Combined lifestyle factors and risk of incident type 2 diabetes and prognosis among individuals with type 2 diabetes: a
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ARTICLE
Combined lifestyle factors and risk of incident type 2 diabetes and prognosis among individuals with type 2 diabetes: a systematic review and meta-analysis of prospective cohort studies Yanbo Zhang 1,2 & Xiong-Fei Pan 1,2 & Junxiang Chen 1,2 & Lu Xia 1,2 & Anlan Cao 1,2 & Yuge Zhang 1,2 & Jing Wang 3 & Huiqi Li 1,2 & Kun Yang 4 & Kunquan Guo 4 & Meian He 2,5 & An Pan 1,2 Received: 20 May 2019 / Accepted: 19 July 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Aims/hypothesis A healthy lifestyle has been widely recommended for the prevention and management of type 2 diabetes. However, no systematic review has summarised the relationship between combined lifestyle factors (including, but not limited to, smoking, alcohol drinking, physical activity, diet and being overweight or obese) and incident type 2 diabetes and risk of health outcomes among diabetic individuals. Methods EMBASE and PubMed were searched up to April 2019 without language restrictions. References included in articles in relevant publications were also screened. Cohort studies investigating the combined associations of at least three lifestyle factors with incident type 2 diabetes and health outcomes among diabetic individuals were included. Reviewers were paired and independently screened studies, extracted data and evaluated study quality. Random-effects models were used to calculate summary HRs. Heterogeneity and publication bias tests were also conducted. Results Compared with participants considered to have the least-healthy lifestyle, those with the healthiest lifestyle had a 75% lower risk of incident diabetes (HR 0.25 [95% CI 0.18, 0.35]; 14 studies with approximately 1 million participants). The associations were largely consistent and significant among individuals from different socioeconomic backgrounds and baseline characteristics. Among individuals with type 2 diabetes (10 studies with 34,385 participants), the HRs (95% CIs) were 0.44 (0.33, 0.60) for all-cause death, 0.51 (0.30, 0.86) for cardiovascular death, 0.69 (0.47, 1.00) for cancer death and 0.48 (0.37, 0.63) for incident cardiovascular disease when comparing the healthiest lifestyle with the least-healthy lifestyle. Conclusions/interpretation Adoption of a healthy lifestyle is associated with substantial risk reduction in type 2 diabetes and long-term adverse outcomes among diabetic individuals. Tackling multiple risk factors, instead of concentrating on one certain lifestyle factor, should be the cornerstone for reducing the global burden of type 2 diabetes. Keywords Cardiovascular disease . Lifestyle . Meta-analysis . Mortality . Systematic review . Type 2 diabetes
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00125-019-04985-9) contains peer-reviewed but unedited supplementary material, which is available to authorised users. * An Pan [email protected] 1
2
Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Tech
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