Globalization of diabetes: the role of diet, lifestyle, and genes.
Globalization of diabetes: the role of diet, lifestyle, and genes.
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DOI：
10.2337/dc11-0442
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发表时间：
2011-06
期刊：
影响因子：
16.2
通讯作者：
Hu FB
中科院分区：
文献类型：
--
作者：
Hu FB
2型糖尿病是一场全球公共卫生危机，威胁着所有国家，特别是发展中国家的经济。在快速城市化、营养转型和日益久坐不动的生活方式的推动下，这一流行病与全球肥胖症的上升同步增长。亚洲人口众多，经济发展迅速，成为疫情的震中。亚洲人群倾向于在较年轻的年龄和较低的BMI水平比高加索人患糖尿病。有几个因素导致亚洲人糖尿病流行加速，包括“正常体重代谢性肥胖”表型;吸烟和酗酒的高患病率;精制碳水化合物的高摄入（例如，白色大米）;以及显著降低的体力活动水平。子宫内和生命早期的营养不良加上晚年的营养过剩也可能在亚洲的糖尿病流行中发挥作用。全基因组关联研究的最新进展极大地促进了我们对糖尿病病理生理学的理解，但目前确定的遗传位点不足以解释糖尿病风险的种族差异。尽管如此，在营养快速转变的背景下，西化的饮食和生活方式以及遗传背景之间的相互作用可能会加速糖尿病的发展。流行病学研究和随机临床试验表明，2型糖尿病在很大程度上可以通过饮食和生活方式的改变来预防。然而，将这些发现转化为实践，需要在公共政策、食品和建筑环境以及卫生系统方面进行根本性的变革。为了遏制糖尿病流行病的不断升级，通过促进健康饮食和生活方式进行初级预防应成为全球公共政策的优先事项。
Type 2 diabetes is a global public health crisis that threatens the economies of all nations, particularly developing countries. Fueled by rapid urbanization, nutrition transition, and increasingly sedentary lifestyles, the epidemic has grown in parallel with the worldwide rise in obesity. Asia's large population and rapid economic development have made it an epicenter of the epidemic. Asian populations tend to develop diabetes at younger ages and lower BMI levels than Caucasians. Several factors contribute to accelerated diabetes epidemic in Asians, including the “normal-weight metabolically obese” phenotype; high prevalence of smoking and heavy alcohol use; high intake of refined carbohydrates (e.g., white rice); and dramatically decreased physical activity levels. Poor nutrition in utero and in early life combined with overnutrition in later life may also play a role in Asia's diabetes epidemic. Recent advances in genome-wide association studies have contributed substantially to our understanding of diabetes pathophysiology, but currently identified genetic loci are insufficient to explain ethnic differences in diabetes risk. Nonetheless, interactions between Westernized diet and lifestyle and genetic background may accelerate the growth of diabetes in the context of rapid nutrition transition. Epidemiologic studies and randomized clinical trials show that type 2 diabetes is largely preventable through diet and lifestyle modifications. Translating these findings into practice, however, requires fundamental changes in public policies, the food and built environments, and health systems. To curb the escalating diabetes epidemic, primary prevention through promotion of a healthy diet and lifestyle should be a global public policy priority.