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 .
Birth weight and later life adherence to unhealthy lifestyles in predicting type 2 diabetes: prospective cohort study
Objectives To prospect ively assess the joint association of birth weight and established lifestyle risk factors in adulthood with incident type 2 diabetes and to quantitatively decompose the attributing effects to birth weight only , to adulthood lifestyle only , and to their interaction . Design Prospect i ve cohort study . Setting Health Professionals Follow-up Study ( 1986 - 2010 ) , Nurses ’ Health Study ( 1980 - 2010 ) , and Nurses ’ Health Study II ( 1991 - 2011 ) . Participants 149 794 men and women without diabetes , cardiovascular disease , or cancer at baseline . Main outcome measure Incident cases of type 2 diabetes , identified through self report and vali date d by a supplementary question naire . Unhealthy lifestyle was defined on the basis of body mass index , smoking , physical activity , alcohol consumption , and the alternate healthy eating index . Results During 20 - 30 years of follow-up , 11 709 new cases of type 2 diabetes were documented . The multivariate adjusted relative risk of type 2 diabetes was 1.45 ( 95 % confidence interval 1.32 to 1.59 ) per kg lower birth weight and 2.10 ( 1.71 to 2.58 ) per unhealthy lifestyle factor . The relative risk of type 2 diabetes associated with a combination of per kg lower birth weight and per unhealthy lifestyle factor was 2.86 ( 2.26 to 3.63 ) , which was more than the addition of the risk associated with each individual factor , indicating a significant interaction on an additive scale ( P for interaction<0.001 ) . The attributable proportions of joint effect were 22 % ( 95 % confidence interval 18.3 % to 26.4 % ) to lower birth weight alone , 59 % ( 57.1 % to 61.5 % ) to unhealthy lifestyle alone , and 18 % ( 13.9 % to 21.3 % ) to their interaction . Conclusion Most cases of type 2 diabetes could be prevented by the adoption of a healthier lifestyle , but simultaneous improvement of both prenatal and postnatal factors could further prevent additional cases
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 .