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OBJECTIVE To examine the secular trends in risk factors, estimate their impact on type 2 diabetes burden from 1991 to 2011, and project trends in the next 20 years. RESEARCH DESIGN AND METHODS Risk factor distributions were based on data from the China Health and Nutrition Survey 1991–2011. Diabetes cases attributable to all nonoptimal levels of each risk factor were estimated by applying the comparative risk assessment method. RESULTS In 2011, high BMI was the leading individual attributable factor for diabetes cases in China responsible for 43.8 million diabetes cases with a population-attributable fraction of 46.8%. Low whole-grain intake and high refined grain intake were the leading dietary risk factors in China responsible for 37.8 million and 21.8 million diabetes-attributable cases, respectively. The number of attributable diabetes cases associated with low physical activity, high blood pressure, and current smoking was 29.5, 21.6, and 9.8 million, respectively. Although intakes of low-fat dairy products, nuts, fruit, vegetables, and fish and seafood increased moderately over time, the average intake was below optimal levels in 2011 and were responsible for 15.8, 11.3, 9.9, 6.0, 3.6, and 2.6 million diabetes cases, respectively. Meanwhile, intakes of processed meat, red meat, and sugar-sweetened beverage showed increasing trends over time and were responsible for 2.8, 1.8, and 0.5 million diabetes cases, respectively, in 2011. CONCLUSIONS A high BMI and low intake of whole grains but high intake of refined grains are the most important individual risk factors related to Chinese diabetes burden; low physical activity and high blood pressure also significantly contributed.

Time Trends of Dietary and Lifestyle Factors and Their Potential Impact on Diabetes Burden in China