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Adherence to a Healthy Lifestyle in Association With Microvascular Complications Among Adults With Type 2 Diabetes
IMPORTANCE: The association between an overall healthy lifestyle and the subsequent risk of microvascular complications among patients with diabetes remains unclear. OBJECTIVE: To examine the association between adherence to a healthy lifestyle before and after diabetes diagnosis and the risk of sub...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Medical Association
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9880795/ https://www.ncbi.nlm.nih.gov/pubmed/36701156 http://dx.doi.org/10.1001/jamanetworkopen.2022.52239 |
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author | Liu, Gang Li, Yanping Pan, An Hu, Yang Chen, Siyu Qian, Frank Rimm, Eric B. Manson, JoAnn E. Stampfer, Meir J. Giatsidis, Giorgio Sun, Qi |
author_facet | Liu, Gang Li, Yanping Pan, An Hu, Yang Chen, Siyu Qian, Frank Rimm, Eric B. Manson, JoAnn E. Stampfer, Meir J. Giatsidis, Giorgio Sun, Qi |
author_sort | Liu, Gang |
collection | PubMed |
description | IMPORTANCE: The association between an overall healthy lifestyle and the subsequent risk of microvascular complications among patients with diabetes remains unclear. OBJECTIVE: To examine the association between adherence to a healthy lifestyle before and after diabetes diagnosis and the risk of subsequent microvascular complications among adults with diabetes. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included incident patients with type 2 diabetes who were free of cardiovascular disease and cancer at the time of diabetes diagnosis and completed the diabetes supplementary questionnaires in the Nurses’ Health Study (in 2000 and 2005) and the Health Professionals Follow-Up Study (in 2000, 2004, and 2008) in the US. Data were analyzed from April to August 2021. EXPOSURES: Diet and lifestyle factors before and after diabetes diagnosis were assessed by validated questionnaires. A healthy lifestyle consisted of nonsmoking, having a healthy body weight (a body mass index of ≥18.5 or <25), engaging in moderate-to-vigorous physical activity (≥150 minutes per week), consuming a high-quality diet (top 40th percentile of the Alternative Healthy Eating Index), and moderate alcohol drinking (5-15 g/d for women and 5-30 g/d for men). MAIN OUTCOMES AND MEASURES: Physician-diagnosed microvascular complications including diabetic neuropathy, retinopathy, nephropathy, and foot disorders were self-reported at questionnaire surveys. RESULTS: A total of 7077 patients with type 2 diabetes were included in the cohort (4982 women in NHS and 2095 men in HPFS, mean [SD] age 61 [8.8], 94.2% White). During follow-up, 2878 patients developed microvascular complications. After multivariable adjustment, adherence to a healthy lifestyle before and after diabetes diagnosis were both associated with a lower risk of developing microvascular complications. The relative risk (RR) for participants with 4 or more low-risk lifestyle factors before diabetes diagnosis compared with zero was 0.73 (95% CI, 0.60-0.91) for any microvascular complications, 0.71 (95% CI, 0.54-0.93) for diabetic neuropathy, 0.76 (95% CI, 0.57-1.01) for diabetic retinopathy, 0.42 (95% CI, 0.23-0.79) for diabetic nephropathy, and 0.60 (95% CI, 0.35-1.00) for diabetic foot disorders. Similar results were observed for adherence to a healthy lifestyle after diabetes diagnosis, with an RR of 0.68 (95% CI, 0.55-0.83) for any microvascular complications, 0.67 (95% CI, 0.51-0.88) for diabetic neuropathy, 0.65 (95% CI, 0.48-0.86) for diabetic retinopathy, 0.57 (95% CI, 0.34-0.98) for diabetic nephropathy, and 0.62 (95% CI, 0.37-1.05) for diabetic foot disorders. In addition, greater improvement in lifestyle factors from before to after diabetes diagnosis was also significantly associated with a lower risk of neuropathy or total microvascular complications. Each increment in number of low-risk lifestyle factors was associated with a 6% (RR, 0.94; 95% CI, 0.90-0.98) lower risk for any microvascular complications and a 9% (RR, 0.91; 95% CI, 0.86-0.96) lower risk for diabetic neuropathy. Consistent results were observed when analyses were stratified by age at diabetes diagnosis, sex/cohort, or lifestyle factors before diabetes diagnosis. CONCLUSIONS AND RELEVANCE: In this cohort study, adhering to an overall healthy lifestyle was associated with a significantly lower risk of microvascular complications among individuals with diabetes. These findings suggest substantial reduction in the burden of microvascular complications associated with adopting a healthy lifestyle among patients with type 2 diabetes. |
format | Online Article Text |
