Background Although many type 2 diabetes mellitus (T2DM) risk factors have been identified, little is known regarding their contributions to the diabetes burden at the population level. Methods The study included 72 655 French women from the Etude Epidemiologique de Femmes de la Mutuelle Générale de l'Education Nationale (E3N) prospective cohort followed between 1993 and 2011. Cox multivariable models including the main T2DM risk factors (metabolic, dietary, clinical, socioeconomic and hormonal) and a healthy lifestyle index combining five characteristics (smoking, body mass index BMI, alcohol consumption, fruit and vegetable consumption, and physical activity) were used to estimate hazard ratios and population attributable fractions (PAFs) for T2DM. Results In multivariate models, factors with the strongest effect on T2DM risk were, in decreasing order, BMI ≥ 30 kg/m2 (PAF = 43%; 95% confidence interval CI 37–47), high adherence to a Western dietary pattern (PAF = 30%; 95% CI 20–40), hypertension (PAF = 26%; 95% CI 20–32), an acidogenic diet (PAF = 24%; 95% CI 16–32), a family history of diabetes (PAF = 20%; 95% CI 17–22), and, with a negative correlation, moderate alcohol consumption (PAF–19%; 95% CI –34, −4). The PAF for an unhealthy lifestyle was 57% (95% CI 50–63). Conclusions We have been able to sort out and quantify the effect of various dietary and biological T2DM risk factors simultaneously in a single population, and to highlight the importance of a healthy lifestyle for primary prevention: more than half the T2DM cases could have been prevented through a healthier lifestyle. 摘要 背景 虽然目前已经确定了2型糖尿病(T2DM)的多个危险因素，但是有关它们在人群水平对糖尿病负担所造成的影响却知之甚少。 方法 研究纳入了72655名法国女性患者，患者来自于法国国家教育互助会的一项流行病学前瞩性队列研究(Etude Epidemiologique de Femmes de la Mutuelle Générale de l'Education Nationale，E3N)，随访时间为1993至2011年。使用包括T2DM主要危险因素(代谢、饮食、临床、社会经济以及激素方面因素)以及结合5个方面特征(吸烟、体重指数BMI、酒精消耗量、水果与蔬菜消耗量、以及体力活动)的健康生活方式指数的Cox多变量模型来评估T2DM的危险比以及人群归因分数(population attributable fractions，PAFs)。 结果 在多变量模型中，对T2DM风险影响最强的因素按照降序分别是BMI ≥ 30 kg/m2(PAF = 43%；95%置信区间CI为37‐47)、长期坚持西方饮食模式(PAF=30%；95% CI为20‐40)、高血压(PAF = 26%；95% CI为20‐32)、产酸饮食(PAF = 24%；95% CI为16‐32)、糖尿病家族史(PAF = 20%；95% CI为17‐22)以及呈负相关的适量饮酒(PAF = ‐19%；95% CI为‐34, ‐4)。不健康生活方式的PAF为57%(95% CI为50‐63)。 结论 我们已经能够在单一人群中同时对T2DM的各种饮食与生物危险因素的影响进行分类与量化，并且强调了健康生活方式对一级预防的重要性:超过一半的T2DM是可以通过更健康的生活方式来预防发生的。 Highlights If all the women from the E3N study had followed a healthy lifestyle, 57% of cases of type 2 diabetes mellitus (T2DM) cases could have been prevented. This study helps sort out and quantify the effects of various dietary and biological T2DM risk factors, and highlights the importance of a healthy lifestyle for primary prevention. Clinicians could use these results to explain to their patients how lifestyle changes can directly affect their risks of developing T2DM.