Elsevier

The Lancet

Volume 368, Issue 9548, 11–17 November 2006, Pages 1681-1688
The Lancet

Review
Epidemic obesity and type 2 diabetes in Asia

https://doi.org/10.1016/S0140-6736(06)69703-1Get rights and content

Summary

The proportions of people with type 2 diabetes and obesity have increased throughout Asia, and the rate of increase shows no sign of slowing. People in Asia tend to develop diabetes with a lesser degree of obesity at younger ages, suffer longer with complications of diabetes, and die sooner than people in other regions. Childhood obesity has increased substantially and the prevalence of type 2 diabetes has now reached epidemic levels in Asia. The health consequences of this epidemic threaten to overwhelm health-care systems in the region. Urgent action is needed, and advocacy for lifestyle changes is the first step. Countries should review and implement interventions, and take a comprehensive and integrated public-health approach. At the level of primary prevention, such programmes can be linked to other non-communicable disease prevention programmes that target lifestyle-related issues. The cost of inaction is clear and unacceptable.

Introduction

The proportions of people with type 2 diabetes and obesity have increased throughout Asia, and the rates of increase show no signs of slowing. The International Diabetes Federation estimates that in 2003, 194 million people had diabetes, and that by 2025, 333 million people will have this disease.1 Some argue that Asia is emerging as the epicentre of this epidemic.2 This region contains some of the most populous countries in the world, and has undergone pronounced demographic, epidemiologic, and socioeconomic change in recent decades. Within the region is the world's most populous country, China, which contains 20% of the world's population, followed by India, with a population of more than one billion. India and China have the greatest numbers of people with diabetes, and are likely to remain in this position in 2025, by which time they could each have 20 million affected individuals.3 The economic burden from type 2 diabetes associated with obesity has also probably been underestimated in this region, which has delayed appropriate prevention and management strategies by national governments and regional agencies. We review the specific clinical characteristics of obesity and type 2 diabetes in Asia, and discuss the effects of environmental changes, such as urbanisation, in the distinct ethnic groups in the region.

Section snippets

Clinical characteristics of the epidemics

The increase in type 2 diabetes in Asia differs from that reported in other parts of the world: it has developed in a much shorter time, in a younger age group, and in people with much lower body-mass index (BMI).4, 5 Substantial differences in the prevalence of obesity and type 2 diabetes have been noted between the different countries in Asia, and between different locations in the same countries. Evidence also shows that the epidemics of obesity and type 2 diabetes can happen at different

Environmental factors and genetic predisposition

If environmental factors have a major role in triggering development of diabetes, one would expect lower prevalence of diabetes in rural areas, where people follow a traditional lifestyle. This urban–rural difference has been reported in several countries.17, 18, 27, 29, 44, 69 In India, two populations with different socioeconomic status showed wide differences in the prevalence of diabetes: 8·2% in the urban group and 2·4% in the rural group,70 and much the same trends have been reported in

Interventions and strategies for prevention

The global emergence of obesity and diabetes is an economic issue as much as a health issue.108 Asia faces especially serious difficulties. Studies such as the Diabetes Prevention Programme,109 Da-qing study,110 Finnish Diabetes Prevention Study,111 Japan lifestyle study,112 and Indian Diabetes Prevention Programme113 have shown that lifestyle changes and some medications are effective in prevention of type 2 diabetes in individuals at risk, such as those with impaired glucose tolerance. In

Search strategy and selection criteria

The data in this review article are based on MEDLINE and PubMed searches with the search term “diabetes mellitus”, “obesity”, or both, in combination with the keywords “prevalence”, “Asia”, and selected Asian countries. A search of MEDLINE and PubMed was also done with search terms “diabetes”, “Asian”, or both, together with the terms “β-cell defect”, “lean body mass”, “abdominal adipose tissue”, “nutrition transit”, and “sedentary lifestyle”.

We selected papers that were published between

References (113)

  • S Kim et al.

    The nutrition transition in South Korea

    Am J Clin Nutr

    (2000)
  • CS Yajnik et al.

    The Y-Y paradox

    Lancet

    (2004)
  • W Gepts et al.

    The pancreatic islets in diabetes

    Am J Med

    (1981)
  • H King et al.

    Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections

    Diabetes Care

    (1998)
  • R Sicree et al.

    The global burden of diabetes

  • G Roglic et al.

    Diabetes mellitus in Asia

    Hong Kong Med J

    (2000)
  • GT Ko et al.

    Prediction of hypertension, diabetes, dyslipidaemia or albuminuria using simple anthropometric indexes in Hong Kong Chinese

    Int J Obes Relat Metab Disord

    (1999)
  • J He et al.

    Body mass and blood pressure in a lean population in southwestern China

    Am J Epidemiol

    (1994)
  • YW Park et al.

    Larger amounts of visceral adipose tissue in Asian Americans

    Obesity Res

    (2001)
  • Q He et al.

