title: Healthy behaviours and 10-year incidence of diabetes: a population cohort study.
abstract: OBJECTIVE
  To examine the association between meeting behavioural goals and diabetes incidence over 10 years in a large, representative Swedish population.
  
  
  METHODS
  Population-based prospective cohort study of 32,120 individuals aged 35 to 55 years participating in a health promotion intervention in Västerbotten County, Sweden (1990 to 2013). Participants underwent an oral glucose tolerance test, clinical measures, and completed diet and activity questionnaires. Poisson regression quantified the association between achieving six behavioural goals at baseline - body mass index (BMI) <25 kg/m(2), moderate physical activity, non-smoker, fat intake <30% of energy, fibre intake ≥15 g/4184 kJ and alcohol intake ≤20 g/day - and diabetes incidence over 10 years.
  
  
  RESULTS
  Median interquartile range (IQR) follow-up time was 9.9 (0.3) years; 2211 individuals (7%) developed diabetes. Only 4.4% of participants met all 6 goals (n=1245) and compared to these individuals, participants meeting 0/1 goals had a 3.74 times higher diabetes incidence (95% confidence interval (CI)=2.50 to 5.59), adjusting for sex, age, calendar period, education, family history of diabetes, history of myocardial infarction and long-term illness. If everyone achieved at least four behavioural goals, 14.1% (95% CI: 11.7 to 16.5%) of incident diabetes cases might be avoided.
  
  
  CONCLUSIONS
  Interventions promoting the achievement of behavioural goals in the general population could significantly reduce diabetes incidence.
authors.affiliation: University of Cambridge School of Clinical Medicine, MRC Epidemiology Unit, University of Cambridge, CB2 0QQ, United Kingdom.
authors.forename: G H
authors.initials: GH
authors.lastname: Long
authors.affiliation: Department of Odontology, Umeå University, 901 87 Umeå, Sweden.
authors.forename: I
authors.initials: I
authors.lastname: Johansson
authors.affiliation: Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, 901 87 Umeå, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Rolandsson
authors.affiliation: Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, 901 87 Umeå, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Wennberg
authors.affiliation: Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, 901 87 Umeå, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Fhärm
authors.affiliation: Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Weinehall
authors.affiliation: University of Cambridge School of Clinical Medicine, MRC Epidemiology Unit, University of Cambridge, CB2 0QQ, United Kingdom; The Primary Care Unit, Institute of Public Health, Cambridge CB2 0SR, United Kingdom.
authors.forename: S J
authors.initials: SJ
authors.lastname: Griffin
authors.affiliation: University of Cambridge School of Clinical Medicine, MRC Epidemiology Unit, University of Cambridge, CB2 0QQ, United Kingdom.
authors.forename: R K
authors.initials: RK
authors.lastname: Simmons
authors.affiliation: Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden; Centre for Population Studies, Ageing and Living Conditions Programme, Umeå University, 901 87 Umeå, Sweden. Electronic address: margareta.norberg@epiph.umu.se.
authors.forename: M
authors.initials: M
authors.lastname: Norberg
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D015438:Health Behavior; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D012044:Regression Analysis; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology
keywords: Health behaviour change; Healthy lifestyle; Population health determinants; Population health promotion; Population impact; Type 2 diabetes