Diabetes research and clinical practice · 2026
Heterogeneity in type 2 diabetes onset across combinations of lifestyle behaviours in the UK Biobank.
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Swain Ansuman, Pearson Natalie, Willis Scott A, Leckie George, Finke Axel, Hutchinson Joseph, Johnson William
Аннотация
BACKGROUND: To examine how combinations of key lifestyle behaviors influence type 2 diabetes (T2D) onset using multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA).
METHODS: We analysed 259,448 UK Biobank adults with up to 16 years of follow-up. Fruit and vegetable intake, physical activity, sleep duration, and alcohol consumption were dichotomised by meeting public health recommendations, while smoking was categorised as never, previous, or current. Cross-classification generated 48 lifestyle strata. Sex-stratified MAIHDA models were fitted with individuals nested within strata: Model 1 (no predictors), Model 2 (lifestyle behaviors), Model 3 (lifestyle plus confounders). Posterior summaries estimated variance partitioning coefficients (VPC), proportional change in variance (PCV), and strata-specific median T2D-free survival times.
RESULTS: In Model over 7% (VPCs) of the variation in T2D onset on the log-hazard scale was attributable to strata differences. In both sexes, additive effects of individual behaviors explained around 93% (PCVs) of between-strata variance. Strata meeting most recommendations had the longest predicted survival, whereas those meeting few had the shortest. Never smoking and meeting physical activity guidelines consistently characterised longer survival.
CONCLUSIONS: Variation in T2D onset is driven primarily by additive lifestyle effects rather than interactions. Each additional recommendation met progressively extends T2D-free survival.
METHODS: We analysed 259,448 UK Biobank adults with up to 16 years of follow-up. Fruit and vegetable intake, physical activity, sleep duration, and alcohol consumption were dichotomised by meeting public health recommendations, while smoking was categorised as never, previous, or current. Cross-classification generated 48 lifestyle strata. Sex-stratified MAIHDA models were fitted with individuals nested within strata: Model 1 (no predictors), Model 2 (lifestyle behaviors), Model 3 (lifestyle plus confounders). Posterior summaries estimated variance partitioning coefficients (VPC), proportional change in variance (PCV), and strata-specific median T2D-free survival times.
RESULTS: In Model over 7% (VPCs) of the variation in T2D onset on the log-hazard scale was attributable to strata differences. In both sexes, additive effects of individual behaviors explained around 93% (PCVs) of between-strata variance. Strata meeting most recommendations had the longest predicted survival, whereas those meeting few had the shortest. Never smoking and meeting physical activity guidelines consistently characterised longer survival.
CONCLUSIONS: Variation in T2D onset is driven primarily by additive lifestyle effects rather than interactions. Each additional recommendation met progressively extends T2D-free survival.