The prospective association between lifestyle factors and incident diabetes during a 10-year follow-up period was investigated in the Cardiovascular Health Study (4,883 men and women, 65 years or older). The following lifestyle variables were considered: physical activity level, dietary score, smoking habits, alcohol use and adiposity (body mass index and waist circumference). After adjusting for age, sex, race, educational level and annual income, each lifestyle factor was independently associated with incident diabetes. For instance, the rate of diabetes was 35% lower for each additional lifestyle risk factor in the low-risk group (relative risk: 0.65, 95% CI: 0.59-0.71). Moreover, the risk of diabetes was reduced by 82% among individuals who had physical activity, dietary habits, smoking habits and alcohol use in the low-risk groups combined compared to individuals not in this group. Thus, even in an older population, lifestyle habits have a major impact on the incidence of new-onset diabetes.