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


METHODS
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.


METHODS
Data were obtained from 173 countries.


METHODS
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.
Department of Medicine, University of California San Francisco, 505 Parnassus Avenue, Room M-987, San Francisco, CA 94131, USA. sanjay.basu@ucsf.edu
Sanjay
S
Basu
David
D
Stuckler
Martin
M
McKee
Gauden
G
Galea
D000328:Adult; D000368:Aged; D003906:Developing Countries; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000209:etiology*; D004032:Diet / Q000009:adverse effects*; D019422:Dietary Sucrose / Q000009:adverse effects*; D002149:Energy Intake; D005247:Feeding Behavior; D005523:Food Supply; D014943:Global Health; D006801:Humans; D007182:Income; D038622:Internationality; D040541:Marketing; D008875:Middle Aged; D015999:Multivariate Analysis; D011203:Poverty; D015995:Prevalence; D012044:Regression Analysis; D012923:Social Class; D014507:Urbanization; D055815:Young Adult
D019422:Dietary Sucrose