BMJ global health · 2026
Age-sex-income triad disparities in diet-attributable diabetes: a GBD 2023 analysis reveals East Asia and Pacific region's decoupling phenomenon and cost-effective solutions.
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Yin Mengting, Fang Yan, Ding Qihang, Mei Huiqin, Zhang Guomiao, Sheng Qichao, Liu Kailong, Shou Yixin, Zhang Xiaoyu, Li Dapeng, Shi Fang, Mao Qingyang, Zheng Chao, Jiang Zipei, Mao Guangyun
Аннотация
OBJECTIVES: Despite the East Asia and Pacific region (EAPR) accounting for 22.7% of global diabetes deaths amid rapid nutrition transition and ageing, it remains unclear how diet-attributable type 2 diabetes (T2D) burden varies across age, sex and income strata, a critical knowledge gap for region-specific policies. This study aims to quantify diet-attributable T2D burden, project 2035 trends and evaluate preventable burden under dietary interventions.
METHODS: We analysed data from the Global Burden of Disease (GBD) 2023 study for 33 countries/regions in EAPR. Key outcomes included age-standardised mortality rates (ASMR), age-standardised disability-adjusted life year rates (ASDR) and population-attributable fractions (PAF). Temporal trends were quantified using estimated annual percentage change with 95% uncertainty intervals. Future burden was projected via Auto-Regressive Integrated Moving Average (ARIMA) models and carefully validated. Scenario-based dietary intervention analyses were further conducted to estimate the preventable fraction of future T2D burden under feasible reductions in major modifiable dietary risk factors.
RESULTS: A ‘mortality-disability decoupling’ phenomenon was observed: ASMR declined slightly, while ASDR rose consistently. Pronounced disparities were observed in ASDR: adults aged ≥75 years had a 6.3-fold higher burden than those aged 15–49 years and males had a 1.4-fold higher rate than females. The PAF of diet-attributable T2D mortality was 3.4-fold higher in high-income countries (HICs) than low-income countries (LICs). Meanwhile, high processed meat intake was the top risk in HICs, low fruit intake in LICs and low whole-grain intake across the region. ARIMA projections indicated ASDR would rise to 167.02/100 000 by 2035 without interventions, but combined dietary interventions reduce this to 158.38/100 000.
CONCLUSIONS: These findings suggest that stratified dietary risk reduction approaches may help address the growing diet-attributable T2D burden in the EAPR. However, specific policy interventions were not evaluated in this study. The results align with the goals of the WHO Global Diabetes Compact.
METHODS: We analysed data from the Global Burden of Disease (GBD) 2023 study for 33 countries/regions in EAPR. Key outcomes included age-standardised mortality rates (ASMR), age-standardised disability-adjusted life year rates (ASDR) and population-attributable fractions (PAF). Temporal trends were quantified using estimated annual percentage change with 95% uncertainty intervals. Future burden was projected via Auto-Regressive Integrated Moving Average (ARIMA) models and carefully validated. Scenario-based dietary intervention analyses were further conducted to estimate the preventable fraction of future T2D burden under feasible reductions in major modifiable dietary risk factors.
RESULTS: A ‘mortality-disability decoupling’ phenomenon was observed: ASMR declined slightly, while ASDR rose consistently. Pronounced disparities were observed in ASDR: adults aged ≥75 years had a 6.3-fold higher burden than those aged 15–49 years and males had a 1.4-fold higher rate than females. The PAF of diet-attributable T2D mortality was 3.4-fold higher in high-income countries (HICs) than low-income countries (LICs). Meanwhile, high processed meat intake was the top risk in HICs, low fruit intake in LICs and low whole-grain intake across the region. ARIMA projections indicated ASDR would rise to 167.02/100 000 by 2035 without interventions, but combined dietary interventions reduce this to 158.38/100 000.
CONCLUSIONS: These findings suggest that stratified dietary risk reduction approaches may help address the growing diet-attributable T2D burden in the EAPR. However, specific policy interventions were not evaluated in this study. The results align with the goals of the WHO Global Diabetes Compact.