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What factors explain the much higher diabetes prevalence in Russia compared with Norway? Major sex differences in the contribution of adiposity.

BMJ Open Diabetes Research and Care. 2021. Vol. 9. No. 1.
Iakunchykova, O., Averina, M., Wilsgaard, T., Malyutina, S., Kudryavtsev, A. V., Cook, S. .., Leon D. A.

Introduction Compared with many other countries
Russia has a high prevalence of diabetes in men and
women. However, contrary to what is found in most other
populations, the risk is greater among women than men.
The reasons for this are unclear.
Research design and methods Prevalence and risk
factors for diabetes at ages 40–69 years were compared
in two population-based
studies: Know Your Heart (KYH)
(Russia, 2015–2018, n=4121) and the seventh wave of the
Tromsø Study (Tromsø 7) (Norway, 2015–2016, n=17 649).
Diabetes was defined by the level of glycated hemoglobin
and/or self-reported
diabetes and/or diabetes medication
use. Marginal structural models were used to estimate the
role of key risk factors for diabetes in differences between
the studies.
Results Age-standardized
prevalence of diabetes was
higher in KYH compared with Tromsø 7 in men (11.6%
vs 6.2%) and in women (13.2% vs 4.3%). Age-adjusted
ORs for diabetes in KYH compared with Tromsø 7 were
2.01 (95% CI 1.68 to 2.40) for men and 3.66 (95% CI
3.13 to 4.26) for women. Adiposity (body mass index
and waist circumference) explained none of this effect
for men but explained 46.0% (39.6, 53.8) for women.
Addition of smoking and C reactive protein, as further
mediators, slightly increased the percentage explained of
the difference between studies to 55.5% (46.5, 66.0) for
women but only to 9.9% (−0.6, 20.8) for men.
Conclusions Adiposity is a key modifiable risk factor
that appears to explain half of the almost threefold higher
female prevalence of diabetes in Russia compared with
Norway, but none of the twofold male difference.