Mian Li1, Yu Xu1, Qin Wan2, Feixia Shen3, Min Xu1, Zhiyun Zhao1, Jieli Lu1, Zhengnan Gao4, Gang Chen5, Tiange Wang1, Yiping Xu1, Jiajun Zhao6, Lulu Chen7, Lixin Shi8, Ruying Hu9, Zhen Ye9, Xulei Tang10, Qing Su11, Guijun Qin12, Guixia Wang13, Zuojie Luo14, Yingfen Qin14, Yanan Huo15, Qiang Li16, Yinfei Zhang17, Yuhong Chen1, Chao Liu18, Yiming Mu19, Youmin Wang20, Shengli Wu21, Tao Yang22, Li Chen23, Xuefeng Yu24, Li Yan25, Huacong Deng26, Guang Ning1, Yufang Bi27, Weiqing Wang27. 1. Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 2. The Affiliated Hospital of Southwest Medical University, Luzhou, China. 3. The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. 4. Dalian Municipal Central Hospital Affiliated to Dalian Medical University, Dalian, China. 5. Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China. 6. Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China. 7. Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 8. Affiliated Hospital of Guiyang Medical College, Guiyang, China. 9. Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China. 10. The First Hospital of Lanzhou University, Lanzhou, China. 11. Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. 12. The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China. 13. The First Hospital of Jilin University, Changchun, China. 14. The First Affiliated Hospital of Guangxi Medical University, Nanning, China. 15. Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China. 16. The Second Affiliated Hospital of Harbin Medical University, Harbin, China. 17. Central Hospital of Shanghai Jiading District, Shanghai, China. 18. Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China. 19. Chinese People's Liberation Army General Hospital, Beijing, China. 20. The First Affiliated Hospital of Anhui Medical University, Hefei, China. 21. Karamay Municipal People's Hospital, Xinjiang, China. 22. The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. 23. Qilu Hospital of Shandong University, Jinan, China. 24. Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 25. Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. 26. The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. 27. Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China wqingw61@163.com byf10784@rjh.com.cn.
Abstract
OBJECTIVE: We aimed to determine the individual and combined associations of lifestyle and metabolic factors with new-onset diabetes and major cardiovascular events among a Chinese population aged ≥40 years. RESEARCH DESIGN AND METHODS: Baseline lifestyle information, waist circumference, blood pressure, lipid profiles, and glycemic status were obtained in a nationwide, multicenter, prospective study of 170,240 participants. During the up to 5 years of follow-up, we detected 7,847 individuals with new-onset diabetes according to the American Diabetes Association 2010 criteria and 3,520 cardiovascular events, including cardiovascular death, myocardial infarction, stroke, and hospitalized or treated heart failure. RESULTS: On the basis of 36.13% (population-attributable fraction [PAF]) risk attributed to metabolic risk components collectively, physical inactivity (8.59%), sedentary behavior (6.35%), and unhealthy diet (4.47%) moderately contributed to incident diabetes. Physical inactivity (13.34%), unhealthy diet (8.70%), and current smoking (3.38%) significantly contributed to the risk of major cardiovascular events, on the basis of 37.42% PAF attributed to a cluster of metabolic risk factors. Significant associations of lifestyle health status with diabetes and cardiovascular events were found across all metabolic health categories. Risks of new-onset diabetes and major cardiovascular events increased simultaneously according to the worsening of lifestyle and metabolic health status. CONCLUSIONS: We showed robust effects of lifestyle status on new-onset diabetes and major cardiovascular events regardless of metabolic status and a graded increment of risk according to the combination of lifestyle and metabolic health, highlighting the importance of lifestyle modification regardless of the present metabolic status.
OBJECTIVE: We aimed to determine the individual and combined associations of lifestyle and metabolic factors with new-onset diabetes and major cardiovascular events among a Chinese population aged ≥40 years. RESEARCH DESIGN AND METHODS: Baseline lifestyle information, waist circumference, blood pressure, lipid profiles, and glycemic status were obtained in a nationwide, multicenter, prospective study of 170,240 participants. During the up to 5 years of follow-up, we detected 7,847 individuals with new-onset diabetes according to the American Diabetes Association 2010 criteria and 3,520 cardiovascular events, including cardiovascular death, myocardial infarction, stroke, and hospitalized or treated heart failure. RESULTS: On the basis of 36.13% (population-attributable fraction [PAF]) risk attributed to metabolic risk components collectively, physical inactivity (8.59%), sedentary behavior (6.35%), and unhealthy diet (4.47%) moderately contributed to incident diabetes. Physical inactivity (13.34%), unhealthy diet (8.70%), and current smoking (3.38%) significantly contributed to the risk of major cardiovascular events, on the basis of 37.42% PAF attributed to a cluster of metabolic risk factors. Significant associations of lifestyle health status with diabetes and cardiovascular events were found across all metabolic health categories. Risks of new-onset diabetes and major cardiovascular events increased simultaneously according to the worsening of lifestyle and metabolic health status. CONCLUSIONS: We showed robust effects of lifestyle status on new-onset diabetes and major cardiovascular events regardless of metabolic status and a graded increment of risk according to the combination of lifestyle and metabolic health, highlighting the importance of lifestyle modification regardless of the present metabolic status.