Simmons R K, Harding A-H, Jakes R W, Welch A, Wareham N J, Griffin S J
MRC Epidemiology Unit, Strangeways Research Laboratory, Wort's Causeway, Cambridge, CB1 8RN, UK.
Diabetologia. 2006 May;49(5):905-11. doi: 10.1007/s00125-006-0163-1. Epub 2006 Mar 1.
AIMS/HYPOTHESIS: Randomised trials targeting high-risk people with impaired glucose tolerance have halved progression to diabetes using behavioural interventions aimed at achieving five goals related to weight, diet and physical activity. The number of people currently meeting these goals in the general population is unknown. The potential impact on the incidence of diabetes of increasing the proportion of people who meet these goals is also unclear. We quantified the association between the achievement of behavioural goals for the prevention of diabetes and the incidence of diabetes in a population-based cohort study.
European Prospective Investigation into Cancer (EPIC)-Norfolk is a prospective cohort of 24,155 participants aged 40-79 years who attended a baseline health check and completed validated diet and activity questionnaires. We assessed the association between achievement of five diabetes healthy behaviour prevention goals (BMI <25 kg/m(2), fat intake <30% of energy intake, saturated fat intake <10% of energy intake, fibre intake > or =15 g/4,184 kJ, physical activity >4 h/week) and risk of developing diabetes at follow-up (mean 4.6 years).
Only 20% of EPIC participants met three or more diabetes prevention goals. Diabetes incidence was inversely related to the number of goals achieved (p<0.001). None of the participants who met all five goals developed diabetes, whereas diabetes incidence was highest in those who did not meet any goals. If the entire population were able to meet one more goal, the total incidence of diabetes would be predicted to fall by 20%.
CONCLUSIONS/INTERPRETATION: In this population-based study, the risk of diabetes was inversely associated with the number of behaviour goals for diabetes prevention that were met. Interventions that promote achievement of these goals in the general population could significantly reduce the growing burden of diabetes-related morbidity and mortality.
目的/假设：针对糖耐量受损的高危人群进行的随机试验表明，通过旨在实现与体重、饮食和体育活动相关的五个目标的行为干预，糖尿病进展风险减半。目前普通人群中达到这些目标的人数尚不清楚。提高达到这些目标的人群比例对糖尿病发病率的潜在影响也不明确。在一项基于人群的队列研究中，我们对实现预防糖尿病行为目标与糖尿病发病率之间的关联进行了量化。
欧洲癌症前瞻性调查（EPIC）-诺福克研究是一项对24155名年龄在40 - 79岁之间的参与者进行的前瞻性队列研究，这些参与者参加了基线健康检查并完成了经过验证的饮食和活动问卷。我们评估了实现五个糖尿病健康行为预防目标（体重指数（BMI）<25 kg/m²、脂肪摄入量<能量摄入量的30%、饱和脂肪摄入量<能量摄入量的10%、纤维摄入量≥15 g/4184 kJ、体育活动>4小时/周）与随访期间（平均4.6年）患糖尿病风险之间的关联。
EPIC参与者中只有20%达到了三个或更多的糖尿病预防目标。糖尿病发病率与实现的目标数量呈负相关（p<0.001）。达到所有五个目标的参与者均未患糖尿病，而未达到任何目标的参与者中糖尿病发病率最高。如果整个人口能够再多实现一个目标，预计糖尿病的总发病率将下降20%。
结论/解读：在这项基于人群的研究中，糖尿病风险与实现的糖尿病预防行为目标数量呈负相关。在普通人群中促进实现这些目标的干预措施可显著减轻糖尿病相关发病和死亡日益增加的负担。
