{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T06:11:37Z","timestamp":1792303897419,"version":"4.4.0"},"reference-count":40,"publisher":"American Diabetes Association","issue":"3","license":[{"start":{"date-parts":[[2024,1,5]],"date-time":"2024-01-05T00:00:00Z","timestamp":1704412800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82273623, 82073554, 81930124, 82021005, and 821929"],"award-info":[{"award-number":["82273623, 82073554, 81930124, 82021005, and 821929"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100019537","name":"Science Fund for Distinguished Young Scholars of Hubei Province","doi-asserted-by":"publisher","award":["2021CFA048"],"award-info":[{"award-number":["2021CFA048"]}],"id":[{"id":"10.13039\/501100019537","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012226","name":"Fundamental Research Funds for the Central Universities","doi-asserted-by":"publisher","award":["2021GCRC076 and 2021GCRC075"],"award-info":[{"award-number":["2021GCRC076 and 2021GCRC075"]}],"id":[{"id":"10.13039\/501100012226","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,3,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>To prospectively evaluate the association between modifiable lifestyle factors and peripheral artery disease (PAD) among individuals with type 2 diabetes (T2D).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>We included 14,543 individuals with T2D from the UK Biobank. We defined a weighted healthy lifestyle score using nonsmoking, regular physical activity, high-quality diet, moderate alcohol consumption, optimal waist-to-hip ratio, and adequate sleep duration, and categorized into unfavorable, intermediate, and favorable lifestyles. We created a genetic risk score (GRS) using 19 single nucleotide polymorphisms previously found to be associated with PAD. We modeled the association between lifestyle score and PAD, overall and stratified by PAD genetic susceptibility.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>After a median 13.5 years of follow-up, 628 incident cases of PAD were documented. A linear inverse association between the weighted lifestyle score and PAD was observed, with a hazard ratio (HR) (95% CI) of 0.27 (0.19, 0.38) for favorable compared with unfavorable lifestyle (Ptrend &amp;lt; 0.0001). An estimated 58.3% (45.0%, 69.1%) of PAD in this population could be potentially avoidable if all participants attained a favorable lifestyle. Moreover, the PAD GRS was associated with increased PAD risk (HR [95% CI] per SD increment: 1.13 [1.03, 1.23]). A favorable lifestyle was able to partially mitigate the excess risk of PAD associated with higher GRS, albeit as a nonsignificant interaction. Several biomarkers in the lipid metabolism, hepatic\/renal function, and systemic inflammation pathways collectively explained 13.3% (8.5%, 20.1%) of the association between weighted lifestyle score and PAD.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>A favorable lifestyle was associated with lower risk of PAD among individuals with T2D, independent of genetic predisposition to PAD.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc23-1503","type":"journal-article","created":{"date-parts":[[2024,1,5]],"date-time":"2024-01-05T20:45:50Z","timestamp":1704487550000},"page":"435-443","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":59,"title":["Modifiable Lifestyle Factors, Genetic Risk, and Incident Peripheral Artery Disease Among Individuals With Type 2 Diabetes: A Prospective Study"],"prefix":"10.2337","volume":"47","author":[{"given":"Kai","family":"Zhu","sequence":"first","affiliation":[{"name":"1Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Qian","sequence":"additional","affiliation":[{"name":"2Section of Cardiovascular Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0385-5712","authenticated-orcid":false,"given":"Qi","family":"Lu","sequence":"additional","affiliation":[{"name":"1Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Li","sequence":"additional","affiliation":[{"name":"1Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6589-8454","authenticated-orcid":false,"given":"Zixin","family":"Qiu","sequence":"additional","affiliation":[{"name":"1Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Li","sequence":"additional","affiliation":[{"name":"1Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruyi","family":"Li","sequence":"additional","affiliation":[{"name":"1Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hancheng","family":"Yu","sequence":"additional","affiliation":[{"name":"1Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yulei","family":"Deng","sequence":"additional","affiliation":[{"name":"3Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun","family":"Yang","sequence":"additional","affiliation":[{"name":"4Department