Convergence of obesity and high glycemic diet on compounding diabetes and cardiovascular risks in modernizing China: an emerging public health dilemma
Open accessAbstract
As China is undergoing dramatic development, it is also experiencing major societal changes, including an emerging obesity epidemic, with the prevalence of overweight and obesity doubling in the past decade. However, the implications of a high glycemic index (GI) and glycemic load (GL) traditional Chinese diet are adversely changing in modern times, as a high-glycemic diet is becoming a greater contributor to diabetes and cardiovascular risks in a population with rising obesity and decreasing physical activity. Specifically, a high GI diet adversely impacts metabolism and appetite control regulation, and notably confers substantially greater risk of weight gain, type 2 diabetes, cardiovascular disease, and certain cancers among overweight and obese individuals (P<0.05 for all); leading to an emerging vicious cycle of compounding adverse health risks. Notably, while no elevated risk of cardiovascular disease and type 2 diabetes were observed with higher GL intake among normal weight individuals, among overweight individuals, higher GL was strongly associated with higher risk of coronary heart disease (RR=2.00, 95%CI: 1.31-2.96), stroke (RR=2.13, 1.28-3.53), and type 2 diabetes (RR=1.52, 1.22-1.89 among Chinese). Additionally, the influx of Western-diets rich in saturated fats and high-glycemic sugar-sweetened beverages also threaten the health of the population. This review highlights the emerging adverse convergence of a high-glycemic Asian diet with a Chinese society experiencing an emerging obesity epidemic, and the important implications of these combined factors on compounding cardiometabolic risks. Potential policy directions in China are also discussed.
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Men with lower BMIs have been shown to be less susceptible to the effects of GI on CHD risk.
“men with lower BMIs have been shown to be less susceptible to the effects of GI on CHD risk.48”
From Associations of Glycemic Index and Load With Coronary Heart Disease Events: A Systematic Review and Meta‐Analysis of Prospective Cohorts (2012) · cites this paper as [48]
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Michaud, D. S., Fuchs, C. S., Liu, S., Willett, W. C., Colditz, G. A., & Giovannucci, E. L. (2005) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.138.14.1 · Cited by 166 · cited 5× · see citing works
“Notably, a high-glycemic diet induces a consistently significantly stronger effect on the development of type 2 diabetes [35,75], coronary heart disease [38,39], and stroke [40], especially among those with greater adiposity (BMI > 23 or BMI > 25), (all 3 diseases: P for interaction 0.05).”
Influentialon behalf of the SHARE Investigators, Razak, F. A., Anand, S. S., Vuksan, V. V. V., Davis, B., Jacobs, R., Teo, K. K., & Yusuf, S. (2005) · International Journal of Obesity · doi:10.1038/sj.ijo.0802937 · Cited by 161 · see citing works
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Optimal Dietary Habits for the Prevention of Stroke
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“From the aspect of social nutrition programs, it is conceivable that the PRC government could implement nationwide or region-specific public campaigns, via all forms of mass media, community-based promotion, as well as work-place promotion, on nutrition and lifestyle changes per recommended guidelines of various healt…”
Self-citationWeight perception and psychological factors in Chinese adolescents
Xie, B., Liu, C., Chou, C.-P., Xia, J., Spruijt‐Metz, D., Gong, J., Li, Y., Wang, H., & Johnson, C. A. (2003) · Journal of Adolescent Health · doi:10.1016/s1054-139x(03)00099-5 · Cited by 128 · cited 1× · see citing works
“Additionally, improved education of what is a healthy body weight in Chinese adolescents may be necessary, as there exists significant discordance between true healthy weight and desired body weight and obesity perception among Chinese children [85-87]; particularly worrisome are the higher-than-optimal or more overwe…”
Murakami, K., Sasaki, S., Okubo, H., Takahashi, Y., Hosoi, Y., ITABASHI, M., & and the Freshmen in Dietetic Courses Study II Group (2007) · European Journal of Clinical Nutrition · doi:10.1038/sj.ejcn.1602610 · Cited by 118 · cited 1× · see citing works
“The high GI of these foods have been strongly correlated with dyslipidemia and metabolic conditions [62,64,65].”
