Mediterranean diet and diabetes prevention: Myth or fact?

Type 2 diabetes is a major, non-communicable disease with increasing prevalence at a global level. Therefore, in order to prevent this condition action should be taken regarding the modifiable factors that influence its development - lifestyle and dietary habits. As the Mediterranean dietary pattern has beneficial effects on both human health and regarding the development and treatment of type 2 diabetes, promoting adherence to this pattern is of considerable public health importance.     

Epidemiology and economic impact of obesity and type 2 diabetes

Obesity has become a major public health concern in the United States and the rest of the world. This disease carries significant health risks that encompass several organ systems. Type 2 diabetes mellitus is a major comorbidity of obesity that predisposes patients to significant end-organ damage. The prevalence of obesity and diabetes is increasing worldwide, and the economic impact of these diseases currently assumes a significant portion of health care expenditure. These factors mandate implementation of therapeutic medical and surgical strategies that target prevention and treatment of obesity and its related medical conditions.     

Diabetes and COVID-19: Diseases of racial,social and glucose intolerance

Diabetes and coronavirus disease 2019(COVID-19) are worldwide pandemics that have had a major impact on public health throughout the globe. Risk factors for developing diabetes and having adverse outcomes of COVID-19 appear to be similar; metabolic factors(such as obesity), non-White ethnicity and poorer socioeconomic status appear to be risk factors for both. Diabetes and COVID-19 have a significant effect on populations adversely affected by health inequality. Whilst we hope that COVID-19 will be mitigated by widespread use of vaccines, no such prospect exists for mitigating the pandemic of diabetes. In this brief opinion review, I compare risk factors for diabetes and adverse outcomes of COVID-19 and argue that tackling health and social inequality is likely to play a major role in solving the global diabetes pandemic and improve outcomes of COVID-19.     

Epidemiology and Control of Hypertension and Diabetes in Costa Rica

Costa Rica is one of the countries that make up Central America, neighboring Nicaragua and Panama. Costa Rica shares with its neighbors the social and economic problems characteristic of developing countries; however, one difference is that Costa Rica can derive a great part of its budget and expense to health and education, as it had abolished the army in 1948. It is for this reason that Costa Rica shares diseases characteristic of their region like the Dengue, yet at the same time have a true explosion in the fields of hypertension (HTA), diabetes (DM), and cardiovascular disease.

The health system of Costa Rica has nearly universal coverage, reaching 98% of the population with primary and secondary diverse levels of attention that give appropriate and satisfactory treatment to all hypertensive and diabetic patients.

The HTA and the DM are true public health problems; however, before 2004, there weren't appropriate data on their prevalence and management. Small studies showed an increase in the prevalence of HTA from 9 to 24%, though no data on the prevalence of DM were available. In 2004, the Multinational Survey of Diabetes and Hypertension and Other Factors of Risk carried out in San José, Costa Rica, determined a prevalence of HTA of 25% and of DM of 8%. Likewise, the methodology of the survey allowed an evaluation of the quality of the attention of the HTA (Tracer of Arterial Hypertension) and, consequently, appropriate control of hypertensive patients in Costa Rica; through it, it was determined that greater effort was required for earlier detection and resource optimization to better handle hypertensive and diabetic patients and thus reduce cardiovascular morbidity-mortality and chronic renal disease.     

Epidemiology and control of hypertension and diabetes in Costa Rica

Costa Rica is one of the countries that make up Central America, neighboring Nicaragua and Panama. Costa Rica shares with its neighbors the social and economic problems characteristic of developing countries; however, one difference is that Costa Rica can derive a great part of its budget and expense to health and education, as it had abolished the army in 1948. It is for this reason that Costa Rica shares diseases characteristic of their region like the Dengue, yet at the same time have a true explosion in the fields of hypertension (HTA), diabetes (DM), and cardiovascular disease.The health system of Costa Rica has nearly universal coverage, reaching 98% of the population with primary and secondary diverse levels of attention that give appropriate and satisfactory treatment to all hypertensive and diabetic patients.The HTA and the DM are true public health problems; however, before 2004, there weren't appropriate data on their prevalence and management. Small studies showed an increase in the prevalence of HTA from 9 to 24%, though no data on the prevalence of DM were available. In 2004, the Multinational Survey of Diabetes and Hypertension and Other Factors of Risk carried out in San José, Costa Rica, determined a prevalence of HTA of 25% and of DM of 8%. Likewise, the methodology of the survey allowed an evaluation of the quality of the attention of the HTA (Tracer of Arterial Hypertension) and, consequently, appropriate control of hypertensive patients in Costa Rica; through it, it was determined that greater effort was required for earlier detection and resource optimization to better handle hypertensive and diabetic patients and thus reduce cardiovascular morbidity-mortality and chronic renal disease.     

