302 Diet and Health
22.6 million and the US 15.3 million, while Brazil recorded only 3.3 million and
Italy 3.1 million. In 2000, the five countries with the highest diabetes prevalence
in the adult population only were Papua New Guinea (15.5 per cent), Mauritius
(15 per cent), Bahrain (14.8 per cent), Mexico (14.2 per cent) and Trinidad &
Tobago (14.1 per cent).99,100 Such disparate statistics reflect a transition from tradi-
tional diet and from an activity-based life-style to a more sedentary one. By 2025,
the prevalence of diabetes is anticipated to triple in Africa, the Eastern Mediterra-
nean, the Middle East and South Asia. It is expected to double in the Americas and
the Western Pacific and to almost double in Europe. In India, incidence is much
higher in urban than rural populations:^101 in urban Chennai (Madras), for exam-
ple, cases of diabetes rose by 40 per cent in 1988–1994. Incidence is rising among
male urban dwellers of South India compared to the rural male population. In
addition to diabetes mellitus, the prevalence of NIDDM increased dramatically
within the urban populations of India within just a decade.^102 In Thailand, also,
NIDDM is more pronounced amongst females in the urban population than it is
in the rural population,^103 whilst in the rural environment, incidence of NIDDM
amongst males is higher.
In the UK, Professor David Barker and colleagues have shown that adult dia-
betes is associated with low birthweight,^104 while studies in India suggest that poor
interuterine growth, combined with obesity later in life is associated with insulin
resistance, diabetes and increased cardiovascular risk.^105 Once again, a single dis-
ease seems attributable to a pattern of poor nutrition related to the life cycle, and
is one whose costs are externalized onto society as a whole and health care in par-
ticular. Devastating complications of diabetes, such as blindness, kidney failure
and heart disease, are imposing a huge financial burden: in some countries 5–10
per cent of national health budgets.
Table 13.13 Prevalence of diabetes worldwide2000 2030 Projected growth
Africa 7020,553 18,244,638 160
Mediterranean 15,189,760 43,483,842 186
Americas 33,014,823 66,828,417 102
European 33,380,754 48,411,977 45
SE Asia 45,810,544 122,023,693 166
Western Pacific 36,138,079 71,685,158 98
Total 171,000,000 366,000,000 114Source: WHO (2004) Diabetes Action Programme. Geneva, World Health Organization,
available at http://www.who.int/diabetes/facts/worid_figures/en/