Abstract
BackgroundThe occurrence of diabetes has greatly increased in low- and middle-income countries, particularly in Asia, as has the prevalence of overweight and obesity; in European-derived populations, overweight and obesity are established causes of diabetes. The shape of the association of overweight and obesity with diabetes risk and its overall impact have not been adequately studied in Asia. Methods and FindingsA pooled cross-sectional analysis was conducted to evaluate the association between baseline body mass index (BMI, measured as weight in kg divided by the square of height in m) and self-reported diabetes status in over 900,000 individuals recruited in 18 cohorts from Bangladesh, China, India, Japan, Korea, Singapore and Taiwan. Logistic regression models were fitted to calculate cohort-specific odds ratios (OR) of diabetes for categories of increasing BMI, after adjustment for potential confounding factors. OR were pooled across cohorts using a random-effects meta-analysis. The sex- and age-adjusted prevalence of diabetes was 4.3% in the overall population, ranging from 0.5% to 8.2% across participating cohorts. Using the category 22.5–24.9 Kg/m2 as reference, the OR for diabetes spanned from 0.58 (95% confidence interval [CI] 0.31, 0.76) for BMI lower than 15.0 kg/m2 to 2.23 (95% CI 1.86, 2.67) for BMI higher than 34.9 kg/m2. The positive association between BMI and diabetes prevalence was present in all cohorts and in all subgroups of the study population, although the association was stronger in individuals below age 50 at baseline (p-value of interaction<0.001), in cohorts from India and Bangladesh (p<0.001), in individuals with low education (p-value 0.02), and in smokers (p-value 0.03); no differences were observed by gender, urban residence, or alcohol drinking.ConclusionsThis study estimated the shape and the strength of the association between BMI and prevalence of diabetes in Asian populations and identified patterns of the association by age, country, and other risk factors for diabetes.
Highlights
The prevalence of diabetes has increased in the last decades in many low- and middle-income countries (LMIC) [1] and this trend, which is almost completely accounted for by type 2 diabetes, is expected to continue [2]
Enrolment in the studies ranged from the mid-1980s to the early 2000’s: the majority of subjects were enrolled in the 1990s
39,794 cohort members reported diabetes at baseline: the age- and sex-adjusted prevalence was lowest in one study from China (0.5%) and highest in the study from Singapore (8.2%)
Summary
The prevalence of diabetes has increased in the last decades in many low- and middle-income countries (LMIC) [1] and this trend, which is almost completely accounted for by type 2 diabetes, is expected to continue [2]. In rural China, the prevalence of overweight has increased from 5.3% in men and 9.8% in women in 1992 [7] to 13.6% in men and 14.4% in women in 2002 [8]. Corresponding figures for obesity were 0.5% (men) and 0.7% (women) in 1992 and 1.8% (men) and 3.0% (women) in 2002 This trend has profound implications for the expected number of diabetes patients who will be diagnosed in this region in future decades.
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