Skip to main content
×
Home
    • Aa
    • Aa

Nutritional determinants of worldwide diabetes: an econometric study of food markets and diabetes prevalence in 173 countries

  • Sanjay Basu (a1) (a2) (a3), David Stuckler (a3) (a4), Martin McKee (a3) and Gauden Galea (a5)
Abstract
AbstractObjective

Ageing and urbanization leading to sedentary lifestyles have been the major explanations proposed for a dramatic rise in diabetes worldwide and have been the variables used to predict future diabetes rates. However, a transition to Western diets has been suggested as an alternative driver. We sought to determine what socio-economic and dietary factors are the most significant population-level contributors to diabetes prevalence rates internationally.

Design

Multivariate regression models were used to study how market sizes of major food products (sugars, cereals, vegetable oils, meats, total joules) corresponded to diabetes prevalence, incorporating lagged and cumulative effects. The underlying social determinants of food market sizes and diabetes prevalence rates were also studied, including ageing, income, urbanization, overweight prevalence and imports of foodstuffs.

Setting

Data were obtained from 173 countries.

Subjects

Population-based survey recipients were the basis for diabetes prevalence and food market data.

Results

We found that increased income tends to increase overall food market size among low- and middle-income countries, but the level of food importation significantly shifts the content of markets such that a greater proportion of available joules is composed of sugar and related sweeteners. Sugar exposure statistically explained why urbanization and income have been correlated with diabetes rates.

Conclusions

Current diabetes projection methods may estimate future diabetes rates poorly if they fail to incorporate the impact of nutritional factors. Imported sugars deserve further investigation as a potential population-level driver of global diabetes.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Nutritional determinants of worldwide diabetes: an econometric study of food markets and diabetes prevalence in 173 countries
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Nutritional determinants of worldwide diabetes: an econometric study of food markets and diabetes prevalence in 173 countries
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Nutritional determinants of worldwide diabetes: an econometric study of food markets and diabetes prevalence in 173 countries
      Available formats
      ×
Copyright
Corresponding author
*Corresponding author: Email sanjay.basu@ucsf.edu
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

2.H King & M Rewers (1993) Global estimates for prevalence of diabetes mellitus and impaired glucose tolerance in adults. WHO Ad Hoc Diabetes Reporting Group. Diabetes Care 16, 157177.

3.J Shaw , RA Sicree & PZ Zimmet (2010) Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 87, 414.

6.AM Prentice (2006) The emerging epidemic of obesity in developing countries. Int J Epidemiol 35, 9399.

7.P Hossain , B Kawar & M El Nahas (2007) Obesity and diabetes in the developing world – a growing challenge. N Engl J Med 356, 213215.

8.JC Seidell (2000) Obesity, insulin resistance and diabetes – a worldwide epidemic. Br J Nutr 83, Suppl. 1, S5S8.

10.A Ramachandran , C Snehalatha , S Mary et al. (1997) The Indian diabetes prevention programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia 49, 289297.

11.K Brownell , T Farley , WC Willett et al. (2009) The public health and economic benefits of taxing sugar-sweetened beverages. N Engl J Med 361, 15991605.

12.K Brownell & TR Frieden (2009) Ounces of prevention – the public policy case for taxes on sugared beverages. N Engl J Med 360, 18051808.

13.J Salmeron , JE Manson , MJ Stampfer et al. (1997) Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. JAMA 277, 472477.

14.J Salmeron , A Ascherio , EB Rimm et al. (1997) Dietary fiber, glycemic load, and risk of NIDDM in men. Diabetes Care 20, 545550.

15.DS Ludwig (2002) The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA 287, 24142423.

16.DM Mourao , J Bressan , WW Campbell et al. (2007) Effects of food form on appetite and energy intake in lean and obese young adults. Int J Obes (Lond) 31, 16881695.

17.MB Schulze , JE Manson , DS Ludwig et al. (2004) Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA 292, 927934.

22.W Yang , J Lu , W Jia et al. (2010) Prevalence of diabetes among men and women in China. N Engl J Med 362, 10901101.

23.J Diamond (2011) Medicine: diabetes in India. Nature 469, 478479.

24.A Ramachandran , S Mary , A Yamuna et al. (2008) High prevalence of diabetes and cardiovascular risk factors associated with urbanization in India. Diabetes Care 31, 893898.

25.H King , RE Aubert & WM Herman (1998) Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care 21, 14141431.

26.S Yusuf , S Reddy , S Ounpuu et al. (2001) Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation 104, 27462753.

27.A Drewnowski & BM Popkin (1997) The nutrition transition: new trends in the global diet. Nutr Rev 55, 3143.

28.KS Reddy & S Yusuf (1998) Emerging epidemic of cardiovascular disease in developing countries. Circulation 97, 596601.

30.K Brownell & KE Warner (2009) The perils of ignoring history: Big Tobacco played dirty and millions died. How similar is Big Food? Milbank Q 87, 259294.

31.D Stuckler (2008) Population causes and consequences of leading chronic diseases: a comparative analysis of prevailing explanations. Milbank Q 86, 273326.

36.G Danaei , MM Finucane , Y Lu et al. (2011) National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet 378, 3140.

38.B Popkin (2002) What is unique about the experience in lower- and middle-income less-industrialised countries compared with the very-high income countries? The shift in the stages of the nutrition transition differs from past experiences! Public Health Nutr 5, 205214.

39.KS Reddy (2002) Cardiovascular diseases in the developing countries: dimensions, determinants, dynamics and directions for public health action. Public Health Nutr 5, 231237.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Type Description Title
WORD
Supplementary Materials

Basu Supplementary Material
Supplementary Material

 Word (804 KB)
804 KB