Lifestyle factors and mortality risk in individuals with diabetes mellitus: Are the associations different from those in individuals without diabetes?

Diewertje Sluik, Heiner Boeing, Kuanrong Li, Rudolf Kaaks, Nina Føns Johnsen, Anne Tjønneland, Larraitz Arriola, Aurelio Barricarte, Giovanna Masala, Sara Grioni, Rosario Tumino, Fulvio Ricceri, Amalia Mattiello, Annemieke M W Spijkerman, Daphne L. Van Der A, Ivonne Sluijs, Paul W. Franks, Peter M. Nilsson, Marju Orho-Melander, Eva FhärmOlov Rolandsson, Elio Riboli, Dora Romaguera, Elisabete Weiderpass, Emilio Sánchez-Cantalejo, Ute Nöthlings

Research output: Contribution to journalArticlepeer-review


Aims/hypothesis: Thus far, it is unclear whether lifestyle recommendations for people with diabetes should be different from those for the general public. We investigated whether the associations between lifestyle factors and mortality risk differ between individuals with and without diabetes. Methods: Within the European Prospective Investigation into Cancer and Nutrition (EPIC), a cohort was formed of 6,384 persons with diabetes and 258,911 EPIC participants without known diabetes. Joint Cox proportional hazard regression models of people with and without diabetes were built for the following lifestyle factors in relation to overall mortality risk: BMI, waist/height ratio, 26 food groups, alcohol consumption, leisure-time physical activity, smoking. Likelihood ratio tests for heterogeneity assessed statistical differences in regression coefficients. Results: Multivariable adjusted mortality risk among individuals with diabetes compared with those without was increased, with an HR of 1.62 (95% CI 1.51, 1.75). Intake of fruit, legumes, nuts, seeds, pasta, poultry and vegetable oil was related to a lower mortality risk, and intake of butter and margarine was related to an increased mortality risk. These associations were significantly different in magnitude from those in diabetes-free individuals, but directions were similar. No differences between people with and without diabetes were detected for the other lifestyle factors. Conclusions/interpretation: Diabetes status did not substantially influence the associations between lifestyle and mortality risk. People with diabetes may benefit more from a healthy diet, but the directions of association were similar. Thus, our study suggests that lifestyle advice with respect to mortality for patients with diabetes should not differ from recommendations for the general population.

Original languageEnglish
Pages (from-to)63-72
Number of pages10
Issue number1
Publication statusPublished - Jan 2014


  • Adiposity
  • Alcohol
  • Diabetes
  • Lifestyle
  • Mortality
  • Nutrition
  • Physical activity
  • Smoking

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism


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