of Endocrinology, Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1089-7945","authenticated-orcid":false,"given":"An","family":"Pan","sequence":"additional","affiliation":[{"name":"5Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1430-3016","authenticated-orcid":false,"given":"Gang","family":"Liu","sequence":"additional","affiliation":[{"name":"1Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2024,1,5]]},"reference":[{"key":"2024022320073512000_B1","doi-asserted-by":"crossref","first-page":"1818","DOI":"10.1161\/CIRCRESAHA.121.318535","article-title":"Epidemiology of peripheral artery disease and polyvascular disease","volume":"128","author":"Aday","year":"2021","journal-title":"Circ Res"},{"key":"2024022320073512000_B2","doi-asserted-by":"crossref","first-page":"e171","DOI":"10.1161\/CIR.0000000000001005","article-title":"Lower extremity peripheral artery disease: contemporary epidemiology, management gaps, and future directions: a scientific statement from the American Heart Association","volume":"144","author":"Criqui","year":"2021","journal-title":"Circulation"},{"key":"2024022320073512000_B3","doi-asserted-by":"crossref","first-page":"e1020","DOI":"10.1016\/S2214-109X(19)30255-4","article-title":"Global, regional, and national prevalence and risk factors for peripheral artery disease in 2015: an updated systematic review and analysis","volume":"7","author":"Song","year":"2019","journal-title":"Lancet Glob Health"},{"key":"2024022320073512000_B4","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1056\/NEJMcp1507631","article-title":"CLINICAL PRACTICE. Peripheral artery disease","volume":"374","author":"Kullo","year":"2016","journal-title":"N Engl J Med"},{"key":"2024022320073512000_B5","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.jsmc.2015.10.007","article-title":"Sleep duration and cardiovascular disease risk: epidemiologic and experimental evidence","volume":"11","author":"Covassin","year":"2016","journal-title":"Sleep Med Clin"},{"key":"2024022320073512000_B6","doi-asserted-by":"crossref","first-page":"529","DOI":"10.2337\/dc14-2073","article-title":"Sleep duration and risk of type 2 diabetes: a meta-analysis of prospective studies","volume":"38","author":"Shan","year":"2015","journal-title":"Diabetes Care"},{"key":"2024022320073512000_B7","doi-asserted-by":"crossref","first-page":"oead008","DOI":"10.1093\/ehjopen\/oead008","article-title":"Sleep duration, daytime napping, and risk of peripheral artery disease: multinational cohort and Mendelian randomization studies","volume":"3","author":"Yuan","year":"2023","journal-title":"Eur Heart J Open"},{"key":"2024022320073512000_B8","first-page":"581","article-title":"Association of weight status with mortality in adults with incident diabetes","volume":"308","author":"Carnethon","year":"2012","journal-title":"JAMA"},{"key":"2024022320073512000_B9","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/j.atherosclerosis.2004.11.024","article-title":"Risk factors for peripheral arterial disease incidence in persons with diabetes: the Atherosclerosis Risk in Communities (ARIC) study","volume":"180","author":"Wattanakit","year":"2005","journal-title":"Atherosclerosis"},{"key":"2024022320073512000_B10","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1001\/jamacardio.2018.1717","article-title":"Associations of combined genetic and lifestyle risks with incident cardiovascular disease and diabetes in the UK Biobank Study","volume":"3","author":"Said","year":"2018","journal-title":"JAMA Cardiol"},{"key":"2024022320073512000_B11","doi-asserted-by":"crossref","first-page":"n604","DOI":"10.1136\/bmj.n604","article-title":"Associations of healthy lifestyle and socioeconomic status with mortality and incident cardiovascular disease: two prospective cohort studies","volume":"373","author":"Zhang","year":"2021","journal-title":"BMJ"},{"key":"2024022320073512000_B12","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/j.atherosclerosis.2016.06.040","article-title":"Association of sleep apnea and sleep duration with peripheral artery disease: The Multi-Ethnic Study of Atherosclerosis (MESA)","volume":"251","author":"Nagayoshi","year":"2016","journal-title":"Atherosclerosis"},{"key":"2024022320073512000_B13","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1001\/jama.2019.9879","article-title":"Association of lifestyle and genetic risk with incidence of