Even as science searches for more clues about the causes of diabetes and medications to prevent it, a modestly healthier lifestyle could prevent the vast majority of new cases of the disease in older adults, according to scientists at the Harvard School of Public Health.
A combination of five lifestyle factors could account for nine in 10 new cases of Type 2 diabetes in men and women age 65 and older, according to a study published Monday in Archives of Internal Medicine. Those factors include physical activity, diet, smoking habits, alcohol use, and amount of body fat (as determined by body mass index and waist circumference).
The findings highlight the fact that Type 2 diabetes really is a largely preventable lifestyle disease, said lead author Dariush Mozaffarian, assistant professor of epidemiology at the school and assistant professor of medicine in the Division of Cardiovascular Medicine, Brigham and Women's Hospital, and Harvard Medical School.
Although previous studies had linked these factors separately to diabetes or in sum to risk of diabetes in specific socioeconomic populations, this study quantifies the overall impact of several lifestyle factors associated with diabetes risk in a general population of older men and women.
Type 2 diabetes, the most common form of the disease, occurs when the body fails to respond to and produce insulin properly, resulting in a build-up of sugar in the blood and other biologic abnormalities. Incidence of diabetes has jumped during the past decade and now is estimated to affect 24 million Americans, or nearly 8 percent of the population, according to the Centers for Disease Control and Prevention. The disease disproportionately affects older Americans.
In this study, researchers tracked 4,883 men and women 65 or older for 10 years as part of the Cardiovascular Health Study, a multicenter study sponsored by the National Heart, Lung and Blood Institute to evaluate risk factors for cardiovascular disease in older adults. Data was collected through annual questionnaires and physical exams.
Participants were asked about their physical activity level, diet, smoking habits, and alcohol use. Their body mass index and waist circumference were measured. Participants were grouped into a low-risk or a high-risk group for each factor.
During the study period, more than 300 subjects were diagnosed with diabetes. After making statistical adjustments for age, sex, race, educational level, and annual income, researchers found that each of the five lifestyle factors they measured was associated independently with the onset of diabetes. Overall, the rate of incident diabetes was 35 percent lower for each one additional lifestyle factor in the low-risk group.
Subjects in the low-risk group for diet consumed slightly better-than-average levels of dietary fiber and polyunsaturated fat and less trans fat and starchy and sugary foods. Other low-risk characteristics included whether participants never had smoked; consumed up to two alcoholic drinks a day (modest alcohol consumption has been shown to be a protective factor against diabetes); and were not overweight (defined by having a body mass index below 25 or a waist circumference of less than 88 cm for women or 92 cm for men).
The study results underscore that people can lower their diabetes risk considerably, even if they are unable to follow a perfect ideal of healthy behavior. Very modest differences in lifestyle can have a tremendous impact on diabetes risk, Mozaffarian said. Even two or three or four of the five factors, in any combination, were associated with substantially lower risk.
Source; Harvard School of Public Health
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