The global burden of type 2 diabetes attributable to high body mass index in 204 countries and territories, 1990-2019: An analysis of the Global Burden of Disease Study

Principal components of type 2 diabetes risk: an exploratory factor analysis in an Iranian cohort

BACKGROUND

The significance of interrelated risk factors for Type 2 diabetes (T2D) is not easily demonstrated by conventional statistical methods. This study aims to investigate the principal components of T2D risk by employing exploratory factor analysis in Iranian cohort. The analysis encompasses a range of sociodemographic, lifestyle, and health-related variables to uncover clusters of factors associated with the risk of T2D.

METHODS

Cross-sectional data of 1200 diabetic and 1200 nondiabetic Iranian adults was analyzed using STATA 14.2 (p < 0.05). Pearson's Chi-squared test was used to assess the difference between the two groups. Spearman correlation explored the relationships between variables. Separate factor analyses were conducted for diabetic, non-diabetic, and combined groups. Principal component analysis (PCA) identified the initial components. Crude and adjusted logistic regressions examined the associations between derived factors and T2D risk.

RESULTS

PCA identified eleven components with eigenvalues ≥ 1, accounting for 65.09% of the variance. Logistic regression analysis highlighted several significant associations with T2D risk. Positive associations were observed for PC1 ("drugs, smoking, and alcohol"), PC2 ("chronic diseases", including age, hypertension, dyslipidemia, and coronary heart disease), PC3 ("lipids", such as triglycerides, cholesterol, and low-density lipoprotein), PC4 ("body mass", including BMI, waist circumference, and waist-to-hip ratio), PC5 ("gestational-related risks", such as gestational diabetes and gestational hypertension), and PC6 ("glucose/lipid factors", including fasting glucose, triglycerides, and an inverse relationship with high-density lipoprotein). Conversely, negative associations with T2D risk were found for PC7 ("socioeconomic factors", such as socioeconomic status and education), PC8 (inverse association with age, along with fatty liver, thyroid disorders, and low waist-to-hip ratio), and PC10 (marital status, sleep duration, low fasting glucose, lower age, and an inverse association with fatty liver).

CONCLUSIONS

Key metabolic clusters, including "Lipids", "Body Mass", "Chronic Diseases", and "Glucose/Lipid" align with previous findings. These results underscore the multifactorial and interconnected nature of T2D risk, highlighting underlying physiological processes.

Burden of diseases attributable to excess body weight in 204 countries and territories, 1990-2019

BACKGROUND

To investigate the global, regional, and national burden of the diseases attributable to excess body weight (EBW) from 1990 to 2019, stratified by age, sex, underlying cause, and sociodemographic index (SDI).

METHODS

Using the Comparative Risk Assessment approach of the Global Burden of Disease (GBD) study 2019, the burden of diseases attributable to EBW was reported for the period from 1990 to 2019. For adults, EBW was defined as a body mass index (BMI) exceeding 25 kg/m2, while for children aged 1 to 19 years, EBW was determined according to the standards set by the International Obesity Taskforce. The burden was reported in terms of numbers, proportions, and age-standardised rates per 100,000, accompanied by corresponding 95% uncertainty intervals (UIs).

RESULTS

In 2019, there were an estimated 5.0 million deaths (95% UI: 3.2-7.1) and 160.3 million DALYs (106.0-218.9) attributable to EBW worldwide. The age-standardised DALY rate attributable to EBW increased by 18.0% (2.2-42.3) from 1990 to 2019, with notable regional variations. Southeast Asia and South Asia exhibited the highest age-standardised DALY rates. Conversely, the age-standardised death rate due to EBW showed no significant change, with an increase of 4.9% (-7.3 to 24.6) over the same period. Significant regional variations were again observed, particularly in Southeast Asia and South Asia, which recorded the highest age-standardised death rates. Moreover, a non-linear association was observed between the SDI and the regional age-standardised DALY rate of diseases attributable to EBW.