dementia","volume":"322","author":"Lourida","year":"2019","journal-title":"JAMA"},{"key":"2024022320073512000_B14","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1053\/j.ajkd.2015.12.019","article-title":"Population-attributable fractions of modifiable lifestyle factors for CKD and mortality in individuals with type 2 diabetes: a\u00a0cohort study","volume":"68","author":"Dunkler","year":"2016","journal-title":"Am J Kidney Dis"},{"key":"2024022320073512000_B15","doi-asserted-by":"crossref","first-page":"e0218463","DOI":"10.1371\/journal.pone.0218463","article-title":"Impacts of unfavourable lifestyle factors on biomarkers of liver function, inflammation and lipid status","volume":"14","author":"Nivukoski","year":"2019","journal-title":"PLoS One"},{"key":"2024022320073512000_B16","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.1186\/s12889-019-7686-0","article-title":"Association of lifestyle factors with blood lipids and inflammation in adults aged 40\u2009years and above: a population-based cross-sectional study in Taiwan","volume":"19","author":"Muga","year":"2019","journal-title":"BMC Public Health"},{"key":"2024022320073512000_B17","doi-asserted-by":"crossref","first-page":"e21","DOI":"10.1016\/j.diabres.2013.06.009","article-title":"Adherence to lifestyle recommendations is associated with improved glycemic control and improved blood lipid levels in Korean adults with type 2 diabetes","volume":"101","author":"Lim","year":"2013","journal-title":"Diabetes Res Clin Pract"},{"key":"2024022320073512000_B18","doi-asserted-by":"crossref","first-page":"605","DOI":"10.7150\/ijms.12446","article-title":"Lifestyle and risk of hypertension: follow-up of a young pre-hypertensive cohort","volume":"12","author":"Lu","year":"2015","journal-title":"Int J Med Sci"},{"key":"2024022320073512000_B19","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.eng.2022.04.010","article-title":"Associations of combined healthy lifestyle factors with risks of diabetes, cardiovascular disease, cancer, and mortality among adults with prediabetes: four prospective cohort studies in China, the United Kingdom, and the United States","volume":"22","author":"Tu","year":"2023","journal-title":"Engineering"},{"key":"2024022320073512000_B20","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/j.amjms.2017.12.004","article-title":"Association between metabolic syndrome and microvascular and macrovascular disease in type 2 diabetic mellitus","volume":"355","author":"Lee","year":"2018","journal-title":"Am J Med Sci"},{"key":"2024022320073512000_B21","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.1038\/s41591-019-0492-5","article-title":"Genome-wide association study of peripheral artery disease in the Million Veteran Program","volume":"25","author":"Klarin","year":"2019","journal-title":"Nat Med"},{"key":"2024022320073512000_B22","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1177\/1358863X211067564","article-title":"Development of a polygenic risk score to improve detection of peripheral artery disease","volume":"27","author":"Wang","year":"2022","journal-title":"Vasc Med"},{"key":"2024022320073512000_B23","doi-asserted-by":"crossref","first-page":"2349","DOI":"10.1056\/NEJMoa1605086","article-title":"Genetic risk, adherence to a healthy lifestyle, and coronary disease","volume":"375","author":"Khera","year":"2016","journal-title":"N Engl J Med"},{"key":"2024022320073512000_B24","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1146\/annurev.psych.58.110405.085542","article-title":"Mediation analysis","volume":"58","author":"MacKinnon","year":"2007","journal-title":"Annu Rev Psychol"},{"key":"2024022320073512000_B25","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1037\/0022-3514.51.6.1173","article-title":"The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations","volume":"51","author":"Baron","year":"1986","journal-title":"J Pers Soc Psychol"},{"key":"2024022320073512000_B26","doi-asserted-by":"crossref","first-page":"319","DOI":"10.2337\/dc21-1512","article-title":"Association of a healthy lifestyle with all-cause and cause-specific mortality among individuals with type 2 diabetes: a prospective study in UK Biobank","volume":"45","author":"Han","year":"2022","journal-title":"Diabetes Care"},{"key":"2024022320073512000_B27","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.1161\/CIR.0000000000001078","article-title":"Life\u2019s essential 8: updating and enhancing the American Heart Association\u2019s construct of cardiovascular health: A presidential advisory from the American Heart Association","volume":"146","author":"Lloyd-Jones","year":"2022","journal-title":"Circulation"},{"key":"2024022320073512000_B28","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1001\/jama.2016.21042","article-title":"Genetic