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Lifestyle Factors and Risk for New-Onset Diabetes: A Population-Based Cohort Study

Jared P. Reis, PhD; Catherine M. Loria, PhD; Paul D. Sorlie, PhD; Yikyung Park, PhD; Albert Hollenbeck, PhD; and Arthur Schatzkin, MD, PhD
[+] Article, Author, and Disclosure Information


From the National Heart, Lung, and Blood Institute, Bethesda, and National Cancer Institute, Rockville, Maryland, and AARP, Washington, DC.

Grant Support: The NIH-AARP Diet and Health Study was supported by the Intramural Research Program of the NIH.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-0030.

Reproducible Research Statement:Study protocol: Available at http://dietandhealth.cancer.gov/. Statistical code: Not available. Data set: Available subject to NIH-AARP Steering Committee approval and NIH policy (e-mail, ncinadhsproposals@mail.nih.gov).

Requests for Single Reprints: Jared P. Reis, PhD, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, 6701 Rockledge Drive, Bethesda, MD 20892; e-mail, reisjp@mail.nih.gov.

Current Author Addresses: Drs. Reis, Loria, and Sorlie: Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, 6701 Rockledge Drive, Bethesda, MD 20892.

Dr. Park: Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, Rockville, MD 20852.

Dr. Hollenbeck: AARP, 601 E Street Northwest, Washington, DC 20049.

Author Contributions: Conception and design: J.P. Reis, P.D. Sorlie, Y. Park, A. Hollenbeck.

Analysis and interpretation of the data: J.P. Reis, C.M. Loria, Y. Park.

Drafting of the article: J.P. Reis.

Critical revision of the article for important intellectual content: J.P. Reis, C.M. Loria, P.D. Sorlie, Y. Park.

Final approval of the article: J.P. Reis, C.M. Loria, P.D. Sorlie, Y. Park, A. Hollenbeck.

Provision of study materials or patients: A. Hollenbeck.

Statistical expertise: J.P. Reis.

Administrative, technical, or logistic support: Y. Park, A. Hollenbeck.

Collection and assembly of data: Y. Park, A. Hollenbeck.

Ann Intern Med. 2011;155(5):292-299. doi:10.7326/0003-4819-155-5-201109060-00006
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Background: Epidemiologic data on the combined influence of several lifestyle factors on diabetes risk are rare, particularly among older adults.

Objective: To examine how combinations of lifestyle risk factors relate to the 11-year risk for incident diabetes.

Design: Population-based prospective cohort study.

Setting: National Institutes of Health (NIH)–AARP Diet and Health Study.

Participants: 114 996 men and 92 483 women, aged 50 to 71 years in 1995 to 1996, without evidence of heart disease, cancer, or diabetes.

Measurements: A comprehensive survey of demographic characteristics and lifestyle factors, including dietary intake, body weight and height, physical activity, smoking, and alcohol consumption at baseline (1995 to 1996). Low-risk groups were formed by dichotomizing each lifestyle factor. Incident self-reported, physician-diagnosed diabetes was identified with a follow-up survey in 2004 to 2006.

Results: 11 031 men (9.6%) and 6969 women (7.5%) developed new-onset diabetes. For each additional lifestyle factor in the low-risk group, the odds for diabetes were 31% lower (odds ratio [OR], 0.69 [95% CI, 0.68 to 0.71]) among men and 39% lower (OR, 0.61 [CI, 0.60 to 0.63]) among women. Men and women whose diet score, physical activity level, smoking status, and alcohol use were all in the low-risk group had ORs for diabetes of 0.61 (CI, 0.56 to 0.66) and 0.43 (CI, 0.34 to 0.55), respectively. When absence of overweight or obesity was added, the respective ORs were 0.28 (CI, 0.23 to 0.34) and 0.16 (CI, 0.10 to 0.24) for men and women. Results did not differ by family history of diabetes or level of adiposity.

Limitation: The study was observational, with potential for residual confounding.

Conclusion: Lifestyle factors, when considered in combination, are associated with a substantial reduction in risk for diabetes.

Primary Funding Source: The NIH-AARP Diet and Health Study was supported by the Intramural Research Program of the NIH.


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Adjusted odds ratios for new-onset diabetes, by number of lifestyle factors in the low-risk category and stratified by sex.

The P value for trend was < 0.001 for both men and women. Odds ratios are adjusted for age, race or ethnicity, highest level of education attained, marital status, and (for women) use of hormone replacement therapy.

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Summary for Patients

Improving Each Additional Lifestyle Factor Further Reduces the Risk for Diabetes

The full report is titled “Lifestyle Factors and Risk for New-Onset Diabetes. A Population-Based Cohort Study.” It is in the 6 September 2011 issue of Annals of Internal Medicine (volume 155, pages 292-299). The authors are J.P. Reis, C.M. Loria, P.D. Sorlie, Y. Park, A. Hollenbeck, and A. Schatzkin.


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