Population-attributable Fractions of Lifestyle Factors for Prediabetes in Korea: A Regression-based Analysis of National Survey Data.

OBJECTIVES

Although lifestyle modification programs are widely implemented for diabetes prevention, the contributions of individual lifestyle factors remain unclear. This study investigated lifestyle risk factors for prediabetes and employed a regression-based approach for estimating their population-attributable fractions (PAFs) using nationally representative data.

METHODS

We analyzed data from 3104 adults aged ≥30 years without diabetes from the 2022 Korea National Health and Nutrition Examination Survey. Seven lifestyle factors were assessed: body weight, alcohol consumption, smoking, physical activity, sleep duration, vegetable intake, and breakfast consumption. Prediabetes was defined as fasting blood glucose of 100-125 mg/dL or hemoglobin A1c levels of 5.7-6.4%. Complex survey-adjusted logistic regression was used to identify significant lifestyle risk factors, and their PAFs were estimated using a regression-based sequential method.

RESULTS

Five lifestyle factors were significantly associated with prediabetes: abnormal body weight (odds ratio [OR], 2.05; 95% confidence interval [CI], 1.68 to 2.50), excessive alcohol consumption (OR, 1.27; 95% CI, 1.00 to 1.62), smoking (OR, 1.35; 95% CI, 1.07 to 1.71), insufficient exercise (OR, 1.26; 95% CI, 1.05 to 1.51), and irregular breakfast consumption (OR, 1.31; 95% CI, 1.08 to 1.59). In sequential PAF estimation, abnormal body weight had the largest contribution (22.2%; 95% CI, 16.2 to 28.2), followed by smoking (6.4%; 95% CI, 1.1 to 11.6), insufficient exercise (5.8%; 95% CI, 1.2 to 10.5), irregular breakfast consumption (4.9%; 95% CI, 0.5 to 9.2), and excessive alcohol consumption (3.6%; 95% CI, 0.1 to 7.4). These results remained consistent in sensitivity analyses including undiagnosed diabetes cases.

CONCLUSIONS

Abnormal body weight emerged as the largest contributor to prediabetes (PAF>20%). Diabetes prevention programs in Korea should prioritize weight management within a comprehensive approach to lifestyle modification.