Dr. Ray O'Connor summarises a very interesting paper on the role of lifestyle and social factors in treating and preventing some chronic diseases and deaths.
Diabetes remission through diet
Randomized controlled trials have shown that total dietary replacement (TDR) can lead to remission of type 2 diabetes. In 2019, the UK National Health Service (NHS) committed to establishing a TDR-based intervention program delivered at scale in real-world settings. Subsequently, the NHS Pathway to Type 2 Diabetes Remission (T2DR) program was developed, a 12-month behavioral intervention supporting weight loss, including an initial 3-month TDR period.
People aged 18–65 years in England who had been diagnosed with type 2 diabetes in the past six years were referred to the programme. Study 1 assessed type 2 diabetes remission in programme participants.
Dr. Ray O'Connor
According to the findings, of those who started TDR before January 2022, 960 (55%) completed the program. The mean weight loss was 8.3% or 9.4 kg. Diabetes remission rates ranged from 27% to 32%. In conclusion, type 2 diabetes remission is possible outside of research settings through large-scale service delivery. However, remission rates achieved are lower than in randomized controlled settings.
Light Exposure and Diabetes Risk
Nighttime light disrupts circadian rhythms, and circadian disruption is a risk factor for type 2 diabetes. In this study, we assessed whether an individual's light exposure patterns predict the risk of developing type 2 diabetes in participants from the UK Biobank. Participants (N = 84,790; mean age 62 years, 58% female) wore light sensors for one week to record their exposure to light during the day and at night. We found that those exposed to bright nighttime light and to light patterns that may disrupt circadian rhythms were at higher risk of type 2 diabetes.
Therefore, avoiding light at night may be a simple, cost-effective recommendation to reduce diabetes risk, even in individuals at high genetic risk.
Physical activity and mortality
Achieving a healthy balance between increasing time spent in physical activity (PA) and decreasing time spent in sedentary behaviour is now widely recommended to achieve multiple health benefits. This prospective cohort study3 introduces the Physical Activity Sedentary Time Balance Index (PASTBI), a potential risk identification tool that addresses the interplay between physical activity and sedentary behaviour. The study analysed Australian Diabetes, Obesity and Lifestyle Study (AusDiab) data on 5836 Australian adults. Results found that a poor balance between time spent in physical activity and sedentary behaviour was associated with a higher risk of all-cause mortality.
Dementia prevention
The Lancet Commission report, authored by 27 experts, estimated that 45 percent of dementia cases could be delayed or prevented altogether by addressing 14 risk factors. These risk factors are:
Provide quality education for all children and encourage cognitively stimulating activities in midlife. Make hearing aids available to all people with hearing loss and reduce exposure to harmful noise. Detect and treat high LDL cholesterol in midlife from around age 40. Make screening and treatment for vision loss available to all. Treat depression effectively. Encourage the use of helmets and head protection when playing contact sports and cycling. Prioritize supportive local environments and housing to increase social contact. Reduce exposure to air pollution through strict clean air policies. Expand measures to reduce smoking, including price controls, raising the minimum purchase age and smoking bans. Encourage physical activity. Maintain a systolic blood pressure below 130mmHg from age 40. Maintain a healthy weight and treat obesity early. Reduce excessive alcohol consumption through price controls and awareness campaigns. Make screening and treatment for vision loss available to all.
Social inequality and life expectancy
The aim of this study5 was to quantify inequalities in life expectancy across multiple social determinants of health, determine how they work in conjunction with each other, and create a scoring system that can accurately identify subgroups of the population at increased risk of mortality.
The study used data from the U.S. Multicause of Death Dataset and American Community Survey data from 2015 to 2019 to compare life tables among 54 subgroups defined by combinations of four social determinants of health: sex, marital status, education, and race.
The authors compared partial life expectancy (PLE) between ages 30 and 90 for all subgroups. They found a difference of 18.0 years between the subgroups with the lowest and highest PLE. The authors concluded that the presence of one characteristic associated with increased mortality is often insufficient to determine an increased risk of death, but an increasing number of such characteristics increases the risk. Reducing inequalities is crucial for society.
References:
Valabhji J et al. Early findings from the NHS Road to Remission of Type 2 Diabetes Programme: a prospective evaluation of real-world implementation. Lancet Diabetes Endocrinol 2024, published online 5 August 2024. https://doi.org/10.1016/S2213-8587(24)00194-3 Windred D et al. Individual light exposure patterns and the development of type 2 diabetes: an analysis of 13 million hours of light sensor data and 670,000 person-years of prospective observation. The Lancet Regional Health – Europe 2024;42: 100943. Published online 5 June 2024. https://doi.org/10.1016/j.lanepe.2024.100943 Botlero R et al. Physical activity and sedentary balance indices and risk of all-cause mortality. Am J Prev Med 2024;000(000):1−9. http://creativecommons.org/licenses/by/4.0/ Livingston G et al. Dementia prevention, intervention, and care: 2024 report of the Lancet Standing Committee. Lancet 2024. doi: 10.1016/S0140-6736(24)01296-0 Bergeron-Boucher M et al. Inequalities in life expectancy and mortality risk in the United States, 2015-2019: a cross-sectional analysis of subpopulations by social determinants of health. BMJ Open 2024;14:e079534. doi:10.1136/bmjopen-2023-079534
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