Combination of Multiple Low-Risk Lifestyle Behaviors and Incident Type 2 Diabetes: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies
Objective: Combined low-risk lifestyle behaviors (LRLBs) have been associated with reduction in type 2 diabetes risk. This relationship has not been systematically quantified.
Research design and methods: A systematic review and meta-analysis was conducted to assess the association of combined low-risk lifestyle behaviors with type 2 diabetes. Databases was searched up to September 2022. Prospective cohort studies reporting the association between a minimum of 3 combined LRLBs (including healthy diet) with incident type 2 diabetes were included. Independent reviewers extracted data and assessed study quality. Risk estimates of extreme comparisons were pooled using random-effects model. Global dose-response meta-analysis (DRM) for maximum adherence was estimated using one-stage linear mixed model. The certainty of the evidence was assessed using GRADE.
Results: 30 cohort comparisons (n=1,693,753) involving 75,669 incident type 2 diabetes cases were eligible. LRLBs, with author defined ranges, were healthy body weight, healthy diet, regular exercise, smoking abstinence or cessation, and light alcohol consumption. LRLBs were associated with 80% lower risk of type 2 diabetes (relative risk (RR), 0.20 [95% confidence interval, 0.17 to 0.23]), comparing the highest with lowest adherence. Global DRM for maximum adherence to all 5 LRLBs reached 85% protection (RR, 0.15 [95% CI, 0.12 to 0.18]. The overall certainty of the evidence was graded as high.
Conclusions: There was a very good indication that combination of LRLBs that include maintaining a healthy bodyweight, healthy diet, regular exercise, smoking abstinence or cessation and light alcohol consumption was associated with a lower risk of incident type 2 diabetes.
Study registration: ClinicalTrials.gov (NCT03234101)