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 Factors and Risk for New-Onset Diabetes
BACKGROUND Epidemiologic data on the combined influence of several lifestyle factors on diabetes risk are rare , particularly among older adults . OBJECTIVE To examine how combinations of lifestyle risk factors relate to the 11-year risk for incident diabetes . DESIGN Population -based prospect i ve cohort study . SETTING National Institutes of Health (NIH)-AARP Diet and Health Study . PARTICIPANTS 114,996 men and 92,483 women , aged 50 to 71 years in 1995 to 1996 , without evidence of heart disease , cancer , or diabetes . MEASUREMENTS A comprehensive survey of demographic characteristics and lifestyle factors  , including dietary intake , body weight and height , physical activity , smoking , and alcohol consumption  at baseline ( 1995 to 1996 ) . Low-risk groups were formed by dichotomizing each lifestyle factor . Incident self-reported , physician-diagnosed diabetes was identified with a follow-up survey in 2004 to 2006 . RESULTS 11,031 men ( 9.6 % ) and 6969 women ( 7.5 % ) developed new-onset diabetes . For each additional lifestyle factor in the low-risk group , the odds for diabetes were 31 % lower ( odds ratio [ OR ] , 0.69 [ 95 % CI , 0.68 to 0.71 ] ) among men and 39 % lower ( OR , 0.61 [ CI , 0.60 to 0.63 ] ) among women . Men and women whose diet score , physical activity level , smoking status , and alcohol use were all in the low-risk group had ORs for diabetes of 0.61 ( CI , 0.56 to 0.66 ) and 0.43 ( CI , 0.34 to 0.55 ) , respectively . When absence of overweight or obesity was added , the respective ORs were 0.28 ( CI , 0.23 to 0.34 ) and 0.16 ( CI , 0.10 to 0.24 ) for men and women . Results did not differ by family history of diabetes or level of adiposity . LIMITATION The study was observational , with potential for residual confounding . CONCLUSION Lifestyle factors , when considered in combination , are associated with a substantial reduction in risk for diabetes . PRIMARY FUNDING SOURCE The NIH-AARP Diet and Health Study was supported by the Intramural Research Program of the NIH
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 .