CONCLUSIONS

The global burden of EBW has increased over the past three decades. This trend aligns with socio-demographic indices and is influenced by the physical activity levels and dietary habits of these populations.

Identification of genetic loci enriched in obese or lean T2D cases in the Korean population

BACKGROUND

Obesity causes many complex diseases including type 2 diabetes (T2D). Obesity increases the risk of T2D in Europeans, but there are many non-obese (lean) T2D patients in East Asia.

OBJECTIVE

To discover genetic factors enriched in obese or lean T2D patients, we conducted a genome-wide association (GWA) analysis for T2D stratified by BMI in the Korean population.

METHODS

In the discovery stage, 654 and 247 individuals classified as obese (BMI > 25) and lean (BMI < 23) T2D patients, respectively, were compared with 3,842 control subjects for GWA analysis. Several BMI-stratified T2D variants detected in the discovery stage were further tested in the replication stage, which included 402 obese and 220 lean T2D cases, and 3,615 controls.

RESULTS

Meta-analysis combining the discovery and replication stages detected two variants with genome-wide significance: rs2356138 [P = 2.8 × 10-8, OR = 2.06 (1.59-2.65)] in obese T2D subjects and rs9295478 [P = 2.5 × 10-9, OR = 1.61 (1.38-1.88)] in lean ones. The SNP rs9295478 is located in CDKAL1, a well-known T2D gene previously identified in several GWA studies. Meanwhile, the SNP rs2356138 is a previously unknown variant located in PKP4.

CONCLUSION

We discovered genetic loci enriched in obese or lean T2D patients in the Korean population. Our findings should facilitate more effective control of T2D in Koreans.

Effect of 3-year changes in adiposity measures on the pre-diabetes regression and progression: a community-based cohort study

AIM

We assessed the impact of a 3-year change-percent in adiposity measures on regression and pre-diabetes (Pre-DM) progression among Iranian adults.

METHODS

Three-year change-percent in body weight (BW), body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and visceral adiposity index (VAI) were calculated for 1458 Pre-DM subjects (mean age of 53.0 ± 13.7, 46.8% men), participated in the third examination of the Tehran Lipid and Glucose Study (2006-2008). Multinomial logistic regression models were used to estimate relative risk ratios (RRRs) of the outcomes [i.e., regression to normal glucose regulation (NGR), persistence in Pre-DM, and progression to newly diagnosed type 2 diabetes (T2D)] across 3-year change categories of adiposity measures (i.e., ≥ 5% decrease, 0-5% decrease, increase).

RESULTS

Over nine years of follow-up, 37.7 and 39.0% returned to NGR and progressed to T2D, respectively. Decreased BW (0-5 and ≥ 5%) was associated with regression to NGR (RRRs = 1.44, 95% CIs = 1.05-1.98, and 2.64, 1.63-4.28, respectively). Decreased BMI and WC ≥ 5% were also associated with regression to NGR (RRRs = 1.63, 95% CI = 1.01-2.64; 1.69, 1.20-2.37, respectively). Changes in WHR and VAI were not associated with Pre-DM regression or progression. Pre-DM subjects with ≥ 5% BW loss had a constant FSG level overtime and a lower overall mean of FSG (116 vs. 111 and 112 mg/dL, P = 0.023 and 0.009, respectively) and 2 h-SG (154 vs. 165 and 168 mg/dL) compared to those had 0-5% BW loss or BW gain.

CONCLUSION

Short-term management of adiposity measures increases the regression probability to NGR. Targeting BW loss seems a more potent predictor of Pre-DM reversion among the adiposity measures.

Global burden of type 2 diabetes in adolescents from 1990 to 2019

Purpose

To evaluate the burden of type 2 diabetes (T2D) among adolescents (15-24 years old) from 1990 to 2019.

Methods

The age-standardized incidence rate (ASIR) and disability-adjusted life years (DALYs) rate of adolescents were analyzed according to age, sex, geographical location, and sociodemographic index (SDI). The estimated annual percentage change (EAPC) was estimated to quantify the trends.

