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Medicine (Baltimore). 2017 Feb;96(6):e6025. doi: 10.1097/MD.0000000000006025.

Healthy lifestyle and normal waist circumference are associated with a lower 5-year risk of type 2 diabetes in middle-aged and elderly individuals: Results from the healthy aging longitudinal study in Taiwan (HALST).

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aInstitute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan bDepartment of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA cHope Doctors Hospital, Miaoli dPuzi Hospital, Ministry of Health and Welfare, Chiayi eYee Zen General Hospital, Taoyuan fDepartment of Family Medicine, Changhua Christian Hospital, Changhua gFamily Medicine, Community Health Department, Mennonite Christian Hospital, Hualien hDepartment of Surgery, Yuan's General Hospital, Kaohsiung iDepartment of Neurology, Shin Kong Wu Ho Su Memorial Hospital, Taipei jCollege of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan kDivision of Cancer Epidemiology, Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.


Type 2 diabetes mellitus (DM) is known to be closely associated with lifestyle and obesity and has a prevalence that increases with age. This study aimed to assess the short-term composite effect of diet, physical activity, psychosocial health, and waist circumference (WC) on the incidence of DM in the elderly and to provide a lifestyle-based predictive index.We used baseline measurements (2009-2013) of 5349 community-dwelling participants (aged 55 years and older, 52% female) of the Healthy Aging Longitudinal Study in Taiwan (HALST) for fasting plasma glucose, HbA1C, serum cholesterol, triglycerides, blood pressures, WC, and outcomes of home-visit questionnaire. Principal component analysis (PCA) was used to identify participants with a healthy lifestyle (HLF: higher diet, physical activity, and psychosocial scores) and a lower WC, with cutoffs determined by the receiver-operating characteristics. A Cox regression model was applied to 3424 participants without DM at baseline by linking to their National Health Insurance records (median follow-up of 3.1 years).In total, 247 new DM cases (7.2%) were identified. The HLF and lower WC group had a relative risk (RR) of DM of 0.54 (95% CI 0.35-0.82) compared to the non-HLF and higher WC group. When stratified by the presence of impaired glucose tolerance (IGT) or metabolic syndrome (MS), only participants with IGT/MS showed significant risks (RR 0.55; 95% CI 0.33-0.92). However, except for WC, the individual lifestyle factors were nonsignificant in the overall model without PCA.A composite protective effect of HLF and normal WC on DM within 5 years was observed, especially in those with IGT or MS. Psychosocial health constituted an important lifestyle factor in the elderly. The cutoffs identified could be used as a lifestyle-based risk index for DM. Maintaining an HLF to prevent DM is especially important for the elderly.

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