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New-Onset Diabetes in Older Adults Attributable to Lifestyle

May 11, 2009

Numerous lifestyle factors affect older adults’ risk of diabetes, a new study finds. As the population ages, even small changes affect incidence, study finds.

U.S. researchers analyzed the link between lifestyle and incidence of diabetes over 10 years in 4,883 men and women aged 65 and older. The lifestyle factors examined included physical activity, dietary habits, tobacco and alcohol use, and amount of body fat.

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.

Dariush Mozaffarian (Brigham and Women’s Hospital, Boston, MA) states that, “Our findings suggest that, even later in life, the great majority of cases of diabetes are related to lifestyle factors…. 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 investigated the relationship between lifestyle risk factors, evaluated in combination, and the incidence of diabetes over a 10-year period in 4,883 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%.

Risk of Diabetes Mellitus According to Low-Risk Lifestyle Factors

Low-risk lifestyle factors, n

Participants (%)

Hazard ratio (95% CI)

2 low-risk lifestyle factors (physical activity level >median and dietary score upper two quintiles)


0.54 (0.38–0.76)

3 low-risk lifestyle factors (same as above plus never smoker or former smoker <5 pack-years or having quit >20 years ago)


0.42 (0.25–0.71)

3 low-risk lifestyle factors (physical activity level >median, dietary score upper two quintiles, and light or moderate alcohol use)


0.32 (0.18–0.55)

4 low-risk lifestyle factors (physical activity level >median, dietary score upper two quintiles, never smoker or former smoker <5 pack-years or having quit >20 years ago, and light or moderate alcohol use)


0.18 (0.06–0.56)

5 low-risk lifestyle factors (same as above plus BMI <25 or waist circumference <88 cm women or <92 cm men)


0.11 (0.01–0.76)

If these associations are causal, “eight in 10 new cases of diabetes might have been prevented if all older adults were in the low-risk group for these lifestyle factors,” write Mozaffarian and colleagues. When not being overweight or not having a large waist circumference was considered as a risk factor in addition to these other lifestyle behaviors, the number of possible prevented cases attributable to lifestyle factors would rise to nine in 10.

“The findings provide an estimate of the public-health burden of combined nonoptimal lifestyle risk factors for incidence of diabetes in older adults, the fastest growing segment of the population,” write the researchers.

Mozaffarian D, Kamineni A, Carnethon M, et al. Lifestyle risk factors and new-onset diabetes mellitus in older adults. Arch Intern Med 2009; 169:798-807.


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