The Impact of Suboptimal Diet on Type 2 Diabetes at Global, Regional, National, and Sub-National Levels: A Comparative Risk Assessment Analysis. (29th May 2020)

• Record Type: Journal Article
• Authors: O'Hearn, Meghan; Singh, Gitanjali; Cudhea, Frederick; Miller, Victoria; Zhang, Jianyi; Shi, Peilin; Reedy, Julia; Puklin, Leah; Micha, Renata; Mozaffarian, Dariush
• Is Part Of: Current developments in nutrition. Volume 4(2020)Supplement 2
• Page Start: 877
• Page End: 877
• Publication Date: 2020-05-29
• Subjects: Nutrition -- Periodicals; Nutritional Physiological Phenomena; Nutrition; Periodicals; Periodicals; Fulltext; Internet Resources; Periodicals; 612.3
• DOI: 10.1093/cdn/nzaa053_082
• Languages: English
• ISSNs: 2475-2991

Abstract

Abstract: Objectives: To prioritize dietary factors for reducing the growing burden of type 2 diabetes (T2D) worldwide, we estimated the impact of suboptimal diet on T2D incidence at global, regional, national, and subnational levels between 1990 and 2015. Methods: A comparative risk assessment framework estimated T2D incidence attributable to suboptimal diet in strata jointly stratified by year, nation, age, and sex, across 185 countries. We estimated direct (dietary composition) etiologic effects of 8 factors including nuts/seeds, whole grains, yogurt, processed meats, unprocessed red meats, glycemic load (estimated from refined grains), sugar-sweetened beverages (SSBs) and potatoes. Population demographics were from the United Nations; stratum-specific mean dietary intakes and distributions from Global Dietary Database (GDD), diet-T2D etiologic effects from meta-analyses of prospective cohort studies; and T2D incidence from the Global Burden of Disease study. These inputs and their uncertainties were used to calculate the stratum-specific population attributable fraction (PAF) and then absolute attributable cases, with joint effects estimated using multiplicative PAFs. Results: In 2015, suboptimal intakes of these 8 factors were jointly estimated to cause 10.9 million T2D cases (95% UI 7.2–15.3), representing 59.6% of all cases (39.3–83.3%) among adults age 25 + y globally. Low intake of whole grains (3.6 million cases (3.4–3.8)) followed by high intake of SSBs (2.7 million cases (2.5–2.9)) had the largest estimated attributable burdens. Across 7 world regions, highest diet-attributable burdens of T2D were in High Income Countries (2516 cases per million (2115, 2870)) and Former Soviet Union (2341 cases per million (1465, 2970)); and lowest in Sub-Saharan Africa (797 cases per million (333, 1435)). The proportion of T2D attributable to suboptimal diet was generally greater in males vs. females and in younger vs. older age groups. Results for specific countries, trends over time, and further sensitivity analyses will be presented. Conclusions: These novel findings provide the most updated estimates of diet-attributable T2D globally, helping to inform priorities for targeted healthcare system, policy, industry and public health interventions to reduce T2D. Funding Sources: Gates Foundation.