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. 2025 Jun 20;5(1):240.
doi: 10.1038/s43856-025-00971-y.

Trajectories of healthy lifestyle index and prediabetes risk of adult workers in Japan

Keisuke Kuwahara  1   2   3 , Shuichiro Yamamoto  4 , Toru Honda  4 , Tohru Nakagawa  4 , Maki Konishi  5 , Tetsuya Mizoue  5
Affiliations

Trajectories of healthy lifestyle index and prediabetes risk of adult workers in Japan

Keisuke Kuwahara et al. Commun Med (Lond). .

Abstract

Background: The relationship between health-related lifestyle trajectories and prediabetes risk among adults with normoglycemia remains unclear. We investigated this issue using data from a cohort of working individuals.

Methods: This cohort study included 10,773 workers (8986 men) aged 30-64 years in Japan, with normoglycemia in 2009, followed until 2017 using annual health checkup data. The trajectories of health-related lifestyles were identified during 2006-2009 using group-based trajectory modeling; we calculated the health-related lifestyle index in each year using five lifestyle factors: smoking, alcohol use, exercise, sleep duration, and body weight control (0-5 points; higher score indicated healthier lifestyles). Prediabetes was defined by fasting plasma glucose and hemoglobin A1c based on the American Diabetes Association criteria; the onset was assessed from 2009 to 2017. Cox regression with adjustment for demographic, health-related, and work-related factors was used to evaluate the association of lifestyle trajectories and prediabetes risk.

Results: Five trajectories of health-related lifestyles are identified. Maintaining or improving health-related lifestyles are linked to lower prediabetes risks. Compared with a persistently very unhealthy pattern, the adjusted hazard ratios (95% confidence intervals) are 0.92 (0.84, 0.99), 0.82 (0.71, 0.95), 0.83 (0.76, 0.90), and 0.74 (0.67, 0.83) for "persistently very unhealthy", "persistently unhealthy", "improved from unhealthy to moderately healthy", "persistently moderately healthy", and "persistently mostly healthy" trajectories, respectively.

Conclusions: Participants with healthier lifestyle trajectories tend to have a lower risk of developing prediabetes. The prediabetes risk at the trajectory of improved from unhealthy lifestyles is lower than that of persistently unhealthy lifestyles.

Plain language summary

Prediabetes can elevate the risk of developing diabetes and cardiovascular diseases. This study looked at how different lifestyle habits affect the risk of developing prediabetes in people who have normal blood sugar levels. The researchers followed 10,773 workers in Japan from 2009 to 2017, tracking their health habits, such as smoking, drinking, exercise, sleep, and weight control. They found that people who maintained or improved their healthy habits had a lower chance of developing prediabetes compared to those with unhealthy habits. For example, people who improved their lifestyle from unhealthy to moderately healthy had a lower risk than those who kept unhealthy habits. This study shows that making healthy changes to your lifestyle can help prevent prediabetes.

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Conflict of interest statement

Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Study design.
Health-related lifestyles were assessed from 2006 to 2009 to determine the trajectories of health-related lifestyles over 3 years among participants without prediabetes and diabetes in 2009. Occurrence of prediabetes was assessed from 2010 to 2017 using annual health checkup data.
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