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Prevention of Type 2 Diabetes by Diet and Lifestyle Modification
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“From the aspect of social nutrition programs, it is conceivable that the PRC government could implement nationwide or region-specific public campaigns, via all forms of mass media, community-based promotion, as well as work-place promotion, on nutrition and lifestyle changes per recommended guidelines of various healt…”
Sugar-Sweetened Soft Drink Consumption and Risk of Pancreatic Cancer in Two Prospective Cohorts
Schernhammer, E. S., Hu, F. B., Giovannucci, E. L., Michaud, D. S., Colditz, G. A., Stampfer, M. J., & Fuchs, C. S. (2005) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-05-0059 · Cited by 114 · cited 1× · see citing works
“Moreover, similar patterns have also been repeated observed for GL and cancer risk, where high GL is more strongly associated with colorectal cancer incidence among those with higher BMI [76,77], and highglycemic sugar-sweetened beverages more strongly linked with pancreatic cancer among those with low physical activi…”
Impact of Obesity and Body Fat Distribution on Cardiovascular Risk Factors in Hong Kong Chinese
Thomas, G. N., Ho, S. Y., Lam, K. S. L., Janus, E. D., Hedley, A. J., & Lam, T. H. (2004) · Obesity Research · doi:10.1038/oby.2004.224 · Cited by 111 · cited 4× · see citing works
“Studies have indeed shown that Asians have a higher percent body fat at lower BMI's compared to Caucasians [51-54].”
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“All thes mechanisms consequently leads to a high GI/GL diet being repeatedly shown to adversely effect glycemic control in individuals with diabetes [32], as well as associated with greater risk of developing type 2 diabetes [33-36], coronary heart disease [9,37-39] and stroke [40,41] in prospective studies.”
Amano, Y., Kawakubo, K., Lee, J. S., Tang, A. C., Sugiyama, M., & Mori, K. (2004) · European Journal of Clinical Nutrition · doi:10.1038/sj.ejcn.1601992 · Cited by 99 · cited 1× · see citing works
“The high GI of these foods have been strongly correlated with dyslipidemia and metabolic conditions [62,64,65].”
Wu, Y.-F., Ma, G., Hu, Y., Li, Y., Li, X., Cui, Z., Chen, C., & Kong, L. (2005) · PubMed · Cited by 95 · see citing works
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“All thes mechanisms consequently leads to a high GI/GL diet being repeatedly shown to adversely effect glycemic control in individuals with diabetes [32], as well as associated with greater risk of developing type 2 diabetes [33-36], coronary heart disease [9,37-39] and stroke [40,41] in prospective studies.”
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The glycaemic index values of Vietnamese foods
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“However, Asian rice, rice porridge, and glutinous (sticky) rice are recognized to be extremely high in GI [58-61], with plain white rice having a high GI value of approximately 80 [62], which elicits postprandial glucose responses close to that of pure glucose [59].”
Obesity and Pancreatic Cancer: Overall Evidence and Latency Period
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“Traditional Chinese diets are characterized and dominated by high-glycemic carbohydrates [55-57], primarily rice as the staple grain.”
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“Traditional Chinese diets are characterized and dominated by high-glycemic carbohydrates [55-57], primarily rice as the staple grain.”
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“Moreover, even higher GI values are observed for varieties of rice porridge and glutinous rice [58,63], also frequently consumed.”
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“However, Asian rice, rice porridge, and glutinous (sticky) rice are recognized to be extremely high in GI [58-61], with plain white rice having a high GI value of approximately 80 [62], which elicits postprandial glucose responses close to that of pure glucose [59].”
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“Moreover, even higher GI values are observed for varieties of rice porridge and glutinous rice [58,63], also frequently consumed.”
Interactions between development and human health.
Song, X. (2000) · PubMed · Cited by 1 · see citing works
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Hu, F. B. (2011) · Diabetes Care · doi:10.2337/dc11-0442 · Cited by 1,954 · see citing works
“The adverse effects of high dietary GI and GL are more evident in overweight or obese individuals who are prone to insulin resistance (24).”
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“effects of GI on CHD risk.(48) There may also be another potential explanation for the difference between men and women, possibly a result of differences in diet reporting.”
Fructose consumption: recent results and their potential implications
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“It is plausible that high consumption of refined carbohydrates may be particularly detrimental for Asian populations, who are likely to be classified as “metabolically obese” (26, 27).”
