Lifestyle Risk Factors and New-Onset Diabetes Mellitus in Older Adults: The Cardiovascular Health Study
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BACKGROUND: The combined impact of lifestyle factors on incidence of diabetes mellitus later in life is not well established. The objective of this study was to determine how lifestyle factors, assessed in combination, relate to new-onset diabetes in a broad and relatively unselected population of older adults. METHODS: We prospectively examined associations of lifestyle factors, measured using repeated assessments later in life, with incident diabetes mellitus during a 10-year period (1989-1998) among 4883 men and women 65 years or older (mean [SD] age at baseline, 73 [6] years) enrolled in the Cardiovascular Health Study. Low-risk lifestyle groups were defined by physical activity level (leisure-time activity and walking pace) above the median; dietary score (higher fiber intake and polyunsaturated to saturated fat ratio, lower trans-fat intake and lower mean glycemic index) in the top 2 quintiles; never smoked or former smoker more than 20 years ago or for fewer than 5 pack-years; alcohol use (predominantly light or moderate); body mass index less than 25 (calculated as weight in kilograms divided by height in meters squared); and waist circumference of 88 cm for women or 92 cm for men. The main outcome measure was incident diabetes defined annually by new use of insulin or oral hypoglycemic medications. We also evaluated fasting and 2-hour postchallenge glucose levels. RESULTS: During 34,539 person-years, 337 new cases of drug-treated diabetes mellitus occurred (9.8 per 1000 person-years). After adjustment for age, sex, race, educational level, and annual income, each lifestyle factor was independently associated with incident diabetes. Overall, the rate of incident diabetes was 35% lower (relative risk, 0.65; 95% confidence interval, 0.59-0.71) for each 1 additional lifestyle factor in the low-risk group. Participants whose physical activity level and dietary, smoking, and alcohol habits were all in the low-risk group had an 82% lower incidence of diabetes (relative risk, 0.18; 95% confidence interval, 0.06-0.56) compared with all other participants. When absence of adiposity (either body mass index <25 or waist circumference < or =88/92 cm for women/men) was added to the other 4 low-risk lifestyle factors, incidence of diabetes was 89% lower (relative risk, 0.11; 95% confidence interval, 0.01-0.76). Overall, 9 of 10 new cases of diabetes appeared to be attributable to these 5 lifestyle factors. Associations were slightly attenuated, but still highly significant, for incident diabetes defined by medication use or glucose level. CONCLUSION: Even later in life, combined lifestyle factors are associated with a markedly lower incidence of new-onset diabetes mellitus.
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A cohort study found that alcohol and smoking also increased the risk of T2D, even in individuals who were classified as having low-risk diet and physical activity profiles.
“A cohort study found that alcohol and smoking also increased the risk of T2D, even in individuals who were classified as having low-risk diet and physical activity profiles.78”
From A review of current trends with type 2 diabetes epidemiology, aetiology, pathogenesis, treatments and future perspectives (2021) · cites this paper as [78]
Most of these disease burdens are preventable and occur at unnecessarily younger ages, largely because of suboptimal lifestyle factors including poor diet, excess calories, inactivity, and smoking.
“Most of these burdens are preventable and are occurring at unnecessarily younger ages, largely owing to suboptimal lifestyle, which includes poor diet quality, excess caloric intake, physical inactivity, and smoking.2–5”
From Components of a Cardioprotective Diet: New Insights (2011) · cites this paper as [5]
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- Authors
- Mozaffarian, D., Kamineni, A., Carnethon, M., Djoussé, L., Mukamal, K. J., & Siscovick, D.
- Affiliations
- Brigham and Women's Hospital (US)
- Northwestern University (US)
- ORCID
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2009-04-27
- Volume
- 169
- Issue
- 8
- Pages
- 798
- ISSN
- 0003-9926 (ISSN-L)
- PMC
- PMC2828342
- OpenAlex
- W2017242961
- Cited by
- 358
- References
- 44
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 12 · 2023: 12 · 2022: 17 · 2021: 22 · 2020: 17 · 2019: 13 · 2018: 16 · 2017: 23 · 2016: 19 · 2015: 23 · 2014: 41 · 2013: 27 · 2012: 32
- FWCI
- 24.44
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01hc085082-026, n01hc085081-021, n01hc045133-001, n01hc085079-024, n01hc015103-009, n01hc085084-005, n01hc085085-011, n01hc085083-027, n01hc085080-026, n01hc085086-022, n01hc55222-0-0-0, n01hc075150-004, n01hc035129-010, 1k08hl075628-01)
- National Heart, Lung, and Blood Institute (N01-HC-85081, N01HC85085, N01 HC085086, N01HC-85083, K01HL070444, K08-HL-075628, N01 HC085079, N01HC85082, N01HC‐75150, N01 HC85086, N01 HC035129, N01HC85080, N01 HC015103, N01 HC55222, U01HL080295, N01 HC055222, K01 HL-70444, N01 HC075150, N01 HC045133, N01-HC85079, N01-HC85084)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- new-onset diabetes, lifestyle risk factors, older adults, physical activity, dietary fiber, dietary fat, smoking, alcohol consumption, body mass index, waist circumference, adiposity, diabetes incidence, Cardiovascular Health Study, weight loss
- MeSH terms
- Aged, Aged, 80 and over, Diabetes Mellitus, Type 2, Female, Humans, Life Style, Male, Prospective Studies, Risk Factors, United States, Incidence, Age of Onset, National Heart, Lung, and Blood Institute (U.S.)
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