The higher adherence to a healthy lifestyle score is associated with a decreased risk of type 2 diabetes in Iranian adults

BACKGROUND: The combined roles of lifestyle factors in the risk of type 2 diabetes (T2D) are not fully investigated. In the present study, we aimed to assess the relationship between a healthy lifestyle score (HLS) and the risk of T2D in Tehranian adults. METHODS: A total of 3859 individuals without T2D were recruited from participants of the Tehran Lipid and Glucose Study (2009–2011) who were followed up for a mean period of 6 years. A food frequency questionnaire was used to collect individuals' dietary intakes at baseline. HLS scores was calculated based on three pre-defined methods with focusing on 4 lifestyle factors including, no current smoking, no obesity, high physical activity, and greater adherence to the healthy diet[determined using the alternate healthy eating index-2010(AHEI-2010), modified French Programme National Nutrition Santé-Guideline Score(mPNNS-GS), and healthy diet pattern score(HDP)]. RESULTS: Mean ± SD age of participants(44.4% men) was 41.1 ± 12.3 years. After 6-year follow-up of study, 295(7.6%) new cases of T2D were reported. Based on the age and sex-adjusted model, an inverse association was observed between the higher score of HLS-AHEI-2010 (OR = 0.24;95%CI:0.10–0.60), HLS-mPNNS-GS (OR = 0.28;95%CI:0.15–0.50), and HLS-HDP (OR = 0.39;95%CI:0.24–0.64) and the risk of T2D (P for trend < 0.05). Also, the fully-adjusted model showed that after controlling the effects of various confounders, this invers association between the higher score of HLS-AHEI-2010 (OR = 0.25;95%CI:0.10–0.61, P for trend:0.001), HLS-mPNNS-GS (OR = 0.29;95%CI:0.15–0.55,P for trend:0.001), and HLS-HDP (OR = 0.36;95%CI:0.22–0.61,P for trend < 0.001) and risk of T2D was remained significant. CONCLUSION: The results of this study suggested that higher score of HLS, characterized by no smoking, normal body weight, vigorous physical activity, and healthy diet, is related to decreased risk of T2D incidence.