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Study links poor diet to 14 million cases of type 2 diabetes globally
Researchers from Tufts University estimate 7 out of 10 cases of type 2 diabetes worldwide in 2018 linked to food choices
A research model of dietary intake in 184 countries, developed by researchers at the Friedman School of Nutrition Science and Policy at Tufts University, estimates that poor diet contributed to over 14.1 million cases of type 2 diabetes in 2018, representing over 70% of new diagnoses globally. The analysis, which looked at data from 1990 and 2018, provides valuable insight into which dietary factors are driving type 2 diabetes burden by world region. The study was published April 17 in the journal Nature Medicine.
Of the 11 dietary factors considered, three had an outsized contribution to the rising global incidence of type 2 diabetes: Insufficient intake of whole grains, excesses of refined rice and wheat, and the overconsumption of processed meat. Factors such as drinking too much fruit juice and not eating enough non-starchy vegetables, nuts, or seeds, had less of an impact on new cases of the disease.
“Our study suggests poor carbohydrate quality is a leading driver of diet-attributable type 2 diabetes globally, and with important variation by nation and over time,” says senior author Dariush Mozaffarian, Jean Mayer Professor of Nutrition and dean for policy at the Friedman School. “These new findings reveal critical areas for national and global focus to improve nutrition and reduce devastating burdens of diabetes.”
Type 2 diabetes is characterized by the resistance of the body’s cells to insulin. Of the 184 countries included in the Nature Medicine study, all saw an increase in type 2 diabetes cases between 1990 and 2018, representing a growing burden on individuals, families, and healthcare systems.
The research team based their model on information from the Global Dietary Database, along with population demographics from multiple sources, global type 2 diabetes incidence estimates, and data on how food choices impact people living with obesity and type 2 diabetes from multiple published papers.
The analysis revealed that poor diet is causing a larger proportion of total type 2 diabetes incidence in men versus women, in younger versus older adults, and in urban versus rural residents at the global level.
Regionally, Central and Eastern Europe and Central Asia —particularly in Poland and Russia, where diets tend to be rich in red meat, processed meat, and potatoes —had the greatest number of type 2 diabetes cases linked to diet. Incidence was also high in Latin America and the Caribbean, especially in Colombia and Mexico, which was credited to high consumption of sugary drinks, processed meat, and low intake of whole grains.
Regions where diet had less of an impact on type 2 diabetes cases included South Asia and Sub-Sharan Africa —though the largest increases in type 2 diabetes due to poor diet between 1990 and 2018 were observed in Sub-Saharan Africa. Of the 30 most populated countries studied, India, Nigeria, and Ethiopia had the fewest case of type 2 diabetes related to unhealthy eating.
“Left unchecked and with incidence only projected to rise, type 2 diabetes will continue to impact population health, economic productivity, health care system capacity, and drive heath inequities worldwide,” says first author Meghan O’Hearn. She conducted this research while a PhD candidate at the Friedman School and currently works as Impact Director for Food Systems for the Future, a non-profit institute and for-profit fund that enables innovative food and agriculture enterprises to measurably improve nutrition outcomes for underserved and low-income communities. “These findings can help inform nutritional priorities for clinicians, policymakers, and private sector actors as they encourage healthier dietary choices that address this global epidemic.”
Other recent studies have estimated that 40% of type 2 diabetes cases globally are attributed to suboptimal diet, lower than the 70% reported in the Nature Medicine paper. The research team attributes this to the new information in their analysis, such as the first ever inclusion of refined grains, which was one of the top contributors to diabetes burdens; and updated data on dietary habits based on national individual-level dietary surveys, rather than agricultural estimates. The investigators also note that they presented the uncertainty of these new estimates, which can continue to be refined as new data emerges.
