title: Reducing the global burden of type 2 diabetes by improving the quality of staple foods: The Global Nutrition and Epidemiologic Transition Initiative.
abstract: BACKGROUND
  The prevalence of type 2 diabetes has been reaching epidemic proportions across the globe, affecting low/middle-income and developed countries. Two main contributors to this burden are the reduction in mortality from infectious conditions and concomitant negative changes in lifestyles, including diet. We aimed to depict the current state of type 2 diabetes worldwide in light of the undergoing epidemiologic and nutrition transition, and to posit that a key factor in the nutrition transition has been the shift in the type and processing of staple foods, from less processed traditional foods to highly refined and processed carbohydrate sources.
  
  
  CONCLUSIONS
  We showed data from 11 countries participating in the Global Nutrition and Epidemiologic Transition Initiative, a collaborative effort across countries at various stages of the nutrition-epidemiologic transition whose mission is to reduce diabetes by improving the quality of staple foods through culturally-appropriate interventions. We depicted the epidemiologic transition using demographic and mortality data from the World Health Organization, and the nutrition transition using data from the Food and Agriculture Organization food balance sheets. Main staple foods (maize, rice, wheat, pulses, and roots) differed by country, with most countries undergoing a shift in principal contributors to energy consumption from grains in the past 50 years. Notably, rice and wheat products accounted for over half of the contribution to energy consumption from staple grains, while the trends for contribution from roots and pulses generally decreased in most countries. Global Nutrition and Epidemiologic Transition Initiative countries with pilot data have documented key barriers and motivators to increase intake of high-quality staple foods. Global research efforts to identify and promote intake of culturally-acceptable high-quality staple foods could be crucial in preventing diabetes. These efforts may be valuable in shaping future research, community interventions, and public health and nutritional policies.
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA. jmattei@hsph.harvard.edu.
authors.forename: Josiemer
authors.initials: J
authors.lastname: Mattei
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA. vmalik@hsph.harvard.edu.
authors.forename: Vasanti
authors.initials: V
authors.lastname: Malik
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA. nwedick@hsph.harvard.edu.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Wedick
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA. fhu@hsph.harvard.edu.|Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA. fhu@hsph.harvard.edu.
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA. stdls@hsph.harvard.edu.|Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA. stdls@hsph.harvard.edu.
authors.forename: Donna
authors.initials: D
authors.lastname: Spiegelman
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA. wwillett@hsph.harvard.edu.|Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA. wwillett@hsph.harvard.edu.
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA. hcampos@hsph.harvard.edu.
authors.forename: Hannia
authors.initials: H
authors.lastname: Campos
mesh_terms: D017281:Cost of Illness; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D004040:Dietary Carbohydrates / Q000592:standards; D006801:Humans; D038622:Internationality; D009753:Nutritive Value; D058996:Quality Improvement
chemical_list: D004040:Dietary Carbohydrates