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Gu L, Ma Y, Zheng Q, Gu W, Ke T, Li L, Zhao D, Dai Y, Dong Q, Ji B, Xu F, Shi J, Peng Y, Zhang Y, Shen T, Du R, Yang J, Kang M, Peng Y, Wang Y, Wang W. The effects of economic status on metabolic control in type 2 diabetes mellitus at 10 metabolic management centers in China. J Diabetes 2024; 16:e13466. [PMID: 37670495 PMCID: PMC10809306 DOI: 10.1111/1753-0407.13466] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 07/15/2023] [Accepted: 08/08/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVE This study investigated the association of economic status with metabolic index control in type 2 diabetes mellitus (T2DM) patients. METHODS In total, 37 454 T2DM patients from 10 National Metabolic Management Centers in China were recruited and categorized into two groups: a high-gross domestic product (GDP) group (n = 23 993) and a low-GDP group (n = 13 461). Sociodemographic characteristics, medical histories, and lifestyle factors were recorded. Logistic regression and interaction analysis were performed to evaluate the association of economic status and healthy lifestyle with metabolic control. RESULTS Compared to the low-GDP group, there were fewer patients with glycated hemoglobin (HbA1c) levels ≥7% in the high-GDP group. Fewer patients with a high GDP had an abnormal metabolic state (HbA1c ≥ 7%, blood pressure [BP] ≥130/80 mm Hg, total cholesterol [TCH] ≥4.5 mmol/L or body mass index [BMI] ≥24 kg/m2 ). The risks of developing HbA1c ≥ 7% (odds ratios [OR] = 0.545 [95% CI: 0.515-0.577], p < .001), BP ≥ 130/80 mm Hg (OR = 0.808 [95% CI: 0.770-0.849], p < .001), BMI ≥ 24 kg/m2 (OR = 0.840 [95% CI: 0.799-0.884], p < .001), and an abnormal metabolic state (OR = 0.533 [95% CI: 0.444-0.636], p < .001) were significantly lower in the high-GDP group even after adjustment for confounding factors. Younger participants; those with a family history of diabetes, normal weight, and a physical activity level up to standard; and those who did not drink alcohol in the high-GDP group were predisposed to better glycemic levels. CONCLUSIONS T2DM patients in economically developed regions had better metabolic control, especially glycemic control. A healthy lifestyle had an additive effect on achieving glycemic goals, even among high-GDP patients.
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Affiliation(s)
- Liping Gu
- Department of Endocrinology and Metabolism, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yuhang Ma
- Department of Endocrinology and Metabolism, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Qidong Zheng
- Department of Internal medicineThe Second People's Hospital of YuhuanYuhuanChina
| | - Weiqiong Gu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Tingyu Ke
- Department of EndocrinologyThe Second Affiliated Hospital of Kunming Medical UniversityKunmingChina
| | - Li Li
- Department of EndocrinologyThe First Affiliated Hospital of Ningbo UniversityNingboChina
| | - Dong Zhao
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe HospitalCapital Medical UniversityBeijingChina
| | - Yuancheng Dai
- Department of Internal medicine of traditional Chinese medicineSheyang Diabetes HospitalYanchengChina
| | - Qijuan Dong
- Department of Endocrinology and MetabolismPeople's Hospital of Zhengzhou Affiliated Henan University of Chinese MedicineZhengzhouChina
| | - Bangqun Ji
- Department of EndocrinologyXingyi People's HospitalXingyiChina
| | - Fengmei Xu
- Department of Endocrinology and Metabolism, Hebi Coal (group). LTDGeneral hospitalHebiChina
| | - Juan Shi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Ying Peng
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yifei Zhang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Tingting Shen
- Department of Endocrinology and Metabolism, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Rui Du
- Department of Endocrinology and Metabolism, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jiaying Yang
- Department of Endocrinology and Metabolism, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Mei Kang
- Clinical Research Center, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yongde Peng
- Department of Endocrinology and Metabolism, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yufan Wang
- Department of Endocrinology and Metabolism, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
