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Associations of combined healthy lifestyles with cancer morbidity and mortality among individuals with diabetes: results from five cohort studies in the USA, the UK and China

Abstract

Aims/hypothesis

Cancer has contributed to an increasing proportion of diabetes-related deaths, while lifestyle management is the cornerstone of both diabetes care and cancer prevention. We aimed to evaluate the associations of combined healthy lifestyles with total and site-specific cancer risks among individuals with diabetes.

Methods

We included 92,239 individuals with diabetes but without cancer at baseline from five population-based cohorts in the USA (National Health and Nutrition Examination Survey and National Institutes of Health [NIH]-AARP Diet and Health Study), the UK (UK Biobank study) and China (Dongfeng-Tongji cohort and Kailuan study). Healthy lifestyle scores (range 0–5) were constructed based on current nonsmoking, low-to-moderate alcohol drinking, adequate physical activity, healthy diet and optimal bodyweight. Cox regressions were used to calculate HRs for cancer morbidity and mortality, adjusting for sociodemographic, medical and diabetes-related factors.

Results

During 376,354 person-years of follow-up from UK Biobank and the two Chinese cohorts, 3229 incident cancer cases were documented, and 6682 cancer deaths were documented during 1,089,987 person-years of follow-up in the five cohorts. The pooled multivariable-adjusted HRs (95% CIs) comparing participants with 4–5 vs 0–1 healthy lifestyle factors were 0.73 (0.61, 0.88) for incident cancer and 0.55 (0.46, 0.67) for cancer mortality, and ranged between 0.41 and 0.63 for oesophagus, lung, liver, colorectum, breast and kidney cancers. Findings remained consistent across different cohorts and subgroups.

Conclusions/interpretation

This international cohort study found that adherence to combined healthy lifestyles was associated with lower risks of total cancer morbidity and mortality as well as several subtypes (oesophagus, lung, liver, colorectum, breast and kidney cancers) among individuals with diabetes.

Graphical abstract

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Fig. 1

Data availability

Reasonable requests to access the data from the Dongfeng-Tongji cohort and the Kailuan study used in this study may be sent to the corresponding authors. Data from the US NHANES are available at www.cdc.gov/nchs/nhis/index.htm. Data from the US NIH-AARP Diet and Health Study are available on application at https://dietandhealth.cancer.gov/. Data from UK Biobank are available on application at www.ukbiobank.ac.uk/register-apply.

Abbreviations

DFTJ:

Dongfeng-Tongji cohort

FPG:

Fasting plasma glucose

Look AHEAD:

Look Action for Health in Diabetes

NHANES:

National Health and Nutrition Examination Survey

NIH-AARP:

National Institutes of Health-AARP

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Authors’ relationships and activities

The authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.

Contribution statement

Y-BZ, X-FP, QL, GL and AP contributed to study design. Y-BZ, X-FP, QL, Y-FZ, J-XC and XH carried out data analysis. Y-BZ, X-FP, QL and T-TG drafted the first version of the manuscript. All authors contributed to data interpretation and final approval of the version to be published, and critically reviewed and edited the manuscript. X-FP, Y-XW, LML, K-QG, KY, H-DY, DY, M-AH, X-MZ, L-GL, TW, S-LW, GL and AP contributed to acquisition of data. X-FP (NIH-AARP Diet and Health Study), S-LW (Kailuan study), GL (UK Biobank) and AP (Dongfeng-Tongji cohort and National Health and Nutrition Examination Survey) are the guarantors of this work and, as such, had full access to the corresponding data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Funding

The research was supported by the National Natural Science Foundation of China (81930124, 82021005 and 82073554), Fundamental Research Funds for the Central Universities (2021GCRC075 and 2021GCRC076), Hubei Province Science Fund for Distinguished Young Scholars (2021CFA048) and the China Postdoctoral Science Foundation (2021M691129). The study sponsors/funders were not involved in the design of the study; the collection, analysis and interpretation of data; writing the report; and did not impose any restrictions regarding the publication of the report.

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Correspondence to An Pan, Gang Liu or Shou-Ling Wu.

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Zhang, YB., Pan, XF., Lu, Q. et al. Associations of combined healthy lifestyles with cancer morbidity and mortality among individuals with diabetes: results from five cohort studies in the USA, the UK and China. Diabetologia (2022). https://doi.org/10.1007/s00125-022-05754-x

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  • DOI: https://doi.org/10.1007/s00125-022-05754-x

Keywords

  • Cancer
  • Diabetes
  • Lifestyle
  • Mortality