Adherence to healthy lifestyle factors and risk of death in men with diabetes mellitus: The Physicians' Health Study

Background & aims: The relationship between healthy lifestyle factors and mortality in people with type 2 diabetes is unclear. The purpose of this study was to examine whether healthy lifestyle factors are associated with mortality in people with type 2 diabetes. Methods: We prospectively studied 1163 men with type 2 diabetes from the Physicians' Health Study. Lifestyle factors consisted of currently not smoking, moderate drinking (1-2 drinks/day), vigorous exercise (1+/week), BMI < 25 kg/m(2), and being in the top 2 quintiles of the alternate healthy eating index-2010 (AHEI-2010). Multivariate Cox regression models were used to estimate hazard ratios (95% confidence intervals) of mortality. Results: At baseline, average age was 69 years and mean follow up was 9 years. About 22% of study participants had <= 1 healthy lifestyle factor, 37% had two, 29% had three, and 12% had four or more healthy lifestyle factors. An inverse relationship was found between the number of lifestyle factors and total mortality. Compared with participants who had <= 1 healthy lifestyle factor, the risk of death was 42% (95% CI; 19%-58%) lower for those with two healthy lifestyle factors, 41% (95% CI; 18%-58%) lower for those with three, and 44% (95% CI; 12%-64%) lower for those with 4 or more healthy lifestyle factors. Conclusion: Adherence to modifiable healthy lifestyle factors is associated with a lower risk of death among adult men with type 2 diabetes. Our study emphasizes the importance of educating individuals with diabetes to adhere to healthy lifestyle factors. (C) 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.