Results

From 1990 to 2019, the ASIR (EAPC = 1.07) and age-standardized DALY rate (EAPC = 2.01) of T2D in adolescents showed an increasing trend. The ASIR was higher in males than in females. The burden was greater in the 20-24-year age group. Of the five SDI regions, the highest ASIR and age-standardized DALY rate were found in low-middle-SDI regions, while the greatest increase in these rates was observed in high-SDI regions (EAPC = 3.28 and 3.55, respectively). Of the 21 regions analyzed, the highest ASIR and age-standardized DALY rate were found in Oceania. Of the 204 countries analyzed, the Marshall Islands (651.16) and Kiribati (277.42) had the highest ASIR and DALYs, respectively. The regions with the greatest increase in the ASIR from 1990 to 2019 were Western Europe (EAPC = 4.15), high-income North America (EAPC = 4.72).

Conclusions

The global burden of T2D in adolescents showed an overall upward trend from 1990 to 2019. It is necessary to strengthen prevention measures related to risk factors for T2D among young people, especially in areas with a low-to-medium SDI.

Low birthweight and overweight during childhood and young adulthood and the risk of type 2 diabetes in men: a population-based cohort study

AIMS/HYPOTHESIS

This study aimed to determine the relative contributions of low birthweight and overweight during childhood and young adulthood to the risk of type 2 diabetes in men.

METHODS

We included 34,231 men born between1945 and 1961 from the population-based BMI Epidemiology Study (BEST) Gothenburg with data on birthweight and overweight status in childhood (8 years, BMI >17.9 kg/m2) and young adulthood (20 years, BMI >25 kg/m2). Participants were followed from age 30 years until 31 December 2019. Information on type 2 diabetes diagnoses was retrieved from Swedish national registers. HRs and 95% CIs for the risk of early (≤59.4 years) and late (>59.4 years) type 2 diabetes were estimated using Cox proportional hazards regression.

RESULTS

During follow-up, a total of 2733 cases of type 2 diabetes were diagnosed. Birthweight below the median (<3.6 kg) and overweight at age 20 (BMI >25 kg/m2), but not overweight at age 8 (BMI >17.9 kg/m2), were associated with an increased risk of early and late type 2 diabetes. Of note, a birthweight below the median followed by overweight at age 20 years was associated with a substantially increased risk of early type 2 diabetes (HR 6.07, 95% CI 5.08, 7.27), and a low birthweight (≤2.5 kg) combined with overweight at age 20 years was associated with a massive risk of early type 2 diabetes (HR 9.94, 95% CI 6.57, 15.05).

CONCLUSIONS/INTERPRETATION

Low birthweight and overweight in young adulthood are the major developmental determinants of adult type 2 diabetes risk in men. They contribute in an additive manner to the risk of type 2 diabetes. To reduce the risk of type 2 diabetes, young adult overweight should be avoided, especially in boys with a low birthweight.

DATA AVAILABILITY

The SPSS analysis code, the R analysis code and a data dictionary have been made available in an online repository ( https://osf.io/bx2as/ ).

Global burden of osteoarthritis from 1990 to 2019 attributable to high body mass index

Introduction

The aim was to examine data from the Global Burden of Disease Study (GBD) 2019 to determine the global burden of osteoarthritis (OA) from 1990 to 2019 that is attributable to high body mass index (BMI).

Material and methods

Disability-adjusted life years (DALYs) and age-standardized DALY rates, and their corresponding estimated annual percentage changes (EAPCs), were used to compare estimated OA burdens between countries and regions. Moreover, a comparative risk assessment framework was used to estimate the risks attributable to high BMI in terms of DALYs.

Results

From 1990 to 2019, the age-standardized DALY rate for OA attributable to high BMI increased significantly (EAPC = 1.45, 95% CI: 1.44-1.47). Moreover, from 1990 to 2019, the age-standardized DALY rate and number of DALYs for OA attributable to high BMI increased less in women than in men. From 1990 to 2019, the age-standardized DALY rate for OA attributable to high BMI increased the most in South Asia (EAPC = 3.94). From 1990 to 2019, among 204 countries worldwide, the age-standardized DALY rate for OA attributable to high BMI increased the most in Equatorial Guinea (EAPC = 7.42). Also, the burden was higher in high-sociodemographic index (SDI) regions than in low-SDI regions.

