title: Lifestyle factors and mortality risk in individuals with diabetes mellitus: are the associations different from those in individuals without diabetes?
abstract: OBJECTIVE
  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
  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.
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany, Diewertje.Sluik@wur.nl.
authors.forename: Diewertje
authors.initials: D
authors.lastname: Sluik
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
authors.forename: Kuanrong
authors.initials: K
authors.lastname: Li
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kaaks
authors.forename: Nina Føns
authors.initials: NF
authors.lastname: Johnsen
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.forename: Larraitz
authors.initials: L
authors.lastname: Arriola
authors.forename: Aurelio
authors.initials: A
authors.lastname: Barricarte
authors.forename: Giovanna
authors.initials: G
authors.lastname: Masala
authors.forename: Sara
authors.initials: S
authors.lastname: Grioni
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.forename: Fulvio
authors.initials: F
authors.lastname: Ricceri
authors.forename: Amalia
authors.initials: A
authors.lastname: Mattiello
authors.forename: Annemieke M W
authors.initials: AM
authors.lastname: Spijkerman
authors.forename: Daphne L
authors.initials: DL
authors.lastname: van der A
authors.forename: Ivonne
authors.initials: I
authors.lastname: Sluijs
authors.forename: Paul W
authors.initials: PW
authors.lastname: Franks
authors.forename: Peter M
authors.initials: PM
authors.lastname: Nilsson
authors.forename: Marju
authors.initials: M
authors.lastname: Orho-Melander
authors.forename: Eva
authors.initials: E
authors.lastname: Fhärm
authors.forename: Olov
authors.initials: O
authors.lastname: Rolandsson
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
authors.forename: Dora
authors.initials: D
authors.lastname: Romaguera
authors.forename: Elisabete
authors.initials: E
authors.lastname: Weiderpass
authors.forename: Emilio
authors.initials: E
authors.lastname: Sánchez-Cantalejo
authors.forename: Ute
authors.initials: U
authors.lastname: Nöthlings
mesh_terms: D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000401:mortality*; D007887:Fabaceae; D005260:Female; D005638:Fruit; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking