Aims

Limited epidemiologic data on the combined impact of several lifestyle factors on type 2 diabetes (T2DM) incidence was reported in Chinese population. This study aimed to examine how combinations of BMI, physical activity and diet relate to T2DM incidence and estimate corresponding population attributable risk in the general population.

Methods

56,691 male and 70,849 female participants aged 40-74 years old in two population-based cohorts from Shanghai Men’s and Women’s Health Studies were used for analysis. Cox regression model was used to estimate the association between lifestyle factors collected at baseline and T2DM incidence. Multivariable-adjusted population attributable risks were calculated for specific combinations of lifestyle factors.

Results

There were 3315 male and 5925 female incident T2DM, with corresponding density incidence rates of 6.39 and 6.04 per 1000 person-years. If the healthiest group of healthy lifestyle index (HLI) was used as a reference, the hazard ratios (95% confidence intervals) of T2DM increased monotonically in males [2.04(1.75,2.38); 2.94 (2.53,3.42); 4.31(3.66,5.07)] and females [1.85(1.64,2.08); 2.79 (2.49,3.13); 4.14(3.66,4.67)]. One point increase of HLI was related to a 35% and 35% lower risk in males and females. About 52.7% and 58.4% cases in males and females could have been avoided if participants had been adherent to a healthy lifestyle of maintaining healthy body weight, eating a healthy diet and keeping physically active.

Conclusions

An increased number of healthy lifestyle factors were associated with a decreased risk of T2DM in the Chinese population. Future interventions targeted at combined healthy lifestyle factors are needed to reduce the burden of T2DM.