Association between Sedentary Lifetype, Physical Activity, and Skin C

Introduction

With the development of know-how in human society, sedentary habits (SB) has develop into an inevitable side of recent life, whether or not it’s white-collar workplace work or fashionable folks’s dependence on the web and tv.^1,2 These components contribute to an extreme period of time spent in SB day by day. Studies have proven that SB has develop into an impartial threat issue for incidence charge and mortality of sure cancers.³ Notably, the affiliation between SB and the elevated incidence of colorectal and endometrial cancers is especially robust.^4,5 Prolonged SB is linked to a 54% elevated incidence of colorectal most cancers and a 66% elevated incidence of endometrial most cancers.^5,6

Regular bodily exercise (PA) has been recognized as a protecting issue in opposition to varied ailments, with the strongest proof supporting its function in decreasing the danger of colon and breast cancers.^7,8 Some research additionally counsel that changing SB with PA is helpful for enhancing sufferers’ illness prognosis.⁹ Although PA serves as a protecting issue for varied cancers,¹⁰ it’s noteworthy that in melanoma sufferers—notably these with acral melanoma—mechanical stimulation of the toes has been recognized as a possible threat issue.¹¹ PA is theoretically believed to stop malignant melanoma and non-melanoma pores and skin cancers (NMSCs) by way of mechanisms equivalent to inhibiting most cancers cell proliferation,¹² inducing apoptosis, modulating metabolism or immunity¹³ and selling weight reduction.¹⁴ However, present proof signifies that the connection between PA and melanoma prevalence could also be constructive¹⁵ or nonsignificant.¹⁶ Consequently, the affiliation between PA and melanoma seems to be extra advanced and fewer definitive than beforehand hypothesized. Furthermore, analysis on the associations between PA and NMSCs is even rarer. To our data, this research is the primary to research the associations amongst SB, PA, and NMSCs, and to used the NHANES to additional validate the affiliation amongst SB, PA and melanoma.

Melanoma and NMSCs are frequent amongst pores and skin most cancers sufferers within the United States, and the incidence of those two ailments has elevated lately.¹⁷ Despite important “milestone” advances in remedy, the emergence of tumor resistance and mutations has additional exacerbated the burden on each sufferers and society.^18,19 The identification of recent preventive methods and threat components for these two ailments has subsequently develop into notably essential. Therefore, investigating whether or not SB and PA affect or predict the event of melanoma and NMSCs is essential. Such insights might assist present early, customized steerage for high-risk populations, aiming to stop or reduce the impression of those ailments.

Methods

Study Population

All uncooked knowledge and samples used on this analysis have been obtained from the National Health and Nutrition Examination Survey (NHANES), essentially the most complete ongoing cross-sectional survey performed by the National Center for Health Statistics (NCHS).²⁰ This survey goals to judge the well being and dietary standing of individuals within the United States. After gaining knowledgeable consent from the topics, specialists on NHANES workforce make the most of phone and cellular NHANES facilities to conduct interviews, bodily measurements and laboratory assessments in addition to advanced, multistage chance sampling designs, which assured the reliability and representativeness of the NHANES. The NHANES interview encompasses health-related, demographic, and socioeconomic questions, whereas the examination part consists of medical or physiological measurements, and laboratory assessments administered by expert medical professionals. NHANES performs a vital function in lots of points, together with evaluating the prevalence and potential threat components for ailments and informing the event of evidence-based public well being insurance policies.

Study Sample, Inclusion and Exclusion Criteria

The detailed participant choice process is proven in Figure 1. Between 2007 and 2016, the NHANES cycles included 62,815 individuals. First, we excluded individuals who have been aged <20 years outdated (n = 21,387) and those that beforehand had tumors apart from melanoma and NMSCs (n = 2221). We subsequently eliminated individuals with lacking knowledge on sedentary habits, key covariates, and people with out bodily exercise knowledge (n = 12,476). Ultimately, a complete of 26,731 individuals have been included on this research.

Figure 1 Flow chart of the participants’ selection from NHANES 2007–2016 *Not melanoma or non-melanoma skin cancer.

