Analysis of lifestyle patterns and underlying factors for better type 2 diabetes prevention

In type 2 diabetes prevention, large-scale lifestyle intervention programs have achieved limited success. These interventions primarily face the following issues:(1) A lack of attention on the combination of lifestyle factors – lifestyle patterns. Are these patterns relevant to diabetes risk?(2) The commonly applied "one-size-fits-all" approach. However, lifestyle is different between individuals. Such a strategy fails to differentiate the needs of different people for improving lifestyle.(3) Population-level lifestyle programs rarely take into account factors that influence lifestyle and health (referred to as underlying factors). To address these issues, this thesis has shown:(1) Dietary/lifestyle factors cluster in different lifestyle patterns in the population. These patterns are differentially associated with diabetes risk. These findings indicate that lifestyle patterns may be intervention targets. It is possible to design tailored lifestyle interventions for each pattern group based on their lifestyle features.(2) Low individual socioeconomic status (SES) and low neighborhood SES are independently associated with unhealthy lifestyle. Low neighborhood SES may amplify the detrimental effects of low individual SES. These findings highlight the importance of improving underlying factors for improving lifestyle, for which collective measures should be applied.(3) Substantial health inequalities can only be partially explained by various individual-level factors (such as lifestyle). In line with other research, this thesis emphasizes that health inequalities are not caused solely by differences in individual-level factors, but lie in the fundamental inequalities between people. From this thesis, two fundamental strategies should be applied: improving education level and reducing income inequalities in the population