Lifestyle factors and mortality risk in individuals with diabetes mellitus: are the associations different from those in individuals without diabetes?
Open accessAbstract
Aims/hypothesis Thus far, it is unclear whether lifestyle recommendations for people with diabetes should be different from those for the general public. We investigated whether the associations between lifestyle factors and mortality risk differ between individuals with and without diabetes. Methods Within the European Prospective Investigation into Cancer and Nutrition (EPIC), a cohort was formed of 6,384 persons with diabetes and 258,911 EPIC participants without known diabetes. Joint Cox proportional hazard regression models of people with and without diabetes were built for the following lifestyle factors in relation to overall mortality risk: BMI, waist/height ratio, 26 food groups, alcohol consumption, leisure-time physical activity, smoking. Likelihood ratio tests for heterogeneity assessed statistical differences in regression coefficients. Results Multivariable adjusted mortality risk among individuals with diabetes compared with those without was increased, with an HR of 1.62 (95% CI 1.51, 1.75). Intake of fruit, legumes, nuts, seeds, pasta, poultry and vegetable oil was related to a lower mortality risk, and intake of butter and margarine was related to an increased mortality risk. These associations were significantly different in magnitude from those in diabetes-free individuals, but directions were similar. No differences between people with and without diabetes were detected for the other lifestyle factors. Conclusions/interpretation Diabetes status did not substantially influence the associations between lifestyle and mortality risk. People with diabetes may benefit more from a healthy diet, but the directions of association were similar. Thus, our study suggests that lifestyle advice with respect to mortality for patients with diabetes should not differ from recommendations for the general population.
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Authors of included studies were contacted for clarification of reported intake amounts.
“The authors of one study22 were contacted for clarification of the amount of whole grain intake, which was reported in ounces/day (1 ounce=28 g) in the publication but was clarified to be in ounces/1000 kcal/day by the authors.”
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- Authors
- Sluik, D., Boeing, H., Li, K., Kaaks, R., Johnsen, N. F., Tjønneland, A., Arriola, L., Barricarte, A., Masala, G., Grioni, S., Tumino, R., Ricceri, F., Mattiello, A., Spijkerman, A. M. W., van der A, D. L., Sluijs, I., Franks, P. W., Nilsson, P. M., Orho-Melander, M., Fhärm, E., Rolandsson, O., Riboli, E., Romaguera, D., Weiderpass, E., Sánchez-Cantalejo, E., & Nöthlings, U.
- Affiliations
- German Institute of Human Nutrition (DE)
- German Cancer Research Center (DE)
- Danish Cancer Society (DK)
- Basque Government (ES)
- Italian institute for Genomic Medicine (IT)
- Federico II University Hospital (IT)
- National Institute for Public Health and the Environment (NL)
- University Medical Center Utrecht (NL)
- Harvard University (US)
- Lund University (SE)
- Umeå University (SE)
- Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition (ES)
- Karolinska Institutet (SE)
- University of Bonn (DE)
- Corresponding author
- Sluik, Diewertje
- ORCID
- Sluik, Diewertje
- Boeing, Heiner
- Li, Kuanrong
- Kaaks, Rudolf
- Johnsen, Nina Føns
- Tjønneland, Anne
- Arriola, Larraitz
- Barricarte, Aurelio
- Masala, Giovanna
- Grioni, Sara
- Tumino, Rosario
- Ricceri, Fulvio
- Mattiello, Amalia
- Sluijs, Ivonne
- Franks, Paul W.
- Nilsson, Peter M.
- Fhärm, Eva
- Rolandsson, Olov
- Romaguera, Dora
- Weiderpass, Elisabete
- Nöthlings, Ute
- Venue
- Diabetologia
- Published
- 2013-10-17
- Volume
- 57
- Issue
- 1
- Pages
- 63-72
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W2123256521
- Cited by
- 70
- References
- 48
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 2 · 2023: 7 · 2022: 6 · 2021: 7 · 2020: 4 · 2019: 14 · 2018: 4 · 2017: 6 · 2016: 5 · 2015: 6 · 2014: 2 · 2013: 2
- FWCI
- 5.11
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
- Socio-Environmental Systems Modeling (acceptedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Rivm (National Institute for Public Health and the Environment) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Sanofi
- European Foundation for the Study of Diabetes
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- diabetes mellitus, lifestyle factors, mortality risk, healthy eating, dietary intake, fruit and vegetable intake, legumes and nuts, alcohol consumption, physical activity, smoking, body mass index, waist-to-height ratio, lifestyle advice
- MeSH terms
- Diabetes Mellitus, Female, Fruit, Humans, Fabaceae, Life Style, Male, Middle Aged, Motor Activity, Prospective Studies, Risk Factors, Smoking
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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