Assessment of SB&PA

Sedentary behavior (SB) was assessed using the NHANES Physical Activity Questionnaire (PAQ).²¹ In response to the query (PAD680): “How much time do you usually spend sitting on a typical day?”, individuals offered self-assessments. Participants self-reported their common day by day sitting time. Implausible values (eg, >18 hours per day or day by day variation >3 hours) have been flagged and verified following NHANES knowledge processing suggestions. SB time was then categorized into three teams primarily based on prior analysis: <5 hours/day, 5–8 hours/day, and >8 hours/day.⁹ The data regarding PA within the NHANES questionnaire primarily consists of labor and leisure actions, which will be labeled in line with depth into average and vigorous actions. Regarding PA standing, we referred to the NHANES PAQ questionnaire from 2007 to 2016 and obtained individuals’ day by day exercise data from PAQ620, PAQ605, PAQ650, PAQ665. And in line with code PAQ610, PAQ625, PAQ655, and PAQ670, we acquire their PA frequency in every week. Using the info above, we have been capable of collect knowledge associated to individuals’ SB time and their engagement in various ranges of PA on a weekly foundation. In accordance with the WHO evaluation pointers, the PA of every participant will be transformed into metabolic equivalents (METs) for quantitative evaluation. The MET values range relying on the kind of train, and NHANES has offered reference MET values for every sort of PA. The PA rating is calculated on the idea of PA sort, frequency, and length of actions in a typical week, through the next method: MET*weekly frequency of every PA*lively length per day.²² Following earlier research, the calculated MET values have been remodeled into categorical variables: <600, 601–2000, 2001–4000, and >4000 MET*min/week.^9,22,23

Assessment of Participants with Melanoma or NMSCs

Information on melanoma and non-melanoma pores and skin cancers (NMSCs) was obtained from the NHANES Medical Conditions Questionnaire (MCQ). Participants have been first requested whether or not they had ever been instructed by a physician or well being skilled that that they had most cancers (MCQ220). Those who responded “yes” have been then requested to specify the most cancers sort (MCQ230A–D). Cancer varieties have been coded in line with NHANES coding pointers, with 31 representing melanoma and 32 representing pores and skin (non-melanoma). Participants reporting these codes have been labeled as melanoma or NMSC circumstances, respectively, whereas all others have been handled as controls. The Dermatology Questionnaire (DEQ) was used as a supplementary supply to substantiate case standing. By integrating data from each MCQ and DEQ questionnaires, we recognized melanoma and NMSC circumstances in line with established inclusion and exclusion standards.

Covariables

Covariables in our research included age (yr), gender (male/feminine), race (white/nonwhite), and the nonwhite class included Mexican American, different Hispanic, non- Hispanic Black, and different races.²⁴ Socioeconomic standing was assessed by way of two dimensions: earnings and training. In phrases of financial system, the Poverty Income Ratio (PIR) was chosen in line with the Supplemental Nutrition Assistance Program (SNAP) eligibility standards cited in NHANES analytic pointers 1999–2010. This measure was subsequently categorized into three ranges: 0–1.30 (lowest), 1.31–3.50 (center), and three.51–5.00 (highest).²⁵ With respect to training, we additionally obtained individuals’ academic data by way of the NHANES questionnaire and labeled their academic ranges into three classes primarily based on related literature:≤High college, College/ AA diploma, and ≥College graduate.²⁵ Additionally, personal-related covariates included smoking historical past (ever/by no means), hours of sleep, and Body Mass Index (BMI) measured in kg/m².

Statistical Analysis

All statistical analyses have been performed utilizing acceptable NHANES sampling weights in accordance with CDC pointers and considering advanced multistage cluster surveys. The dependent variables have been melanoma and NMSCs. The major impartial variables was SB time, PA sort, and PA scores. We use survey-weighted percentages (95% Cl) to explain categorical variables. For all steady variables, we use survey-weighted share (95% Cl) to explain them. Survey-weighted linear regression (steady variable) or survey-weighted chi sq. check (categorical variable) have been used to judge the variations between individuals with and with out melanoma. Similarly, we consider the variations between individuals with and with out NMSC. We use a number of logistic regression to discover the correlation between SB, totally different PA varieties, PA scores, and melanoma/NMSC. The covariates within the absolutely adjusted mannequin embrace gender (male/feminine), age, race (white/non-white), and training degree (≤ High college, College/AA diploma, ≥ College graduate), PIR (0–1.30, 1.31–3.50, 3.51–5.00), smoking historical past (ever, by no means), sleep length, and BMI. Age, gender, race, and PIR have been included within the subgroup evaluation of the correlation between PA scores and these two ailments. All statistical analyses have been performed utilizing EmpowerStats 4.2 and R 4.4.1, with a significance threshold set at P < 0.05.

