Diet and physical activity in relation to overall mortality amongst adult diabetics in a general population cohort


Antonia Trichopoulou MD, Department of Hygiene and Epidemiology, University of Athens Medical School, 75, Mikras Asias Str., Goudi, 11527 Athens, Greece.
(fax: +30 210 7462079; e-mail:


Objectives.  To evaluate the effect on overall and cardiovascular mortality of diet and physical activity amongst diabetic persons.

Design.  Population-based prospective investigation, from 1993 to mid-2004, in the Greek arm of the European Prospective Investigation into Cancer and Nutrition.

Setting.  Volunteers from the general adult Greek population.

Subjects.  From an original sample of 28 572 volunteers, 1013 were taking at enrolment drugs for diabetes mellitus, had no missing information on the study variables and no comorbidity. Diet was assessed at baseline through a validated questionnaire. Proportional hazards regression was used to assess the relation of dietary factors and physical activity with mortality.

Interventions.  None.

Main outcome measures.  Mortality ratios overall and from cardiovascular causes.

Results.  During 4579 person-years, 80 deaths have occurred, 46 of which from cardiovascular causes. Physical activity was strongly inversely associated with mortality. Two nutritional variables were significantly associated with diabetic mortality, with hazard ratios for increases of daily intake by one standard deviation being 1.31 for eggs [95% confidence interval (95% CI) 1.07 to 1.60] and 1.82 for saturated lipids (95% CI, 1.14 to 2.90). These two associations were considerably stronger for cardiovascular mortality. Waist-to-height ratio was positively, whereas hip circumference inversely associated with mortality. No significant interactions with gender for any of the study variables were evident.

Discussion.  Amongst confirmed diabetic persons, increased physical activity is associated with significant reduction of mortality, whereas increased consumption of eggs and saturated fats is associated with significant increase of mortality. Monounsaturated lipids are preferable for diabetic persons.