Associations of Combined Healthy Lifestyle Factors with Risks of Diabetes, Cardiovascular Disease, Cancer, and Mortality Among Adults with Prediabetes: Four Prospective Cohort Studies in China, the United Kingdom, and the United States
Zhou-Zheng Tu,
Qi Lu,
Yan-Bo Zhang,
Zhe Shu,
Yu-Wei Lai,
Meng-Nan Ma,
Peng-Fei Xia,
Ting-Ting Geng,
Jun-Xiang Chen,
Yue Li,
Lin-Jing Wu,
Jing Ouyang,
Zhi Rong,
Xiong Ding,
Xu Han,
Shuo-Hua Chen,
Mei-An He,
Xiao-Min Zhang,
Lie-Gang Liu,
Tang-Chun Wu,
Shou-Ling Wu,
Gang Liu,
An Pan
Affiliations
Zhou-Zheng Tu
Key Laboratory of Environment and Health of the Ministry of Education, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Qi Lu
Key Laboratory of Environment and Health of the Ministry of Education, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Yan-Bo Zhang
Key Laboratory of Environment and Health of the Ministry of Education, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Zhe Shu
School of Public Health, North China University of Science and Technology, Tangshan 063000, China
Yu-Wei Lai
Key Laboratory of Environment and Health of the Ministry of Education, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Meng-Nan Ma
Key Laboratory of Environment and Health of the Ministry of Education, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Peng-Fei Xia
Key Laboratory of Environment and Health of the Ministry of Education, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Ting-Ting Geng
Key Laboratory of Environment and Health of the Ministry of Education, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Jun-Xiang Chen
Key Laboratory of Environment and Health of the Ministry of Education, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Yue Li
Key Laboratory of Environment and Health of the Ministry of Education, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Lin-Jing Wu
Key Laboratory of Environment and Health of the Ministry of Education, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Jing Ouyang
Key Laboratory of Environment and Health of the Ministry of Education, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Zhi Rong
Key Laboratory of Environment and Health of the Ministry of Education, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Xiong Ding
School of Public Health, North China University of Science and Technology, Tangshan 063000, China
Xu Han
Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan 063000, China
Shuo-Hua Chen
Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan 063000, China
Mei-An He
Key Laboratory of Environment and Health of the Ministry of Education, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Xiao-Min Zhang
Key Laboratory of Environment and Health of the Ministry of Education, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Lie-Gang Liu
Key Laboratory of Environment and Health of the Ministry of Education, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Tang-Chun Wu
Key Laboratory of Environment and Health of the Ministry of Education, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Shou-Ling Wu
Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan 063000, China; Corresponding authors.
Gang Liu
Key Laboratory of Environment and Health of the Ministry of Education, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Corresponding authors.
An Pan
Key Laboratory of Environment and Health of the Ministry of Education, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Corresponding authors.
Lifestyle modification is an effective measure for diabetes prevention in people with prediabetes, but its associations with the long-term risks of cardiovascular disease (CVD), cancer, and mortality remain largely uncertain. We aimed to investigate the associations of combined healthy lifestyle factors with these health outcomes among participants with prediabetes. The study included 121 254 people with prediabetes from four prospective cohorts: the Dongfeng-Tongji (DFTJ) cohort and Kailuan study, both from China; the UK Biobank; and the US National Health and Nutrition Examination Survey (NHANES; for mortality analysis only). We documented a total of 18 333 incident diabetes, 10 829 incident CVD, 6926 incident cancer, and 9877 deaths during follow-up. Combined healthy lifestyle scores (scored from 0 to 5) were constructed based on never smoking or quitting smoking for ≥ 10 years, low-to-moderate alcohol drinking, optimal physical activity, healthy diet, and optimal waist circumference. First, Cox proportional-hazards regression models were used to quantify the associations of combined lifestyle score with health outcomes in each cohort; then, multivariable-adjusted hazard ratios (HRs) were pooled via a random-effects model of meta-analysis. Compared with participants with the least healthy lifestyle (a score of 0–1), participants with the healthiest lifestyle (a score of 4–5) had significantly reduced risks of all outcomes. The HRs (95% confidence interval (CI)) were 0.57 (0.48–0.69) for diabetes, 0.67 (0.62–0.73) for CVD, 0.80 (0.73–0.88) for cancer, and 0.54 (0.42–0.70) for mortality. Significant associations were consistently found across subgroups of baseline demographic characteristics and metabolic health status. In conclusion, our pooled analyses of four cohorts from three countries reveal that greater adherence to a healthy lifestyle is associated with considerably lower risks of diabetes and its major complications among adults with prediabetes. These findings provide informative and compelling evidence for establishing clinical guidelines and public health policies.
