The higher adherence to a healthy lifestyle score is associated with a decreased risk of type 2 diabetes in Iranian adults

Association between lifestyle factors and liver function parameters in the middle-aged and older population

BACKGROUND

Increasing evidence supports a higher risk of abnormal liver function parameters due to unfavorable lifestyles. We therefore explored the synergistic effects of various lifestyle factors on liver function.

METHODS

8710 participants from Guangzhou Biobank Cohort Study were included. Five lifestyle factors including non-smoking, non-alcohol use, physically active, non-central and non-general obesity were assessed and a Healthy Lifestyle Index (HLI) (0-5, a higher score indicates healthier lifestyle) was generated. Multivariable linear regression was used to examine the association of HLI with liver function parameters, yielding regression coefficients (βs) and 95% confidence intervals (CIs).

RESULTS

A total of 8710 participants with an average age of 64.67 years (standard deviation = 6.07) were included. Of them, 71.65% were women. After adjusting for sex, age, education, family income, and comorbidities, compared with those with HLI of zero, those with HLI scores of 1, 2, 3, 4, and 5 showed a lower ALT level by -5.85 IU/L (95% CI: -10.73, -0.97), -9.97 IU/L (95% CI: -14.53, -5.42), -11.34 IU/L(95% CI: -15.86, -6.82), -12.81 IU/L (95% CI: -17.33, -8.30), and - 14.15 IU/L (95% CI: -18.68, -9.62), respectively (P for trend < 0.001), and a lower AST level by 1.82 IU/L (95% CI: -4.85,1.21), -3.74 IU/L (95% CI: -6.57, -0.91), -4.47 IU/L (95% CI: -7.28, -1.66), -4.69 IU/L (95% CI: -7.49, -1.88), and - 4.75 IU/L (95% CI: -7.57, -1.94), respectively (P for trend < 0.001). Similar trends were observed for a higher ALB level with higher healthy lifestyle scores (P for trend = 0.003).

CONCLUSIONS

A healthy lifestyle was associated with optimal liver function parameters, highlighting the importance of advocating for health-conscious behaviors to potentially mitigate the incidence of liver dysfunction.

Adherence to combined healthy lifestyle and odds of metabolic syndrome in Iranian adults: the PERSIAN Dena cohort study

The relationship between lifestyle choices and health outcomes has received significant scholarly attention. Research indicates that factors such as obesity, insufficient physical activity, tobacco use, and poor dietary habits may elevate the odds of developing metabolic disorders. This study aimed to investigate the association between the combined healthy lifestyle score (HLS) and the odds of metabolic syndrome (MetS) and its associated components in a population of apparently healthy adults. This cross-sectional study utilized data from the Dena PERSIAN cohort, which comprised 2,971 healthy adults. Participants' combined HLS were evaluated using validated questionnaires that assessed body mass index (BMI), physical activity level (PAL), smoking status, and dietary quality. The evaluation of dietary nutritional quality was conducted using the most recent version of the Healthy Eating Index (HEI), known as HEI-2020. The combined HLS was measured on a scale ranging from zero, indicating an unhealthy lifestyle, to four, representing the healthiest lifestyle. Individuals with the highest combined HLS score had 81% lower odds of having MetS compared to those with the lowest score (OR: 0.19; 95% CI: 0.11-0.33). Higher combined HLS scores were significantly associated with decreased odds of abdominal adiposity (OR: 0.11; 95% CI: 0.07-0.18), abnormal glucose homeostasis (OR: 0.55; 95% CI: 0.35-0.86), elevated serum triglycerides (OR: 0.41; 95% CI: 0.26-0.67), and low high-density lipoprotein cholesterol (HDL-C) levels (OR: 0.39; 95% CI: 0.24-0.65) after adjusting for sex, age, education level, and marital status (P < 0.05). The findings indicated a significant association between adherence to a combined HLS and a decreased odds of developing MetS and its associated components among Iranian adults.

Associations between spice or pepper (Capsicum annuum) consumption and diabetes or metabolic syndrome incidence

BACKGROUND

Spice and pepper are recognized as sources of antioxidants and anti-inflammatory compounds. This study investigated the association between spice or pepper intake and metabolic syndrome (MetS), related risk factors, or type 2 diabetes (T2D) incidences.

METHODS

The qualified Tehran Lipid and Glucose Study (TLGS) participants were included. In all examinations, dietary, anthropometrical, and biochemical variables were measured. Multivariable Cox proportional hazards regression models were exploited to determine the relationship between spice or pepper consumption and the hazard ratios for Type 2 Diabetes (T2D), Metabolic Syndrome (MetS), or its components.

