2023, Volume 22, Issue 3
Engineering >> 2023, Volume 22, Issue 3 doi: 10.1016/j.eng.2022.04.010
Associations of Combined Healthy Lifestyle Factors with Risks of Diabetes, Cardiovascular Disease, Cancer, and Mortality Among Adults with Prediabetes: Four Prospective Cohort Studies in China, the United Kingdom, and the United States
a Key Laboratory of Environment and Health of the Ministry of Education, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
b School of Public Health, North China University of Science and Technology, Tangshan 063000, China
c Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan 063000, China
# These authors contributed equally to this work.
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Abstract
Lifestyle modification is an effective measure for diabetes prevention in people with prediabetes, but its associations with the long-term risks of cardiovascular disease (CVD), cancer, and mortality remain largely uncertain. We aimed to investigate the associations of combined healthy lifestyle factors with these health outcomes among participants with prediabetes. The study included 121 254 people with prediabetes from four prospective cohorts: the Dongfeng-Tongji (DFTJ) cohort and Kailuan study, both from China; the UK Biobank; and the US National Health and Nutrition Examination Survey (NHANES; for mortality analysis only). We documented a total of 18 333 incident diabetes, 10 829 incident CVD, 6926 incident cancer, and 9877 deaths during follow-up. Combined healthy lifestyle scores (scored from 0 to 5) were constructed based on never smoking or quitting smoking for ≥ 10 years, low-to-moderate alcohol drinking, optimal physical activity, healthy diet, and optimal waist circumference. First, Cox proportional-hazards regression models were used to quantify the associations of combined lifestyle score with health outcomes in each cohort; then, multivariable-adjusted hazard ratios (HRs) were pooled via a random-effects model of meta-analysis. Compared with participants with the least healthy lifestyle (a score of 0–1), participants with the healthiest lifestyle (a score of 4–5) had significantly reduced risks of all outcomes. The HRs (95% confidence interval (CI)) were 0.57 (0.48–0.69) for diabetes, 0.67 (0.62– 0.73) for CVD, 0.80 (0.73–0.88) for cancer, and 0.54 (0.42–0.70) for mortality. Significant associations were consistently found across subgroups of baseline demographic characteristics and metabolic health status. In conclusion, our pooled analyses of four cohorts from three countries reveal that greater adherence to a healthy lifestyle is associated with considerably lower risks of diabetes and its major complications among adults with prediabetes. These findings provide informative and compelling evidence for establishing clinical guidelines and public health policies.
Keywords
Prediabetes ; Lifestyle ; Diabetes ; Cardiovascular disease ; Cancer ; Mortality
SupplementaryMaterials
References
[ 1 ] Echouffo-Tcheugui JB, Selvin E. Prediabetes and what it means: the epidemiological evidence. Annu Rev Publ Health 2021;42(1):59–77. link1
[ 2 ] Yudkin JS, Montori VM. The epidemic of pre-diabetes: the medicine and the politics. BMJ 2014;349:g4483. link1
[ 3 ] Wang L, Peng W, Zhao Z, Zhang M, Shi Z, Song Z, et al. Prevalence and treatment of diabetes in China, 2013–2018. JAMA 2021;326(24):2498. link1
[ 4 ] Mainous AG, Tanner RJ, Baker R, Zayas CE, Harle CA. Prevalence of prediabetes in England from 2003 to 2011: population-based, cross-sectional study. BMJ Open 2014;4(6):e005002. link1
[ 5 ] Cheng YJ, Kanaya AM, Araneta MRG, Saydah SH, Kahn HS, Gregg EW, et al. Prevalence of diabetes by race and ethnicity in the United States, 2011–2016. JAMA 2019;322(24):2389. link1
[ 6 ] Ligthart S, van Herpt TTW, Leening MJG, Kavousi M, Hofman A, Stricker BHC, et al. Lifetime risk of developing impaired glucose metabolism and eventual progression from prediabetes to type 2 diabetes: a prospective cohort study. Lancet Diabetes Endocrinol 2016;4(1):44–51. link1
[ 7 ] Richter B, Hemmingsen B, Metzendorf MI, Takwoingi Y. Development of type 2 diabetes mellitus in people with intermediate hyperglycaemia. Cochrane Database Syst Rev 2018;10(11):CD012661.
