Association of a lifestyle score with cardiometabolic markers among individuals with diabetes: a cross-sectional study

Abstract

Introduction: To investigate the associations of a lifestyle score with various cardiovascular risk markers, indicators for fatty liver disease as well as MRI-determined total, subcutaneous and visceral adipose tissue mass in adults with new-onset diabetes.

Research design and methods: This cross-sectional analysis included 196 individuals with type 1 (median age: 35 years; median body mass index (BMI): 24 kg/m²) and 272 with type 2 diabetes (median age: 53 years; median BMI: 31 kg/m²) from the German Diabetes Study. A healthy lifestyle score was generated based on healthy diet, moderate alcohol consumption, recreational activity, non-smoking and non-obese BMI. These factors were summed to form a score ranging from 0 to 5. Multivariable linear and non-linear regression models were used.

Results: In total, 8.1% of the individuals adhered to none or one, 17.7% to two, 29.7% to three, 26.7% to four, and 17.7% to all five favorable lifestyle factors. High compared with low adherence to the lifestyle score was associated with more favorable outcome measures, including triglycerides (β (95% CI) -49.1 mg/dL (-76.7; -21.4)), low-density lipoprotein (-16.7 mg/dL (-31.3; -2.0)), and high-density lipoprotein cholesterol (13.5 mg/dL (7.6; 19.4)), glycated hemoglobin (-0.5% (-0.8%; -0.1%)), high-sensitivity C reactive protein (-0.4 mg/dL (-0.6; -0.2)), as well as lower hepatic fat content (-8.3% (-11.9%; -4.7%)), and visceral adipose tissue mass (-1.8 dm³ (-2.9; -0.7)). The dose-response analyses showed that adherence to every additional healthy lifestyle factor was associated with more beneficial risk profiles.

Conclusions: Adherence to each additional healthy lifestyle factor was beneficially associated with cardiovascular risk markers, indicators of fatty liver disease and adipose tissue mass. Strongest associations were observed for adherence to all healthy lifestyle factors in combination.

Trial registration number: NCT01055093.

Keywords: cardiovascular; diabetes complications; diet; lifestyle.

Figure 1

Dose–response associations of the lifestyle score with cardiovascular markers. The figures show the best possible cubic spline (red solid line) with 95% CI (black dashed line). The reference is the value for a lifestyle score ≤1 (green dashed line). All analyses were adjusted for age (years), sex, socioeconomic status score (continuous), diabetes type (type 1 diabetes/type 2 diabetes), diabetes treatment (untreated/dietary/pharmacological), family history of diabetes (yes/no), and energy intake (kcal/day). Numbers of observations used: systolic and diastolic blood pressure: 289; triglycerides, LDL cholesterol, HDL cholesterol: 363; HbA1c: 405; hsCRP: 355. ^aReported only for people who were not taking antihypertensive medication. ^bReported only for people who were not taking lipid-lowering medication. ^cReported only for people who were not taking non-steroidal anti-inflammatory drugs. HbA1c, glycated hemoglobin; HDL, high-density lipoprotein; hsCRP, high-sensitivity C reactive protein; LDL, low-density lipoprotein.

Figure 2

Dose–response associations of the lifestyle score with indicators for fatty liver disease. The figures show the best possible cubic spline (red solid line) with 95% CI (black dashed line). The reference is the value for a lifestyle score ≤1 (green dashed line). All analyses were adjusted for age (years), sex, socioeconomic status score (continuous), diabetes type (type 1 diabetes/type 2 diabetes), diabetes treatment (untreated/dietary/pharmacological), family history of diabetes (yes/no), and energy intake (kcal/day). Numbers of observations used: AST, ALT, GGT: 405; hepatic fat content: 228; FIB-4: 404. ALT, alanine transaminase; AST, aspartate transaminase; GGT, gamma-glutamyltransferase.

Figure 3

Dose–response associations of the lifestyle score with adipose tissue mass. The figures show the best possible cubic spline (red solid line) with 95% CI (black dashed line). The reference is the value for a lifestyle score ≤1 (green dashed line). All analyses were adjusted for age (years), sex, socioeconomic status score (continuous), diabetes type (type 1 diabetes/type 2 diabetes), diabetes treatment (untreated/dietary/pharmacological), family history of diabetes (yes/no), and energy intake (kcal/day). Numbers of observations used: 146.