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

Christina Baechle; Alexander Lang; Klaus Strassburger; Oliver Kuss; Volker Burkart; Julia Szendroedi; Karsten Müssig; Katharina Susanne Weber; Vera Schrauwen-Hinderling; Christian Herder; Michael Roden; Sabrina Schlesinger; GDS group

doi:10.1136/bmjdrc-2023-003469

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

BMJ Open Diabetes Res Care. 2023 Jul;11(4):e003469. doi: 10.1136/bmjdrc-2023-003469.

Authors

Christina Baechle^{1

2}, Alexander Lang^{1

2}, Klaus Strassburger^{1

2}, Oliver Kuss^{1

2

3}, Volker Burkart^{2

4}, Julia Szendroedi^{2

4

5

6}, Karsten Müssig^{2

4

6

7}, Katharina Susanne Weber^{2

4

8}, Vera Schrauwen-Hinderling^{2

4}, Christian Herder^{2

4

6}, Michael Roden^{2

4

6}, Sabrina Schlesinger^{9

2}; GDS group

Collaborators

GDS group:
H Al-Hasani, A E Buyken, G Geerling, A Icks, K Jandeleit-Dahm, J Kotzka, E Lammert, W Rathmann, S Trenkamp, D Ziegler, V Burkart, A Herder, O Kuss, V Schrauwen-Hinderling, J Szendroedi, M Roden

Affiliations

¹ Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Duesseldorf, Germany.
² German Center for Diabetes Research (DZD), Partner Duesseldorf, Muenchen-Neuherberg, Germany.
³ Center for Health and Society, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany.
⁴ Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Duesseldorf, Germany.
⁵ Internal Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany.
⁶ Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine Uinversity, Duesseldorf, Germany.
⁷ Department of Internal Medicine and Gastroenterology, Niels Stensen Hospitals, Franziskus Hospital Harderberg, Georgsmarienhutte, Germany.
⁸ Institute for Epidemiology, Kiel University, Kiel, Germany.
⁹ Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Duesseldorf, Germany [email protected].

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cardiovascular Diseases* / epidemiology
Cardiovascular Diseases* / etiology
Cross-Sectional Studies
Diabetes Mellitus, Type 2*
Humans
Life Style
Middle Aged
Non-alcoholic Fatty Liver Disease*

Associated data

ClinicalTrials.gov/NCT01055093