Reddy, S. P., Resnicow, K., James, S., Funani, I. N., Kambaran, N. S., Omardien, R. G., Masuka, P., Sewpaul, R., VAUGHAN, R. D., & Mbewu, A. D. (2011) · American Journal of Public Health · doi:10.2105/ajph.2011.300222 · Cited by 92 · see citing works
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Predicting nationwide obesity from food sales using machine learning
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“The adverse effects of high-GI and -GL diets tend to be more evident in individuals with excess adiposity, who are generally more insulin-resistant than lean individuals(29).”
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White rice, brown rice and the risk of type 2 diabetes: a systematic review and meta-analysis
Yu, J., Bhavadharini, B., Tinajero, M., Jarvis, S., Khan, T. A., Sudha, V., Ranawana, V., Poobalan, A. S., Bhupathiraju, S. N., Sun, Q., et al. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-065426 · Cited by 46 · see citing works
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Kristoffersen, E., Hjort, S. L., Thomassen, L. M., Arjmand, E. J., Perillo, M., Balakrishna, R., Onni, A. T., Sletten, I. S. K., Lorenzini, A., & Fadnes, L. T. (2025) · Nutrients · doi:10.3390/nu17040662 · Cited by 29 · see citing works
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“The traditional Chinese high-glycemic diet consists of a variety of high-glycemic staple rice products such as boiled rice, rice congee, and glutinous rice which pose adverse cardiovascular and MetS risks [167].”
InfluentialRole of fructose concentration on cataractogenesis in senile diabetic and non-diabetic patients
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“High fructose syrup and crystalline fructose are used extensively as sweeteners in pharmaceuticals and in mainstream food applications such as carbonated beverages, baked goods, canned fruits, jams, jellies and dairy products, and its consumption has increased steadily over the past two decades [6, 7].”
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Risk factors of obesity in a cohort of 1001 Cypriot adults: An epidemiological study.
Andreou, E. P., Hajigeorgiou, P. G., Kyriakou, K., Avraam, T., Chappa, G., Kallis, P., Lazarou, C., Philippou, C., Christoforou, C., Kokkinofta, R., et al. (2012) · Europe PMC (PubMed Central) · Cited by 16 · see citing works
Correlates of Overweight Status in Chinese Youth: An East-West Paradox
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“Moreover, these studies did not focus on the elderly, even though elderly people have different eating patterns than their younger counterparts, including a higher frequency of consumption of ethnic foods, smaller portion sizes, and a more organized, traditional three meals a day [10,11].”
BackgroundAsian Children's Obesogenic Diets—Time to Change This Part of the Energy Balance Equation?
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“Ding and Malik (2008 ) noted that, using the Chinese diet as an example, the traditional high- glycemic diet made up of a variety of high-glycemic staple rice products such as boiled rice, rice congee, and glutinous rice have carbohydrate qualities close to that of pure glucose, which poses adverse cardiovascular risk…”
BackgroundRisk factors of obesity in a cohort of 1001 Cypriot adults: An epidemiological study
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“Ding and Malik (2008) found that the change to a high-glycemic-index diet (including U.S. fast food chain consumption) has contributed to increasing type 2 diabetes and cardiovascular risks in China.”
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“Researches also illustrate linkages between highly glycemic diets and various types of cancer (Eyre et al., 2004; Bonovas et al., 2004; Ding and Malik, 2008).”
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The role of diet, lifestyle, and genes
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“The following question emerged: Can the excessive restriction of GL, mostly through an extreme reduction in the intake of carbohydrates, result in a relatively high intake of fat and protein and result in overweight and obesity [19]? Indeed, China is facing an emerging obesity epidemic, and the prevalence of overweigh…”
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Food Addiction, Obesity and Neuroimaging
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“The traditional Chinese high-glycemic diet consists of a variety of high-glycemic staple rice products such as boiled rice, rice congee, and glutinous rice which pose adverse cardiovascular and MetS risks (Ding & Malik, 2008).”
InfluentialEffect of low glycaemic index diets on satiety
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Relationship between Glycemic Load and Blood Lipid Level in Hospitalized Adult Chinese.
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The APOBEC1 Paradigm for Mammalian Cytidine Deaminases That Edit DNA and RNA
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Nutritional Quality Assessment of Elementary School Lunches of South Korea and the United States
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“A number of studies have examined the status and quality between countries, mainly focusing on individual nutrients and foods (Adair & Popkin, 2005; Ding & Malik, 2008; Hawkes, 2007).”