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Animal-source foods as a suitable complementary food for improved physical growth in 6 to 24-month-old children in low- and middle-income countries: a systematic review and meta-analysis of randomised controlled trials. Br J Nutr 2022; 128:2453-2463. [PMID: 35109944 DOI: 10.1017/s0007114522000290] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Although animal-source foods are suitable complementary food for child growth in low- and middle-income countries (LMICs), their efficacy is still under discussion. This systematic review and meta-analysis was done to investigate the suitability of animal-source foods intake on child physical growth in LMICs. A systematic literature search was done using electronic databases and scanning the reference list of included studies, previous meta-analysis and systematic reviews. Paper selection was based on the PICO (ST) criteria. Papers were selected if based on 6 to 24-month-old children, if they were randomised controlled trials evaluating the effect of complementary animal-based food supplementation of any natural origin, if reporting at least a measure of body size and published after 2000. The PRISMA guidelines for reporting systematic review was followed in the paper selection. Fourteen papers were included in the systematic review and eight were considered for the meta-analysis. Animal-based food supplementation resulted in a higher length-for-age LAZ and weight-for-age (WAZ) Z-scores compared with the control group with random effect size of 0·15 (95 % CI 0·02, 0·27) and 0·20 (95 % CI 0·03, 0·36), respectively. Results were confirmed after influence analyses, and publication bias resulted as negligible. An increased effect on LAZ and WAZ was observed when the food supplementation was based on egg with effect size of 0·31 (95 % CI = -0·03, 0·64) and 0·36 (95 % CI = -0·03, 0·75), respectively. Animal-source foods are a suitable complementary food to improve growth in 6 to 24-month-old children in LMICs.
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Aoun R, Chokor FAZ, Taktouk M, Nasrallah M, Ismaeel H, Tamim H, Nasreddine L. Dietary fructose and its association with the metabolic syndrome in Lebanese healthy adults: a cross-sectional study. Diabetol Metab Syndr 2022; 14:29. [PMID: 35139893 PMCID: PMC8827166 DOI: 10.1186/s13098-022-00800-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Epidemiological studies investigating the association between dietary fructose intake and the metabolic syndrome (MetS) are scarce and have produced controversial findings. This study aimed at (1) assessing total dietary fructose intake in a sample of Lebanese healthy adults, and determining the intake levels of natural vs. added fructose; (2) investigating the association of dietary fructose with MetS; and (3) identifying the socioeconomic and lifestyle factors associated with high fructose intake. METHODS A cross-sectional survey was conducted on a representative sample of adults living in Beirut, Lebanon (n = 283). Anthropometric and biochemical data were collected, and dietary intake was assessed using a food frequency questionnaire. Intakes of naturally-occurring fructose from fructose-containing food sources, such as fruits, vegetables, honey, were considered as "natural fructose". Acknowledging that the most common form of added sugar in commodities is sucrose or High Fructose Corn Syrup (HFCS), 50% of added sugar in food products was considered as added fructose. Total dietary fructose intake was calculated by summing up natural and added fructose intakes. Logistic regression analyses were conducted to investigate the association of total, added and natural fructose intakes with the MetS and to identify the socioeconomic predictors of high fructose intake. RESULTS Mean intake of total fructose was estimated at 51.42 ± 35.54 g/day, representing 6.58 ± 3.71% of energy intakes (EI). Natural and added fructose intakes were estimated at 12.29 ± 8.57 and 39.12 ± 34.10 g/day (1.78 ± 1.41% EI and 4.80 ± 3.56% EI), respectively. Participants in the highest quartile of total and added fructose intakes had higher odds of MetS (OR = 2.84, 95%CI: 1.01, 7.94 and OR = 3.18, 95%CI: 1.06, 9.49, respectively). In contrast, natural fructose intake was not associated with MetS. Age, gender and crowding index were identified as factors that may modulate dietary fructose intakes. CONCLUSIONS The observed association between high added fructose intake and the MetS highlights the need for public health strategies aimed at limiting sugar intake from industrialized foods and promoting healthier dietary patterns in Lebanon.
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Affiliation(s)
- Rita Aoun
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Fatima Al Zahraa Chokor
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Mandy Taktouk
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Mona Nasrallah
- Department of Internal Medicine, Division of Endocrinology, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Vascular Medicine Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hussain Ismaeel
- Vascular Medicine Program, American University of Beirut Medical Center, Beirut, Lebanon
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
- Clinical Research Institute, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Lara Nasreddine
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon.