Conclusions

The global burden of OA attributable to high BMI increased significantly from 1990 to 2019. In particular, this burden was higher in women than in men; primarily affected middle-aged and older adults; and was generally greater in high-SDI regions than in low-SDI regions.

The global burden of periodontal diseases in 204 countries and territories from 1990 to 2019

AIMS

The aim of this study was to report the incidence, prevalence, and disability-adjusted life-years (DALYs) of periodontal diseases during the period 1990-2019.

METHODS

Data on periodontal diseases were retrieved from the Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2019. The estimated annual percentage changes were calculated to evaluate the changing trend of age-standardized incidence, prevalence, and DALY rates related to periodontal diseases.

RESULTS

Globally, there were 1,087,367,744.0 cases with 91,518,820.6 new incidence and 7,090,390.3 DALYs of periodontal diseases in 2019, almost twice as many as in 1990. Moreover, the pace of increase in age-standardized incidence, age-standardized prevalence, and age-standardized DALY rates had accelerated during the 1990-2019 time period, with EAPC of 0.29 (95% CI, 0.22 to 0.35), 0.34 (95% CI, 0.26 to 0.43), and 0.35 (95% CI, 0.27 to 0.44) separately. The corresponding age-standardized percentage changes were more pronounced in females, Southeast Asia, and low-middle SDI regions. Western Sub-Saharan Africa was the high-risk area of standardized periodontal diseases burden in 2019, among which Gambia was the country with the heaviest burden.

CONCLUSION

The globally incidence, prevalence, and DALYs of periodontal diseases are substantially increased from 1990 to 2019, which highlights the importance and urgency of periodontal care.

Assessing the Global, Regional, and National Impact of High Body Mass Index on Alzheimer's Disease and Other Dementias Between 1990 and 2019

BACKGROUND

Obesity significantly increases Alzheimer's disease (AD) and dementia risk. Understanding the link between a high body mass index (BMI) and these conditions is crucial for effective management and prevention.

OBJECTIVE

We aimed to estimate the burden of AD and other dementias attributed to high BMI from 1990 to 2019 based on sex, age, and socio-demographic indicators (SDI) at global, regional, and national levels.

METHODS

We collected data on deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMR), and age-standardized DALY rates (ASDR) from the 2019 Global Burden of Disease study for AD and dementia attributed to high BMI. We explored the correlation between SDI levels and ASDR.

RESULTS

In 2019, there were 198,476.2 deaths (95% UI: 32,695.4-593,366.4) and 3,159,912.4 DALYs (848,330.5-8,042,531) attributed to high BMI. Numbers of deaths, DALYs, ASMR, and ASDR increased since 1990. Females had higher deaths, ASMR, and ASDR than males. Mortality and DALYs rates increased with age. ASMR and ASDR increased across five SDI levels, with the highest rise in Low-middle SDI. High-income North America had the most deaths [30,993.9 (5,101.7-89,912.9)], while North Africa and the Middle East had the highest ASMR [4.61 (0.79-13.64)] and ASDR [72.56 (20.98-181.16)] in 2019.

CONCLUSIONS

The burden of AD and other dementias attributed to high BMI increased since 1990 globally and is still heaviest in developed regions. Females accounted predominantly for the burden than males. Timely measures are needed to against high BMI.

The global burden of cardiovascular diseases and type 2 diabetes attributable to low physical activity, 1990-2019: an analysis from the global burden of disease study

Background

Cardiovascular diseases (CVD) and type 2 diabetes (T2D) account for the majority of the burden of noncommunicable disease caused by low physical activity (LPA). In order to inform future interventions, this study aims to assess the burden and trends in mortality and disability-adjusted life years (DALYs) of CVD and T2D attributable to LPA by year, location, sex, and age from 1990 to 2019.