association of waist-to-hip ratio with cardiometabolic traits, type 2 diabetes, and coronary heart disease","volume":"317","author":"Emdin","year":"2017","journal-title":"JAMA"},{"key":"2024022320073512000_B29","doi-asserted-by":"crossref","first-page":"807","DOI":"10.3945\/ajcn.2008.26955","article-title":"Adipose tissue distribution is different in type 2 diabetes","volume":"89","author":"Gallagher","year":"2009","journal-title":"Am J Clin Nutr"},{"key":"2024022320073512000_B30","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/j.jacc.2019.05.049","article-title":"Cigarette smoking, smoking cessation, and long-term risk of 3\u00a0major\u00a0atherosclerotic diseases","volume":"74","author":"Ding","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2024022320073512000_B31","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1161\/CIR.0000000000000623","article-title":"Optimal exercise programs for patients with peripheral artery disease: a scientific statement from the American Heart Association","volume":"139","author":"Treat-Jacobson","year":"2019","journal-title":"Circulation"},{"key":"2024022320073512000_B32","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1001\/jama.2013.280618","article-title":"Association of Mediterranean diet with peripheral artery disease: the PREDIMED randomized trial","volume":"311","author":"Ruiz-Canela","year":"2014","journal-title":"JAMA"},{"key":"2024022320073512000_B33","doi-asserted-by":"crossref","first-page":"e002814","DOI":"10.1161\/CIRCGEN.119.002814","article-title":"Alcohol consumption and cardiovascular disease: a Mendelian randomization study","volume":"13","author":"Larsson","year":"2020","journal-title":"Circ Genom Precis Med"},{"key":"2024022320073512000_B34","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1016\/S2213-8587(16)30162-0","article-title":"Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial","volume":"4","author":"Gregg","year":"2016","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2024022320073512000_B35","doi-asserted-by":"crossref","first-page":"1876","DOI":"10.1016\/S0140-6736(22)00122-2","article-title":"Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial","volume":"399","author":"Delgado-Lista","year":"2022","journal-title":"Lancet"},{"key":"2024022320073512000_B36","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1056\/NEJMoa0806470","article-title":"10-year follow-up of intensive glucose control in type 2 diabetes","volume":"359","author":"Holman","year":"2008","journal-title":"N Engl J Med"},{"key":"2024022320073512000_B37","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1038\/nrendo.2017.151","article-title":"Global aetiology and epidemiology of type 2 diabetes mellitus and its complications","volume":"14","author":"Zheng","year":"2018","journal-title":"Nat Rev Endocrinol"},{"key":"2024022320073512000_B38","doi-asserted-by":"crossref","first-page":"1862","DOI":"10.1161\/CIRCULATIONAHA.109.918417","article-title":"Inflammation in peripheral artery disease","volume":"122","author":"Brevetti","year":"2010","journal-title":"Circulation"},{"key":"2024022320073512000_B39","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1053\/j.ackd.2014.07.005","article-title":"Peripheral artery disease and chronic kidney disease: clinical synergy to improve outcomes","volume":"21","author":"Garimella","year":"2014","journal-title":"Adv Chronic Kidney Dis"},{"key":"2024022320073512000_B40","doi-asserted-by":"crossref","first-page":"e2252239","DOI":"10.1001\/jamanetworkopen.2022.52239","article-title":"Adherence to a healthy lifestyle in association with microvascular complications among adults with type 2 diabetes","volume":"6","author":"Liu","year":"2023","journal-title":"JAMA Netw Open"}],"container-title":["Diabetes Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/47\/3\/435\/748477\/dc231503.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/47\/3\/435\/748477\/dc231503.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,23]],"date-time":"2024-02-23T20:08:01Z","timestamp":1708718881000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/care\/article\/47\/3\/435\/154054\/Modifiable-Lifestyle-Factors-Genetic-Risk-and"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,5]]},"references-count":40,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,1,5]]},"published-print":{"date-parts":[[2024,3,1]]}},"URL":"https:\/\/doi.org\/10.2337\/dc23-1503","relation":{},"ISSN":["0149-5992","1935-5548"],"issn-type":[{"value":"0149-5992","type":"print"},{"value":"1935-5548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,5]]}}}