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 .
Healthy living is the best revenge: findings from the European Prospective Investigation Into Cancer and Nutrition-Potsdam study.
BACKGROUND Our objective was to describe the reduction in relative risk of developing major chronic diseases such as cardiovascular disease , diabetes , and cancer associated with 4 healthy lifestyle factors among German adults . METHODS We used data from 23,153 German participants aged 35 to 65 years from the European Prospect i ve Investigation Into Cancer and Nutrition-Potsdam study . End points included confirmed incident type 2 diabetes mellitus , myocardial infa rct ion , stroke , and cancer . The 4 factors were never smoking , having a body mass index lower than 30 ( calculated as weight in kilograms divided by height in meters squared ) , performing 3.5 h/wk or more of physical activity , and adhering to healthy dietary principles ( high intake of fruits , vegetables , and whole-grain bread and low meat consumption ) . The 4 factors ( healthy , 1 point ; unhealthy , 0 points ) were summed to form an index that ranged from 0 to 4 . RESULTS During a mean follow-up of 7.8 years , 2006 participants developed new-onset diabetes ( 3.7 % ) , myocardial infa rct ion ( 0.9 % ) , stroke ( 0.8 % ) , or cancer ( 3.8 % ) . Fewer than 4 % of participants had zero healthy factors , most had 1 to 3 healthy factors , and approximately 9 % had 4 factors . After adjusting for age , sex , educational status , and occupational status , the hazard ratio for developing a chronic disease decreased progressively as the number of healthy factors increased . Participants with all 4 factors at baseline had a 78 % ( 95 % confidence interval [ CI ] , 72 % to 83 % ) lower risk of developing a chronic disease ( diabetes , 93 % [ 95 % CI , 88 % to 95 % ] ; myocardial infa rct ion , 81 % [ 95 % CI , 47 % to 93 % ] ; stroke , 50 % [ 95 % CI , -18 % to 79 % ] ; and cancer , 36 % [ 95 % CI , 5 % to 57 % ] ) than participants without a healthy factor . CONCLUSION Adhering to 4 simple healthy lifestyle factors can have a strong impact on the prevention of chronic diseases
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 .