The prevalence of diabetes in China is rapidly increasing. China now has the largest number of people living with diabetes worldwide, accounting for approximately one-quarter of the global diabetes population. Since the late 1970s, China has experienced profound changes and rapid economic growth, leading to shifts in lifestyle. Changing dietary patterns, reduced physical activity, and stress have contributed to the growing prevalence of overweight and obesity, which are important determinants potentiating the link between insulin resistance and diabetes. Social and environmental factors, such as education, air pollution, and exposure to endocrine-disrupting chemicals, have also contributed to the growing diabetes epidemic in China. The country has one of the fastest ageing populations in the world, which forecasts continued increases in the prevalence of diabetes and its complications. This Review provides an overview of the ongoing diabetes epidemic and risk factors, providing evidence to support effective implementation of public health interventions to slow and prevent the diabetes epidemic in China.

During the past 40 years, the prevalence of diabetes in China has increased from less than 1·0% in 1980 to 12·4% in 2018, an increase in line with the rapid growth of the nation's economy. To address such a burden, the Healthy China 2030 initiative and subsequent Action Plan, including a diabetes prevention and control campaign, were launched. A shift from a disease-centred approach to a health-centred approach and from treatment to prevention is the core of the Action Plan and diabetes management in China. In this Review, we discuss the challenges of diabetes prevention in China, including unhealthy lifestyle, increasing young-onset type 2 diabetes, and substantial diabetes care disparities. To address such challenges, countermeasures across different stages of diabetes prevention and targeted at different populations, are needed. Such countermeasures include primordial prevention of risk factors in the general population, primary prevention of diabetes onset in high-risk populations, and secondary prevention of cardiovascular complications for individuals with diabetes. We reflect on China's current progress, strategies, and achievements.

China has one of the highest levels of tobacco consumption globally, and there is no national smoke-free legislation. Although more than 20 Chinese cities have passed local smoke-free laws since 2008, evidence on their effectiveness in reducing smoking behaviours and their economic benefits is scarce. By exploiting a natural quasi-experiment, whereby a comprehensive public smoking ban was implemented in Shanghai in March, 2017, this study aims to assess the impact of the policy on individual smoking behaviours and quantify its effect on macroeconomic outcomes. In this difference-in-differences analysis and modelling study, we used data on smoking behaviours from the 2012, 2014, 2016, and 2018 waves of the China Family Panel Studies. We used a difference-in-differences approach to investigate trends in smoking prevalence in respondents in Shanghai, relative to respondents from other direct-administered municipalities, provincial capital cities, and subprovincial municipalities (control group), after the implementation of a smoking ban in 2017. All respondents aged 18 years or older were included, with the exception of people who lived in Beijing and rural areas. The primary variable of interest in the difference-in-differences analysis was self-reported smoking status. Based on the difference-in-differences estimation of reduction in smoking prevalence, we then used a health-augmented macroeconomic model to estimate the potential macroeconomic gains if such a ban was implemented across China for the period 2017-35. 14 688 respondents were included in the analysis: 5766 from Shanghai and 8922 from the control group. After the implementation of the smoking ban in Shanghai in 2017, smoking prevalence decreased by 2·2 percentage points (95% CI 2·1-2·3), equivalent to an 8·4% reduction in the number of current smokers. The smoking ban had a larger effect on men, people with a higher level of education, unmarried people, and younger people when compared with their respective counterparts. The modelling analysis showed that implementing a nationwide comprehensive public smoking ban similar to that in Shanghai would result in a 0·04-0·07% increase in the national gross domestic product in China between 2017 and 2035, outweighing the economic costs of smoking ban enforcement. The smoking ban in Shanghai shows that a comprehensive public smoking ban with strict enforcement is effective in curbing smoking behaviours. Moreover, the implementation of a comprehensive public smoking ban across China would be cost-effective. National Social Science Fund of China.

SummaryBackgroundAlcohol consumption is a leading cause of premature death globally, but there is no large-scale prospective evidence from Mexico.MethodsThe Mexico City Prospective Study recruited 150 000 adults aged 35 years or older between 1998 and 2004. Participants were followed up until Oct 1, 2022 for cause-specific mortality. Cox regression in those with no self-reported chronic disease at entry (adjusted for age, sex, district, education, physical activity, smoking, and diabetes) was used to relate baseline-reported alcohol consumption (never, former, occasional [less than monthly], and regular [at least monthly, split into <70, ≥70 to <140, ≥140 to <210, and ≥210 g/week]) to mortality at ages 35−74 from all causes, and from a pre-specified alcohol-related set of underlying causes. Heavy episodic drinking (normally consuming >5 [men] or >4 [women] drinks on a single occasion) and type of preferred drink were also examined.FindingsAmong 138 413 participants aged 35−74 years at recruitment, 21 136 (15%) were regular alcohol drinkers (14 863 [33%] men, 6273 [7%] women), of whom 13 383 (63%) favoured spirits and 6580 (31%) favoured beer. During follow-up, there were 13 889 deaths at ages 35−74 years, including 3067 deaths from the pre-specified alcohol-related causes. Overall, J-shaped associations with mortality were observed. Compared with occasional drinkers, those with baseline-reported consumption ≥210 g/week had 43% higher all-cause mortality (rate ratio [RR] 1·43 [95% CI 1·30−1·56]) and nearly three times the mortality from the pre-specified alcohol-related causes (2·77 [2·39−3·20]). Death from liver disease was strongly related to alcohol consumption; the RR comparing regular drinkers of ≥140 g/week with occasional drinkers was 4·03 (3·36−4·83). Compared with occasional light drinking, occasional heavy episodic drinking was associated with 20% higher alcohol-related mortality (1·20 [1·06−1·35]), and regular heavy episodic drinking was associated with 89% higher alcohol-related mortality (1·89 [1·67−2·15]). Drinks with alcohol percentages higher than spirits were associated with the greatest increased mortality risk, even after accounting for the total alcohol consumed.InterpretationIn this Mexican population, higher alcohol consumption, episodic drinking, and very high percentage alcoholic products were all associated with increased mortality.FundingWellcome Trust, the Mexican Health Ministry, the National Council of Science and Technology for Mexico, Cancer Research UK, British Heart Foundation, and the UK Medical Research Council.