Abstract
BackgroundPromoting positive changes in lifestyle behavior in the whole population may be a feasible and effective approach to reducing type 2 diabetes burden, but the impact of population shifts of modifiable risk factors remains unclear. Currently most of the evidence on modifiable lifestyle behavior and type 2 diabetes risk on a population level comes from studies of between-individual differences. The objective of the study was to investigate the association and potential impact on disease burden for within-individual change in lifestyle behavior and diabetes risk.MethodsPopulation-based prospective cohort study of 35,680 participants aged 30–50 at baseline in 1990–2003 in Västerbotten County, Sweden (follow-up until 2013). Five self-reported modifiable lifestyle behaviors (tobacco use, physical activity, alcohol intake, dietary fiber intake and dietary fat intake) were measured at baseline and 10 year follow-up. Lifestyle behaviors were studied separately, and combined in a score. Incident diabetes was detected by oral glucose tolerance tests. Multivariate logistic regression models and population attributable fractions (PAF) were used to analyze the association between change in lifestyle behavior between baseline and 10 year follow-up, and risk of incident diabetes.ResultsIncident diabetes was detected in 1,184 (3.3%) participants at 10 year follow-up. There was a reduced diabetes risk associated with increase in dietary fiber intake, odds ratio (OR) 0.79 (95% confidence interval (CI) 0.66, 0.96) for increase of at least one unit standard deviation (3.0 g/1,000 kcal) of the baseline distribution, PAF 16.0% (95% CI 4.2, 26.4%). Increase in the lifestyle behavior score was associated with reduced diabetes risk, OR 0.92 (95% CI 0.85, 0.99) per unit increase of the score.ConclusionsThese results support a causal link between lifestyle behavior and type 2 diabetes incidence. A small shift in lifestyle behaviors, in particular intake of dietary fiber, has the potential to reduce diabetes burden in the population and might be a suitable target for public health intervention.
Highlights
Promoting positive changes in lifestyle behavior in the whole population may be a feasible and effective approach to reducing type 2 diabetes burden, but the impact of population shifts of modifiable risk factors remains unclear
The proportion of participants who achieved individual lifestyle recommendations increased for tobacco use by 4.3%, for physical activity by 2.7%, for dietary fiber intake by 8.5% and for fat intake by 3.5% (Table 1)
There was a reduced diabetes risk associated with increase in dietary fiber intake; odds ratio (OR) 0.86, per increase of unit Standard deviation (SD) of the baseline distribution (3.0 g/ 1,000 kcal of total energy) (Table 2)
Summary
Promoting positive changes in lifestyle behavior in the whole population may be a feasible and effective approach to reducing type 2 diabetes burden, but the impact of population shifts of modifiable risk factors remains unclear. In prospective cohort studies it has been shown that between-individual differences in meeting lifestyle behavior recommendations for diet [9, 10], alcohol consumption [11], physical activity/sedentary behavior [12, 13], smoking [14] or a combination of risk factors [15,16,17], at one time-point (baseline) is inversely associated with risk of incident diabetes. It has been shown in US data that within-individual changes in diet quality over time are associated with reduced diabetes risk [18]. We aimed to quantify the impact of feasible changes in lifestyle behavior in the adult population on risk of type 2 diabetes
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