2023-05-12 05:20:00
At the end of 2022, a study published in The British Medical Journal warned of an increase of almost 60% in the last three decades of the cases of type 2 diabetes among the adolescent and young population (15-39 years) worldwide. Now, another study led by researchers from Tufts University (Boston, USA) and published in the journal Nature Medicine, which collects data from 184 countries between 1990 and 2018, concludes that poor diet is the main factor for the development of this non-communicable chronic disease. Specifically, according to the study data, in 2018 70% of the new cases of type 2 diabetes diagnosed worldwide (more than 14.1 million) could be attributed to a poor diet. In Spain, the figure is even higher: more than three out of four new cases of this disease (76.4%) are attributable to diet.
For the study, the researchers took eleven dietary factors into account: excess consumption of refined grains, processed meats, unprocessed red meats, sugary drinks, fruit juices, and snacks salty; and insufficient consumption of whole grains, yogurts and unsweetened dairy products, fruits, nuts, legumes and non-starchy vegetables. Of these 11 dietary factors, there were three that had a particular contribution to the rising global incidence of type 2 diabetes: insufficient intake of whole grains, excess consumption of refined rice and wheat, and excessive intake of processed meats. Spain almost follows the international pattern, but with nuances: excess consumption of unprocessed red meat sneaks onto the Spanish podium of dietary factors responsible for type 2 diabetes (23%), in a sad ranking led by excessive consumption of processed meats (40%) and deficient intake of whole grains (30%).
“The percentage (and number) of diabetes cases due to poor diet is alarming and a wake-up call for policy makers, public health professionals and physicians to put policies in place. and interventions that address dietary priorities within the local context”, comments Meghan O’Hearn, lead author of the study, to EL PAÍS, who also calls for the involvement of the food industry “to promote changes in the diet of the population necessary to quell this growing epidemic of type 2 diabetes worldwide. In this sense, the researcher suggests measures such as government disincentives for unhealthy foods (through fiscal policies, strict labeling requirements or restrictions), incentives for healthy foods, and private sector innovation strategies to create an environment that promotes healthy eating. .
Stop eating worse to eat better?
One of the relevant data obtained in the research published in Nature Medicine shows that excessive consumption of harmful foods contributes to a greater extent (60.8%) to the global burden of type 2 diabetes than insufficient consumption of health-protective foods (39.2%), which would corroborate a maximum that some dietitians-nutritionists have been defending for some time: that it makes more sense to reduce the consumption of unhealthy foods than to increase the consumption of healthy ones. For O’Hearn, however, both factors are critical: “As can be seen from the data, insufficient intake of whole grains was the leading global dietary driver of type 2 diabetes. Public health interventions, policies and messages of physicians should therefore focus on an overall balanced diet, both limiting harmful foods and increasing intake of healthy and protective foods.”
Giuseppe Russolillo, president of the Spanish Academy of Nutrition and Dietetics, is of the same opinion, who considers that the fact that the consumption of unhealthy foods has more weight in the burden of type 2 diabetes is fundamentally due to the fact that this consumption displaces the intake of healthy food. “The main cause of the appearance of non-communicable chronic diseases such as type 2 diabetes resides mainly in the reduction of the consumption of substances called plant phytochemicals (present in fruits, vegetables, whole grains and legumes, nuts, and vegetable oils). such as extra virgin olive oil) that have the capacity to exert a protective effect on our health”, maintains the expert, who considers that if we were to increase the consumption of these healthy foods again, “our satiety mechanism” would not allow us to continue consuming the same amount of unhealthy food that we eat now.
“In our society we have changed the consumption of products of vegetable origin for a high consumption of red meat, processed meat and refined cereals. This anthropological change that has occurred in recent decades is what is causing us to have so many cases of type 2 diabetes and other diseases, especially cancer,” reflects Russolillo.
Furthermore, Cristóbal Morales, an endocrinologist at the Virgen Macarena University Hospital in Seville and a member of the Spanish Diabetes Society (SED), explains that this anthropological change has not been accompanied by our metabolism: “We have prehistoric genes with a metabolism very thrifty, designed to defend against weight loss, genes that had an explanation in prehistory and other historical stages to face famines. We are designed to save energy and this, which has been a competitive advantage throughout evolution, suddenly in a society like ours, characterized by an obesogenic environment, the tendency to gain weight and develop type 2 diabetes increases.
The role of the zip code
According to the study, the largest increases in the burden of type 2 diabetes attributable to diet over the past three decades have occurred in sub-Saharan Africa and in Southeast and East Asia, parts of the world that have, by far, adding to the western eating pattern and abandoning their traditional dietary patterns, more attached to products of plant origin. “Our findings in many respects reflect local socioeconomic contexts, including globalization and Westernization. For example, the increases in type 2 diabetes due to excessive consumption of unprocessed red meat in East Asia from 1990 to 2018 reflect the tremendous population growth, increased urbanization, and demographic changes in this region. Similarly, the significant increase in the burden of type 2 diabetes attributable to excessive intake of sugar-sweetened beverages in sub-Saharan Africa suggests the globalization of large multinational beverage companies and the westernization of traditional diets,” reflects Meghan O’Hearn. .
It is paradoxical, according to the research results, that globally the estimated burden of type 2 diabetes attributable to diet was highest among people with high education (and presumably high income). However, in countries with a medium-high economic level, including Spain, just the opposite occurs: the highest incidence is found among people with less education and, therefore, with less economic income. “In the poorest countries the phenomenon is determined precisely by that situation of poverty. Only those who have more purchasing power can afford this type of unhealthy but attractive food”, argues Cristóbal Morales, who points out that in countries like Spain, however, the data shows that people with a higher socioeconomic level also have more training and information, which leads them to take more care of themselves. “In Spain, obesity levels are much higher among the socioeconomically less favored population strata. There is a very important social gap. In the end, the zip code influences the quality of your health almost more than your genes”, he adds.
This evidence, suggests the main author of the study, shows that to fight against the unstoppable proliferation of cases of type 2 diabetes, the strategies cannot be the same for all parts of the world. “In high-income countries, nutrition education interventions and social safety net programs could work to reduce disparities between socioeconomic levels. In contrast, in Latin America and the Caribbean, South Asia, and sub-Saharan Africa, improving education may not reduce the prevalence of the disease and may require alternative strategies, such as labeling, taxation, and other schemes. of financial incentives”.
In the case of countries like Spain, Cristóbal Morales advocates implementing these educational interventions from early childhood. “Type 2 diabetes begins in the womb, in nurseries, in schools,” says the SED spokesman, who points out that the current rates of childhood obesity already warn of the problems that the National System of Health with Type 2 Diabetes within a decade or two. “Children increasingly develop diabetes earlier, and that is medically more dangerous, because the disease has more time to develop its complications, which are many. Until we educate on the importance of good nutrition, physical exercise and quality sleep, we are going to continue walking not towards climate change, but towards a metabolic change that will make us look much more like citizens of the United States that of the Mediterranean”, he concludes.
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