RESULTS

The analysis was performed on 5340 individuals, with a mean age of 39.9±13.4 and 406 incident cases of T2D. Also, 4353 participants were included for MetS analysis with 1211 incident cases and a median follow-up of 5.8 years. After adjusting for confounding factors, spice and pepper intakes were not associated with T2D or MetS incidence. Further, in the upper quartile of spice intake, the HRs of high triglyceride (TG) [HR Q4: 1.19 (CI: 1.05-1.35)] and high blood pressure (BP) [HR Q4: 1.16 (CI: 1.04-1.30), P-trend = 0.007] increased. The risk of HDL-C appeared to decrease in the third quartile of pepper consumption (HR: 1, 0.97, 0.87, 1.03, P-trend = 0.008).

CONCLUSION

The findings showed that spice and pepper consumption had no association with the incidence of T2D and MetS. The risk of high TG and high BP incidence was elevated in the upper quartiles of spice intake. Also, greater consumption of pepper decreased the incidence of low HDL-C.

Associations between the Global Diet Quality Score and risk of type 2 diabetes: Tehran lipid and glucose study

BACKGROUND

Previous studies reported that focusing on healthy lifestyle, especially high diet quality is necessary for preventing type 2 diabetes (T2D). This study investigated the association between the innovative index, the Global Diet Quality Score (GDQS), and the risk of Type 2 Diabetes incidence.

METHODS

In this secondary analysis, we included elective adult participants (n = 5948) from the third and fourth survey of the Tehran Lipid and Glucose Study. Participants checked out until the sixth phase with an average follow-up of 6.65 years. Expert nutritionists collected dietary data using a valid and reliable semi-quantitative food frequency questionnaire. The GDQS were calculated, including healthy and unhealthy food group scores. Biochemical and anthropometric characteristics were assessed during the first and follow-up surveys. Multivariable Cox proportional hazards regression models were used to estimate the progression of T2D in association with the GDQS.

RESULTS

This study was implemented on 2,688 men and 3,260 women, respectively with the mean (SD) age of 41.5(14.1) and 39.3(13.02) years. A total of 524 subjects were found to have had T2D incidence. The healthy component of GDQS was conversely associated with T2D incidence [HR: 1, 0.91 (0.84-0.98), 0.91 (0.84-0.98), 0.84 (0.77-0.92) P trend = <0.001] in an adjusted model. The unhealthy component of GDQS was conversely associated with T2D incidence in an adjusted model [HR: 1, 0.86 (0.80-0.92), 0.93 (0.86-1.01), 0.89 (0.81-0.98) P trend = 0.009].

CONCLUSION

The results of this study suggested that higher adherence to the healthy component of GDQS and lower intake of the unhealthy component decreased the risk of T2D incidence.

Gender and Age Discrepancies of Lifestyle Indices Related to Metabolic Syndrome among Iranian Aging Population

Background

We aimed to investigate the relationship between lifestyle status and metabolic syndrome (MetS) components across gender and age groups of the older population, specifically focusing on identifying the association between MetS and lifestyle factors in classified age groups in older individuals.

Methods

Overall, 582 older people with MetS in Yazd (Iran) urban primary health care centers were randomly included from 10 health centers and invited to participate in the study in 2022. During the phone invitation, eligible interested people were asked to refer to health care centers for clinical assessments by trained health researchers. MetS components, dietary intakes using validated frequency food questionnaire, and physical activity by International physical activity questionnaire (IPAQ-short form) were measured.

Results

Women with Mets under 75 yr had significantly higher BMI, weight, and FBS than men and men had significantly higher WC than women. Among patients over 75 yr old, women had significantly higher weight than men had and lower WC and lower HDL_C than men. There were significant differences between gender groups of the aging patient under 75 yr old in terms of vigorous physical activity, total metabolic equivalent of activity, total fat intake, PUFA, and sodium intake, with men reporting level of mentioned lifestyle factors than women.

Conclusion

There were significant gender differences between two aged groups (>75 and <75 yr old) of patients for MetS components and lifestyle risk factors. Weight and WC showed noteworthy gender differences, with variations in both age groups.

The efficacy of theory driven treatment adherence promotion program among type 2 diabetic patients: application of intervention mapping and mHealth

Background

Mobile health interventions (mHealth) may improve health-related lifestyle behaviors and disease management. Successful management of diabetes is patient-centered responsibility. The aim of this research was to determine the efficacy of the theory driven program of promoting treatment adherence in type 2 diabetes (T2DM) patients based on mHealth.

