A recent study published in the European Journal of Nutrition examined how a combined lifestyle score relates to the risk of developing type 2 diabetes mellitus (T2DM) among different ethnic groups. The research focused on a Lifestyle Risk Factor Index (LSRI), which combines smoking, physical activity, alcohol use, and diet into one score.
Type 2 diabetes affects 1 in 10 adults worldwide, and this number is expected to rise to over 780 million by 2045. Most people with diabetes have T2DM, which can cause serious health problems like kidney disease, eye damage, nerve damage leading to amputations, and increased risk of heart disease and death. Both genetics and lifestyle choices, such as smoking, exercise, diet, and drinking habits, play a role in T2DM risk.
The study analyzed data from the Multiethnic Cohort, which included over 165,000 adults aged 45 to 75 from Hawaii and California. Participants belonged to five ethnic groups: African American, Native Hawaiian, Latino, Japanese American, and European American. Researchers collected information on lifestyle behaviors at the start of the study but did not track changes over time. Diabetes cases were identified through self-reports, medication records, and Medicare data.
The LSRI gave one point for each of these factors: not smoking, doing at least 150 minutes of moderate to vigorous exercise per week, drinking less than two (men) or one (women) alcoholic drinks per day, and meeting at least three of seven diet recommendations. These diet guidelines included eating enough fruits, vegetables, whole grains, and fish, while limiting refined grains, processed meat, and red meat.
Over an average follow-up of 17 years, about 27% of participants developed T2DM. The average LSRI score was 2.73 out of 4. Only 22% met the dietary guidelines, but most followed the alcohol, smoking, and exercise recommendations. Fish consumption was the only diet component with high adherence (73%), while few met the limits for refined grains (3%) or red meat (6%).
The study found that higher LSRI scores were linked to a lower risk of developing T2DM. People scoring 4 points had a 16% lower risk compared to those scoring 0 or 1 point. Each additional point on the LSRI reduced risk by 6%. Not smoking and getting enough exercise were the strongest protective factors. Surprisingly, moderate alcohol consumption was linked to a 19% increased risk, though this group also included non-drinkers. Diet quality showed only a weak link to diabetes risk after adjusting for body weight.
When looking at ethnic groups, higher LSRI scores were strongly connected to lower diabetes risk among African Americans, Latinos, and European Americans. However, this link was not significant for Japanese Americans or Native Hawaiians after accounting for body mass index (BMI). BMI was a stronger predictor overall; obese participants were over three times more likely to develop diabetes. The impact of BMI varied among ethnic groups, likely due to differences in fat distribution.
The researchers noted that the LSRI treats all lifestyle factors as equally important, which might not be accurate. Also, since lifestyle habits were only measured once at the start, changes over time were not captured. These results highlight the need for public health programs that encourage healthy lifestyle habits tailored to cultural and ethnic differences, alongside efforts to reduce obesity. Such strategies could better prevent type 2 diabetes across diverse populations.
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