医学
糖尿病前期
危险系数
腰围
前瞻性队列研究
比例危险模型
队列
糖尿病
队列研究
全国健康与营养检查调查
体质指数
人口学
置信区间
环境卫生
老年学
内科学
2型糖尿病
人口
内分泌学
社会学
作者
Zhou-Zheng Tu,Qi Lu,Yanbo Zhang,Zhe Shu,Yu-Wei Lai,Meng Ma,Pengfei Xia,Tingting Geng,Junxiang Chen,Yue Li,Linjing Wu,Jing Ouyang,Zhi Rong,Xiong Ding,Xu Han,Shuohua Chen,Meian He,Xiaomin Zhang,Liegang Liu,Tangchun Wu,Shouling Wu,Gang Liu,An Pan
标识
DOI:10.1016/j.eng.2022.04.010
摘要
Lifestyle modification is an effective measure for diabetes prevention in people with prediabetes, but its associations with the long-term risks of cardiovascular disease (CVD), cancer, and mortality remain largely uncertain. We aimed to investigate the associations of combined healthy lifestyle factors with these health outcomes among participants with prediabetes. The study included 121 254 people with prediabetes from four prospective cohorts: the Dongfeng-Tongji (DFTJ) cohort and Kailuan study, both from China; the UK Biobank; and the US National Health and Nutrition Examination Survey (NHANES; for mortality analysis only). We documented a total of 18 333 incident diabetes, 10 829 incident CVD, 6926 incident cancer, and 9877 deaths during follow-up. Combined healthy lifestyle scores (scored from 0 to 5) were constructed based on never smoking or quitting smoking for ≥ 10 years, low-to-moderate alcohol drinking, optimal physical activity, healthy diet, and optimal waist circumference. First, Cox proportional-hazards regression models were used to quantify the associations of combined lifestyle score with health outcomes in each cohort; then, multivariable-adjusted hazard ratios (HRs) were pooled via a random-effects model of meta-analysis. Compared with participants with the least healthy lifestyle (a score of 0–1), participants with the healthiest lifestyle (a score of 4–5) had significantly reduced risks of all outcomes. The HRs (95% confidence interval (CI)) were 0.57 (0.48–0.69) for diabetes, 0.67 (0.62–0.73) for CVD, 0.80 (0.73–0.88) for cancer, and 0.54 (0.42–0.70) for mortality. Significant associations were consistently found across subgroups of baseline demographic characteristics and metabolic health status. In conclusion, our pooled analyses of four cohorts from three countries reveal that greater adherence to a healthy lifestyle is associated with considerably lower risks of diabetes and its major complications among adults with prediabetes. These findings provide informative and compelling evidence for establishing clinical guidelines and public health policies.
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