The associations were largely consistent and significant among individuals from different socioeconomic background s and baseline characteristics .
Conclusions /interpretationAdoption of a healthy lifestyle is associated with substantial risk reduction in type 2 diabetes and long-term adverse outcomes among diabetic individuals .
Aims /hypothesisA healthy lifestyle has been widely recommended for the prevention and management of type 2 diabetes .
However , no systematic review has summarised the relationship between combined lifestyle factors ( including , but not limited to , smoking , alcohol drinking , physical activity , diet and being overweight or obese ) and  incident type 2 diabetes and risk of health outcomes among diabetic individuals .
Lifestyle risk factors and new-onset diabetes mellitus in older adults: the cardiovascular health study.
BACKGROUND The combined impact of lifestyle factors on incidence of  diabetes mellitus later in life is not well established . The objective of this study was to determine how lifestyle factors , assessed in combination , relate to new-onset diabetes in a broad and relatively unselected population of older adults . METHODS We prospect ively examined associations of lifestyle factors , measured using repeated assessment s later in life , with incident  diabetes mellitus  during a 10-year period ( 1989 - 1998 ) among 4883 men and women 65 years or older ( mean [ SD ] age at baseline , 73 [ 6 ] years ) enrolled in the Cardiovascular Health Study . Low-risk lifestyle groups were defined by physical activity level ( leisure-time activity and walking pace ) above the median ; dietary score ( higher fiber intake and polyunsaturated to saturated fat ratio , lower trans-fat intake and lower mean glycemic index ) in the top 2 quintiles ; never smoked or former smoker more than 20 years ago or for fewer than 5 pack-years ; alcohol use ( predominantly light or moderate ) ; body mass index less than 25 ( calculated as weight in kilograms divided by height in meters squared ) ; and waist circumference of 88 cm for women or 92 cm for men . The main outcome measure was incident diabetes defined annually by new use of insulin or oral hypoglycemic medications . We also evaluated fasting and 2-hour postchallenge glucose levels . RESULTS During 34,539 person-years , 337 new cases of drug-treated diabetes mellitus occurred ( 9.8 per 1000 person-years ) . After adjustment for age , sex , race , educational level , and annual income , each lifestyle factor was independently associated with incident diabetes . Overall , the rate of incident diabetes was 35 % lower ( relative risk , 0.65 ; 95 % confidence interval , 0.59 - 0.71 ) for each 1 additional lifestyle factor in the low-risk group . Participants whose physical activity level and dietary , smoking , and alcohol habits were all in the low-risk group had an 82 % lower incidence of diabetes ( relative risk , 0.18 ; 95 % confidence interval , 0.06 - 0.56 ) compared with all other participants . When absence of adiposity ( either body mass index < 25 or waist circumference < or = 88/92 cm for women/men ) was added to the other 4 low-risk lifestyle factors , incidence of diabetes was 89 % lower ( relative risk , 0.11 ; 95 % confidence interval , 0.01 - 0.76 ) . Overall , 9 of 10 new cases of diabetes appeared to be attributable to these 5 lifestyle factors . Associations were slightly attenuated , but still highly significant , for incident diabetes defined by medication use or glucose level . CONCLUSION Even later in life , combined lifestyle factors are associated with a markedly lower incidence of new-onset diabetes mellitus
The associations were largely consistent and significant among individuals from different socioeconomic background s and baseline characteristics .
Conclusions /interpretationAdoption of a healthy lifestyle is associated with substantial risk reduction in type 2 diabetes and long-term adverse outcomes among diabetic individuals .
Aims /hypothesisA healthy lifestyle has been widely recommended for the prevention and management of type 2 diabetes .
However , no systematic review has summarised the relationship between combined lifestyle factors ( including , but not limited to , smoking , alcohol drinking , physical activity , diet and being overweight or obese ) and  incident type 2 diabetes and risk of health outcomes among diabetic individuals .