Methods

Mortality, DALYs, and their age-standardised rates (ASMR, ASDR) for CVD and T2D attributable to LPA were retrieved from Global Burden of Disease (GBD) 2019. The estimated annual percentage changes (EAPCs) were calculated using linear regression model to describe the trend over time.

Results

From 1990 to 2019, the number of deaths caused by both CVD and T2D due to LPA increased significantly globally. However, the overall ASMR and ASDR for CVD declined over this same period [EAPC for ASMR (CVD) = -1.44 (95% CI: -1.50-1.38), EAPC for ASDR (CVD) = -1.30 (95% CI: -1.35 to -1.25)]. In terms of disparities, ASMR (CVD) and ASDR (CVD) in North Africa and the Middle East were consistently higher than the global average; also, the sex difference in ASMR was greatest in Central Asia. ASMR among people aged 25-44 in high Socio-Demographic Index (SDI) region has increased significantly over the past three decades. ASMR (T2D) due to LPA showed an increasing trend year by year, with EAPC = 0.26 (95% CI: 0.13-0.39), and this rate increased faster in males than in females. Consistent with cardiovascular diseases, ASMR of type 2 diabetes attributable to LPA increased among people aged 25-44, while decreased in other age groups in high SDI region.

Conclusion

Interventions targeting LPA are warranted in controlling the burden of cardiovascular diseases and type 2 diabetes. Countries should adapt strategies to their local contexts, considering the sex and age differences among their populations. The 25-44 age group should be given special attention to prevent the disease burden from worsening among younger people.

Burden of type 1 and type 2 diabetes and high fasting plasma glucose in Europe, 1990-2019: a comprehensive analysis from the global burden of disease study 2019

Introduction

With population aging rampant globally, Europe faces unique challenges and achievements in chronic disease prevention. Despite this, comprehensive studies examining the diabetes burden remain absent. We investigated the burden of type 1 and type 2 diabetes, alongside high fasting plasma glucose (HFPG), in Europe from 1990-2019, to provide evidence for global diabetes strategies.

Methods

Disease burden estimates due to type 1 and type 2 diabetes and HFPG were extracted from the GBD 2019 across Eastern, Central, and Western Europe. We analyzed trends from 1990 to 2019 by Joinpoint regression, examined correlations between diabetes burden and Socio-demographic indices (SDI), healthcare access quality (HAQ), and prevalence using linear regression models. The Population Attributable Fraction (PAF) was used to described diabetes risks.

Results

In Europe, diabetes accounted for 596 age-standardized disability-adjusted life years (DALYs) per 100,000 people in 2019, lower than globally. The disease burden from type 1 and type 2 diabetes was markedly higher in males and escalated with increasing age. Most DALYs were due to type 2 diabetes, showing regional inconsistency, highest in Central Europe. From 1990-2019, age-standardized DALYs attributable to type 2 diabetes rose faster in Eastern and Central Europe, slower in Western Europe. HFPG led to 2794 crude DALYs per 100,000 people in 2019. Type 1 and type 2 diabetes burdens correlated positively with diabetes prevalence and negatively with SDI and HAQ. High BMI (PAF 60.1%) and dietary risks (PAF 34.6%) were significant risk factors.

Conclusion

Europe's diabetes burden was lower than the global average, but substantial from type 2 diabetes, reflecting regional heterogeneity. Altered DALYs composition suggested increased YLDs. Addressing the heavy burden of high fasting plasma glucose and the increasing burden of both types diabetes necessitate region-specific interventions to reduce type 2 diabetes risk, improve healthcare systems, and offer cost-effective care.

The global, regional and national burden of type 2 diabetes mellitus in the past, present and future: a systematic analysis of the Global Burden of Disease Study 2019

Aim

To report the global, regional, and national burden of type 2 diabetes mellitus (T2DM) in 2019, assess its trends in the past, and forecast its trends in the future.

