Q&A: Poor diet caused 73% of type 2 diabetes cases in US in 2018
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Key takeaways:
- Most cases of type 2 diabetes in the United States in 2018 were due to poor diet, according to a new study.
- Healio spoke with the lead researcher to learn more about the study’s implications for PCPs.
Poor diet was responsible for seven in 10 new cases of type 2 diabetes worldwide in 2018, according to researchers.
Although it has long been known that diet “plays an outsized role” in type 2 diabetes risk, it was unclear how specific dietary factors contributed to the disease’s prevalence, Meghan O’Hearn, PhD, a doctoral researcher with the Friedman School of Nutrition Science and Policy at Tufts University, and colleagues wrote.
O’Hearn and colleagues conducted a comparative risk-assessment model to better understand the effects that 11 dietary factors — excess intake of refined rice and wheat, processed meats, unprocessed red meat, sugar-sweetened beverages, potatoes and fruit juice and insufficient intake of whole grains, yogurt, fruit, nuts and seeds, and non-starchy vegetables — had on the proportional and absolute burdens of new type 2 diabetes cases in 1990 and 2018.
They found that, in 2018, the global prevalence of diet-attributable type 2 diabetes rose by 2.6 absolute percentage points, translating to about 8.6 million more cases, compared with 1990.
O’Hearn and colleagues approximated that the suboptimal intake of the 11 dietary factors was responsible for about 14.1 million (95% UI, 13.8-14.4 million) incident cases of type 2 diabetes, representing 70.3% of new cases across the globe. Additionally, the largest burdens were linked to excess processed meat intake (20.3%), excess refined rice and wheat intake (24.6%) and insufficient whole-grain intake (26.1%).
The researchers also noted variations in the trends by dietary factor and world region, writing that their findings “inform dietary priorities and clinical and public health planning to improve dietary quality and reduce type 2 diabetes globally.”
Healio spoke with O’Hearn to learn more about the study and what primary care providers should take away from it.
Healio: Can you briefly describe your findings and their clinical implications?
O’Hearn: We estimated that that poor diet contributed to over 14.1 million cases of type 2 diabetes in 2018, representing over 70% of new diagnoses globally. The most important global dietary drivers of type 2 diabetes were estimated to be insufficient intake of whole grains, excess intake of refined rice and wheat, and excess intake of processed meat.
The analysis also revealed poor diet is causing a larger proportion of type 2 diabetes in men vs. women, in younger vs. older adults and in urban vs. rural residents at the global level. There were also significant differences in the dietary drivers of type 2 diabetes across world regions, and changes in the last 28 years (1990-2018).
Our findings help inform nutritional priorities for clinicians as they encourage healthy dietary choices. Messaging should focus on improving carbohydrate quality (increasing intake of whole grains, fruits and vegetables, beans and legumes; decreasing intake of refined rice and wheat as well as sugar-sweetened beverages) and reducing intake of red and processed meats.
Healio: How might diabetes risk be connected to poor diet in the United Sates specifically?
O’Hearn: The U.S. was one of the 184 countries in our analysis. Our team based our model on dietary intake estimates 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.
At the national level in the U.S., we found that about 73% of new type 2 diabetes cases (~2,800 cases per 1 million population) were due to poor diet in 2018. Of the 11 dietary factors assessed, the greatest contributors were high intake of processed meats (33%), low intake of whole grains (32%), high intake of sugar-sweetened beverages (16%) and high intake of unprocessed red meats (15%). Note that the estimated burden for each individual dietary factor are not additive (ie, do not add up to the burden for poor diet jointly).
Healio: What is the take-home message for primary care physicians?
O’Hearn: Poor diet, both directly and through its effects on weight gain, is a serious driver of type 2 diabetes globally. Primary care physicians should encourage healthy dietary choices at an early age and recognize disparities in the dietary burden of type 2 diabetes by education level and among those living in rural vs. urban areas.