Association between modifiable lifestyle factors and residual lifetime risk of diabetes

Djoussé, L.; Driver, J.A.; Gaziano, J.M.; Buring, J.E.; Lee, I.M.

doi:10.1016/j.numecd.2011.08.002

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Association between modifiable lifestyle factors and residual lifetime risk of diabetes

L. Djoussé
- Divisions of Aging, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Massachusetts Veterans Epidemiology and Research Information Center and Geriatric Research, Education and Clinical Center, Boston Veterans Affairs Healthcare System, Boston, MA, USA
- Corresponding author. Division of Aging, Brigham and Women’s Hospital and Harvard Medical School, 1620 Tremont St, 3rd floor, Boston 02120, MA, USA. Tel.: +617 525 7591; fax: +617 525 7739.
J.A. Driver
- Divisions of Aging, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Massachusetts Veterans Epidemiology and Research Information Center and Geriatric Research, Education and Clinical Center, Boston Veterans Affairs Healthcare System, Boston, MA, USA
J.M. Gaziano
- Divisions of Aging, Boston, MA, USA
- Preventive Medicine, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Massachusetts Veterans Epidemiology and Research Information Center and Geriatric Research, Education and Clinical Center, Boston Veterans Affairs Healthcare System, Boston, MA, USA
J.E. Buring
- Divisions of Aging, Boston, MA, USA
- Preventive Medicine, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, MA, USA
I.M. Lee
- Preventive Medicine, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

Received 28 February 2011; received in revised form 2 August 2011; accepted 3 August 2011. published online 10 October 2011.
Corrected Proof

Abstract

Background and aims

While clinical trials have reported beneficial effects of diet, exercise, and weight loss on incident diabetes in subjects with obesity or impaired glucose tolerance, little is known about the incremental benefit of not smoking and moderate drinking on diabetes risk. We sought to examine the association between modifiable lifestyle factors and residual lifetime risk of diabetes.

Methods and Results

Prospective cohorts involving 20,915 men (1982–2008) and 36,594 women (1992–2008). Modifiable lifestyle factors and adiposity were ascertained at baseline in each cohort and incident diabetes was ascertained during follow up. The mean age at baseline was 53.5 y in men and 54.6 y in women. During an average follow up of 22.6 y in men and 13.0 y in women, 2096 men and 2390 women developed diabetes. At age 45 y, the residual lifetime risk of diabetes (95% CI) for men with 0, 1, 2, 3, and 4 + healthy lifestyle factors was 30.5 (27.3–33.7); 21.5 (19.9–23.0); 15.1 (13.9–16.3); 10.3 (9.1–11.5); and 7.3 (5.7–8.9) percent; respectively. Corresponding values for women were 31.4 (28.3–34.5); 24.1 (21.8–26.5); 14.2 (12.7–15.7); 11.6 (9.7–13.5); and 6.4 (4.2–8.6) percent, respectively.

Conclusions

These data show an inverse and graded relation between desirable lifestyle factors and residual lifetime risk of diabetes in men and women. Not smoking and moderate drinking may have additional benefits when added to exercise, weight control, and diet.

Keywords: Smoking, Exercise, Weight loss, Diabetes, Diet, Epidemiology, Physicians’ health study, Women’s health study