Lifestyle behavior and the risk of type 2 diabetes in the Seguimiento Universidad de Navarra (SUN) cohort

• Published in: Nutrition, metabolism, and cardiovascular diseases metabolism, and cardiovascular diseases, 2020-07, Vol.30 (8), p.1355-1364
• Main Authors: Ruiz-Estigarribia, Liz, Martínez-González, Miguel A., Díaz-Gutiérrez, Jesús, Sayón-Orea, Carmen, Basterra-Gortari, Francisco J., Bes-Rastrollo, Maira
• Format: Article
• Language: English
• Subjects: Diabetes; Healthy lifestyle; Longitudinal; Prevention; Prospective cohort study
• ISSN: 0939-4753; 1590-3729
• DOI: 10.1016/j.numecd.2020.04.006

We prospectively assessed the association between a healthy lifestyle score (HLS) and the risk of type 2 diabetes mellitus (T2DM) in a Mediterranean cohort. We followed up 11,005 participants initially free of diabetes diagnosis in the “Seguimiento Universidad de Navarra” (SUN) cohort. We evaluated the influence of lifestyle-related factors based on a score previously related to a lower risk of cardiovascular disease. Only one incident case of T2DM was found among those with a baseline BMI ≤22 kg/m2. Therefore, we excluded the BMI item and restricted the analysis to participants with a baseline BMI >22 kg/m2. We measured the baseline adherence of a HLS that included: never smoking, physical activity, Mediterranean diet adherence, moderate alcohol consumption, avoidance of binge drinking, low television exposure, taking a short nap, spending time with friends and working hours. Incident cases of T2DM were self-reported by participants and confirmed by a physician. Cox proportional-hazards regression models were fitted to assess the association between HLS and the incidence of T2DM. After a median follow-up of 12 years, 145 incident cases of T2DM were observed. Among participants with a BMI >22 kg/m2, the highest category of HLS adherence (7–9 points) showed a significant 46% relatively decreased hazard of T2DM compared with the lowest category (0–4 points) (multivariable adjusted HR: 0.54; 95% CI: 0.30–0.99). Higher adherence to a HLS, including some factors not typically studied, may reduce T2DM risk. Preventive efforts should preferentially focus on weight control. However, this score may promote a comprehensive approach to diabetes prevention beyond weight reduction.