BackgroundMicrobiome profile and nutritional benefits of traditional overnight soaked cooked rice
Afrin, S., Orr, C. H., Kuba, S. Y., Naser, S. R., Farooq, R., Khan, M. S., Menon, M., Domingues, L. Z., & Sarker, M. H. (2024) · Food and Humanity · doi:10.1016/j.foohum.2024.100410 · Cited by 2 · see citing works
Obesity and orthodontic treatment: A scoping review
Michelogiannakis, D., Kheir, N. A., Rossouw, P. E., & Kotsailidi, E. A. (2025) · Seminars in orthodontics · doi:10.1053/j.sodo.2025.01.004 · Cited by 1 · see citing works
Guzzardi, M. A., & Iozzo, P. (2013) · Springer eBooks · doi:10.1007/978-3-319-01050-2_2 · Cited by 2 · see citing works
High Glycaemic Index (GI) of Asian Diet—What are the Clinical Implications?
Tey, B. H., Lee, L. F., & Lee, S. M. (2014) · Annals of the Academy of Medicine Singapore · doi:10.47102/annals-acadmedsg.v43n11p524 · Cited by 2 · see citing works
Dzandu, B. A., Mensah, D. L., & Sarpong, V. A. (2025) · Journal of Culinary Science & Technology · doi:10.1080/15428052.2025.2488787 · Cited by 1 · see citing works
“On the other hand, regular consumption of high GI foods may increase the risk of diabetes (type 2), obesity and heart disease (Ding & Malik, 2008; Jenkins et al., 2008; Jung & Choi, 2017; Kopp, 2006).”
Globalization and health scholarship in a time of pandemic: from critical past to uncertain future
Labonté, R. (2020) · Globalization and Health · doi:10.1186/s12992-020-00563-6 · Cited by 1 · see citing works
Reddy, P. S., Resnicow, K., Funani, I. N., Kambaran, N. S., Omardien, R. G., Masuka, P., Sewpaul, R., VAUGHAN, R. D., & Mbewu, A. D. (2012)
Shrestha, D. (2012) · UWA Profiles and Research Repository (UWA)
Comparison of Fasting Plasma Glucose amongSmoking and Non Smoking Medical StudentPopulation
Tey, R., Manjrekar, P., & D’Souza, V. (2014)
Lo, C. Y.-P. (2015) · Palgrave Macmillan US eBooks · doi:10.1057/9781137504210_3
Drinking Plain Water Before Having Breakfast Lowers Body Weight in Obese Male Adolescents
Gracia, V. V. D., Indarto, D., & Tamtomo, D. G. (2018) · Jurnal Keperawatan Soedirman · doi:10.20884/1.jks.2018.13.3.819
Lifestyle intervention strategies for diabetes management
Tay, J., & Tay, J. (2016) · Adelaide Research & Scholarship (AR&S) (University of Adelaide) · doi:10.25909/5b63b9ac0685f
Pinheiro, L. A., Sampaio, H. A. D. C., Carioca, A. A. F., Portela, C. L. D. M., Sabry, M. O. D., Passos, T. U., de Melo, M. L. P., & Pereira, I. B. (2013) · PubMed
- Authors
- Ding, E. L., & Malik, V. S.
- Affiliations
- Harvard University (US)
- Corresponding author
- Ding, Eric L
- Venue
- Globalization and Health
- Published
- 2008
- Volume
- 4
- Issue
- 1
- Pages
- 4
- ISSN
- 1744-8603 (ISSN-L)
- PMC
- PMC2292178
- OpenAlex
- W2026812917
- Cited by
- 61
- References
- 91
- Citations by year
- 2025: 4 · 2024: 1 · 2022: 3 · 2021: 2 · 2020: 3 · 2019: 2 · 2018: 1 · 2016: 3 · 2015: 6 · 2014: 7 · 2013: 4 · 2012: 8
- FWCI
- 4.11
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Globalization and Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- American Diabetes Association
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- obesity, high glycemic index diet, glycemic load, type 2 diabetes, cardiovascular disease, coronary artery disease, stroke, cardiometabolic risk, Western diet, sugar-sweetened beverages, traditional Chinese diet, physical inactivity
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