University of Oulu

Alkaf, B., Blakemore, A.I., Järvelin, MR. et al. Secondary analyses of global datasets: do obesity and physical activity explain variation in diabetes risk across populations?. Int J Obes 45, 944–956 (2021).

Secondary analyses of global datasets : do obesity and physical activity explain variation in diabetes risk across populations?

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Author: Alkaf, Budour1,2; Blakemore, Alexandra I.3,4; Järvelin, Marjo-Riitta2,3,5,6;
Organizations: 1Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates
2Department of Epidemiology and Biostatistics, Imperial College London, London, UK
3College of Health, Medicine, and Life Sciences, Brunel University London, Uxbridge, UK
4Department of Medicine, Imperial College London, London, UK
5Centre for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
6Unit of Primary Health Care and Medical Research Centre, Oulu University Hospital, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.9 MB)
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Language: English
Published: Springer Nature, 2021
Publish Date: 2021-06-07


Type 2 diabetes rates vary significantly across geographic regions. These differences are sometimes assumed to be entirely driven by differential distribution of environmental triggers, including obesity and insufficient physical activity (IPA). In this review, we discuss data which conflicts with this supposition. We carried out a secondary analysis of publicly available data to unravel the relative contribution of obesity and IPA towards diabetes risk across different populations. We used sex-specific, age-standardized estimates from Non-Communicable Disease Risk Factor Collaboration (NCD-RisC) on diabetes (1980–2014) and obesity (1975–2016) rates, in 200 countries, and from WHO on IPA rates in 168 countries in the year 2016. NCD-RisC and WHO organized countries into nine super-regions. All analyses were region- and sex-specific. Although obesity has been increasing since 1975 in every part of the world, this was not reflected in a proportional increase in diabetes rates in several regions, including Central and Eastern Europe, and High-income western countries region. Similarly, the association of physical inactivity with diabetes is not homogeneous across regions. Countries from different regions across the world could have very similar rates of diabetes, despite falling on opposite ends of IPA rate spectrum. The combined effect of obesity and IPA on diabetes risk was analyzed at the worldwide and country level. The overall findings highlighted the larger impact of obesity on disease risk; low IPA rates do not seem to be protective of diabetes, when obesity rates are high. Despite that, some countries deviate from this overall observation. Sex differences were observed across all our analyses. Overall, data presented in this review indicate that different populations, while experiencing similar environmental shifts, are apparently differentially subject to diabetes risk. Sex-related differences observed suggest that males and females are either subject to different risk factor exposures or have different responses to them.

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Series: International journal of obesity
ISSN: 0307-0565
ISSN-E: 1476-5497
ISSN-L: 0307-0565
Volume: 45
Issue: 5
Pages: 944 - 956
DOI: 10.1038/s41366-021-00764-y
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3141 Health care science
3121 General medicine, internal medicine and other clinical medicine
Funding: The work presented in this paper is part of a PhD project by the first author (Budour Alkaf); internal funding by Imperial College London Diabetes Centre is gratefully acknowledged. The authors are also grateful for The Medical Research Council, UK (grant numbers: MR/M013138/1, MRC/BBSRC MR/S03658X/1 (JPI HDHL H2020)) for their financial support during the authors time when conducting this piece of work and writing this paper.
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