Results

In accordance with our inclusion and exclusion standards, a complete of 20,731 topics from the NHANES have been in the end included on this research. The baseline traits of the individuals are introduced in Tables 1 and 2. In our evaluation, The common age of melanoma sufferers was 61.67 years, whereas that of NMSC sufferers was 62.94 years, each considerably greater than the common ages of the respective management teams (with out melanoma: 45.95 years; with out NMSCs: 28.30 years). In this research, 144 circumstances of melanoma have been recognized, with a prevalence of 0.54%, whereas 405 circumstances of NMSC have been noticed, with a prevalence of 1.52%. For each melanoma and NMSCs, the proportion of male sufferers was greater (for melanoma: 57%; for NMSCs: 53.02%). However, this distinction didn’t attain statistical significance. (p > 0.05). Participants with melanoma have been extra more likely to establish as white people in comparison with these with out melanoma (P < 0.01), and have been additionally extra more likely to have a school diploma or greater (P = 0.01), a similar pattern equally noticed in individuals with NMSCs (P < 0.01 for race; P < 0.01 for training). However, no important distinction in sedentary habits was recognized between individuals with melanoma (P = 0.34). Furthermore, the proportion of individuals identified with melanoma or NMSC elevated considerably with rising earnings ranges (p < 0.01). Individuals with a historical past of smoking have been considerably extra more likely to report melanoma (p = 0.02) or NMSC (p = 0.02).

Table 1 Characteristics of Study Participants Aged ≥20, by Type of Skin Cancer (Melanoma) (N=26,731), National Health and Nutrition Examination Survey (NHANES), 2007–2016a, b

Table 2 Characteristics of Study Participants Aged ≥20, by Type of Skin Cancer (Non-melanoma skin cancer, NMSCs) (N=26,731), National Health and Nutrition Examination Survey (NHANES), 2007–2016a, b

Association Between SB with Melanoma and NMSCs

As illustrated in Table 3, our absolutely adjusted mannequin revealed that there isn’t a affiliation between melanoma and SB time (OR = 1.09; 95% CI, 0.68–1.75 for SB time 5–8 h and OR = 0.72; 95% CI, 0.36–1.40 for SB time > 8 h). Similarly, in our absolutely adjusted mannequin, no important affiliation was noticed between SB time and the prevalence of NMSCs. (OR = 1.09; 95% CI, 0.82–1.44 for SB occasions of 5–8 h/day and OR = 1.01; 95% CI, 0.73–1.40 for SB time > 8 h/day).

Table 3 Associations Between SB Time and Participants Aged ≥20 with Melanoma and with NMSCs (n=26731)a

Association Between PA Type and Melanoma and NMSCs

We included PA type as an independent variable in our fully adjusted model for logistic regression, and the results are shown in Table 4. Our evaluation discovered that there isn’t a statistically important correlation between PA sort and melanoma. However, amongst topics with NMSCs, participating in average depth work actions and average depth leisure actions are positively correlated with the prevalence of NMSCs (OR = 1.46; 95% CI, 1.11–1.91 for average work exercise and OR = 1.36; 95% CI, 1.02–1.82 for average recreation exercise). This consequence signifies that in comparison with individuals who didn’t take part in some of these bodily actions, have been 46% and 36% extra more likely to develop NMSCs.

Table 4 The Association Between Different PAs and Melanoma & NMSCs (n=26731)a

Association Between PA Scores with Melanoma and NMSC

As previously mentioned, we calculated the PA scores (MET*min/week) for the subjects by using the methods from the previous studies and transformed them into categorical variables to explore their correlation with MM and NMSCs prevalence. The results, as shown in Table 5, point out that topics with PA scores >2000 and ≤4000 have been positively correlated with the prevalence of NMSC (OR = 1.47; 95% CI, 1.00 −2.15 for NMSCs). This signifies that in comparison with topics with PA scores ≤600, individuals with PA scores within the vary of 2001–4000 have a 47% greater chance of creating NMSCs.

Table 5 Relationship Between PA Score (MET-min/Week) with Melanoma and NMSCs (n=26731) a

Sensitivity Analysis Adjusting for Sunburn History

In order to address potential confounding by ultraviolet exposure, we further incorporated sunburn history as a proxy variable for UV exposure into the fully adjusted logistic regression models, with missing values imputed using multiple imputation. After additional adjustment, the previously observed positive association between PA and NMSC was attenuated and no longer statistically significant (eg, PA score 2001–4000 MET·min/week: OR = 0.87, 95% CI: 0.44–1.74, p = 0.69; PA score >4000 MET·min/week: OR = 0.63, 95% CI: 0.29–1.35, p = 0.22). Similarly, no significant associations were observed between PA and melanoma after adjustment for sunburn history (Table 6).