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Siegel KR, Albright AL. Population-Level Approaches to Preventing Type 2 Diabetes Globally. Endocrinol Metab Clin North Am 2021; 50:401-414. [PMID: 34399953 DOI: 10.1016/j.ecl.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Type 2 diabetes (T2DM) is increasingly considered an epidemic rooted in modern society as much as in individual behavior. Addressing the T2DM burden thus involves a dual approach, simultaneously addressing high-risk individuals and whole populations. Within this context, this article summarizes the evidence base, in terms of effectiveness and cost-effectiveness, for population-level approaches to prevent T2DM: (1) modifications to the food environment; (2) modifications to the built environment and physical activity; and (3) programs and policies to address social and economic factors. Existing knowledge gaps are also discussed.
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Affiliation(s)
- Karen R Siegel
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Highway Northeast, Atlanta, GA 30341, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Ann L Albright
- Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Highway Northeast, Atlanta, GA 30341, USA
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Kroemer G, López-Otín C, Madeo F, de Cabo R. Carbotoxicity-Noxious Effects of Carbohydrates. Cell 2019; 175:605-614. [PMID: 30340032 DOI: 10.1016/j.cell.2018.07.044] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/18/2018] [Accepted: 07/26/2018] [Indexed: 02/06/2023]
Abstract
Modern nutrition is often characterized by the excessive intake of different types of carbohydrates ranging from digestible polysaccharides to refined sugars that collectively mediate noxious effects on human health, a phenomenon that we refer to as "carbotoxicity." Epidemiological and experimental evidence combined with clinical intervention trials underscore the negative impact of excessive carbohydrate uptake, as well as the beneficial effects of reducing carbs in the diet. We discuss the molecular, cellular, and neuroendocrine mechanisms that link exaggerated carbohydrate intake to disease and accelerated aging as we outline dietary and pharmacologic strategies to combat carbotoxicity.
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Affiliation(s)
- Guido Kroemer
- Equipe 11 labellisée par la Ligue contre le Cancer, Centre de Recherche des Cordeliers, Paris, France; Cell Biology and Metabolomics Platforms, Gustave Roussy Cancer Campus, Villejuif, France; INSERM, U1138, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Université Pierre et Marie Curie, Paris, France; Pôle de Biologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Karolinska Institute, Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden.
| | - Carlos López-Otín
- Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Instituto Universitario de Oncología (IUOPA), Universidad de Oviedo, 33006 Oviedo, Spain; Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
| | - Frank Madeo
- Institute of Molecular Biosciences, NAWI Graz, University of Graz, Graz, Austria; BioTechMed Graz, Graz, Austria
| | - Rafael de Cabo
- Experimental Gerontology Section, Translational Gerontology Branch, National Institute on Aging, NIH, Baltimore, MD 21224, USA.
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Mirtschink P, Jang C, Arany Z, Krek W. Fructose metabolism, cardiometabolic risk, and the epidemic of coronary artery disease. Eur Heart J 2018; 39:2497-2505. [PMID: 29020416 PMCID: PMC6037111 DOI: 10.1093/eurheartj/ehx518] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 07/16/2017] [Accepted: 08/15/2017] [Indexed: 02/06/2023] Open
Abstract
Despite strong indications that increased consumption of added sugars correlates with greater risks of developing cardiometabolic syndrome (CMS) and cardiovascular disease (CVD), independent of the caloric intake, the worldwide sugar consumption remains high. In considering the negative health impact of overconsumption of dietary sugars, increased attention is recently being given to the role of the fructose component of high-sugar foods in driving CMS. The primary organs capable of metabolizing fructose include liver, small intestine, and kidneys. In these organs, fructose metabolism is initiated by ketohexokinase (KHK) isoform C of the central fructose-metabolizing enzyme KHK. Emerging data suggest that this tissue restriction of fructose metabolism can be rescinded in oxygen-deprived environments. In this review, we highlight recent progress in understanding how fructose metabolism contributes to the development of major systemic pathologies that cooperatively promote CMS and CVD, reference recent insights into microenvironmental control of fructose metabolism under stress conditions and discuss how this understanding is shaping preventive actions and therapeutic approaches.