1990—2019年中国胰腺炎疾病负担分析

目的 分析我国1990—2019年胰腺炎疾病负担数据,为公共卫生策略的制定提供依据。方法 采用2019年全球疾病负担的发病率、患病率、死亡率和伤残调整寿命年（disability-adjusted life years,DALYs）的指标,对我国1990年至2019年间胰腺炎疾病负担变化情况进行描述和分析。联结点回归模型用于分析胰腺炎疾病负担变化趋势和不同年龄组的疾病负担。结果 中国胰腺炎的患病率自1990年以来呈上升趋势,发病率自2000年以后也呈上升趋势,而DALYs和饮酒导致的胰腺炎DALYs均呈下降趋势。死亡率则呈现明显的性别差异,男性总体呈上升趋势,而女性总体呈下降趋势。同时,无论是1990年还是2019年,胰腺炎导致的DALYs随着年龄段的增加而明显上升。结论 过去30年,中国胰腺炎所导致的DALYs呈下降趋势,同时胰腺炎导致的疾病负担存在明显的性别和年龄差异。这些发现可为进一步减轻胰腺炎负担的公共卫生策略的制定提供重要依据。     

Strategies for national health care systems and centers in the emerging world: Central America and the Caribbean--the case of Cuba

Over 40% of the 76 million people in Central America and the Caribbean live in poverty with no safety net. Communicable and noncommunicable diseases significantly impact morbidity and mortality, and a tendency toward aging suggests increasing prevalence of chronic conditions. Among factors related to renal diseases: obesity is an epidemic among the near-poor; prevalence of diabetes mellitus is 6% to 8%; and hypertension is 8% to 30%. The region's racial-ethnic composition--associated with depressed socioeconomic conditions--is comparable to US minorities showing greater chronic renal disease (CRD) rates than those registered in Central America and the Caribbean, which suggests that this region may be among the world's most seriously affected by CRD. This is a reality masked by lack of health care coverage. Health policies generally have not prioritized human resource development, and training is biased toward curative care instead of prevention. Nephrologists are less than 20 per million population in most countries. Health care infrastructures are poor, lacking the primary care facilities charged with prevention. Cuba shares economic limitations with its neighbors but is one of the region's least socially stratified countries, with a universal, free, and public health care system emphasizing primary health care and prevention. Human resource development has resulted in 59.6 physicians per 10,000 inhabitants and a family physician program covering the whole population. A national renal diseases program incorporates preventive strategies at all care levels. Nevertheless, early detection of patients with CRD remains a challenge in the Cuban context. In Central America and the Caribbean, prevention is the key to reducing medical, social, and economic costs of renal disease.     

Trends in prevalence of diabetes in Asian countries

Diabetes is a major lifestyle disorder,the prevalence of which is increasing globally.Asian countries contribute to more than 60% of the world’s diabetic population as the prevalence of diabetes is increasing in these countries.Socio-economic growth and industrialization are rapidly occurring in many of these countries.The urban-rural divide in prevalence is narrowing as urbanization is spreading widely,adversely affecting the lifestyle of populations.Asians have a strong ethnic and genetic predisposition for diabetes and have lower thresholds for the environmental risk factors.As a result,they develop diabetes at a younger age and at a lower body mass index and waist circumference when compared with the Western population.The adverse effect of physical inactivity and fatty food are manifested as the increasing rate of overweightness and obesity,even among children.The health care budgets for the disease management are meager and the health care outcome is far from the optimum.As a result,complications of diabetes are common and the economic burden is very high,especially among the poor strata of the society.National endeavors are urgently needed for early diagnosis,effective management and for primary prevention of diabetes.This editorial aims to highlight the rising trend in prevalence of diabetes in Asia,its causative factors and the urgent need to implement national strategies for primary prevention of type 2 diabetes.     

