Simple indices of diet and activity are feasible to collect, predict future diabetes risk and might enhance routine data collection in primary care. However, they do not improve the prediction of risk scores based on known risk factors.

Aims/hypothesis: Randomised trials targeting high-risk people with impaired glucose tolerance have halved progression to diabetes using behavioural interventions aimed at achieving five goals related to weight, diet and physical activity. The number of people currently meeting these goals in the general population is unknown. The potential impact on the incidence of diabetes of increasing the proportion of people who meet these goals is also unclear. We quantified the association between the achievement of behavioural goals for the prevention of diabetes and the incidence of diabetes in a population-based cohort study. Subjects and methods: European Prospective Investigation into Cancer (EPIC)-Norfolk is a prospective cohort of 24,155 participants aged 40-79 years who attended a baseline health check and completed validated diet and activity questionnaires. We assessed the association between achievement of five diabetes healthy behaviour prevention goals (BMI <25 kg/ m 2 , fat intake <30% of energy intake, saturated fat intake <10% of energy intake, fibre intake ≥15 g/4,184 kJ, physical activity >4 h/week) and risk of developing diabetes at follow-up (mean 4.6 years). Results: Only 20% of EPIC participants met three or more diabetes prevention goals. Diabetes incidence was inversely related to the number of goals achieved (p<0.001). None of the participants who met all five goals developed diabetes, whereas diabetes incidence was highest in those who did not meet any goals. If the entire population were able to meet one more goal, the total incidence of diabetes would be predicted to fall by 20%. Conclusions/ interpretation: In this population-based study, the risk of diabetes was inversely associated with the number of behaviour goals for diabetes prevention that were met. Interventions that promote achievement of these goals in the general population could significantly reduce the growing burden of diabetes-related morbidity and mortality.

Objective: To investigate the association between total level and type of alcohol consumed and glycaemia. Design: Cross-sectional study. Setting: The EPIC-Norfolk Study, a population-based cohort study of diet and chronic disease. Subjects and methods: Non-diabetic men (n ¼ 2842) and women (n ¼ 3572), aged 40 -78 y. Alcohol intake was assessed by self-reported questionnaire, and glycaemia measured by glycosylated haemoglobin (HbA 1c ). Results: Ten percent of men and 18% of women reported drinking no alcohol. Among drinkers, median alcohol intake was 8 units=week for men and 3 units=week for women. In analyses stratified by sex and adjusted for age, total energy intake, education, fruit and vegetable intake, smoking, family history of diabetes, physical activity, body mass index and waist:hip ratio, alcohol intake was inversely associated with HbA 1c in men and women, although the association was stronger in women. A 1 unit=week increase in alcohol intake was associated with 0.0049% (s.e. ¼ 0.00223; P-value ¼ 0.028) and 0.017% (s.e. ¼ 0.00343; P-value < 0.001) reduction in HbA 1c in men and women respectively. In similar multivariate analyses, wine intake was inversely associated with HbA 1c in men, and wine, spirits and beer intake were inversely associated with HbA 1c in women. When also adjusted for total alcohol intake, only the association between wine intake and HbA 1c in men remained significant. Conclusion: Alcohol intake was associated with lower HbA 1c level, an association not explained by confounding. The distinction between type of alcohol consumed was particularly important in men. Sponsorship: NJW is an MRC Clinician Scientist Fellow.

Objective: To investigate the association between habitual fish consumption and a continuous measure of glycaemia. Design: Cross-sectional study. Setting: EPIC-Norfolk, a population-based cohort study of diet and chronic disease. Subjects and methods: In all, 4500 men and 5509 women, aged 40-78 y, without self-reported diabetes. Diet was assessed by a semiquantitative food frequency questionnaire, and glycaemia was measured by glycated haemoglobin. Results: In women only, in analyses adjusted for age, the HbA 1c level was positively associated with eating fried fish and inversely associated with eating oily fish (b ¼ 0.036, 95% confidence interval (CI): 0.0033, 0.069; and b ¼ À0.046, 95% CI:À0.086, À0.0064 respectively). These associations were attenuated by adjustment for family history of diabetes, smoking status and physical activity level, but the association with fried fish remained statistically significant (b ¼ 0.033, 95% CI: 0.00056, 0.066). Adjusting for total energy, alcohol, fruit and vegetable intakes resulted in further attenuation and both associations were no longer statistically significant. In men, there was no evidence that HbA 1c level was associated with fish consumption. Conclusions: The study found no evidence of an association between fish consumption and HbA 1c after taking other lifestyle factors into account.