Incident type 2 diabetes attributable to suboptimal diet in 184 countries
Meghan O’Hearn, Laura Lara-Castor, Frederick Cudhea, Victoria Miller, Julia Reedy, Peilin Shi, Jianyi Zhang, John B. Wong, Christina D. Economos, Renata Micha, Dariush Mozaffarian, Global Dietary Database, Murat Baş, Jemal Haidar, Suhad Abumweis, Anand Krishnan, Puneet Misra, Nahla Chawkat Hwalla, Chandrashekar Janakiram, Nur Indrawaty Liputo, Abdulrahman O. Musaiger, Farhad Pourfarzi, Iftikhar Alam, Karin DeRidder, Céline Termote, Anjum Memon, Aida Turrini, Elisabetta Lupotto, Raffaela Piccinelli, Stefania Sette, Karim Anzid, Marieke Vossenaar, Paramita Mazumdar, Ingrid Rached, Alicia Rovirosa, María Elisa Zapata, Tamene Taye Asayehu, Francis Oduor, Julia Boedecker, Lilian Aluso, Johana Ortíz‐Ulloa, J.V. Meenakshi, Michelle Alessandra de Castro, Giuseppe Grosso, Anna Waśkiewicz, Umber S. Khan, Anastasia Thanopoulou, Reza Malekzadeh, Neville Calleja, Marga C. Ocké, Zohreh Etemad, Mohannad Al Nsour, Lydiah M. Waswa, Eha Nurk, Joanne E Arsenault, Patricio López‐Jaramillo, Abla Mehio Sibai, Albertino Damasceno, Carukshi Arambepola, Carla Lopes, Mílton Severo, Nuno Lunet, Duarte Torres, Heli Tapanainen, Jaana Lindström, Suvi Μ. Virtanen, Cristina Palacios, Eva Roos, Imelda Angeles‐Agdeppa, Josie Desnacido, Mario V. Capanzana, Anoop Misra, Ilse Khouw, Swee Ai Ng, Edna Gamboa Delgado, Mauricio Caballero, Johanna Otero, Hae‐Jeung Lee, Eda Köksal, Idris Guessous, Carl Lachat, Stefaan De Henauw, Ali Reza Rahbar, Alison Tedstone, Androniki Naska, Angie Mathee, Annie Ling, Bemnet Tedla, Beth Hopping, Brahmam Ginnela, Catherine Leclercq, Charmaine Duante, Christian Haerpfer, Christine Hotz, Christos Pitsavos, Colin D. Rehm, Coline van Oosterhout, Corazon Cerdeña, Debbie Bradshaw, Dimitrios Trichopoulos
Abstract
The global burden of diet-attributable type 2 diabetes (T2D) is not well established. This risk assessment model estimated T2D incidence among adults attributable to direct and body weight-mediated effects of 11 dietary factors in 184 countries in 1990 and 2018. In 2018, suboptimal intake of these dietary factors was estimated to be attributable to 14.1 million (95% uncertainty interval (UI), 13.8-14.4 million) incident T2D cases, representing 70.3% (68.8-71.8%) of new cases globally. Largest T2D burdens were attributable to insufficient whole-grain intake (26.1% (25.0-27.1%)), excess refined rice and wheat intake (24.6% (22.3-27.2%)) and excess processed meat intake (20.3% (18.3-23.5%)). Across regions, highest proportional burdens were in central and eastern Europe and central Asia (85.6% (83.4-87.7%)) and Latin America and the Caribbean (81.8% (80.1-83.4%)); and lowest proportional burdens were in South Asia (55.4% (52.1-60.7%)). Proportions of diet-attributable T2D were generally larger in men than in women and were inversely correlated with age. Diet-attributable T2D was generally larger among urban versus rural residents and higher versus lower educated individuals, except in high-income countries, central and eastern Europe and central Asia, where burdens were larger in rural residents and in lower educated individuals. Compared with 1990, global diet-attributable T2D increased by 2.6 absolute percentage points (8.6 million more cases) in 2018, with variation in these trends by world region and dietary factor. These findings inform nutritional priorities and clinical and public health planning to improve dietary quality and reduce T2D globally.