Attilio Giacosa

Professor Attilio Giacosa was born in Neive, Italy, in 1948.

In 1973 he graduated (Medical Doctor) at the University of Turin. After spending two years at the Nutritional and Intestinal Unit at the General Hospital of Birmingham (UK), he became a specialist in “Diseases of the digestive tract and digestive endoscopy” at the University of Turin.

From 1976 to June 1983, he collaborated with the Gastroenterology Department at the S. Martino Hospital in Genoa, and in June 1983 he became Director of the Clinical Nutrition Unit at the National Cancer Research Institute of Genoa. In 1987 Prof. Giacosa  became Scientific Coordinator of  the research projects of European Organization for Cancer Prevention (ECP). In 1991 he founded and became Co-Editor of the “European Journal of Cancer Prevention” (Lippincott Williams & Wilkins, USA).

From June 2000 to May 2005, Professor Giacosa was Director of the Gastroenterology and Nutrition Unit at the National Cancer Research Institute of Genoa. Since november 2002 he has been appointed Professor of  Gastroenterology at the University of Genoa. From 2005 to 2015 he was Director of the Department of Gastroenterology and Digestive Endoscopy at the Policlinico di Monza, Milan and now he is Consultant in Gastroenterology at the CDI of Milan, Italy.

He has been member of several national and international Scientific Societies. He has been Vice-President of the Italian Society of Parenteral and Enteral Nutrition (SINPE) and  Coordinator of the Nutritional Study Group of the Italian Society of Gastroenterology and member of the Scientific Committee of the same Society (AIGO).  Moreover, he has been member of the Public Affairs Committee of the United European Gastroenterology Federation (UEGF).

Prof Giacosa published 183 scientific papers and 14 monographies.

His research interest is focused on the gastrointestinal health area as well as on the correlation between diet, nutrition and health.

Type 2 diabetes – is sugar the new saturated fat?

Attilio Giacosa, University of Pavia, Italy

The rising burden of type 2 diabetes is a major concern in healthcare worldwide. In 2017, approximately 462 million individuals were affected by type 2 diabetes (T2DM) corresponding to 6.28% of the world’s  population with  a prevalence rate of 6059 cases per 100,000. Over 1 million deaths per year can be attributed to diabetes alone, making it the ninth leading cause of mortality. The burden of diabetes mellitus is rising globally, and at a much faster rate in developed regions, such as Western Europe. The gender distribution is equal, and the incidence peaks at around 55 years of age. Global prevalence of type 2 diabetes is projected to increase to 7079 individuals per 100,000 by 2030   At age 50, life expectancy is 6 years shorter for people with type 2 diabetes than for people without diabetes.  The  global prevalence of prediabetes is also critical. The latter estimate corresponds to approximately 374 million adults aged 18–99 years, with about half (48.1%) below the age of 50 years and about one-third (28.3%) in the age group of 20–39 years. The global prevalence of impaired glucose tolerance (IGT) in 2021 was 9.1% (464 million) and is projected to increase to 10.0% (638 million) in 2045. The global prevalence of impaired fasting glucose (IFG)  in 2021 was 5.8% (298 million) and is projected to increase to 6.5% (414 million) in 2045. The 2021 prevalence of IGT and IFG was highest in high-income countries. In 2045, the largest relative growth in cases of IGT and IFG would be in low-income countries.   Nutrition, dietary macronutrient composition, and in particular dietary carbohydrates and overweight and obesity play a major role in the development of type 2 diabetes. Consumption of sugar has been widely held responsible  for the global rise in T2DM. For most of human history, consumption of sugar, in refined form, was virtually zero. This slowly began to change about 2,000 years ago with the discovery of sugar cane. However, it is only in the last couple of hundred years that there has been a profound change in this regard. Sugarcane is now the world’s third most valuable crop after cereals and rice, occupying 26,942,686 hectares of land across the globe. In 1700, the average person consumed approximately 4.9 grams of sugar each day (1.81 kg per year).  This value rose to 22,4 g in 1800 and  to 112 g in 1900 .  In 2009, 50 per cent of Americans consumed approximately 227 grams of sugar each day – equating to 81.6 kg per year. The digestibility or availability of carbohydrates and their glycemic index (and glycemic load) markedly influence the glycemic response. High consumption of dietary fiber is beneficial for management of T2DM, whereas high consumption of both glycemic starch and sugars may have a harmful effect on glucose metabolism.  Some other factors are involved in glucose metabolism, such as meal composition, gut microbiota , genetics and physical activity.  Inflammaging refers to the chronic, low-grade inflammation associated with aging, which can be exacerbated by metabolic disturbances such as hyperglycemia. This relationship has significant implications for understanding age-related diseases and chronic conditions.  Early and sustained control of blood glucose levels is crucial for minimizing the risk of diabetes-related complications, such as cardiovascular disease , stroke, kidney failure,cancer and dementia. Early markers such as blood glucose control, BMI management, cholesterol levels, and specific metabolic indicators are crucial for promoting longevity in individuals with diabetes. Research  found that diets low in added sugars and rich in vitamins and minerals are linked to a younger biological age at the cellular level. Each gram of added sugar consumed was associated with an increase in epigenetic age, highlighting the detrimental effects of sugar on metabolic health.  The evidence supports a clear relationship between magnesium levels and glycemic control in T2DM patients. Maintaining adequate serum magnesium levels is critical for reducing insulin resistance and improving glycemic indicators       Zinc homeostasis is essential for preventing metabolic disorders, including T2DM.    Vitamin D appears to play a crucial role in modulating insulin sensitivity and reducing the risk of type 2 diabetes, particularly among those with prediabetes.    The global burden of prediabetes and T2MD is substantial and growing. Enhancing prediabetes surveillance is necessary to effectively implement diabetes prevention policies and interventions.   A balanced diet poor in sugar and  rich in fiber, low in processed foods  and possibly associated with regular physical activity and body weight control  are crucial for the prevention of glucose related clinical problems.

For many years, dietary saturated fats have represented one of the most critical dietary determinants of health, particularly for cardiovascular diseases. For the time to come, sugar and dysglycemia are proposed as a new critical reality, with great impact on human health. It is necessary to take these aspects into account and plan urgent public health measures to combat this situation and the eating behaviors related to it.