SummaryBackgroundOne of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes.MethodsWe pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence—defined as fasting plasma glucose of 7·0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs—in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue.FindingsWe used data from 751 studies including 4 372 000 adults from 146 of the 200 countries we make estimates for. Global age-standardised diabetes prevalence increased from 4·3% (95% credible interval 2·4–7·0) in 1980 to 9·0% (7·2–11·1) in 2014 in men, and from 5·0% (2·9–7·9) to 7·9% (6·4–9·7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28·5% due to the rise in prevalence, 39·7% due to population growth and ageing, and 31·8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target.InterpretationSince 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults affected, has increased faster in low-income and middle-income countries than in high-income countries.FundingWellcome Trust.

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Type 2 diabetes and its precursor obesity are major global public health problems, requiring concerted preventive efforts (1) . Although energy intake, energy density and nutrient intakes are implicated in type 2 diabetes risk in adults, little is known about their influence on emerging obesity and type 2 diabetes risk in childhood. We therefore examined these associations in a multi-ethnic population of children. This is a cross-sectional study of 2017 children predominantly of white European, South Asian and black African-Caribbean origin aged 9-10 years. Children provided detailed 24 hour dietary recalls, measurements of body composition and a fasting blood sample for measurements of serum glucose, HbA1c and fasting insulin; HOMA insulin resistance was also derived.After the removal of under and over reporters of energy intake, energy intake was positively associated with insulin resistance, HbA1c, glucose and fat mass index; energy density was positively associated with insulin resistance and fat mass index. Individual nutrients showed no associations with any type 2 diabetes risk markers. In mutually adjusted analyses, the associations for energy intake remained while those for energy density became non-significant. Additional adjustment for fat mass index reduced the associations for insulin resistance and HbA1c by about 40 %; the association for fasting glucose was only slightly reduced. Adjustment for differences in total energy intake reduced the South Asian -white European differences in insulin resistance, HbA1c and fasting glucose and the black African-Caribbean-white European differences in insulin resistance and HbA1c.

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. To examine trends independent of anti-hypertensive treatment, untreated BP was estimated from the recorded BP on treatment. To do this, a model was derived using published data on the effect of anti-hypertensives used singly and in combination at differing pre-treatment BP levels. BP untreated with statins was similarly estimated. Results Among an average 9,147 subjects per year, mean systolic BP (SBP) Conclusion For 15 years, BP declined in English adults. The overall decline in SBP of nearly 5 mmHg over the study period is likely to be of clinical significance in reducing CVD events. For an individual aged 40-49 a 5 mmHg reduction in SBP, as seen here, would be expected to reduce the risk of stroke by 23% and of IHD by 16%. It is therefore of concern that, in recent years, the decline has essentially ceased in the youngest age groups, particularly in younger men. The effect of treatment was modest; less than 25% of the male SBP decline is attributable to it. Other explanations for this fall, occurring whilst obesity has increased, need further exploration, but reduced salt intake is a likely candidate. Background It has been hypothesised that dissolved minerals in water, particularly calcium carbonate and magnesium carbonate, are protective against heart disease. Animal studies suggest biologically plausible mechanisms for this and statistically significant effects have been presented from several large ecological studies. Setting The West Midlands Government Office Region in central England, has a large and diverse population which has great variation in water hardness over a relatively small area. Our units of analysis were West Midlands neighbourhoods (lower level super output areas) falling in areas supplied by two water companies. We obtained exposure estimates from water industry measurements taken in 2007. Methods Using geographical information system software, digitised supply water supply maps were mapped to our neighbourhood geography. Having established the distribution of water hardness through neighbourhoods, we mapped tertiles of hardness and identified neighbourhoods inside them. To these we linked emergency myocardial infarction (MI) admissions for 45-74 year-old residents for a three year period, adjusting for the age distribution of the neighbourhoods, ethnic mix and socio-economic deprivation. We used a negative binomial model to determine the degree of association between water hardness and MI admission counts, adjusting for the other variables. Results We were able to accurately determine the mineral content of water supplied to 2,925 neighbourhoods with a total population of over 4.5 million. Contrary to other studies, we found just a small but non-significant negative correlation between hardness and MI admissions were seen in men, with an incidence rate ratio (IRR) of 0.97, per tertile, (0.92 -1.03, p=0.37) and a small, non-significant positive one seen in women, IRR=1.02, (0.93 -1.12, p=2). IS THERE A PROTECTIVE EFFECT OF HIGH MINERAL CONTENT IN DRINKING WATER ON CORONARY HEART DIS...