Incident type 2 diabetes attributable to suboptimal diet in 184 countries
Authors: O’Hearn Meghan , Lara-Castor Laura , Cudhea Frederick , Miller Victoria , Reedy Julia , Shi Peilin , Zhang Jianyi , Wong John B. , Economos Christina D. , Micha Renata , Mozaffarian Dariush ,   Global Dietary Database, Bas Murat , Ali Jemal Haidar , Abumweis Suhad , Krishnan Anand , Misra Puneet , Hwalla Nahla Chawkat , Janakiram Chandrashekar , Liputo Nur Indrawaty , Musaiger Abdulrahman , Pourfarzi Farhad , Alam Iftikhar , DeRidder Karin , Termote Celine , Memon Anjum , Turrini Aida , Lupotto Elisabetta , Piccinelli Raffaela , Sette Stefania , Anzid Karim , Vossenaar Marieke , Mazumdar Paramita , Rached Ingrid , Rovirosa Alicia , Zapata María Elisa , Asayehu Tamene Taye , Oduor Francis , Boedecker Julia , Aluso Lilian , Ortiz-Ulloa Johana , Meenakshi J. V. , Castro Michelle , Grosso Giuseppe , Waskiewicz Anna , Khan Umber S. , Thanopoulou Anastasia , Malekzadeh Reza , Calleja Neville , Ocke Marga , Etemad Zohreh , Nsour Mohannad Al , Waswa Lydiah M. , Nurk Eha , Arsenault Joanne , Lopez-Jaramillo Patricio , Sibai Abla Mehio , Damasceno Albertino , Arambepola Carukshi , Lopes Carla , Severo Milton , Lunet Nuno , Torres Duarte , Tapanainen Heli , Lindstrom Jaana , Virtanen Suvi , Palacios Cristina , Roos Eva , Agdeppa Imelda Angeles , Desnacido Josie , Capanzana Mario , Misra Anoop , Khouw Ilse , Ng Swee Ai , Delgado Edna Gamboa , Caballero Mauricio , Otero Johanna , Lee Hae-Jeung , Koksal Eda , Guessous Idris , Lachat Carl , De Henauw Stefaan , Rahbar Ali Reza , Tedstone Alison , Naska Androniki , Mathee Angie , Ling Annie , Tedla Bemnet , Hopping Beth , Ginnela Brahmam , Leclercq Catherine , Duante Charmaine , Haerpfer Christian , Hotz Christine , Pitsavos Christos , Rehm Colin , van Oosterhout Coline , Cerdena Corazon , Bradshaw Debbie , Trichopoulos Dimitrios , Gauci Dorothy , Fernando Dulitha , Sygnowska Elzbieta , Vartiainen Erkki , Farzadfar Farshad , Zajkas Gabor , Swan Gillian , Ma Guansheng , Pekcan Gulden , Ibrahim Hajah Masni , Sinkko Harri , Barbieri Helene Enghardt , Sioen Isabelle , Myhre Jannicke , Gaspoz Jean-Michel , Odenkirk Jillian , Bundhamcharoen Kanitta , Nelis Keiu , Zarina Khairul , Biro Lajos , Johansson Lars , Steingrimsdottir Laufey , Riley Leanne , Yap Mabel , Inoue Manami , Szabo Maria , Ovaskainen Marja-Leena , Lee Meei-Shyuan , Chan Mei Fen , Cowan Melanie , Kandiah Mirnalini , Kally Ola , Jonsdottir Olof , Palmer Pam , Vollenweider Peter , Orfanos Philippos , Asciak Renzo , Templeton Robert , Don Rokiah , Yaakub Roseyati , Selamat Rusidah , Yusof Safiah , Al-Zenki Sameer , Hung Shu-Yi , Beer-Borst Sigrid , Wu Suh , Lukito Widjaja , Hadden Wilbur , Becker Wulf , Cao Xia , Ma Yi , Lai Yuen , Hjdaud Zaiton , Ali Jennifer , Gravel Ron , Tao Tina , Veerman Jacob Lennert , Chiplonkar Shashi , Arici Mustafa , Ngoan Le Tran , Panagiotakos Demosthenes , Li Yanping , Trichopoulou Antonia , Barengo Noel , Khadilkar Anuradha , Ekbote Veena , Mohammadifard Noushin , Kovalskys Irina , Laxmaiah Avula , Rachakulla Harikumar , Rajkumar Hemalatha , Meshram Indrapal , Avula Laxmaiah , Arlappa Nimmathota , Hemalatha Rajkumar , lacoviello Licia , Bonaccio Marialaura , Costanzo Simona , Martin-Prevel Yves , Castetbon Katia , Jitnarin Nattinee , Hsieh Yao-Te , Olivares Sonia , Tejeda Gabriela , Hadziomeragic Aida , de Moura Souza Amanda , Pan Wen-Harn , Huybrechts Inge , de Brauw Alan , Moursi Mourad , Maghroun Maryam , Zeba Augustin Nawidimbasba , Sarrafzadegan Nizal , Keinan-Boker Lital , Goldsmith Rebecca , Shimony Tal , Jordan Irmgard , Mastiholi Shivanand C. , Mwangi Moses , Kombe Yeri , Bukania Zipporah , Alissa Eman , Al-Daghri Nasser , Sabico Shaun , Gulliford Martin , Diba Tshilenge S. , Oh Kyungwon , Kweon Sanghui , Park Sihyun , Cho Yoonsu , Al-Hooti Suad , Luangphaxay Chanthaly , Douangvichit Daovieng , Siengsounthone Latsamy , Marques-Vidal Pedro , Rybak Constance , Luke Amy , Piaseu Noppawan , Rojroongwasinkul Nipa , Sundram Kalyana , Baykova Donka , Abedi Parvin , Sandjaja Sandjaja , Fadzil Fariza , Bukhary Noriklil Bukhary Ismail , Bovet Pascal , Chen Yu , Sawada Norie , Tsugane Shoichiro , Rangelova Lalka , Petrova Stefka , Duleva Vesselka , Lindroos Anna Karin , Sipinen Jessica Petrelius , Moraeus Lotta , Bergman Per , Siamusantu Ward , Szponar Lucjan , Chang Hsing-Yi , Sekiyama Makiko , Le Nguyen Bao Khanh , Nagalla Balakrishna , Polasa Kalpagam , Boindala Sesikeran , El Ati Jalila , Silva Ivonne Ramirez , Dommarco Juan Rivera , Barquera Simon , Rodríguez-Ramírez Sonia , Illescas-Zarate Daniel , Sanchez-Romero Luz Maria , Ikeda Nayu , Zaghloul Sahar , Houshiar-rad Anahita , Mohammadi-Nasrabadi Fatemeh , Abdollahi Morteza , Chuah Khun-Aik , Mahdy Zaleha Abdullah , Eldridge Alison , Ding Eric L. , Kruger Herculina , Henjum Sigrun , Fernandez Anne , Suarez-Ortegon Milton Fabian , Al-Hamad Nawal , Janská Veronika , Tayyem Reema , Mirmiran Parvin , Kelishadi Roya , Lemming Eva Warensjo , Richter Almut , Mensink Gert , Wieler Lothar , Hoffman Daniel , Salanave Benoit , Kim Cho-il , Kuriyan-Raj Rebecca , Swaminathan Sumathi , Garriguet Didier , Dastgiri Saeed , Vaask Sirje , Karupaiah Tilakavati , Zohoori Fatemeh Vida , Esteghamati Alireza , Hashemian Maryam , Noshad Sina , Mwaniki Elizabeth , Yakes-Jimenez Elizabeth , Chileshe Justin , Mwanza Sydney , Marques Lydia Lera , Preston Alan Martin , Aguero Samuel Duran , Oleas Mariana , Posada Luz , Ochoa Angelica , Shamsuddin Khadijah , Shariff Zalilah Mohd , Jan Bin Jan Mohamed Hamid , Manan Wan , Nicolau Anca , Tudorie Cornelia , Poh Bee Koon , Abbott Pamela , Pakseresht Mohammadreza , Sharma Sangita , Strand Tor , Alexy Ute , Nöthlings Ute , Carmikle Jan , Brown Ken , Koster Jeremy , Waidyatilaka Indu , Lanerolle Pulani , Jayawardena Ranil , Long Julie M. , Hambidge K. Michael , Krebs Nancy F. , Haque Aminul , Keding Gudrun B. , Korkalo Liisa , Erkkola Maijaliisa , Freese Riitta , Eleraky Laila , Stuetz Wolfgang , Thorsdottir Inga , Gunnarsdottir Ingibjorg , Serra-Majem Lluis , Moy Foong Ming , Anderson Simon , Jeewon Rajesh , Zugravu Corina Aurelia , Adair Linda , Ng Shu Wen , Skeaff Sheila , Marchioni Dirce , Fisberg Regina , Henry Carol , Ersino Getahun , Zello Gordon , Meyer Alexa , Elmadfa Ibrahim , Mitchell Claudette , Balfour David , Geleijnse Johanna M. , Manary Mark , El-kour Tatyana , Nikiema Laetitia , Mirzaei Masoud , Hakeem Rubina 
Published: April 2023

The global burden of diet-attributable type 2 diabetes (T2D) is not well established. This risk assessment model estimated T2D incidence among adults attributable to direct and body weight-mediated effects of 11 dietary factors in 184 countries in 1990 and 2018. In 2018, suboptimal intake of these dietary factors was estimated to be attributable to 14.1 million (95% uncertainty interval (UI), 13.8–14.4 million) incident T2D cases, representing 70.3% (68.8–71.8%) of new cases globally. Largest T2D burdens were attributable to insufficient whole-grain intake (26.1% (25.0–27.1%)), excess refined rice and wheat intake (24.6% (22.3–27.2%)) and excess processed meat intake (20.3% (18.3–23.5%)). Across regions, highest proportional burdens were in central and eastern Europe and central Asia (85.6% (83.4–87.7%)) and Latin America and the Caribbean (81.8% (80.1–83.4%)); and lowest proportional burdens were in South Asia (55.4% (52.1–60.7%)). Proportions of diet-attributable T2D were generally larger in men than in women and were inversely correlated with age. Diet-attributable T2D was generally larger among urban versus rural residents and higher versus lower educated individuals, except in high-income countries, central and eastern Europe and central Asia, where burdens were larger in rural residents and in lower educated individuals. Compared with 1990, global diet-attributable T2D increased by 2.6 absolute percentage points (8.6 million more cases) in 2018, with variation in these trends by world region and dietary factor. These findings inform nutritional priorities and clinical and public health planning to improve dietary quality and reduce T2D globally.