Table 6 Association Between PA Categories and Skin Cancer Outcomes After Adjustment for Sunburn History a, b

Subgroup Analysis

Subsequently, we further explored the relationship between PA scores ranging from 2001 to 4000 and the prevalence of NMSCs in different subgroups (gender, age, education level, PIR, smoking). The results are shown in Figure 2. Regarding the affiliation between PA and NMSC prevalence, we noticed a constructive correlation amongst feminine individuals (OR = 1.77, 95% CI: 1.04–3.01), these with decrease training ranges (OR = 1.58, 95% CI: 1.02–2.44), and people within the PIR vary of three.51–5.00. (OR = 2.01, 95% CI: 1.01–3.99). However, interplay assessments indicated that the affiliation between PA Score (2001–4000) and NMSCs prevalence didn’t range considerably throughout totally different strata, suggesting that gender, training degree, and PIR didn’t considerably affect this constructive correlation.

Figure 2 Subgroup analysis for the association between NMSCs and the PA score.

Discussion

In this study, involving 26,731 noninstitutionalized participants from the United States, we observed no significant association between SB and the prevalence of melanoma or NMSCs. However, no statistically significant correlation was found between PA and melanoma prevalence. Interestingly, in NMSCs patients, we observed a positive association between daily moderate PA (including both work and leisure activities) and weekly moderate physical activity (with a PA score in the range of 2001–4000) and the prevalence of NMSCs. Our findings may reflect that individuals engaging in moderate or high levels of physical activity are more likely to spend time outdoors, thereby experiencing higher cumulative UV exposure. This mechanism has been highlighted in previous studies²⁶ and will partly clarify the noticed affiliation between PA and NMSC.

Previous research have explored the connection between PA and melanoma, but the findings stay controversial. A current knowledge evaluation from the UK Biobank yielded outcomes according to ours, displaying no important affiliation between PA, SB, and melanoma prevalence.¹⁶ However, a large-scale epidemiological research involving 1.44 million adults discovered that leisure-time PA was positively related to the danger of melanoma (HR = 1.27; 95% CI, 1.16–1.40).²⁷ Some research have additionally instructed an inverse affiliation between PA and melanoma incidence. However, this affiliation was not statistically important (RR = 0.85, 95% CI = 0.63–1.14).¹⁵ A research performed in Canada investigating the connection between occupational PA and melanoma threat discovered that people with greater ranges of PA had an elevated threat of creating cutaneous malignant melanoma.²⁸ In the current research, no important affiliation was discovered between PA and melanoma prevalence. This is probably going attributable to the usage of solar safety measures within the US inhabitants, the variety of accessible train venues, and the rising choice for indoor bodily actions.²⁹ As a consequence, UV publicity, a recognized threat issue for melanoma, could not essentially coincide with bodily exercise concurrently. Moreover, with the at present obtainable knowledge, it’s difficult to completely regulate for all high-risk components of melanoma as covariates. Consequently, any protecting impact of bodily exercise on melanoma threat could also be tough to detect statistically, because it may very well be obscured by the affect of unaccounted threat components.

To the most effective of our data, the current investigation represents the inaugural cross-sectional research inspecting the correlation between PA and the prevalence of NMSCs. Consequently, the literature pertaining to this affiliation is reasonably sparse. Utilizing knowledge from the National Health and Nutrition Examination Survey, our evaluation revealed a constructive correlation between day by day moderate-intensity PA, encompassing each occupational and leisure actions, and the prevalence of NMSCs. Furthermore, weekly moderate-intensity PA, quantified by a PA rating throughout the vary of 2001 to 4000, was additionally discovered to be positively related to the incidence of NMSCs. A potential Australian research has investigated the connection between bodily exercise and squamous cell carcinoma of the pores and skin (SCC) – a subtype of NMSC. Although a constructive correlation between PA and the incidence of pores and skin SCC was noticed, statistical significance was not established.³⁰ A 14-year potential Danish research has demonstrated a considerably elevated threat of NMSC related to PA, with an adjusted odds ratio of 1.72 (95% CI 1.23–2.40; p = 0.001), notably in males.³¹ In sensitivity analyses, we additional integrated sunburn historical past as a proxy for ultraviolet publicity, with lacking values imputed utilizing a number of imputation. After this extra adjustment, the beforehand noticed constructive affiliation between PA and NMSC was attenuated and misplaced statistical significance. This attenuation means that the noticed affiliation could also be partly defined by residual confounding from UV publicity.

