Body Mass Index and Diabetes in Asia: A Cross-Sectional Pooled Analysis of 900,000 Individuals in the Asia Cohort Consortium
Background
The 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.
Background
The 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 Findings
A 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.
A 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.
Conclusions
This 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.
PLoS ONE 6(6): e19930. doi:10.1371/journal.pone.0019930
This 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.
PLoS ONE 6(6): e19930. doi:10.1371/journal.pone.0019930
Why is this cool?
The researchers recorded the body mass index of 900,000 people across Bangladesh, China, India, Japan, Korea, Singapore and Taiwan. They found that there was a positive correlation between high body mass index and presence of diabetes. This correlation extends across gender, location, and alcohol consumption.
You may ask "We already knew that, so what is the big deal?"
Well, it is an interesting thing, but most studies on diabetes on on people of European descent and it is entirely possible that the Asian peoples are sufficiently different, due to their particular evolutionary history, such that diabetes does not result from being fat. Well, that was not the case. Another idea, and I don't know if they checked it, is that the Asian diet may make a huge difference and as such it could disconnect diabetes from weight. Again, their data suggests that no matter how you get fat, you are racing towards diabetes.
Why is this interesting to me? Well, I live in the States and here we worry about China dominating everything because of their invincible economy. An economy which is not as burdened as the American one is with old people and overweight people. Can China's economy grow as quickly as it has been when it becomes saddled with the long lived and obese? I suspect not. I wonder what cultural initiatives will be cooked up to deal with their obesity. What has been done for the obesity problem of the U.S. of A.?
I also see this issue as another aspect of global warfare! Imagine that the USA projected unparalleled spending power on the part of China and was running out of options on how to contain or otherwise mitigate that growth, what choices would it have?
The US would institute a system of actively prompting massive food consumption! The people would be obese. The economy burdened with health costs. This is the future!
You may ask "We already knew that, so what is the big deal?"
I also see this issue as another aspect of global warfare! Imagine that the USA projected unparalleled spending power on the part of China and was running out of options on how to contain or otherwise mitigate that growth, what choices would it have?
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