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Affiliation(s)
- Peter Mirtschink
- Department of Biology, Institute of Molecular Health Sciences, ETH Zurich, Otto-Stern-Weg 7, Zurich, Switzerland
- Department of Clinical Pathobiochemistry, Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Dresden, Fetscherstr. 74, Dresden, Germany
| | - Cholsoon Jang
- Department of Medicine, Cardiovascular Institute and Institute Diabetes Obesity and Metabolism, Perelman School of Medicine, University of Pennsylvania, 11th floor, Civic Blvd, Philadelphia, 19104 PA, USA
| | - Zoltan Arany
- Department of Medicine, Cardiovascular Institute and Institute Diabetes Obesity and Metabolism, Perelman School of Medicine, University of Pennsylvania, 11th floor, Civic Blvd, Philadelphia, 19104 PA, USA
| | - Wilhelm Krek
- Department of Biology, Institute of Molecular Health Sciences, ETH Zurich, Otto-Stern-Weg 7, Zurich, Switzerland
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Siegel KR, Bullard KM, Imperatore G, Ali MK, Albright A, Mercado CI, Li R, Gregg EW. Prevalence of Major Behavioral Risk Factors for Type 2 Diabetes. Diabetes Care 2018; 41:1032-1039. [PMID: 29500166 PMCID: PMC6436527 DOI: 10.2337/dc17-1775] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 02/08/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We examined the proportion of American adults without type 2 diabetes that engages in lifestyle behaviors known to reduce type 2 diabetes risk. RESEARCH DESIGN AND METHODS We conducted a cross-sectional analysis of 3,679 nonpregnant, nonlactating individuals aged ≥20 years without diabetes (self-reported diagnosis or glycated hemoglobin ≥6.5% [8 mmol/mol] or fasting plasma glucose ≥126 mg/dL) and who provided 2 days of reliable dietary data in the 2007-2012 National Health and Nutrition Examination Surveys (NHANES). We used the average of 2 days of dietary recall and self-reported leisure-time physical activity to assess whether participants met type 2 diabetes risk reduction goals (meeting four or more MyPlate recommendations [adequate consumption of fruits, vegetables, dairy, grains, meat, beans, and eggs]; not exceeding three maximum allowances for alcoholic beverages, added sugars, fat, and cholesterol; and meeting physical activity recommendations [≥150 min/week]). RESULTS Approximately 21%, 29%, and 13% of individuals met fruit, vegetable, and dairy goals, respectively. Half (51.6%) met the goal for total grains, compared with 18% for whole grains, and 54.2% met the meat/beans goal and 40.6% met the oils goal. About one-third (37.8%) met the physical activity goal, and 58.6% met the weight loss/maintenance goal. Overall, 3.1% (95% CI 2.4-4.0) of individuals met the majority of type 2 diabetes risk reduction goals. Younger age and lower educational attainment were associated with lower probability of meeting goals. CONCLUSIONS A small proportion of U.S. adults engages in risk reduction behaviors. Research and interventions targeted at young and less-educated segments of the population may help close gaps in risk reduction behaviors.
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Affiliation(s)
- Karen R Siegel
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kai McKeever Bullard
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Mohammed K Ali
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Ann Albright
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Carla I Mercado
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Rui Li
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Edward W Gregg
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge AW, Malanda B. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract 2018; 138:271-281. [PMID: 29496507 DOI: 10.1016/j.diabres.2018.02.023] [Citation(s) in RCA: 3953] [Impact Index Per Article: 658.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 02/16/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Since the year 2000, IDF has been measuring the prevalence of diabetes nationally, regionally and globally. AIM To produce estimates of the global burden of diabetes and its impact for 2017 and projections for 2045. METHODS A systematic literature review was conducted to identify published studies on the prevalence of diabetes, impaired glucose tolerance and hyperglycaemia in pregnancy in the period from 1990 to 2016. The highest quality studies on diabetes prevalence were selected for each country. A logistic regression model was used to generate age-specific prevalence estimates or each country. Estimates for countries without data were extrapolated from similar countries. RESULTS It was estimated that in 2017 there are 451 million (age 18-99 years) people with diabetes worldwide. These figures were expected to increase to 693 million) by 2045. It was estimated that almost half of all people (49.7%) living with diabetes are undiagnosed. Moreover, there was an estimated 374 million people with impaired glucose tolerance (IGT) and it was projected that almost 21.3 million live births to women were affected by some form of hyperglycaemia in pregnancy. In 2017, approximately 5 million deaths worldwide were attributable to diabetes in the 20-99 years age range. The global healthcare expenditure on people with diabetes was estimated to be USD 850 billion in 2017. CONCLUSION The new estimates of diabetes prevalence, deaths attributable to diabetes and healthcare expenditure due to diabetes present a large social, financial and health system burden across the world.
