Mozaffarian Dariush, Kamineni Aruna, Carnethon Mercedes, Djoussé Luc, Mukamal Kenneth J, Siscovick David
Divisions of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard School of Public Health, 665 Huntington Ave, Bldg 2-319, Boston, MA 02115, USA.
Arch Intern Med. 2009 Apr 27;169(8):798-807. doi: 10.1001/archinternmed.2009.21.
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.
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.
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.
Even later in life, combined lifestyle factors are associated with a markedly lower incidence of new-onset diabetes mellitus.
生活方式因素对晚年糖尿病发病率的综合影响尚未完全明确。本研究的目的是确定在广泛且相对未经过筛选的老年人群中，综合评估的生活方式因素与新发糖尿病之间的关系。
我们前瞻性地研究了生活方式因素与糖尿病发病之间的关联，这些生活方式因素是通过对心血管健康研究中纳入的4883名65岁及以上（基线时平均[标准差]年龄为73[6]岁）的男性和女性在晚年进行多次评估来测量的。低风险生活方式组的定义为：身体活动水平（休闲时间活动和步行速度）高于中位数；饮食评分（较高的纤维摄入量、多不饱和脂肪酸与饱和脂肪酸的比例、较低的反式脂肪摄入量和较低的平均血糖指数）处于前两个五分位数；从不吸烟或20多年前戒烟或吸烟量少于5包年；饮酒（主要为轻度或中度）；体重指数小于25（计算方法为体重（千克）除以身高（米）的平方）；女性腰围小于88厘米或男性腰围小于92厘米。主要结局指标是每年通过新使用胰岛素或口服降糖药物定义的新发糖尿病。我们还评估了空腹血糖和餐后2小时血糖水平。
在34539人年的随访期间，共发生337例药物治疗的糖尿病新病例（每1000人年9.8例）。在调整了年龄、性别、种族、教育水平和年收入后，每个生活方式因素均与糖尿病发病独立相关。总体而言，低风险组中每增加一个生活方式因素，糖尿病发病率降低35%（相对风险，0.65；95%置信区间，0.59 - 0.71）。身体活动水平、饮食、吸烟和饮酒习惯均处于低风险组的参与者与所有其他参与者相比，糖尿病发病率低82%（相对风险，0.18；95%置信区间，0.06 - 0.56）。当将无肥胖（体重指数<25或女性腰围<或=88厘米/男性腰围<或=92厘米）添加到其他4个低风险生活方式因素中时，糖尿病发病率降低89%（相对风险，0.11；95%置信区间，0.01 - 0.76）。总体而言，10例糖尿病新病例中有9例似乎可归因于这5个生活方式因素。对于通过药物使用或血糖水平定义的糖尿病发病，关联略有减弱，但仍高度显著。
即使在晚年，综合生活方式因素与新发糖尿病的发病率显著降低相关。
