India, China top Asia-Pacific region with highest metabolic diseases burden

India and China have among the highest absolute metabolic disease burdens in Asia-Pacific, a recent review of data from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD), 1990–2023, revealed. It also includes forecasts up to 2030 for the Asia-Pacific region, based on these trends.  

Published recently in the peer-reviewed journal Metabolism, the article by Huang Zhang et al presents an analysis of the GBD with specific reference to the Asia Pacific region. Scholars from multiple research institutes across the world analysed estimates of disability-adjusted life years (DALYs) and mortality for five common metabolic diseases and risk factors in the region - Type 2 diabetes mellitus, high systolic blood pressure, high body mass index (BMI), high LDL cholesterol, and metabolic dysfunction-associated steatotic liver disease (MASLD). Metabolic diseases occur when the normal process of breaking down, storing or using energy from food is disrupted due to a range of factors. 

India’s burden

In all the parameters considered, India and China top the list. Anoop Misra, one of the co-authors of the study and chairman, Fortis Centre for Diabetes, Obesity and Cholesterol, New Delhi, says India has one of the highest absolute metabolic disease burdens in Asia-Pacific. “In 2023, India had approximately 21 million DALYs and 5.8 lakh deaths from type 2 diabetes. High systolic BP caused nearly 3.8 crore DALYs and about 15.7 lakh deaths. We also need to be aware that high BMI is also rising steadily ( at a 2.7-2.9 % annually), as are LDL cholesterol and MASLD,” he explains. The burden is so heavy, these two countries not only top the sub region, but also are the highest worldwide.

In terms of DALYs, in 2023 India replaced China (from its top position in 1990) to lead the list of top 5 countries in the region. Under all the other four parameters, India continues to be in the second position after China, but the gap between the nations is steadily narrowing. This is particularly true with High BMI, LDL cholesterol, and MASLD. 

Urgent prevention called for

“It is clear that most metabolic risks will continue rising, up until 2030,” says Dr. Misra, “This is why the time is opportune to launch urgent integrated prevention strategies.” In his opinion, the government should promote healthier diets by regulating ultra-processed foods, introducing clear front-of-pack nutrition labelling, and reducing excess sugar, salt, and unhealthy fats in commonly consumed foods. While this is being done in some areas, what is required is more uniform implementation across the country. 

He further adds that cities and communities must be redesigned to encourage daily activity through safe walking spaces, cycling tracks, and school- and workplace-based exercise programs. “Frankly, this is the most difficult part, and I don’t see it happening in most cities any time in the near future,” he says. 

Besides this, large-scale screening for obesity, diabetes, hypertension, and fatty liver disease should be integrated into primary health care so that high-risk individuals can be identified and treated early. This has been done by the Union Health Ministry, and some States independently, but needs to be consolidated and strengthened.