注释：
outsized: adj
表示" 特别大的"，means "larger than normal for its kind"，如：Immigrants continue to make an outsized contribution to the American economy. 移民依然在为美国经济做出超出比例的贡献。
starchy: adj
表示" 含淀粉的"，means "consisting of or containing starch"，如：He eat too much starchy food.他贪吃含淀粉多的食物。
devastating: adj
表示"毁灭性的；破坏性的"，means " completely destructive"，如：A smouldering cigarette can kindle a devastating bushfire. 闷燃着的香烟会引起毁灭性的林区大火。
insulin: n
表示"胰岛素"，means "hormone secreted by the isles of Langerhans in the pancreas"，如：They were all dependent on supplemental insulin. 他们都依赖于外源胰岛素。
demographic: n
表示" (尤指市场测算的)人口统计数据"，means "a statistic characterizing human populations "，如：The demographics of the Southwest indicate a growing population of older consumers. 西南部的人口统计状况显示了老年消费者数量的增长。
incidence: n
表示"发生(率)；"，means "extent to which sth happens or has an effect"，如：Each incidence of truancy will impact the citizenship credit. 每次发生玩忽职守事件都会影响公民的信用。
Inequity: n
表示" 不公平；不公正"，means "injustice by virtue of not conforming with rules or standards"，如：Reducing inequity is the highest human achievement. 减少不平等才是人类的最大成就。
Clinician: n
表示" 临床医生"，means "a practitioner (of medicine or psychology) who does clinical work instead of laboratory experiments"，如：Diagnosis and treatment of gastric cancer should attract clinician's attention. 临床医生必须重视胃癌的诊治。
suboptimal: adj
表示"未达最佳标准的；不最理想的"，如：This results in a suboptimal, but fixed, services model. 这会产生一个未达到最佳状态、却又固定的服务模型
中文简要说明：
最新美国研究显示，2018年全球1400万名第二型糖尿病（Type 2 Diabetes）患者罹病和不良饮食习惯有关，其中三大不良习惯包括吃太多精制碳水化合物、加工肉品，以及全谷类摄取不足。
综合美国塔夫兹大学（Tufts University）新闻稿、美国有线电视新闻网（CNN）、《纽约邮报》（New York Post）报导，国际学术期刊《自然医学》（Nature Medicine）17日刊登塔夫兹大学团队有关第二型糖尿病的相关研究，研究人员分别比对1990年与2018年全球184国第二型糖尿病患者的数目及饮食习惯，发现2018年全球1410万第二型糖尿病病例和不良饮食习惯有关，这项因素占全球新增病例的70%。报导指出，当胰脏无法产生足够的胰岛素，导致大量葡萄糖留在血液中，无法被人体消耗、产生能量，长期下来演变成第二型糖尿病。
研究人员一共分析11种饮食习惯，结果显示关联最大的前三项不良饮食习惯依序为全谷类摄取不足（占26.1%）、摄取过多精制米食及小麦（24.6%）、摄取过多加工肉品（20.3%）；相较之下，水果、非淀粉蔬菜、坚果、种子、优格等摄取不足仅占新增病例的39%。
整体而言，超过60%病例和摄取过多精制米食与小麦、加工肉品、未加工红肉、含糖饮料、马铃薯、果汁等6大类有害饮食因子有关。研究作者塔夫兹大学教授莫扎法利安（Dariush Mozaffarian）表示：「我们的研究显示，不良碳水化合物是全球饮食引起的第二型糖尿病主要因素。」
研究也发现，不同地区的饮食习惯也导致病例数有明显差异，饮食以马铃薯、红肉及加工肉品为主的波兰、俄罗斯，以及中欧、东欧、中亚地区的第二型糖尿病病例较高，拉丁美洲、加勒比海地区的病例数也不低，当中以哥伦比亚及墨西哥的病例数较高，主因在于当地人经常摄取含糖饮料及加工肉品，吃较少全谷类。
病例数也男女有别，男性患者多过女性，年轻患者多过老年人，城市病例多过乡村病例。 研究强调，研究中的模型无法证实饮食与患病的因果关系，应被视为「风险评估」。
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