Population-attributable Fractions of Lifestyle Factors for Prediabetes in Korea: A Regression-based Analysis of National Survey Data.

Objectives: Although lifestyle modification programs are widely implemented for diabetes prevention, the contributions of individual lifestyle factors remain unclear. This study investigated lifestyle risk factors for prediabetes and employed a regression-based approach for estimating their population-attributable fractions (PAFs) using nationally representative data.

Methods: We analyzed data from 3,104 adults aged ≥30 years without diabetes from the 2022 Korea National Health and Nutrition Examination Survey. Seven lifestyle factors were assessed: body weight, alcohol consumption, smoking, physical activity, sleep duration, vegetable intake, and breakfast consumption. Prediabetes was defined as fasting blood glucose of 100-125 mg/dL or HbA1c levels of 5.7-6.4%. Complex survey-adjusted logistic regression was used to identify significant lifestyle risk factors, and their PAFs were estimated using a regression-based sequential method.

Results: Five lifestyle factors were significantly associated with prediabetes: abnormal body weight (OR: 2.046; 95% CI, 1.676-2.498), excessive alcohol consumption (OR: 1.274; 95% CI, 1.000-1.623), smoking (OR: 1.354; 95% CI, 1.073-1.709), insufficient exercise (OR: 1.259; 95% CI, 1.049-1.512), and irregular breakfast consumption (OR: 1.309; 95% CI, 1.078-1.590). In sequential PAF estimation, abnormal body weight had the largest contribution (22.2%; 95% CI, 16.2-28.2%), followed by smoking (6.4%; 95% CI, 1.1-11.6%), insufficient exercise (5.8%; 95% CI, 1.2-10.5%), irregular breakfast consumption (4.9%; 95% CI, 0.5-9.2%), and excessive alcohol consumption (3.6%; 95% CI, 0.1-7.4%). These results remained consistent in sensitivity analyses including undiagnosed diabetes cases.

Conclusions: Abnormal body weight emerged as the largest contributor to prediabetes (PAF>20%). Diabetes prevention programs in South Korea should prioritize weight management within a comprehensive approach to lifestyle modification.