baseline BMI, smoking, leisure time physical activity, questionnaire method, and job seniority.
c
Adjusted as in model 2 + SES.
Table 4
Association between level of baseline occupational sitting time and change in BMI (BMI), N = 3544. The Danish Work Environment Cohort (NAK), 2005 to 2010.
Crude (Model 1)a
BMI
Males
Low
Moderate
High
Females
Low
Moderate
High
CI
BMI
CI
0.4085
0.11
0.06
0.00
0.05
0.28
0.13
0.27
Reference
0.1843
0.4977
0.20
0.09
0.00
0.00
0.40
0.13
0.31
Reference
0.0496
0.4317
BMI
CI
0.02
0.03
0.00
0.16
0.20
0.17
0.23
Reference
0.8383
0.7742
0.18
0.07
0.00
0.02
0.39
0.15
0.29
Reference
0.0823
0.5436
0.5268
0.09
0.06
0.00
0.07
0.26
0.13
0.26
Reference
0.2663
0.5237
0.22
0.08
0.00
0.02
0.42
0.14
0.30
Reference
0.0297
0.4711
0.1442
*
0.9554
0.0893
0.2133
BMI: Change in BMI from 2005 to 2010. CI: 95% condence interval. P: Signicance level. *Overall signicance level. Low: 10 h. Moderate: N10 h to b25 h. High: 25 h.
a
Crude analysis: Adjusted for age.
b
Adjusted for age + baseline BMI, smoking, leisure time physical activity, questionnaire method, and job seniority.
c
Adjusted as in model 2 + SES.
the waking hours for working adults (Tudor-Locke et al., 2011). Therefore, the occupational domain is a relevant setting for intervening on extensive sitting (Chau et al., 2012; Owen et al., 2011).
Strengths and limitations
The main strength of this study is the prospective study design with
a large representative sample of Danish workers. The question on occupational sitting time has been used in earlier studies and have shown acceptable validity and reliability (Stock et al., 2005; Andersen et al., 2000;
Holtermann et al., 2012; Choi et al., 2010), and the ability to estimate the
weekly number of hours sitting at work strengthens the study (van
Uffelen et al., 2010). Additional strength is the ability to investigate
the association between changes in occupational sitting time and BMI.
We adjusted for baseline BMI and other potential confounders. We did
not adjust for baseline sitting time. Given the chosen analytical approach in this study, including the treatment of ordinal variables as
quantitative, we consider that changes in sitting time are associated
with similar changes in BMI independent of baseline.
The main limitation is the use of self-reported measures of occupational sitting time and BMI, which may have been inuenced by selfreporting bias. Self-reported sitting time is often overestimated (Clark
et al., 2011; Juneau and Potvin, 2010), while self-reported BMI is often
underestimated (Nyholm et al., 2007). These issues might have led to
underestimation of the association between change in occupational sitting time and BMI. It would be a methodological strength for future cohort studies to collect objective data on these variables (LagerstedOlsen et al., 2013). The survey response rate was 63% in 2005 and 53%
in 2010. Additionally the study only included individuals, who
responded in both years. This might have led to selection biases, if participants were healthier than non-participants. Potentially this might
cause underestimation of the association between changes in occupational sitting time and BMI. Moreover some methodological weaknesses
are present, like not being able to estimate the energy expenditure, not
having a clear denition of smoking and not having information on
commuting physical activity, which may have a signicant inuence
on BMI, even independently of occupational and recreational physical
activity. We cannot exclude the risk of reversed causation, since the
changes in occupational sitting and associated changes in BMI are measured during the same time span. Future studies should focus on prospective designs using objective measures for occupational and leisure
time sitting, and might focus on the potential difference between men
and women concerning the association between occupational sitting
and overweight/obesity.
Conclusion
We found a positive association between change in occupational sitting time and BMI from 2005 to 2010 in women. More prospective
Acknowledgment
For help with managing the data in SAS: Data manager Ebbe
Villadsen, National Research Center for the Working Environment,
Copenhagen, Denmark
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