Methods

The main data source was the Global Burden of Disease 2019 database. We assessed the changes in T2DM burden from 1990 to 2019 with joinpoint regression analysis. Age-period-cohort analysis was used to forecast the T2DM incidence and mortality rate from 2020 to 2034.

Results

The burden of T2DM has increased from 1990 to 2019 generally. The low-middle socio-demographic index (SDI) region had the highest increase in age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years (ASDR) due to T2DM. Nationally, the increase in ASIR (r=0.151, p=0.046) and the decrease in ASMR (r=0.355, p<0.001) were positively correlated with SDIs. In 2019, the global ASIR, ASPR, ASMR, ASDR due to T2DM were 259.9 (95% UI 240.3-281.4), 5282.9 (95% UI 4853.6-5752.1), 18.5 (95% UI 17.2-19.7), and 801.5 (95% UI 55477000-79005200) per 100,000 population, respectively. Additionally, the ASIR (r=0.153, p=0.030) and ASPR (r=0.159, p=0.024) of T2DM were positively correlated with SDIs, while ASMR (r=-0.226, p=0.001) and ASDR (r=-0.171, p=0.015) due to T2DM were negatively correlated with SDIs. The ASIR was estimated to increase to 284.42, and ASMR was estimated to increase to 19.1 from 2030 to 2034, per 100,000 population.

Conclusion

Globally, the burden of T2DM has increased in the past and was forecast to continue increasing. Greater investment in T2DM prevention is needed.

Trends of the burden of type 2 diabetes mellitus attributable to high body mass index from 1990 to 2019 in China

Background

Overweight and obesity are well-known risk factors for developing type 2 diabetes (T2DM). However, details on the evolution of the T2DM burden attributed to China's high body mass index (BMI) in China have not been thoroughly studied. This study aimed to investigate the temporal trends of the T2DM burden attributable to a high BMI in China from 1990 to 2019 and to evaluate the independent effects of age, period, and cohort on the burden of T2DM attributed to a high BMI.

Methods

Data on T2DM burden attributable to a high BMI from 1990 to 2019 were obtained from the Global Burden of Disease Study 2019. Deaths, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) of T2DM attributable to a high BMI were estimated by age and sex. The joinpoint regression model was performed to calculate the annual percentage change (APC) and the average annual percentage change (AAPC) in the burden of T2DM attributed to a high BMI. The age-period-cohort analysis was applied to estimate the independent effects of age, period, and cohort on the temporal trends of mortality and the DALY rate.

Results

In 2019, deaths and DALYs from T2DM attributable to a high BMI in China were 47.53 thousand and 3.74 million, respectively, five times higher than in 1990. Among those under 60 years of age, men had higher deaths and DALYs than women, while the gender differences reversed in those over 60 years of age. Furthermore, the ASMR and ASDR in 2019 were 2.39 per 100,000 (95%UI 1.12-3.90) and 181.54 per 100,000 (95%UI 93.71-286.33), respectively, representing a 91% and 126% increase since 1990. In China, women previously had a higher ASMR and ASDR than men, while the differences in the ASMR and ASDR between the sexes were reversed in recent years. From 1990 to 2019, the ASMR in women increased before 2004 and then decreased from 2004 to 2015, and increased again after, with an overall AAPC value of 1.6%. In contrast, the ASMR in men continued to increase, with an overall AAPC value of 3.2%. The ASDR continued to increase in men and women, with AAPCs of 2.2% and 3.5%, respectively. The age effect showed that the relative risk of mortality increased with age in both men and women, except for the 75-84 age group. The impact of the age on the DALY rate revealed a trend of first rising and then decreasing, peaking at 65-69 years. The effect of the period on the burden of T2DM attributable to a high BMI increased from 1990 to 2019. The cohort effect generally showed a downward trend.

Conclusion

The burden of T2DM attributed to a high BMI in China increased substantially from 1990 to 2019, particularly in men. Therefore, there is an urgent need for gender- and age-based public health guidelines on prevention strategies, early diagnosis, and effective management of T2DM, overweight, and obesity in China.