Prevalence and risk factors associated with chronic kidney disease in adults over 40 years: A population study from Central China

Aim: Chronic kidney disease (CKD) poses a serious public health problem worldwide. Population‐based studies determining the prevalence of this disease in China have been limited in several large developed cities. In the present study, a population‐based screening study in Henan, a representative province in Central China, was conducted in order to quantify the prevalence of CKD and identify the associated risk factors for this disease in a population of developing areas of China. Methods: Residents (n = 4156) over 40 years old in four major cities of Henan Province were interviewed and their albuminuria, reduced renal function, haematuria and blood pressure were measured. Associations between age, components of metabolism syndrome and indicators of CKD were examined. Results: Among these subjects, the prevalence rates of albuminuria, haematuria and reduced renal function were 4.51%, 6.28% and 1.53%, respectively. Approximately 10.49% of the subjects had at least one indicator of kidney damage. The awareness rate of this disease in subjects with CKD was only 9.50%. Hypertension, diabetes and hyperuricaemia were three independent risk factors for CKD. Conclusion: The high prevalence and low awareness of CKD in the studied population suggest that CKD is a severe public health problem in Central China. Effectively preventive and therapeutic interventions are needed.     

Literature review of type 2 diabetes mellitus among minority Muslim populations in Israel

This review surveys the literature published on the characteristics and implications of pre-diabetes and type 2 diabetes mellitus(T2DM) for the Arab andBedouin populations of Israel. T2 DM is a global health problem. The rapid rise in its prevalence in the Arab and Bedouin populations in Israel is responsible for their lower life expectancy compared to Israeli Jews. The increased prevalence of T2 DM corresponds to increased rates of obesity in these populations. A major risk group is adult Arab women aged 55-64 years. In this group obesity reaches 70%. There are several genetic and nutritional explanations for this increase. We found high hospitalization rates for micro and macrovascular complications among diabetic patients of Arab and Bedouin origin. Despite the high prevalence of diabetes and its negative health implications, there is evidence that care and counseling relating to nutrition, physical activity and self-examination of the feet are unsatisfactory. Economic difficulties are frequently cited as the reason for inadequate medical care. Other proposed reasons include faith in traditional therapy and misconceptions about drugs and their side effects. In Israel, the quality indicators program is based on one of the world’s leading information systems and deals with the management of chronic diseases such as diabetes. The program’s baseline data pointed to health inequality between minority populations and the general population in several areas, including monitoring and control of diabetes. Based on these data, a pilot intervention program was planned, aimed at minority populations. This program led to a decrease in inequality and served as the basis for a broader, more comprehensive intervention that has entered the implementation stage. Interventions that were shown to be effective in other Arabic countries may serve as models for diabetes management in the Arab and Bedouin populations in Israel.     

Disparities in end-stage renal disease care in South America

South America is one of the most heterogeneous regions in the world regarding ethnical composition and socioeconomic development level. Our aim was to analyze the status of end-stage renal disease (ESRD) management in the Portuguese-speaking and Spanish-speaking countries of South America. Data were collected using a survey sent to the Society of Nephrology of each country, and complemented with data available in the Latin American Dialysis and Transplant Registry or personal communication with collaborators within the nephrology societies. Most of South America countries have a hybrid of public and private healthcare system. Universal access to renal replacement therapy (RRT) is provided in Argentina, Brazil, Chile, Uruguay and Venezuela which comprise nearly 73% of South America population. The expenditure on health per capita varies from nearly US$ 200 per year in Bolivia to more than US$ 1,600 per year in Argentina. The prevalence of patients on RRT varies from 95 pmp. in Paraguay and 924 pmp in Chile. There is an important association between the prevalence of diabetes and the number of patients on RRT. Older people also are at a higher risk of developing ESRD. The rapid aging of the population and a higher prevalence of diabetes will probably translate into a burden of ESRD in the future. It is to be hoped that political and economical stability in the region can ease the adoption of universal access to ESRD treatment in all South American countries.     

Fetal programming of obesity and type 2 diabetes

The prevalence of obesity and type 2 diabetes mellitus has increased rapidly over the past few decades, and prevention efforts have not been successful. Fetal programming involves the earliest stage of obesity development, and provides a novel concept to complement other strategies for lifelong prevention of obesity and type 2 diabetes mellitus. The World Health Organization now advocates a life-course approach to prevent/control obesity, starting with pre-conceptional and antenatal maternal health. Maternal overnutrition, gestational diabetes mellitus and excessive gestational weight gain lead to fetal overgrowth, and “programs” the offspring with an increased risk of obesity and type 2 diabetes mellitus in childhood and adulthood. This review summarizes current data on fetal programming of obesity and type 2 diabetes mellitus including potential causative factors, mechanisms and interventions to reduce its impact.     

