Lifestyle factors and mortality among adults with diabetes: findings from the European Prospective Investigation into Cancer and Nutrition–Potsdam study

Authors

  • Ute NÖTHLINGS,

    1. Department of Epidemiology, German Institute for Human Nutrition (DIfE), Potsdam-Rehbrücke, Nuthetal
    2. Epidemiology Section, Institute of Experimental Medicine, Christian-Albrechts University Kiel, Kiel, Germany
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  • Earl S. FORD,

    1. Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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  • Janine KRÖGER,

    1. Department of Epidemiology, German Institute for Human Nutrition (DIfE), Potsdam-Rehbrücke, Nuthetal
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  • Heiner BOEING

    1. Department of Epidemiology, German Institute for Human Nutrition (DIfE), Potsdam-Rehbrücke, Nuthetal
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  • The findings and conclusions in this article are those of the authors and do not represent the official position of the Centers for Disease Control and Prevention.

Heiner Boeing, German Institute of Human Nutrition Potsdam-Rehbrücke, Department of Epidemiology, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
Tel: +49 33200 88710
Fax: +49 33200 88721
Email: boeing@dife.de

Abstract

Background:  Healthy lifestyle behaviors are among the cornerstones of diabetes self-management, but the extent to which healthy lifestyle factors could potentially prevent premature mortality among people with diabetes remains unknown. The aim of the present study was to estimate the reduction in mortality that could be achieved if people with diabetes did not smoke, had a body mass index <30 kg/m2, performed physical activity for ≥3.5 h/week, reported better dietary habits, and consumed alcohol moderately.

Methods:  A prospective cohort study of 1263 German men and women with diabetes aged 35–65 years who were followed for an average of 7.8 years was used and multivariate Cox regression models for all-cause and cause-specific mortality were calculated.

Results:  Approximately 7% of study participants had no favorable factors, 24% had one, 35% had two, and 34% had three or more. Compared with participants who had no favorable factors, the reduction in risk was 34% [95% confidence interval (CI) 19%, 63%] for those with one favorable factor, 49% (95% CI 9%, 71%) for those with two, and 63% (95% CI 31%, 80%) for those with three or more. Furthermore, a competing risk analysis did not show any difference in the inverse associations with mortality due to cardiovascular disease, cancer, or other causes.

Conclusions:  Favorable lifestyle factors can potentially achieve substantial reductions in premature mortality among people with diabetes. Our results emphasize the importance of helping people with diabetes optimize their lifestyle behaviors.

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