Healthy Lifestyle and Incident Hypertension and Diabetes in Participants with and without Chronic Kidney Disease: The Japan Specific Health Checkups (J-SHC) Study

OBJECTIVE: Whether or not combined lifestyle factors are associated with similar decreases in risks of incident hypertension and diabetes among individuals with and without chronic kidney disease (CKD) remains unclear. METHODS: This population-based prospective cohort study included participants 40-74 years old who were free from heart disease, stroke, renal failure, hypertension, diabetes, and hypercholesterolemia at baseline (n=60,234). Healthy lifestyle scores (HLSs) were calculated by adding the total number of 5 healthy lifestyle factors (non-smoking, body mass index <25 kg/m(2), regular exercise, healthy eating habits, and moderate or less alcohol consumption). Cox proportional hazards models were used to examine associations between the HLS and incident hypertension or type 2 diabetes and whether or not CKD modified these associations. RESULTS: During a median of 4 years, there were 2,773 incident hypertension cases (30.1 cases per 1,000 person-years) and 263 incident diabetes cases (2.4 cases per 1,000 person-years). The risk of developing hypertension and diabetes decreased linearly as participants adhered to more HLS components. Compared with adhering to 0, 1, or 2 components, adherence to all 5 HLS components was associated with a nearly one-half reduction in the risk of hypertension [hazard ratio (HR) =0.52; 95% confidence interval (CI), 0.45-0.60] and diabetes (HR=0.51; 95% CI, 0.32-0.81) in fully adjusted models. CKD did not have a modifying effect on associations between the HLS and incident hypertension (P(interaction)=0.6) or diabetes (P(interaction)=0.3). CONCLUSION: Adherence to HLS components was associated with reduced risks of incident hypertension and diabetes, regardless of CKD status.