Although bodily exercise can scale back most cancers threat by way of varied mechanisms, components equivalent to native strain,¹¹ pores and skin sort,³² and solar publicity could confound the connection between train and pores and skin tumors. Thus, the function of bodily exercise in melanoma and NMSCs could differ from its established protecting impact noticed in different forms of cancers.^7,8

The current research boasts a number of deserves. Firstly, this research is predicated on knowledge from the NHANES, which employs a nationally consultant, standardized, protocol-based sampling of the United States inhabitants. All analyses integrated the usage of acceptable NHANES sampling weights, thereby strengthening the generalizability of the findings to the US inhabitants. Secondly, this research examined the associations between a number of frequent life-style components and the danger of pores and skin tumors, together with melanoma and NMSCs. Based on earlier research and the literature, we used two metrics to evaluate bodily exercise: sort of PA and PA scores, to qualitatively and quantitatively assess the impression of train on these ailments. Furthermore, frequent covariates have been adjusted to make sure the reliability of the present outcomes.

Nevertheless, the restrictions of this research are to not be ignored. Due to the cross-sectional nature of the info, establishing a causal relationship between outcomes and exposures is difficult. Additionally, the evaluation of individuals’ bodily exercise was primarily based on self-reported questionnaires, that are vulnerable to potential recall bias. Despite the adjustment for quite a few covariates, the opportunity of confounding by unmeasured components stays. In sensitivity analyses, we used sunburn historical past as a proxy for UV publicity to deal with potential confounding. While this variable offered some adjustment, it might not absolutely seize cumulative UV publicity in real-world situations. Therefore, a point of residual confounding by UV publicity can’t be solely excluded. For individuals identified with NMSCs, the dangers related to average PA, equivalent to elevated solar publicity, fatigue, and environmental toxin publicity, could outweigh the advantages derived from train. The carcinogenic results of PA are multifaceted, relying on vitality expenditure and components such because the age of the individuals, in addition to the frequency, depth, and length of PA. Based solely on knowledge from the NHANES, the interaction between PA and the carcinogenic course of is difficult to elucidate. Interpretation of the ultimate outcomes must be approached with warning, and additional analysis is required to validate or refute our findings.

Conclusion

Our research findings point out that SB shouldn’t be related to the prevalence of melanoma or NMSCs. No important correlation was noticed between PA and melanoma. While the first evaluation instructed a constructive correlation between moderate-intensity PA and the prevalence of NMSCs, this affiliation was attenuated and misplaced statistical significance after adjustment for sunburn historical past as a proxy for UV publicity. These outcomes counsel that the noticed relationship between PA and NMSC could also be partly attributable to residual confounding by UV publicity. Therefore, the findings must be interpreted with warning, and future longitudinal research with extra exact measures of UV publicity are warranted to make clear the true nature of this affiliation.

Abbreviations

SB, Sedentary habits; PA, Physical exercise; NMSCs, Non-Melanoma Skin Cancers; NHANES, the National Health and Nutrition Examination Surveys; MET, Metabolic Equivalent; OR, Odds Ratio; CI, Confidence Interval; PIR, Poverty Income Ratio; US, United States.

Data Sharing Statement

The datasets introduced on this research will be present in on-line repositories. The names of the repository/repositories and accession quantity(s) will be discovered at: https://wwwn.cdc.gov/nchs/nhanes.

Ethics Approval and Consent to Participate

Data assortment for the NHANES was authorized by the National Center for Health Statistics (NCHS) Research Ethics Review Board (ERB), and all individuals offered written knowledgeable consent. The NHANES datasets are publicly obtainable and absolutely de-identified; subsequently, separate moral approval was not required for this secondary evaluation. According to the Measures for Ethical Review of Life Science and Medical Research Involving Human Subjects (China, 2023, merchandise 1 and a couple of of Article 32), research primarily based solely on publicly obtainable and anonymized knowledge are exempt from further institutional assessment board (IRB) approval.

Acknowledgments

The authors want to acknowledge the help from all of the workforce members and Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College and are grateful to all of the employees within the National Center for Health Statistics (NCHS) for his or her contribution to the NHANES program.

Funding

National Key Research and Development Program (Project Numbers: 2022YFC2504700, 2022YFC2504701, 2022YFC2504705), CAMS InnovationFund for Medical Sciences (CIFMS) (Project Numbers: 2024-I2M-C&T-B-089) and National Natural Science Foundation of China (NSFC; 81872216).

Disclosure

The authors declare that the analysis was performed within the absence of any business or monetary relationships that may very well be construed as a possible battle of curiosity.

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