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Affiliation(s)
- N H Cho
- International Diabetes Federation, Chaussee de la Hulpe 166, Brussels, Belgium; Department of Preventive Medicine, Ajou University School of Medicine, 164 World Cup-ro, Suwon, South Korea.
| | - J E Shaw
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Australia.
| | - S Karuranga
- International Diabetes Federation, Chaussee de la Hulpe 166, Brussels, Belgium.
| | - Y Huang
- International Diabetes Federation, Chaussee de la Hulpe 166, Brussels, Belgium.
| | | | - A W Ohlrogge
- International Diabetes Federation, Chaussee de la Hulpe 166, Brussels, Belgium.
| | - B Malanda
- International Diabetes Federation, Chaussee de la Hulpe 166, Brussels, Belgium.
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Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho NH, Cavan D, Shaw JE, Makaroff LE. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract 2017; 128:40-50. [PMID: 28437734 DOI: 10.1016/j.diabres.2017.03.024] [Citation(s) in RCA: 2294] [Impact Index Per Article: 327.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 03/26/2017] [Indexed: 02/06/2023]
Abstract
AIM To produce current estimates of the national, regional and global impact of diabetes for 2015 and 2040. METHODS A systematic literature review was conducted to identify data sources on the prevalence of diabetes from studies conducted in the period from 1990 to 2015. An analytic hierarchy process was used to select the most appropriate studies for each country, and estimates for countries without data were modelled using extrapolation from similar countries that had available data. A logistic regression model was used to generate smoothed age-specific estimates, which were applied to UN population estimates. RESULTS 540 data sources were reviewed, of which 196 sources from 111 countries were selected. In 2015 it was estimated that there were 415 million (uncertainty interval: 340-536 million) people with diabetes aged 20-79years, 5.0 million deaths attributable to diabetes, and the total global health expenditure due to diabetes was estimated at 673 billion US dollars. Three quarters (75%) of those with diabetes were living in low- and middle-income countries. The number of people with diabetes aged 20-79years was predicted to rise to 642 million (uncertainty interval: 521-829 million) by 2040. CONCLUSION Diabetes prevalence, deaths attributable to diabetes, and health expenditure due to diabetes continue to rise across the globe with important social, financial and health system implications.
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Affiliation(s)
- K Ogurtsova
- International Diabetes Federation, Chaussee de la Hulpe 166, Brussels, Belgium
| | | | - Y Huang
- International Diabetes Federation, Chaussee de la Hulpe 166, Brussels, Belgium.
| | - U Linnenkamp
- International Diabetes Federation, Chaussee de la Hulpe 166, Brussels, Belgium
| | - L Guariguata
- International Diabetes Federation, Chaussee de la Hulpe 166, Brussels, Belgium.
| | - N H Cho
- International Diabetes Federation, Chaussee de la Hulpe 166, Brussels, Belgium; Department of Preventive Medicine, Ajou University School of Medicine, 164 World Cup-ro, Suwon, South Korea.
| | - D Cavan
- International Diabetes Federation, Chaussee de la Hulpe 166, Brussels, Belgium.
| | - J E Shaw
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Australia.
| | - L E Makaroff
- International Diabetes Federation, Chaussee de la Hulpe 166, Brussels, Belgium; Department of Microbiology and Immunology, University of Leuven, Herestraat 49, Leuven, Belgium.
