Healthy lifestyle habits including regular exercise, healthy weight, adequate sleep and never smoking were associated with substantially lower infection rates among people with type 2 diabetes
Following a healthy lifestyle may reduce the incidence of infections by approximately 44% among people with type 2 diabetes mellitus (T2DM), according to a prospective cohort study published in BMC Medicine.
The findings suggest that healthier lifestyle patterns may be associated with lower risks of overall infections, pneumonia and sepsis in people with T2DM, a population already known to have increased susceptibility to infectious diseases.
Researchers also identified potential biological pathways linking healthier lifestyles with lower infection risk, involving lipid metabolism, fatty acid profiles and inflammatory and innate immune signaling.
Study Included Nearly 13,000 Patients With Type 2 Diabetes
Researchers conducted a prospective cohort study involving 12,885 patients with T2DM from the UK Biobank.
The participants had a mean age of 60.1 years, and 30.6% were women, corresponding to 3,943 participants. The median follow-up period was 13.1 years.
The researchers assessed adherence to a healthy lifestyle based on several factors, including smoking status, body mass index (BMI), dietary intake, physical activity, sleep duration and alcohol consumption.
They also examined the Life’s Essential 8 (LE8) score among 9,164 participants to assess overall cardiovascular health and its relationship with infection risk.
Healthy Lifestyle Associated With 44% Lower Infection Incidence
Participants with ideal adherence to healthy lifestyle factors had a substantially lower incidence of infections compared with those with poor adherence.
Ideal lifestyle adherence was associated with a 44% lower overall infection incidence rate, with an incidence rate ratio (IRR) of 0.56 (95% CI, 0.46–0.68).
Similar protective associations were observed for specific infectious outcomes, including pneumonia and sepsis.
The study assessed infection events using hospital discharge records and mortality registry data.
Smoking, Healthy BMI, Sleep and Exercise Show Strongest Associations
Among the individual lifestyle factors examined, four were most strongly associated with lower infection incidence.
These included:
- Never having smoked
- Maintaining a healthy BMI
- Getting adequate sleep
- Exercising regularly
The findings indicate that several modifiable lifestyle behaviors may contribute to lower infection incidence among people with T2DM.
Higher LE8 Scores Linked to Lower Infection Risk
The researchers also found a dose-dependent association between the LE8 score and infection incidence.
For every 5-point increase in the total LE8 score, the infection incidence rate was 11% lower, corresponding to an IRR of 0.89 (95% CI, 0.87–0.91).
This dose-response relationship suggests that progressively better overall health-related behaviors were associated with progressively lower infection incidence in the study population.
Metabolic Changes May Help Explain the Association
To investigate potential biological mechanisms, researchers performed multi-omics mediation analyses.
Nuclear magnetic resonance metabolomics was conducted in 8,971 participants and examined 325 metabolic biomarkers. Olink proteomics was performed in 1,078 participants, covering 2,920 proteins.
The mediation analyses identified several lipid and fatty acid-related measures that appeared to contribute to the association between healthy lifestyle and lower infection incidence.
These included the degree of fatty acid unsaturation, HDL-associated lipid sub-fractions and levels of GlycA.
Inflammatory and Immune Proteins Identified as Potential Mediators
Plasma protein profiling also identified proteins involved in inflammatory and innate immune signaling that may help explain the observed relationship.
TRAIL-R2 and Galectin-9 were among the proteins identified as significant biological mediators between lifestyle-related measures and infection risk.
The findings suggest that healthier lifestyle behaviors may be linked to infection susceptibility through pathways involving lipid metabolism and immune-inflammatory processes.
Implications for Type 2 Diabetes Management
People with T2DM have an increased susceptibility to infectious diseases, making strategies that may reduce infection risk clinically relevant.
The study suggests that maintaining healthy lifestyle behaviors and improving overall health metrics may be associated with fewer infectious events in this population.
However, because the study is observational, the findings demonstrate an association rather than proving that lifestyle changes directly prevent infections. Further research is needed to establish the causal mechanisms and determine how lifestyle interventions may affect infection outcomes in people with T2DM.
Important Highlights
- A prospective cohort study of 12,885 people with T2DM examined lifestyle factors and infection risk over a median of 13.1 years.
- Ideal healthy lifestyle adherence was associated with a 44% lower infection incidence rate compared with poor adherence (IRR, 0.56; 95% CI, 0.46–0.68).
- Never smoking, maintaining a healthy BMI, adequate sleep and regular exercise were among the strongest protective lifestyle factors identified.
- Every 5-point increase in LE8 score was associated with an 11% lower infection incidence rate (IRR, 0.89; 95% CI, 0.87–0.91).
- Multi-omics analyses implicated lipid metabolism, fatty acid measures and immune-inflammatory pathways in the observed associations.
- TRAIL-R2 and Galectin-9 were identified as potential biological mediators linking lifestyle measures with infection risk.