id | pubmed-9880795 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | American Medical Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-98807952023-02-08 Adherence to a Healthy Lifestyle in Association With Microvascular Complications Among Adults With Type 2 Diabetes Liu, Gang Li, Yanping Pan, An Hu, Yang Chen, Siyu Qian, Frank Rimm, Eric B. Manson, JoAnn E. Stampfer, Meir J. Giatsidis, Giorgio Sun, Qi JAMA Netw Open Original Investigation IMPORTANCE: The association between an overall healthy lifestyle and the subsequent risk of microvascular complications among patients with diabetes remains unclear. OBJECTIVE: To examine the association between adherence to a healthy lifestyle before and after diabetes diagnosis and the risk of subsequent microvascular complications among adults with diabetes. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included incident patients with type 2 diabetes who were free of cardiovascular disease and cancer at the time of diabetes diagnosis and completed the diabetes supplementary questionnaires in the Nurses’ Health Study (in 2000 and 2005) and the Health Professionals Follow-Up Study (in 2000, 2004, and 2008) in the US. Data were analyzed from April to August 2021. EXPOSURES: Diet and lifestyle factors before and after diabetes diagnosis were assessed by validated questionnaires. A healthy lifestyle consisted of nonsmoking, having a healthy body weight (a body mass index of ≥18.5 or <25), engaging in moderate-to-vigorous physical activity (≥150 minutes per week), consuming a high-quality diet (top 40th percentile of the Alternative Healthy Eating Index), and moderate alcohol drinking (5-15 g/d for women and 5-30 g/d for men). MAIN OUTCOMES AND MEASURES: Physician-diagnosed microvascular complications including diabetic neuropathy, retinopathy, nephropathy, and foot disorders were self-reported at questionnaire surveys. RESULTS: A total of 7077 patients with type 2 diabetes were included in the cohort (4982 women in NHS and 2095 men in HPFS, mean [SD] age 61 [8.8], 94.2% White). During follow-up, 2878 patients developed microvascular complications. After multivariable adjustment, adherence to a healthy lifestyle before and after diabetes diagnosis were both associated with a lower risk of developing microvascular complications. The relative risk (RR) for participants with 4 or more low-risk lifestyle factors before diabetes diagnosis compared with zero was 0.73 (95% CI, 0.60-0.91) for any microvascular complications, 0.71 (95% CI, 0.54-0.93) for diabetic neuropathy, 0.76 (95% CI, 0.57-1.01) for diabetic retinopathy, 0.42 (95% CI, 0.23-0.79) for diabetic nephropathy, and 0.60 (95% CI, 0.35-1.00) for diabetic foot disorders. Similar results were observed for adherence to a healthy lifestyle after diabetes diagnosis, with an RR of 0.68 (95% CI, 0.55-0.83) for any microvascular complications, 0.67 (95% CI, 0.51-0.88) for diabetic neuropathy, 0.65 (95% CI, 0.48-0.86) for diabetic retinopathy, 0.57 (95% CI, 0.34-0.98) for diabetic nephropathy, and 0.62 (95% CI, 0.37-1.05) for diabetic foot disorders. In addition, greater improvement in lifestyle factors from before to after diabetes diagnosis was also significantly associated with a lower risk of neuropathy or total microvascular complications. Each increment in number of low-risk lifestyle factors was associated with a 6% (RR, 0.94; 95% CI, 0.90-0.98) lower risk for any microvascular complications and a 9% (RR, 0.91; 95% CI, 0.86-0.96) lower risk for diabetic neuropathy. Consistent results were observed when analyses were stratified by age at diabetes diagnosis, sex/cohort, or lifestyle factors before diabetes diagnosis. CONCLUSIONS AND RELEVANCE: In this cohort study, adhering to an overall healthy lifestyle was associated with a significantly lower risk of microvascular complications among individuals with diabetes. These findings suggest substantial reduction in the burden of microvascular complications associated with adopting a healthy lifestyle among patients with type 2 diabetes. American Medical Association 2023-01-26 /pmc/articles/PMC9880795/ /pubmed/36701156 http://dx.doi.org/10.1001/jamanetworkopen.2022.52239 Text en Copyright 2023 Liu G et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License. |
spellingShingle | Original Investigation Liu, Gang Li, Yanping Pan, An Hu, Yang Chen, Siyu Qian, Frank Rimm, Eric B. Manson, JoAnn E. Stampfer, Meir J. Giatsidis, Giorgio Sun, Qi Adherence to a Healthy Lifestyle in Association With Microvascular Complications Among Adults With Type 2 Diabetes |
title | Adherence to a Healthy Lifestyle in Association With Microvascular Complications Among Adults With Type 2 Diabetes |
title_full | Adherence to a Healthy Lifestyle in Association With Microvascular Complications Among Adults With Type 2 Diabetes |
title_fullStr | Adherence to a Healthy Lifestyle in Association With Microvascular Complications Among Adults With Type 2 Diabetes |
title_full_unstemmed | Adherence to a Healthy Lifestyle in Association With Microvascular Complications Among Adults With Type 2 Diabetes |
title_short | Adherence to a Healthy Lifestyle in Association With Microvascular Complications Among Adults With Type 2 Diabetes |
title_sort | adherence to a healthy lifestyle in association with microvascular complications among adults with type 2 diabetes |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9880795/ https://www.ncbi.nlm.nih.gov/pubmed/36701156 http://dx.doi.org/10.1001/jamanetworkopen.2022.52239 |
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