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Karimabad MN, Khoramdelazad H, Hassanshahi G. Genetic variation, biological structure, sources, and fundamental parts played by CXCL12 in pathophysiology of type 1 diabetes mellitus. Int J Diabetes Dev Ctries 2016. [DOI: 10.1007/s13410-016-0534-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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11
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Green R, Sutherland J, Dangour AD, Shankar B, Webb P. Global dietary quality, undernutrition and non-communicable disease: a longitudinal modelling study. BMJ Open 2016; 6:e009331. [PMID: 26758259 PMCID: PMC4716260 DOI: 10.1136/bmjopen-2015-009331] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 11/11/2015] [Accepted: 11/13/2015] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To determine the relationship between global dietary energy availability and dietary quality, and nutrition-related health outcomes. DESIGN A worldwide longitudinal modelling study using country-level data. Data on total dietary energy availability and dietary energy from 10 distinct food groups (as a proxy for dietary quality) were obtained from the FAO Food Balance Sheets database. Indicators of development were abstracted from the World Bank's World Development Indicators database. Data on nutrition and health outcomes were taken from the WHO mortality database and major cross-country analyses. We investigated associations of energy availability from food groups and health and nutrition outcomes in the combined data set using mixed effects models, while adjusting for measures of development. POPULATION 124 countries over the period 1980-2009. MAIN OUTCOME MEASURES Prevalence of stunting in children under 5 years and mortality rate from ischaemic heart disease (IHD) in adults aged 55+ years. RESULTS From 1980 to 2009, global dietary energy availability increased, and rates of child stunting and adult IHD mortality declined. After adjustment for measures of development, increased total dietary energy availability was significantly associated with reduced stunting rates (-0.84% per 100 kcal increase in energy, 95% CI -0.97 to -0.72) and non-significantly associated with increased IHD mortality rates (by 4.2 deaths per 100,000/100 kcal increase, 95% CI -1.85 to 10.2). Further analysis demonstrated that the changing availability of energy from food groups (particularly fruit, vegetables, starchy roots, meat, dairy and sugar) was important in explaining the associations with health outcomes. CONCLUSIONS Our study has demonstrated that by combining large, publicly available data sets, important patterns underlying trends in diet-related health can be uncovered. These associations remain even after accounting for measures of development over a 30-year period. Further work and joined-up multisectoral thinking will be required to translate these patterns into policies that can improve nutrition and health outcomes globally.
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Affiliation(s)
- Rosemary Green
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH), London, UK
| | - Jennifer Sutherland
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH), London, UK
| | - Alan D Dangour
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH), London, UK
| | - Bhavani Shankar
- Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH), London, UK
- Centre for Development, Environment and Policy, School of Oriental and African Studies, London, UK
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
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Laher I. Diabetes and the Arab nations: have we reached a tipping point, and how do we silence the alarm? IEEE Pulse 2015; 5:26-9. [PMID: 24838207 DOI: 10.1109/mpul.2014.2309576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Siegel KR, Ali MK, Srinivasiah A, Nugent RA, Narayan KMV. Do we produce enough fruits and vegetables to meet global health need? PLoS One 2014; 9:e104059. [PMID: 25099121 PMCID: PMC4123909 DOI: 10.1371/journal.pone.0104059] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 07/09/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Low fruit and vegetable (FV) intake is a leading risk factor for chronic disease globally, but much of the world's population does not consume the recommended servings of FV daily. It remains unknown whether global supply of FV is sufficient to meet current and growing population needs. We sought to determine whether supply of FV is sufficient to meet current and growing population needs, globally and in individual countries. METHODS AND FINDINGS We used global data on agricultural production and population size to compare supply of FV in 2009 with population need, globally and in individual countries. We found that the global supply of FV falls, on average, 22% short of population need according to nutrition recommendations (supply:need ratio: 0.78 [Range: 0.05-2.01]). This ratio varies widely by country income level, with a median supply:need ratio of 0.42 and 1.02 in low-income and high-income countries, respectively. A sensitivity analysis accounting for need-side food wastage showed similar insufficiency, to a slightly greater extent (global supply:need ratio: 0.66, varying from 0.37 [low-income countries] to 0.77 [high-income countries]). Using agricultural production and population projections, we also estimated supply and need for FV for 2025 and 2050. Assuming medium fertility and projected growth in agricultural production, the global supply:need ratio for FV increases slightly to 0.81 by 2025 and to 0.88 by 2050, with similar patterns seen across country income levels. In a sensitivity analysis assuming no change from current levels of FV production, the global supply:need ratio for FV decreases to 0.66 by 2025 and to 0.57 by 2050. CONCLUSION The global nutrition and agricultural communities need to find innovative ways to increase FV production and consumption to meet population health needs, particularly in low-income countries.