Methods

This quasi-experimental research was conducted on 70 T2DM patients in Tehran, Iran. Participants were randomly divided into intervention (n = 35) or control (n = 35) groups. The data collection tool was a questionnaire based on some of constructs Social Cognitive Theory (SCT) which elicit from formative evaluation. The SCT theory-based intervention program was developed, implemented, and evaluated based on Intervention Mapping (IM) as a framework in 8 sessions using online WhatsApp application. The data was collected through by online interviews before and one month after the implementation of the program and analyzed in SPSS version 16.

Results

After the implementation of the program, a significant increase in self-efficacy (P = 0.009), outcome expectations (P < 0.001), and also diabetes treatment adherence behaviors (P = 0.024) were indicated in the intervention group. The estimated effect sizes for self-efficacy, outcome expectations, social support, and diabetes treatment adherence behaviors were 0.78, 0.06, 0.07, and 0.62, respectively.

Conclusion

Estimated effect size of the implemented intervention was evaluated as "large" effect for diabetes treatment adherence behaviors. Findings indicated the usefulness and efficacy of the mHealth educational program based on SCT constructs and the IM approach in treatment adherence behaviors promotion among T2DM patients in Iran.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01291-5.

The association of healthy lifestyle score and risk of non-alcoholic fatty liver disease

BACKGROUND

The combined role of important environmental factors as a single lifestyle index in predicting non-alcoholic fatty liver disease (NAFLD) risk is not fully assessed. Therefore, we aimed to investigate the association of healthy lifestyle factor score (HLS) with the odds of NAFLD in Iranian adults.

METHODS

This case-control study was conducted on 675 participants, aged ≥ 20-60 years, including 225 new NAFLD cases and 450 controls. We measured dietary intake information using a validated food frequency questionnaire and determined diet quality based on the alternate healthy eating index-2010(AHEI-2010). The score of HLS was calculated based on four lifestyle factors, including a healthy diet, normal body weight, non-smoking, and high physical activity. An ultrasound scan of the liver was used to detect NAFLD in participants of the case group. Logistic regression models were used to determine the odds ratios(ORs) and 95% confidence interval(CI) of NAFLD across tertiles of HLS and AHEI.

RESULTS

Mean ± SD age of the participants were 38.13 ± 8.85 years. The Mean ± SD HLS in the case and control groups was 1.55 ± 0.67 and 2.53 ± 0.87, respectively. Also, the Mean ± SD AHEI in the case and control groups was 48.8 ± 7.7 and 54.1 ± 8.1, respectively. Based on the age and sex-adjusted model, the odds of NAFLD were decreased across tertiles of AHEI (OR:0.18;95%CI:0.16-0.29,P_trend<0.001) and HLS(OR:0.03;95%CI:0.01-0.05,P_trend<0.001). Also, in the multivariable model, the odds of NAFLD were decreased across tertiles AHEI (OR:0.12;95%CI:0.06-0.24,P_trend<0.001) and HLS(OR:0.02;95%CI:0.01-0.04,P_trend<0.001).

CONCLUSIONS

Our findings reported that higher adherence to lifestyle with a higher score of HLS was associated with decreased odds of NAFLD. Also, a diet with a high AHEI score can reduce the risk of NAFLD in the adult population.

The association between healthy lifestyle score and risk of metabolic syndrome in Iranian adults: a cross-sectional study

BACKGROUND

Lifestyle risk factors, such as obesity, physical inactivity, smoking, and having an unhealthy diet are significantly associated to the risk of developing metabolic diseases such as type 2 diabetes, insulin resistance, and metabolic syndrome (MetS). Consequently, it is important to examine multiple lifestyle risk factors instead of single ones. Moreover, the combined effects of these factors on risk of MetS are not fully investigated. This study investigated the relationship between HLS and MetS and its components among apparently healthy adults living in Tabriz-Iran.

METHODS

This cross-sectional study includes 347 apparently healthy adults aged 20-50. To assess healthy lifestyle, four habits were used to examine HLS: physical activity (PA), smoking, healthy eating index-2015 (HEI-2015), and body mass index (BMI). Smoking status, PA, and dietary intakes (147-item) of study participants were evaluated using valid questionnaires. The lifestyle score ranged from zero (non-healthy) to four (most healthy) points. Binary logistic regression with adjusted models was used to examine the association of HLS and MetS, and its components. P < 0.05 was considered statistically significant.