[ 8 ] Tabak AG, Herder C, Rathmann W, Brunner EJ, Kivimaki M. Prediabetes: a highrisk state for diabetes development. Lancet 2012;379(9833):2279–90. link1
[ 9 ] Schlesinger S, Neuenschwander M, Barbaresko J, Lang A, Maalmi H, Rathmann W, et al. Prediabetes and risk of mortality, diabetes-related complications and comorbidities: umbrella review of meta-analyses of prospective studies. Diabetologia 2022;65(2):275–85. link1
[10] Dall TM, Yang W, Gillespie K, Mocarski M, Byrne E, Cintina I, et al. The economic burden of elevated blood glucose levels in 2017: diagnosed and undiagnosed diabetes, gestational diabetes mellitus, and prediabetes. Diabetes Care 2019;42(9):1661–8. link1
[11] Gong Q, Zhang P, Wang J, Ma J, An Y, Chen Y, et al. Morbidity and mortality after lifestyle intervention for people with impaired glucose tolerance: 30-year results of the Da Qing Diabetes Prevention Outcome Study. Lancet Diabetes Endocrinol 2019;7(6):452–61. link1
[12] Li G, Zhang P, Wang J, An Y, Gong Q, Gregg EW, et al. Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: a 23-year follow-up study. Lancet Diabetes Endocrinol 2014;2 (6):474–80. link1
[13] Li G, Zhang P, Wang J, Gregg EW, Yang W, Gong Q, et al. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet 2008;371(9626):1783–9. link1
[14] Uusitupa M, Peltonen M, Lindström J, Aunola S, Ilanne-Parikka P, KeinänenKiukaanniemi S, et al. Ten-year mortality and cardiovascular morbidity in the Finnish Diabetes Prevention Study—secondary analysis of the randomized trial. PLoS ONE 2009;4(5):e5656. link1
[15] Ratner R, Goldberg R, Haffner S, Marcovina S, Orchard T, Fowler S, et al. Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the diabetes prevention program. Diabetes Care 2005;28(4):888–94. link1
[16] Lee CG, Heckman-Stoddard B, Dabelea D, Gadde KM, Ehrmann D, Ford L, et al. Effect of metformin and lifestyle interventions on mortality in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study. Diabetes Care 2021;44(12):2775–82. link1
[17] Hemmingsen B, Gimenez-Perez G, Mauricio D, Roque IFM, Metzendorf MI, Richter B. Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus. Cochrane Database Syst Rev 2017;12 (12):CD003054..
[18] Haw JS, Galaviz KI, Straus AN, Kowalski AJ, Magee MJ, Weber MB, et al. Longterm sustainability of diabetes prevention approaches: a systematic review and meta-analysis of randomized clinical trials. JAMA Intern Med 2017;177 (12):1808. link1
[19] Nathan DM, Bennett PH, Crandall JP, Edelstein SL, Goldberg RB, Kahn SE, et al. Does diabetes prevention translate into reduced long-term vascular complications of diabetes? Diabetologia 2019;62(8):1319–28. link1
[20] Wang F, Zhu J, Yao P, Li X, He M, Liu Y, et al. Cohort profile: the DongfengTongji cohort study of retired workers. Int J Epidemiol 2013;42(3):731–40. link1
[21] Zhang Q, Zhou Y, Gao X, Wang C, Zhang S, Wang A, et al. Ideal cardiovascular health metrics and the risks of ischemic and intracerebral hemorrhagic stroke. Stroke 2013;44(9):2451–6. link1
[22] Sudlow C, Gallacher J, Allen N, Beral V, Burton P, Danesh J, et al. UK Biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age. PLoS Med 2015;12(3):e1001779. link1
[23] CDC/NCHS. About the national health and nutrition examination survey [Internet]. Atlanta: CDC/NCHS; [cited 2022 Mar 26]. Available from: https:// www.cdc.gov/nchs/nhanes/about_nhanes.htm. link1
[24] ADA. 2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes—2021. Diabetes Care 2021;44(Suppl 1):S15–33. link1
[25] Zhang Y, Pan XF, Chen J, Xia L, Cao A, Zhang Y, et al. Combined lifestyle factors and risk of incident type 2 diabetes and prognosis among individuals with type 2 diabetes: a systematic review and meta-analysis of prospective cohort studies. Diabetologia 2020;63(1):21–33. link1
