Diabetes risk and lifestyle habits
Prediabetes and lifestyle factors have been associated with the risks of multiple adverse health outcomes, however, the effect of a healthy lifestyle on prediabetes related complications remains unknown. This study investigated whether the risks of multiple adverse outcomes including incident type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), and chronic kidney disease (CKD) among individuals with prediabetes can be offset by a combination of healthy lifestyle factors.
Prediabetes, which is characterized by elevated blood glucose levels that fall between normal and diabetic ranges, represents a high-risk state for diabetes development. Evidence has indicated that individuals with prediabetes are at a higher risk of developing diabetes and related complications, such as cardiovascular disease (CVD) and chronic kidney disease (CKD). Consequently, it is critical to control progression of prediabetes to reduce the risk of prediabetes‐related adverse health problems.
In this large prospective study, a healthy lifestyle score (HLi) (*) was constructed based on six modifiable behavioral factors: non-smoking, physical activity, consumption of alcoholic beverages, body mass index (BMI), diet and sleep duration, with 1 point for each of these factors. The lifestyle habits of 202 993 participants from the UK Biobank cohort were assessed during a median follow-up of 14 years. The results showed that insulin resistance is linked to a lower adherence of health promoting lifestyle behaviors. Significantly higher HLi scores were observed among insulin-sensitive individuals than among insulin-resistant individuals. The difference in HLi scores was primarily due to reduced levels of physical activity in insulin-resistant individuals.
The authors highlight that combined healthy lifestyle factors (moderate consumption of alcoholic beverages, healthy diet, no current smoking, regular physical activity, adequate sleep duration, and not being overweight or obese) were associated with a substantial decrease in the risk of prediabetes‐related type 2 diabetes, CVD, and CKD.
(*) Healthy lifestyle score:
We constructed a healthy lifestyle score based on 6 modifiable behavioral factors, including 5 traditional factors (smoking, physical activity, alcohol consumption, body mass index (BMI) and diet) and 1 emerging factors (sleep duration) assessed at baseline.
Participants scored 1 point for the healthy category of each lifestyle factor on the basis of national recommendations if available.
- Smoking status: no current smoking was classified as healthy category
- Regular physical activity: defined as at least 150 min/wk of moderate activity or 75 min/wk of vigorous activity or an equivalent combination.
- Healthy diet: defined as an adequate consumption of at least 4 of 7 food groups (an increased amount of fruits, vegetables, whole grains, and fish and a reduced amount of refined grains and processed and unprocessed meats)
- Healthy drinking: defined as moderate alcohol consumption with up to 1 drink (14 g)/day for women and up to 2 drinks (28 g)/day for men.
- Sleep: adequate sleep duration (7–9 h/d) was classified as healthy
- Overweight/obese: defined as BMI > 25.0
- The lifestyle score ranged from 0 to 6, with a higher score indicating higher adherence to an overall healthy lifestyle