RESULTS

In the current study, the average age and BMI of study participants were 40.78 ± 9.23 years old and 29.23 ± 5.97 kg/m², respectively. Participants in the highest quartile of HLS had significantly lower waist circumference (WC), BMI, weight, and had less fasting blood sugar (FBS), and triglyceride (TG) compared to the lowest quartile of HLS. Individuals in the second quartile of HLS had 24% greater odds for having MetS compared with those in the first quartile (adjusted OR: 1.24; 95% CI: 1.05-2.66). A significant reduction in hyperglycemia (adjusted OR: 0.85, 95% CI: 0.55-0.96) and high TG (adjusted OR: 0.83; 95% CI: 0.55-0.93) risk was also observed in the highest category of HLS compared to the lowest category. Moreover, after taking potential confounders into account, low score of HLS was associated with increased odds of MetS in women (adjusted OR: 1.32; 95% CI: 1.03-2.91).

CONCLUSION

The results showed that the lowest adherence to HLS was associated with higher odds MetS in women, after adjusting for all covariates. Moreover, adherence to a healthy lifestyle was related to lower odds of hyperglycemia and high TG in Iranian adults. To confirm these results, prospective studies are required.

Lifestyle patterns and incident type 2 diabetes in the Dutch lifelines cohort study

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Lifestyle factors clustered in behavioral patterns within the population.

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Different lifestyle patterns were differentially associated with risk of developing type 2 diabetes.

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A lifestyle pattern may be a proxy for an underlying variable that is relevant for the prevention of type 2 diabetes.

We aimed to identify the underlying subgroups of the population characterized by distinct lifestyle patterns, and to investigate the associations between lifestyle patterns and risk of incident type 2 diabetes. Using data from the Dutch Lifelines cohort study, latent class analysis was performed to derive lifestyle patterns on five lifestyle factors, i.e., smoking, diet quality, TV watching time, physical activity level, and risk drinking. Associations between lifestyle patterns and incident type 2 diabetes were estimated. Among 61,869 participants analyzed, we identified 900 cases of type 2 diabetes during follow-up (205,696 person-years; incidence rate 4.38 per 1000 person-years). Five lifestyle pattern groups were identified. Using the “healthy lifestyle group” as reference, the “unhealthy lifestyle group” had the highest risk for type 2 diabetes (HR 1.51 [95%CI 1.24, 1.85]), followed by the “poor diet and low physical activity group” (HR 1.26 [95%CI 1.03, 1.55]). The “risk drinker group” and the “couch potato group” (characterized by excessive TV watching) showed no significantly elevated risk. These models were adjusted for age, sex, total energy intake, education, BMI, family history of diabetes, and blood glucose level at baseline. Our study shows that lifestyle factors tended to cluster in unique behavioral patterns within the heterogeneous population. These lifestyle patterns were differentially associated with incident type 2 diabetes. Our findings support the relevance of considering lifestyle patterns in type 2 diabetes prevention. Tailored prevention strategies that target multiple lifestyle risk factors for different lifestyle pattern groups may optimize the effectiveness of diabetes prevention at the population level.

Dietary habits are associated with the prevalence of type 2 diabetes: a study among a middle eastern population

Worldwide type 2 diabetes (T2D) prevalence is increasing dramatically. The present study aimed to evaluate the association between dietary habits and T2D in an Iranian adult population using a cross-sectional analysis of the Shahedieh cohort study. Participants were adults aged 35-70 years (n 9261) from Zarch and Shahedieh, Yazd, Iran, who attended the baseline phase of the Shahedieh cohort study. Dietary habits including meal frequency, fried-food consumption, adding salt to prepared meals and grilled-food consumption were assessed by a standard questionnaire. T2D was defined as fasting plasma glucose (FPG) ≥126 mg/dl according to the American Diabetes Association. Multiple logistic regression assessed the association between dietary habits and T2D. Individuals who consumed a meal more than six times per day compared to three times per day had greater odds for T2D (OR 2⋅503, 95 % CI 1⋅651, 3⋅793). These associations remained significant in a fully adjusted model. There was a significant association between greater intakes of fried foods and prevalence of T2D (OR 1⋅294, 95 % CI 1⋅004, 1⋅668) in the adjusted model. No significant associations were observed between other dietary habits (adding salt to prepared meals and grilled-food consumption) and odds of T2D in all crude and adjusted models. In conclusion, we have highlighted the association between meal and fried-food consumption frequencies with risk of T2D. Large longitudinal studies in different ethnicities are needed to confirm these associations.