Effects of the COVID-19 pandemic on the outcome and mortality of patients with diabetic foot ulcer

The outbreak of the coronavirus disease 2019 (COVID-19) led to events that significantly impaired the treatment and management of patients with chronic diabetes. Therefore, elective treatments at hospitals were cancelled and patients with chronic ailments were instructed to stay at home and minimise the time spent in public areas. The second was due to COVID-19-induced anxiety that deterred many patients from seeking care and adhering to periodic out-patient visits. In this study, we examined the short-term effects of the COVID-19 pandemic on patients with chronic diabetes who suffered from contaminated diabetic ulcers. We conducted a retrospective study with patients who had undergone amputations following diabetic ulcers during 2019-2020. The research group included diabetic amputees during the COVID-19 outbreak period ranging from March 2020 to December 2020. The control group included diabetic amputees from the corresponding period in 2019. Using the Wagner Scale, we measured the difference in the severity of ulcers upon the patient's initial admission. Additionally, we examined patient survival rates based on the size of amputations, by specifically focusing on the period between 1- and 6-months post-surgery. The results failed to suggest a clear and statistically significant worsening trend in the condition of patients in the research and control groups. Due to public lockdowns, transportation restrictions, scarcity of healthcare staff, and reduced adherence to exposure anxiety, patients with diabetic foot ulcers received inferior medical care during the COVID-19 pandemic. However, this study could not find a statistically significant difference in the mortality and major amputation rates in patients with diabetic ulcer before and during the pandemic. The health system should incorporate the existing institutional and technological recommendations to facilitate care and follow-up of patients with diabetic foot ulcers during the current and future pandemics.     

Epidemiology and costs of diabetes

The prevalence of diabetes is increasing worldwide, particularly in developing countries. In the next decades, India and China are expected to provide the greatest numbers of affected people, mainly owing to the increasing incidence of this disease in those countries. Regarding developed countries, such as in Europe and the United States, the increasing trend is mainly due to the prolonged survival of both the general and the diabetic populations. From an epidemiologic point of view, the first relevant point is that almost 80% of diabetes cases could be prevented just by avoiding overweight and obesity. The estimated attributable risk of excess body weight is extremely high; no other modifiable effect has such an impact on the health of the general population. The second relevant point is that the global trend of the disease shows a tendency to onset at a younger age. The third point is that in developed countries the prevalence of diabetes is increasing mainly among the elderly, who are responsible for the highest consumption of health care resources in absolute terms. Regarding type 1 diabetes, which represents one-tenth of affected individuals, both large geographic and temporal variations in disease incidence have been found, supporting the hypothesis of as yet unknown environmental determinants. The incidence is increasing in linear fashion, not supporting the hypothesis of younger age at onset as the main explanation for this trend. Because the prevalences of both type 1 and type 2 diabetes are increasing worldwide, they will produce a profound impact on overall health care costs.     

Maternal low protein diet and fetal programming of lean type 2 diabetes

Maternal nutrition is found to be the key factor that determines fetal health in utero and metabolic health during adulthood. Metabolic diseases have been primarily attributed to impaired maternal nutrition during pregnancy, and impaired nutrition has been an immense issue across the globe. In recent years, type 2 diabetes (T2D) has reached epidemic proportion and is a severe public health problem in many countries. Although plenty of research has already been conducted to tackle T2D which is associated with obesity, little is known regarding the etiology and pathophysiology of lean T2D, a variant of T2D. Recent studies have focused on the effects of epigenetic variation on the contribution of in utero origins of lean T2D, although other mechanisms might also contribute to the pathology. Observational studies in humans and experiments in animals strongly suggest an association between maternal low protein diet and lean T2D phenotype. In addition, clear sex-specific disease prevalence was observed in different studies. Consequently, more research is essential for the understanding of the etiology and pathophysiology of lean T2D, which might help to develop better disease prevention and treatment strategies. This review examines the role of protein insufficiency in the maternal diet as the central driver of the developmental programming of lean T2D.     

Epidemiology and burden of pelvic fractures: Results from the Global Burden of Disease Study 2019