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Affiliation(s)
- Karen R. Siegel
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
- Hubert Department of Global Health, Emory University, Atlanta, Georgia, United States of America
| | - Mohammed K. Ali
- Hubert Department of Global Health, Emory University, Atlanta, Georgia, United States of America
| | - Adithi Srinivasiah
- Emory College, Emory University, Atlanta, Georgia, United States of America
| | - Rachel A. Nugent
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - K. M. Venkat Narayan
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
- Hubert Department of Global Health, Emory University, Atlanta, Georgia, United States of America
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Stanhope KL, Schwarz JM, Havel PJ. Adverse metabolic effects of dietary fructose: results from the recent epidemiological, clinical, and mechanistic studies. Curr Opin Lipidol 2013; 24:198-206. [PMID: 23594708 PMCID: PMC4251462 DOI: 10.1097/mol.0b013e3283613bca] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The effects of dietary sugar on risk factors and the processes associated with metabolic disease remain a controversial topic, with recent reviews of the available evidence arriving at widely discrepant conclusions. RECENT FINDINGS There are many recently published epidemiological studies that provide evidence that sugar consumption is associated with metabolic disease. Three recent clinical studies, which investigated the effects of consuming relevant doses of sucrose or high-fructose corn syrup along with ad libitum diets, provide evidence that consumption of these sugars increase the risk factors for cardiovascular disease and metabolic syndrome. Mechanistic studies suggest that these effects result from the rapid hepatic metabolism of fructose catalyzed by fructokinase C, which generates substrate for de novo lipogenesis and leads to increased uric acid levels. Recent clinical studies investigating the effects of consuming less sugar, via educational interventions or by substitution of sugar-sweetened beverages for noncalorically sweetened beverages, provide evidence that such strategies have beneficial effects on risk factors for metabolic disease or on BMI in children. SUMMARY The accumulating epidemiological evidence, direct clinical evidence, and the evidence suggesting plausible mechanisms support a role for sugar in the epidemics of metabolic syndrome, cardiovascular disease, and type 2 diabetes.
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Affiliation(s)
- Kimber L Stanhope
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, Davis, California 95616, USA.
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The relationship of sugar to population-level diabetes prevalence: an econometric analysis of repeated cross-sectional data. PLoS One 2013; 8:e57873. [PMID: 23460912 PMCID: PMC3584048 DOI: 10.1371/journal.pone.0057873] [Citation(s) in RCA: 217] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 01/29/2013] [Indexed: 02/07/2023] Open
Abstract
While experimental and observational studies suggest that sugar intake is associated with the development of type 2 diabetes, independent of its role in obesity, it is unclear whether alterations in sugar intake can account for differences in diabetes prevalence among overall populations. Using econometric models of repeated cross-sectional data on diabetes and nutritional components of food from 175 countries, we found that every 150 kcal/person/day increase in sugar availability (about one can of soda/day) was associated with increased diabetes prevalence by 1.1% (p <0.001) after testing for potential selection biases and controlling for other food types (including fibers, meats, fruits, oils, cereals), total calories, overweight and obesity, period-effects, and several socioeconomic variables such as aging, urbanization and income. No other food types yielded significant individual associations with diabetes prevalence after controlling for obesity and other confounders. The impact of sugar on diabetes was independent of sedentary behavior and alcohol use, and the effect was modified but not confounded by obesity or overweight. Duration and degree of sugar exposure correlated significantly with diabetes prevalence in a dose-dependent manner, while declines in sugar exposure correlated with significant subsequent declines in diabetes rates independently of other socioeconomic, dietary and obesity prevalence changes. Differences in sugar availability statistically explain variations in diabetes prevalence rates at a population level that are not explained by physical activity, overweight or obesity.
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