[26] Beaglehole R, Bonita R, Horton R, Adams C, Alleyne G, Asaria P, et al. Priority actions for the non-communicable disease crisis. Lancet 2011;377 (9775):1438–47. link1
[27] WHO. Global status report on noncommunicable diseases 2014 [Internet]. Geneva: WHO; 2014 [cited 2022 Mar 26]. Available from: https://www.who. int/publications/i/item/9789241564854. link1
[28] Pan XF, Wang L, Pan A. Epidemiology and determinants of obesity in China. Lancet Diabetes Endocrinol 2021;9(6):373–92. link1
[29] Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s Strategic Impact Goal through 2020 and beyond. Circulation 2010;121(4):586–613. link1
[30] Griswold MG, Fullman N, Hawley C, Arian N, Zimsen SRM, Tymeson HD, et al. Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet 2018;392(10152):1015–35. link1
[31] Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 1999;94(446):496–509. link1
[32] Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21(11):1539–58. link1
[33] Hopper I, Billah B, Skiba M, Krum H. Prevention of diabetes and reduction in major cardiovascular events in studies of subjects with prediabetes: metaanalysis of randomised controlled clinical trials. Eur J Cardiov Prev Rehabil 2011;18(6):813–23. link1
[34] Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346(6):393–403. link1
[35] ADA. 3. Prevention or delay of type 2 diabetes: Standards of Medical Care in Diabetes—2021. Diabetes Care 2021;44(Suppl 1):S34–9. link1
[36] Pearson-Stuttard J, Bennett J, Cheng YJ, Vamos EP, Cross AJ, Ezzati M, et al. Trends in predominant causes of death in individuals with and without diabetes in England from 2001 to 2018: an epidemiological analysis of linked primary care records. Lancet Diabetes Endocrinol 2021;9(3):165–73. link1
[37] Li H, Khor CC, Fan J, Lv J, Yu C, Guo Y, et al. Genetic risk, adherence to a healthy lifestyle, and type 2 diabetes risk among 550,000 Chinese adults: results from 2 independent Asian cohorts. Am J Clin Nutr 2020;111(3):698–707. link1
[38] Lv J, Yu C, Guo Y, Bian Z, Yang L, Chen Y, et al. Adherence to a healthy lifestyle and the risk of type 2 diabetes in Chinese adults. Int J Epidemiol 2017;46 (5):1410–20. link1
[39] Lv J, Yu C, Guo Y, Bian Z, Yang L, Chen Y, et al. Adherence to healthy lifestyle and cardiovascular diseases in the Chinese population. J Am Coll Cardiol 2017;69(9):1116–25. link1
[40] Song C, Lv J, Yu C, Zhu M, Yu C, Guo Y, et al. Adherence to healthy lifestyle and liver cancer in Chinese: a prospective cohort study of 0.5 million people. Brit. J Cancer 2022;126(5):815–21. link1
[41] Zhu N, Yu C, Guo Yu, Bian Z, Han Y, Yang L, et al. Adherence to a healthy lifestyle and all-cause and cause-specific mortality in Chinese adults: a 10- year prospective study of 0.5 million people. Int J Behav Nutr Phy 2019;16 (1):98. link1
[42] Keller A, O’Reilly EJ, Malik V, Buring JE, Andersen I, Steffen L, et al. Substitution of sugar-sweetened beverages for other beverages and the risk of developing coronary heart disease: results from the Harvard Pooling Project of Diet and Coronary Disease. Prev Med 2020;131:105970. link1
[43] Qi Q, Chu AY, Kang JH, Jensen MK, Curhan GC, Pasquale LR, et al. Sugarsweetened beverages and genetic risk of obesity. N Engl J Med 2012;367 (15):1387–96. link1
[44] Xia B, Yang M, Nguyen LH, He Q, Zhen J, Yu Y, et al. Regular use of proton pump inhibitor and the risk of inflammatory bowel disease: pooled analysis of 3 prospective cohorts. Gastroenterology 2021;161(6). 1842–52.e10. link1
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