Association of Sedentary Behavior and Physical Activity With the Risk of Post‐Transplant Diabetes Mellitus Among Living Donor Liver Transplant Recipients: A Cross‐Sectional Isotemporal Substitution Analysis

Post-transplant diabetes mellitus (PTDM) affects long-term outcomes in liver transplant recipients (LTRs). While prolonged sedentary time and low physical activity (PA) increase diabetes risk, their association with PTDM among LTRs remains unclear. We investigated the relationship between sedentary behavior, PA, and PTDM while considering their interdependence. We analyzed data from 68 living donor LTRs at a single hospital. Participants wore an accelerometer on their waist for 7 consecutive days to measure sedentary time and PA. PTDM was identified from medical records, and its association with sedentary time was assessed using logistic regression. Isotemporal substitution analysis estimated the effect of substituting sedentary time with PA. The participants' mean age was 63.4 ± 10.5 years, with a mean time since transplant of 9.0 ± 6.7 years. PTDM was present in 54% of participants, and the odds ratio for PTDM associated with ≥8 h of sedentary time was 1.60 (95% confidence interval [CI], 1.15-1.78, p = 0.015). Replacing 30 min of sedentary time with light-intensity PA lowered the odds to 0.81 (95% CI, 0.70-0.92, p = 0.001), whereas replacing it with moderate-to-vigorous PA reduced the odds to 0.28 (95% CI, 0.09-0.69, p = 0.002). Reducing sedentary time and increasing PA may contribute to the prevention of PTDM in LTRs.