News Author: Michael O'Riordan
CME Author: Hien T. Nghiem, MD
April 30, 2009 — Even among older adults, a healthy lifestyle, one that includes physical activity, healthy dietary habits, smoking cessation, and light or moderate alcohol use, is associated with a significantly lower incidence of new-onset diabetes mellitus. Researchers showed that 80% of new cases of diabetes are attributable to these risk factors, a number that increases when obesity is included as a risk factor.
"Our findings suggest that, even later in life, the great majority of cases of diabetes are related to lifestyle factors," write Dariush Mozaffarian (Brigham and Women's Hospital, Boston, MA) and colleagues in the April 28, 2009 issue of the Archives of Internal Medicine. "Our results support the need for emphasizing healthy and achievable physical activity and dietary goals among older adults, including moderate leisure-time activity and walking pace, higher intake of dietary fiber and polyunsaturated fat, and lower intake of trans fat and easily digestible carbohydrates."
Previous studies, including a secondary analysis of the Diabetes Prevention Program trial, have shown that structured dietary advice and physical activity were most effective at reducing the risk of diabetes among the oldest participants. However, as the investigators point out, that trial included mostly high-risk patients participating in a highly structured intervention. Other studies have shown that certain lifestyle behaviors can lower the risk of diabetes, but these often looked at each lifestyle factor individually.
In this analysis of the Cardiovascular Health Study, Mozaffarian and colleagues investigated the relationship between lifestyle risk factors, evaluated in combination, and the incidence of diabetes over a 10-year period in 4883 men and women 65 years of age and older. The group defined optimal lifestyle characteristics and compared these low-risk behaviors with the risk of incident diabetes mellitus.
Low-risk lifestyle behaviors were defined by physical-activity levels above the median and never smoking or smoking ≤5 pack-years or having quit ≥20 years ago. Alcohol use in this cohort was rare, with 94% consuming less than two drinks daily. Individuals were also assigned a dietary score based on their intake of dietary fiber, low glycemic index foods, lower trans fats, and a higher polyunsaturated-to-saturated-fat ratio. Assessments of adiposity were also performed, with a low-risk body-mass index (BMI) defined as not being overweight, or a BMI <25, while a low-risk waist circumference for men was <92 cm and <88 cm for women.
Basic lifestyle risk factors, according to the researchers, strongly predicted diabetes incidence, with individuals cutting their risk in half when they were physically active and had good dietary habits.
Overall, the risk of diabetes was 80% lower among individuals with physical-activity levels above the median, healthy dietary and smoking habits, and moderate alcohol use.
When healthy BMIs and waist circumference were added to the model, the risk of new diabetes was reduced by 89%.
for rest of article refer:
http://cme.medscape.com/viewarticle/702086?sssdmh=dm1.465854&src=nldne
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