The level of body mass index (BMI) at which a person is at increased risk of developing diabetes is not the same in all countries. Screening criteria should be adapted to regional specificities.
- Researchers analyzed data from 57 countries to see if BMI and age were the same for diagnosing diabetes: there are big differences.
- For example, men in East or Southeast Asia had an increased risk of developing diabetes from a BMI of 23.8, whereas the WHO advises screening from 25.
79% of people with diabetes live in low-income countries (LICs) or middle-income countries (MICs). The reason is linked to the very strong increase in overweight and obesity in these countries, which has favored the development of this pathology. “World Health Organization guidelines (WHO) recommend screening for diabetes in people 40 years and older with a body mass index (BMI) of 25 and over”, underlines Jennifer Manne-Goehler, one of the authors of a study published in the journal The Lancet. This shows that BMI, depending on the country, is not the same risk factor for diabetes. In fact, it would not be a relevant indicator – with the recommendations currently in force – for detecting this disease in LMICs and MICs.
BMI and age, poor indicators in some regions
The BMI is an indicator which makes it possible to estimate the corpulence of an individual. To calculate it, simply divide the weight in kilograms by the height in centimeters squared. The result of this operation gives a figure which determines in which category the person is located: malnutrition (below 16.5), thinness (from 16.5 to 18.5), normal corpulence (from 18.5 to 25) , overweight (from 25 to 30), moderate obesity (from 30 to 35), severe obesity (from 35 to 40), morbid or massive obesity (over 40). “It has long been suspected that BMI and age thresholds may not be optimal for diabetes screening in all regions of the world.develops Jennifer Manne-Goehler. Our goal was to estimate the relationship between BMI and diabetes risk in many low- and middle-income countries to help them improve their screening programs.”
Diabetes very present in people aged 35 to 44
The researchers therefore analyzed data from 57 developing countries – which included more than 680,000 people – on weight, height and blood sugar and hemoglobin levels, which indicate whether a person has diabetes. According to their results, in these countries, people with a BMI of 23 or more had an increased risk of diabetes. But this figure differed by region and gender within all these countries: 23.8 for men in East or Southeast Asia, 28.3 for women in the Middle East, Africa North and Latin America. In all cases, this remains below the threshold of 25 set by the WHO for detecting this pathology. On the other hand, this study also highlights the fact that diabetes is increasing sharply, in all regions, among people aged 35 to 44 and, in sub-Saharan Africa, among men aged 25 to 34. Well below the 40 years from which the WHO recommends screening for diabetes. “Diagnosis in young adults can prevent long-term complications of the disease“, explains Dr. Manne-Goehler. Ideally, the specificities of these populations should be taken into account and the disease systematically detected earlier in these regions.
Answers to review the screening criteria
“LICs and PRIs now have clear, evidence-based answers to the question ‘Who? When ? and how much ?’ concerning the prevention and screening of diabetes in relation to BMIunderlines Siméon Pierre Choukem, doctor and dean of the faculty of medicine and pharmaceutical sciences of Dschang, in Cameroon, in a comment in parallel with the study. The public health problem of diabetes in LICs and MICs is likely underestimated due to current screening guidelines, and it is unclear to what extent.” The researchers are continuing their work by studying other criteria that may favor the development of diabetes in these 57 countries, such as waist circumference and behavioral factors (alcohol, smoking, low physical activity and unbalanced diet). In the future, the scientists’ goal is to compare this data with that of high-income countries to expand the list of risk factors.
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