The Association Between Non-exercise Activity Thermogenesis and Diabetes Status in U.S. Adults: NHANES 2013-2014

Non-exercise activity thermogenesis (NEAT), the energy expended through daily unstructured movement, may influence type 2 diabetes (T2D) risk but is rarely emphasized in diabetes care. Few studies have examined NEAT-diabetes associations using nationally representative data. We conducted a cross-sectional analysis of 4436 U.S. adults aged ≥18 years from NHANES 2013-2014 with ≥4 days of valid wrist accelerometer wear. Daily movement was quantified using Monitor-Independent Movement Summary (MIMS) units as a proxy for NEAT and categorized as low, moderate, or high. Multivariable logistic regression estimated adjusted odds ratios (ORs) for T2D across NEAT levels, controlling for key demographic and socioeconomic factors. Stratified models examined racial and ethnic differences. Low NEAT was associated with nearly threefold higher odds of diabetes compared with high NEAT (OR = 2.88). Moderate NEAT also showed elevated odds (OR = 1.61). Associations were significant among Hispanic, non-Hispanic White, and non-Hispanic Asian adults and marginal among non-Hispanic Black adults. Lower NEAT levels are strongly associated with higher odds of diabetes, highlighting NEAT as an accessible behavior that may support equitable diabetes prevention and management.