Diabetes more likely to strike the young in Asia

[May 27, 2009]  JAKARTA, Indonesia (AP) -- Diabetes is spiraling in Asia but -- unlike the West -- those affected are relatively young and less likely to be struggling with obesity, a new study shows.

Research published in the Journal of the American Medical Association on Wednesday said the disease has turned into a global problem, with the number of victims expected to grow from 240 million in 2007 to 380 million in 2025.

More than 60 percent of those will be in Asia, the world's fastest growing region, with low- and middle-income countries hardest hit.

India will see its numbers grow from 40 million to nearly 70 million; China 39 million to 59 million; and Bangladesh 3.8 million to 7.4 million, the authors wrote, citing figures from the International Diabetes Federation. Indonesia, the Philippines, Malaysia, Vietnam and others will also see their figures skyrocket.

Frank Hu, a professor at the Harvard School of Public Health, noted the disease is associated with serious complications such as heart disease, stroke and renal failures -- all of which are expensive to treat.

Without strong government policy, education and good clinical care, Asia's escalating epidemic could "erase economic gains made in recent decades," said Hu, one of the authors.

Trends of diabetes in the region are influenced by everything from genetic makeup and cultural differences to smoking and degrees of urbanization, the JAMA study showed. But the most startling findings -- which tended to vary from country to country -- related to body mass and age.

Obesity has long been seen as a major factor leading to type 2 diabetes in nations across Europe and North America.

But while Asians still weigh less than their Western counterparts, they've gotten fatter around the waist -- seen as particularly detrimental with respect to diabetes. It is around the abdomen that fat stores excess energy and releases chemicals that control metabolism and the use of insulin.

So while people from Japan in the east to Pakistan in the west generally have lower body mass indexes, a figure determined by dividing weight by height, "they can have a similar or even higher prevalence of diabetes than Western countries," the study showed.

Stephen Corbett, a professor at the school of Public Health at the University of Sydney, said all developing countries that are starting to have relatively stable food supplies -- and more sedentary Western lifestyles -- are seeing diabetes in epidemic proportions.

"For thousands of years, most people in China, India, Indonesia, were subsistence farmers," he said, noting it was a marginal existence for most, with food shortages often occurring several months a year.

"It took 150 or 200 years for Europeans to make the dietary transition that happened in Asia in the last 40 to 50 years," said Corbett, who is not connected with the study. "I think that the diabetes epidemic is a direct result of that."

The study also noted while the disease most often affects people between the ages of 60 and 79 in North America and Europe, the age in Asia tends to be disproportionally lower, ranging between 20 years to 59.

This appears to be the result of both low birth weights, which are common in developing countries, and over-nutrition in later life.

The report says this may be partly because Asian women are two to three times as likely to have gestational diabetes as their white counterparts.

"Their offspring exhibit early features of metabolic syndrome, thus setting up a vicious cycle of diabetes begetting diabetes," Hu and the other authors wrote.

The findings were based on analysis of hundreds of articles, data and studies published between January 1980 and March 2009.

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On the Net:

Journal of the American Medical Association:
http://jama.ama-assn.org/

[Associated Press; By ROBIN McDOWELL]

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