Combined lifestyle factors and the risk of LADA and type 2 diabetes – Results from a Swedish population-based case-control study

Abstract

We investigated the risk of latent autoimmune diabetes in adults (LADA) and type 2 diabetes in relation to a healthy lifestyle, the proportion of patients attributable to an unhealthy lifestyle, and the influence of family history of diabetes (FHD) and genetic susceptibility. Methods:The population-based study included incident LADA (n = 571), type 2 diabetes (n = 1962), and matched controls (n = 2217). A healthy lifestyle was defined by BMI < 25 kg/m 2 , moderate-to-high physical activity, a healthy diet, no smoking, and moderate alcohol consumption. We estimated odds ratios (OR) with 95% confidence intervals (CIs) adjusted for age, sex, education, and FHD.Results: Compared to a poor/moderate lifestyle, a healthy lifestyle was associated with a reduced risk of LADA (OR 0.51, CI 0.34-0.77) and type 2 diabetes (OR 0.09, CI 0.05-0.15). A healthy lifestyle conferred a reduced risk irrespective of FHD and high-risk HLA genotypes.Having a BMI < 25 kg/m 2 conferred the largest risk reduction for both LADA (OR 0.54, CI 0.43-0.66) and type 2 diabetes (OR 0.12, CI 0.10-0.15) out of the individual items. Conclusion:People with a healthy lifestyle, especially a healthy body weight, have a reduced risk of LADA including those with genetic susceptibility to diabetes.

Lifestyle or Environmental Influences and Their Interaction With Genetic Susceptibility on the Risk of LADA

“…In such instances, results from the most recent publication are presented, and if there were separate effect estimates for the same exposure in different publications, those were pooled to get an overall estimate of the associations. To address the heterogeneity of LADA, some studies reported results separately for LADA with high vs. low GADA levels, divided by the median ( 36 , 39 – 42 , 49 ). These subgroups will be referred to as LADA high and LADA low .…”

“… Lifestyle factors and LADA-findings from observational studies. Relative risk estimates extracted from references ( 28 , 36 , 39 – 47 ). …”

“…Randomized controlled trials confirm the beneficial effect of lifestyle modification on type 2 diabetes risk ( 52 ) while it is unknown how to prevent type 1 diabetes ( 11 ). Regarding LADA, Swedish data indicate that the risk can be reduced by 60% through an overall healthy lifestyle including normal weight, non-smoking, physical activity, moderate alcohol consumption, and a healthy diet ( 39 ). Among the individual items, the largest risk reduction comes from maintaining a healthy weight.…”

“…Importantly, a healthy lifestyle was also associated with a reduced risk of LADA in individuals with high-risk HLA genotypes or family history of diabetes. In addition, the risk reduction applied to more autoimmune LADA; a 50% reduced risk of LADA high was observed in individuals with a healthy compared to unhealthy lifestyle ( 39 ).…”

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“…In such instances, results from the most recent publication are presented, and if there were separate effect estimates for the same exposure in different publications, those were pooled to get an overall estimate of the associations. To address the heterogeneity of LADA, some studies reported results separately for LADA with high vs. low GADA levels, divided by the median (36,(39)(40)(41)(42)49). These subgroups will be referred to as LADA high and LADA low .…”