Lifestyle risk factors and new-onset diabetes mellitus in older adults: the cardiovascular health study.
Lifestyle risk factors and new-onset diabetes mellitus in older adults: the cardiovascular health study.
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DOI：
10.1001/archinternmed.2009.21
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发表时间：
2009-04-27
影响因子：
--
通讯作者：
Siscovick, David
中科院分区：
文献类型：
--
作者：
Mozaffarian, Dariush;Kamineni, Aruna;Carnethon, Mercedes;Djousse, Luc;Mukamal, Kenneth J.;Siscovick, David
生活方式因素对晚年糖尿病发病率的综合影响尚未得到很好的证实。这项研究的目的是确定综合评估的生活方式因素如何与广泛且相对未选定的老年人群中的新发糖尿病有关。我们前瞻性地研究了心血管健康研究中登记的4883名65岁或65岁以上的男性和女性(基线平均年龄73[6]岁)的生活方式因素与10年(1989-1998)期间糖尿病发病率的关系。低风险生活方式组的定义为：身体活动水平(休闲活动和步行速度)高于中位数；饮食得分(较高的纤维摄入量和多不饱和脂肪与饱和脂肪的比率，较低的反式脂肪摄入量和较低的平均血糖指数)位于前两个五分之一；从未吸烟或在20年前从未吸烟或吸烟少于5年；饮酒(主要是轻度或中度)；身体质量指数小于25(体重以公斤除以身高，以米为平方)；以及腰围，女性为88厘米，男性为92厘米。主要的结果衡量标准是每年新使用胰岛素或口服降糖药物定义的糖尿病事件。我们还评估了空腹和挑战后2小时的血糖水平。在34539人年期间，发生了337例新的药物治疗糖尿病病例(每1000人年9.8例)。在调整了年龄、性别、种族、教育水平和年收入后，每个生活方式因素都与糖尿病事件独立相关。总体而言，低风险组每增加1个生活方式因素，糖尿病发病率降低35%(相对风险为0.65；95%可信区间为0.59-0.71)。与所有其他参与者相比，体力活动水平和饮食、吸烟和饮酒习惯都属于低风险组的参与者的糖尿病发病率(相对风险为0.18；95%可信区间为0.06-0.56)降低了82%。在其他4个低风险生活方式因素中加上非肥胖(体重指数或男性腰围≤为88/92 cm)，糖尿病的发病率降低了%(相对危险度为0.11；95%可信区间为0.01-0.76)。总体而言，10个新的糖尿病病例中有9个似乎与这5个生活方式因素有关。由药物使用或血糖水平定义的糖尿病事件的相关性略有减弱，但仍非常显著。即使在晚年，综合的生活方式因素也与新发糖尿病的发病率显著降低有关。
The combined impact of lifestyle factors on incidence of diabetes mellitus later in life is not well established. The objective of this study was to determine how lifestyle factors, assessed in combination, relate to new-onset diabetes in a broad and relatively unselected population of older adults. We prospectively examined associations of lifestyle factors, measured using repeated assessments later in life, with incident diabetes mellitus during a 10-year period (1989–1998) among 4883 men and women 65 years or older (mean [SD] age at baseline, 73[6] years) enrolled in the Cardiovascular Health Study. Low-risk lifestyle groups were defined by physical activity level (leisure-time activity and walking pace) above the median; dietary score (higher fiber intake and polyunsaturated to saturated fat ratio, lower trans-fat intake and lower mean glycemic index) in the top 2 quintiles; never smoked or former smoker more than 20 years ago or for fewer than 5 pack-years; alcohol use (predominantly light or moderate); body mass index less than 25 (calculated as weight in kilograms divided by height in meters squared); and waist circumference of 88 cm for women or 92 cm for men. The main outcome measure was incident diabetes defined annually by new use of insulin or oral hypoglycemic medications. We also evaluated fasting and 2-hour postchallenge glucose levels. During 34 539 person-years, 337 new cases of drug-treated diabetes mellitus occurred (9.8 per 1000 person-years). After adjustment for age, sex, race, educational level, and annual income, each lifestyle factor was independently associated with incident diabetes. Overall, the rate of incident diabetes was 35% lower (relative risk, 0.65; 95% confidence interval, 0.59–0.71) for each 1 additional lifestyle factor in the low-risk group. Participants whose physical activity level and dietary, smoking, and alcohol habits were all in the low-risk group had an 82% lower incidence of diabetes (relative risk, 0.18; 95% confidence interval, 0.06–0.56) compared with all other participants. When absence of adiposity (either body mass index <25 or waist circumference ≤88/92 cm for women/men) was added to the other 4 low-risk lifestyle factors, incidence of diabetes was 89% lower (relative risk, 0.11; 95% confidence interval, 0.01–0.76). Overall, 9 of 10 new cases of diabetes appeared to be attributable to these 5 lifestyle factors. Associations were slightly attenuated, but still highly significant, for incident diabetes defined by medication use or glucose level. Even later in life, combined lifestyle factors are associated with a markedly lower incidence of new-onset diabetes mellitus.
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影响因子：
158.5
作者：
Knowler, WC;Barrett-Connor, E;Nathan, DM
通讯作者：
Nathan, DM
DOI：
10.1046/j.1365-2362.1997.1330680.x
发表时间：
1997-05-01
影响因子：
5.5
作者：
Eliasson, B;Attvall, S;Smith, U
通讯作者：
Smith, U
影响因子：
158.5
作者：
Hu, FB;Manson, JE;Willett, WC
通讯作者：
Willett, WC
影响因子：
5
作者：
COLDITZ, GA;WILLETT, WC;SPEIZER, FE
通讯作者：
SPEIZER, FE
影响因子：
11.1
作者：
ATTVALL, S;FOWELIN, J;SMITH, U
通讯作者：
SMITH, U