    Sex and race differences in fat distribution among Asian, African-American, and Caucasian prepubertal children

    J Clin Endocrinol Metab

    (2002)
  • KW Chen et al.

    Earlier appearance of impaired insulin secretion than of visceral adiposity in the pathogenesis of NIDDM. 5-Year follow-up of initially nondiabetic Japanese-American men

    Diabetes Care

    (1995)
  • K Matsumoto et al.

    Glucose tolerance, insulin secretion, and insulin sensitivity in nonobese and obese Japanese subjects

    Diabetes Care

    (1997)
  • M Fukushima et al.

    Insulin secretion capacity in the development from normal glucose tolerance to type 2 diabetes

    Diabetes Res Clin Pract

    (2004)
  • C Rattarasarn et al.

    Decreased insulin secretion but not insulin sensitivity in normal glucose tolerant Thai subjects

    Diabetes Care

    (2006)
  • EW Gregg et al.

    Trends in the prevalence and ratio of diagnosed to undiagnosed diabetes according to obesity levels in the US

    Diabetes Care

    (2004)
  • H King et al.

    Global estimates for prevalence of diabetes mellitus and impaired glucose tolerance in adults. WHO Ad Hoc Diabetes Reporting Group

    Diabetes Care

    (1993)
  • A mass survey of diabetes mellitus in a population of 300 000 in 14 provinces and municipalities in China

    Chinese J Intern Med

    (1981)
  • HD Xiang et al.

    An epidemiological study on diabetes mellitus 1995–1996, in China

    Chinese J Diabetes

    (1998)
  • Q Qiao et al.

    Age- and Sex-Specific Prevalence of Diabetes and Impaired Glucose Regulation in 11 Asian Cohorts

    Diabetes Care

    (2003)
  • A Ramachandran et al.

    Temporal changes in prevalence of diabetes and impaired glucose tolerance associated with lifestyle transition occurring in the rural population in India

    Diabetologia

    (2004)
  • A Ramachandran et al.

    High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey

    Diabetologia

    (2001)
  • KS Kim et al.

    Epidemiological study on diabetes mellitus among rural Korean

    J Kor Diabetes Assoc

    (1972)
  • SM Kim et al.

    Prevalence of diabetes and impaired fasting glucose in Korea: Korean national health and nutrition survey 2001

    Diabetes Care

    (2006)
  • D Sutanegara et al.

    The epidemiology and management of diabetes mellitus in Indonesia

    Diabetes Res Clin Pract

    (2000)
  • BA Khalid et al.

    Prevalence of diabetes, hypertension and renal disease amongst railway workers in Malaysia

    Med J Malaysia

    (1990)
  • W Aekplakorn et al.

    The prevalence and management of diabetes in Thai adults: The international collaborative study of cardiovascular disease in Asia

    Diabetes Care

    (2003)
  • XR Pan et al.

    Impaired glucose tolerance and its relationship to ECG-indicated coronary heart disease and risk factors among Chinese. Da Qing IGT and diabetes study

    Diabetes Care

    (1993)
  • D Gu et al.

    Prevalence of diabetes and impaired fasting glucose in the Chinese adult population: International Collaborative Study of Cardiovascular Disease in Asia (InterASIA)

    Diabetologia

    (2003)
  • I Chau et al.

    A survey of diabetes mellitus and its complications in the General Hospital, Kuala Lumpur

    J ASEAN Fed Endoc Soc

    (1987)
  • JS Cheah et al.

    Epidemiology of diabetes mellitus in Singapore: comparison with other ASEAN countries

    Ann Acad Med Singapore

    (1985)
  • CE Tan et al.

    Prevalence of diabetes and ethnic differences in cardiovascular risk factors. The 1992 Singapore National Health Survey

    Diabetes Care

    (1999)
  • C-J Chang et al.

    Epidemiologic study of type 2 diabetes in Taiwan

    Diabetes Res Clin Pract

    (2000)
  • Lu Feng-Hwa et al.

    A population-based study of the prevalence and associated factors of diabetes mellitus in southern Taiwan

    Diabet Med

    (1998)
  • Diabetes Mellitus: Technical Report Series 727

    (1985)
  • KGMM Alberti et al.

    Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus

    (1999)
  • JR Gavin et al.

    Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus

    Diabetes Care

    (1997)
  • M Segi

    Cancer mortality for selected sites in 24 countries (1950–57)

    (1960)
  • C Cockram

    The epidemiology of diabetes mellitus in the Asia-Pacific region

    Hong Kong Med J

    (2000)
  • Y Takahashi et al.

    Prevalence of diabetes estimated by plasma glucose criteria combined with standardized measurement of HbA1c among health checkup participants on Miyako Island, Japan

    Diabetes Care

    (2000)
  • Prevalence of diabetes and impaired fasting glucose in adults—United States, 1999–2000

    MMWR Morb Mortal Wkly Rep

    (2003)
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