HEALTHY LIFESTYLE AND COMMUNITY INDEX AND TYPE 2 DIABETES RISK IN TWINS

Aasara Khatiwada

Background: Type 2 diabetes (T2D) is influenced by a complex interplay of genetics, individual behaviors, and community-level factors. This study aimed to construct a Healthy Lifestyle and Community Index (HLCI) and to examine its association with sociodemographic factors and T2D status within a large twin population to address genetic and shared environmental factors that may confound this relationship. Methods: This study used a cross-sectional design. The HLCI included 11 individual (related to diet, physical activity, and substance use) and community-level (related to neighborhood walkability, area deprivation, green space) factors. Participants were categorized into tertiles based on their HLCI scores. Binary logistic regression using Generalized Estimating Equations (GEE) was used to examine the association between the full HLCI, its individual components, and T2D status, providing a point estimate with 95% confidence intervals for the odds of T2D associated in a sequence of multiple models. Results: In the between-twin analysis, 11,748 participants with mean age 43.4 were included in the study. The participants in the healthiest tertile (tertile 3) showed significantly higher levels of education and household income compared to the least healthy tertile (tertile 1). T2D prevalence decreased across tertiles of the index from 7.2% in tertile 1 to 2.9% in tertile 3. The participants without T2D had a significantly higher mean HLCI score (6.2) compared to the ones with T2D (5.5). Participants without T2D lived in areas with significantly higher neighborhood walkability (25.5% vs 18.7%) and lower area deprivation index (ADI) (51.4% vs 35.2%). In model 3, after adjustments for demographic factors and BMI, a 1-point increase in HLCI score was associated with 7% reduction in odds (95% CI: 0.87,0.99) of T2D. For individual lifestyle components, lower fast food intake was the strongest dietary predictor with 33% reduction in T2D odds (95% CI: 0.50, 0.91). For the community level component, higher ADI was a major predictor for T2D, with individuals living in better community conditions (i.e., lower ADI) having 27% lower odds of T2D (95% CI: 0.60, 0.90). Conclusion: Higher HLCI scores are associated with lower odds of T2D and more favorable lifestyle and sociodemographic conditions. While the independent role of fast food consumption in odds of T2D emphasizes the importance of nutritional quality, the strong link between high index scores and socioeconomic conditions suggests that income and education, proxy measures of healthy diets and neighborhood environments, also play a key role in T2D risk.

HEALTHY LIFESTYLE AND COMMUNITY INDEX AND TYPE 2 DIABETES RISK IN TWINS

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