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The association of a healthy lifestyle index and imaging-based body fat distribution with glycemic status and Type 2 diabetes in the Multi Ethnic Cohort: a cross-sectional analysis

European Journal of Clinical Nutrition volume 78, pages 236–242 (2024)Cite this article

Subjects

Abstract

Introduction

As several behaviors captured by the Lifestyle Risk Factor Index (LSRI) are protective against Type 2 diabetes (T2D) and may affect body fat distribution, we examined its relation with both outcomes.

Methods

In a subset of the Multiethnic Cohort, participants from five ethnic groups (60–77 years) were assigned LSRI scores (one point each for consuming <1 (women)/<2 (men) alcoholic drinks/day, ≥1.5 physical activity hours/week, not smoking, and adhering to ≥3/7 dietary recommendations). All participants completed an extensive Quantitative Food Frequency Questionnaire to allow estimation of adherence to intake recommendations for fruits, vegetables, refined and whole grains, fish, processed and non-processed meat. Glycemic/T2D status was classified according to self-reports and fasting glucose. We estimated prevalence odds ratios (POR) of LSRI with glycemic/T2D status and DXA- and MRI-based body fat distribution using logistic regression.

Results

Of 1713 participants, 43% had normoglycemia, 30% Pre-T2D, 9% Undiagnosed T2D, and 18% T2D. Overall, 39% scored 0–2, 49% 3, and 12% 4 LSRI points. T2D prevalence was 55% (POR 0.45; 95% confidence intervals 0.27, 0.76) lower for 4 vs. 0–2 LSRI points with weaker associations for abnormal glycemic status. Despite the low adherence to dietary recommendations (22%), this was the only component related to lower T2D prevalence. The inverse LSRI-T2D association was only observed among Latinos and Japanese Americans in ethnic-specific models. Visceral fat measures were higher in T2D patients and attenuated the LSRI-T2D association.

Conclusion

These findings support the role of a healthy lifestyle, especially diet, in T2D prevention with differences across ethnicity.

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Fig. 1: Association of the Lifestyle Risk Factor Index (LSRI) with Prevalence of Type 2 Diabetes (T2D) for the five ethnic groups, when adjusted for basic covariates or additionally adjusted for abdominal MRI- and DXA-based Body Fat Distribution, Adiposity Phenotype Study in Hawai’i and Los Angeles, 2013-2016.

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Data availability

The data underlying this study cannot be made publicly available because they contain patient identifying information. Data are available from the Multiethnic Cohort study (http://www.uhcancercenter.org/research/the-multiethnic-cohort-study-mec/data-sharing-mec) for researchers who meet the criteria for access to data.

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Funding

Funding

This research was funded by grants from the US National Institutes of Health (P01 CA168530, U01CA164973, P30CA071789). GM was supported by Berlin Institute of Health Visiting Professorship, funded by Stiftung Charité. CG was supported by a postdoctoral fellowship, funded by the University of Hawai’i Cancer Center (T32CA229110).

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Authors and Affiliations

  1. University of Hawai’i Cancer Center, Honolulu, HI, USA

    Rebecca Klapp, Lynne R. Wilkens, Unhee Lim, Cherie Guillermo, John A. Shepherd, Loïc Le Marchand & Gertraud Maskarinec

  2. Max Delbrück Centrum für Molekulare Medizin, Berlin, Germany

    Katharina Nimptsch, Tobias Pischon & Gertraud Maskarinec

  3. University of Southern California, Los Angeles, CA, USA

    V. Wendy Setiawan

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Contributions

LLM, LRW, UL, and JS led the design and implementation of the APS study; RK, and GM analyzed the data and wrote the first draft of the paper; RK, KN, TP, LRW, UL, CG, VWS, JS, LLM, GM contributed to the interpretation of data and the critical revision of the article for important intellectual content. All authors provided final approval of the version to be published. RK and GM have overall responsibility for the final content.

Corresponding author

Correspondence to Gertraud Maskarinec.

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The authors declare no competing interests.

Ethical approval

The study protocol was approved by the Institutional Review Boards at the University of Hawai’i (CHS# 17200) and the University of Southern California (#HS-12-00623). Informed consent forms were signed by all participants.

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Klapp, R., Nimptsch, K., Pischon, T. et al. The association of a healthy lifestyle index and imaging-based body fat distribution with glycemic status and Type 2 diabetes in the Multi Ethnic Cohort: a cross-sectional analysis. Eur J Clin Nutr 78, 236–242 (2024). https://doi.org/10.1038/s41430-023-01381-w

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