IntroductionPelvic fracture is a severe injury resulting in high mortality and disability rate, and brought heavy health burden. However, existing research conclusions only restricted to the national level while global estimation of pelvic fracture was lack. We aimed to estimate the global incidence, prevalence, and years lived with disability (YLDs) of pelvic fracture by region, age, gender, cause and sociodemographic index (SDI).Materials and methodsPublicly available data was gained based on the Global Burden of Disease Study (GBD) 2019. We calculated the estimated annual percent change (EAPC) to analyze the temporal trends of pelvic fractures from 1990 to 2019. Incidence, prevalence and YLDs were analyzed by region, age, gender, cause and SDI. Spearman's rank order correlation was used to determine the correlation between SDI and incidence, prevalence and YLDs.ResultsGlobally, there were about 6 million incident cases, 18.8 million prevalent cases and 3.2 million YLDs cases of pelvic fractures for both sexes in 2019. The incidence number increased over 40% compared to 1990. However, the age standardized rate of incidence (ASIR) (EAPC = ?0.22; 95% CI, ?0.38 to ?0.05), prevalence (ASPR) (EAPC = ?0.42; 95% CI, ?0.51 to ?0.32) and YLDs (ASYR) (EAPC = ?0.41; 95% CI, ?0.50 to ?0.32) all presented downward trends. Males had higher ASIR, ASPR and ASYR than females in each year from 1990 to 2019. The incidence, prevalence and YLDs rates were higher in males in early adulthood but exceeded in females at older age. A positive correlation was observed between ASIR and SDI (rho = 0.3732, p < 0.01). Regions with higher SDI tended to have higher ASIR, ASPR and ASYR than lower SDI regions. Falls and road injuries were the major causes of pelvic fracture at all ages and during the whole period.ConclusionThe global health burden of pelvic fracture still remained high during the past thirty years. More policies and strategies are needed to face the challenge brought by population growth and aging.     

Diabetes in the Kokan region of India

BACKGROUND BKL Walawalkar Hospital is situated near the village of Dervan in the Kokan region of the state of Maharashtra in India. A survey of 2200 surrounding villages showed 51.8% adults had body mass index(BMI) below 18.5 kg/m2 and only4.5% were overweight. A survey of 11521 adolescent girls from rural schools showed 64% prevalence of thinness. In the same region, government survey reported the prevalence of diabetes around 7%, and 70% prevalence of leanness.This reinforced the fact that the overall population of Kokan is lean. Hence, we decided to investigate body composition of diabetic people from our hospital clinic by carrying out a clinic-based case control study.AIM To study body composition of diabetics in a rural clinic of Kokan.METHODS In a case-control study, 168 type 2 diabetic patients(102 men) attending the outpatient department at a rural hospital and 144 non-diabetic controls(68 men)in the Chiplun area of the Kokan region were recruited. History of diabetes(age of onset, duration), anthropometric measurements(height, weight, waist and hip circumference) were recorded. Body composition was measured by bioimpedance using the TANITA analyzer.RESULTS More than 45% of diabetic subjects had a 1 st degree family history of diabetes, and more than 50% had macrovascular complications. The average BMI in diabetic subjects was 24.3 kg/m2. According to World Health Organization standards,prevalence of underweight was 8% and that of normal BMI was around 50%.Underweight and normal diabetic subjects(men as well as women) hadsignificantly lower body fat percentage, higher muscle mass percentage, lower visceral fat and lower basal metabolic rate when compared to their overweight counterparts.CONCLUSION The diabetic population in Kokan has near normal body composition, and BMI has considerable limitations in assessing body composition and it also lacks sensitivity for assessing risk for diabetes in this population. High prevalence of family history of diabetes may point towards genetic predisposition. Leanness is an inherent characteristic of this population and its metabolic significance needs further investigations with a larger sample size.     

Albuminuria predicting outcome in diabetes: incidence of microalbuminuria in Asia-Pacific Rim

Microalbuminuria is not an unusual finding in the general population, even in individuals without diabetes, hypertension, or cardiovascular risk factors. Prevalence studies in the United States, such as NHANES III, reported an overall incidence of microalbuminuria in 22,244 patients, with and without diabetes, of 7.8%. In those individuals with diabetes, the prevalence was 28.8%. Even in patients without diabetes, cardiovascular disease, or abnormal serum creatinine levels, the prevalence of microalbuminuria was still 5.1%. Similarly, a large Dutch study of 41,000 participants demonstrated a 7% incidence of microalbuminuria. In those individuals with diabetes, the microalbuminuria rate was 16%. Thus, in both the United States and Europe, prevalence studies indicate that microalbuminuria is not uncommon. In southeast Asia and the western Pacific, the incidence of type 2 diabetes is rapidly escalating. It is expected that by 2025 the major prevalence of type 2 diabetes in the world will not be in North America or Europe but in Asia-Pacific Rim. Consequently, there is great interest in evaluating the incidence of microalbuminuria in this region. In the Microalbuminuria Prevalence Study (MAPS) the prevalence of macroalbuminuria was noted to be 18.8% and microalbuminuria 39.8% in a total of 6800 hypertensive diabetic adult patients from 10 Asian countries. Thus, there is important evidence that the substantial prevalence of microalbuminuria and macroalbuminuria in the Pacific region indicates an impending pandemic of diabetic cardiovascular and renal disease.