Is diabetes mellitus related to undernutrition in rural Tanzania?

[Nutrition transition, prevalence of double burden of malnutrition and cardiovascular risk factors in the adult population living in the island of Anjouan, Comoros]

Introduction

le surpoids et de l'obésité progressent de manière effrayante, notamment dans les pays en développement. Cette étude vise à déterminer la prévalence de l'insuffisance et de la surcharge pondérale et à évaluer la relation entre l'Indice de Masse Corporelle et les facteurs de risque cardiovasculaires associés chez les adultes de l'île d'Anjouan.

Méthodes

l'enquête est une étude transversale, où un échantillon de 902 individus âgés de 25 à 64 ans est sélectionné en utilisant la méthode de sondage empirique « des quotas ». Le statut nutritionnel est déterminé en calculant l'indice de masse corporelle (IMC), le périmètre abdominal et le rapport tour de taille/tour de hanche (RTH). La pression artérielle, le périmètre abdominal et le tour de hanche ont été mesurés pendant l'interview tandis que la glycémie capillaire à jeun a été mesurée le lendemain.

Résultats

les résultats ressortis font état d'une moyenne d'âge de 39,5 ± 11,67 ans. La prévalence globale de l'insuffisance pondérale, du surpoids et de l'obésité est respectivement de 4,1%, 28,6% et 22,2%. Les facteurs de risque associés au surpoids/obésité sont l'âge avancé (P= 0,004), le genre (P=0,000), le poids (P=0,000), le diabète (P= 0,006), l'hypertension (P= 0,01), l'obésité abdominale (P= 0,000), le tour de hanche (P=0,000), le RTH (P=0,000), la durée inactive/jour (P=0,001) et le tabagisme (P< 0,05), contrairement à l'inactivité physique (P= 0,10).

Conclusion

les résultats confirment la présence du double fardeau nutritionnel. D'où l'urgence de mettre en place des stratégies de prévention des maladies non transmissibles.

Prevalence, Risk Factors, and Complications of Diabetes in the Kilimanjaro Region: A Population-Based Study from Tanzania

BACKGROUND

In sub-Saharan Africa, diabetes is a growing burden, yet little is known about its prevalence, risk factors, and complications. To address these gaps and help inform public health efforts aimed at prevention and treatment, we conducted a community-based study assessing diabetes epidemiology.

METHODS AND FINDINGS

We conducted a stratified, cluster-designed, serial cross-sectional household study from 2014-2015 in the Kilimanjaro Region, Tanzania. We used a three-stage cluster probability sampling method to randomly select individuals. To estimate prevalence, we screened individuals for glucose impairment, including diabetes, using hemoglobin A1C. We also screened for hypertension and obesity, and to assess for potential complications, individuals with diabetes were assessed for retinopathy, neuropathy, and nephropathy. We enrolled 481 adults from 346 urban and rural households. The prevalence of glucose impairment was 21.7% (95% CI 15.2-29.8), which included diabetes (5.7%; 95% CI 3.37-9.47) and glucose impairment with increased risk for diabetes (16.0%; 95% CI 10.2-24.0). Overweight or obesity status had an independent prevalence risk ratio for glucose impairment (2.16; 95% CI 1.39-3.36). Diabetes awareness was low (35.6%), and few individuals with diabetes were receiving biomedical treatment (33.3%). Diabetes-associated complications were common (50.2%; 95% CI 33.7-66.7), including renal (12.0%; 95% CI 4.7-27.3), ophthalmic (49.6%; 95% CI 28.6-70.7), and neurological (28.8%; 95% CI 8.0-65.1) abnormalities.

CONCLUSIONS

In a northern region of Tanzania, diabetes is an under-recognized health condition, despite the fact that many people either have diabetes or are at increased risk for developing diabetes. Most individuals were undiagnosed or untreated, and the prevalence of diabetes-associated complications was high. Public health efforts in this region will need to focus on reducing modifiable risk factors, which appear to include obesity, as well as early detection that includes increasing awareness. These findings highlight a growing urgency of diabetes prevention in this region as well as the need for treatment, including management of complications.

Profile of patients with diabetes in Eritrea: results of first phase registry analyses

A cross-sectional descriptive study was done on patients recently entered into the National Diabetes Registry in Eritrea where the prevalence was estimated to be 2.2% based on patient information in 2004. Of the 627 patients with diabetes, two thirds were type 2. Although type 1 had poorer control (42.9%) than type 2 (29.9%), some of the risk factors such as cholesterol (43.4 vs. 28.2%), triglyceride (23.4 vs. 12.8%), hypertension (55.2 vs. 12.7%) as well as BMI and waist/hip ratio were higher in type 2 than type 1. More than one-third (41.2%) of patients with type 2 compared to type 1 (19.5%) had complications, the commonest being retinopathy (33%) followed by foot ulcers (14%) and neuropathy (4%). Many of the diabetic patients demonstrated the presence of the metabolic syndrome components such as hypertension, obesity and dyslipidemia. The authors conclude that diabetes registry is invaluable in providing evidence-based prevention and control of the disease.

Differences in height explain gender differences in the response to the oral glucose tolerance test- the AusDiab study

AIM

To determine the extent of gender-related differences in the prevalence of glucose intolerance for the Australian population and whether body size may explain such differences.

METHODS

Cross-sectional data were collected from a national cohort of 11 247 Australians aged > or = 25 years. Glucose tolerance status was assessed according to both fasting plasma glucose (FPG) and 2-h plasma glucose (2hPG) levels following a 75-g oral glucose tolerance test (OGTT). Anthropometric and glycated haemoglobin measurements were also made.

RESULTS

Undiagnosed diabetes and non-diabetic glucose abnormalities were more prevalent among men than women when based only on the FPG results (diabetes: men 2.2%, women 1.6%, P = 0.02; impaired fasting glycaemia: men 12.3%, women 6.6%, P < 0.001). In contrast 16.0% of women and 13.0% of men had a 2hPG abnormality (either diabetes or impaired glucose tolerance, P = 0.14). Women had a mean FPG 0.3 mmol/l lower than men (P < 0.001), but 2hPG 0.3 mmol/l higher (P = 0.002) and FPG-2hPG increment 0.5 mmol/l greater (P < 0.001). The gender difference in mean 2hPG and FPG-2hPG increment disappeared following adjustment for height. For both genders, those in the shortest height quartile had 2hPG levels 0.5 mmol/l higher than the tallest quartile, but height showed almost no relationship with the FPG.

CONCLUSIONS

Men and women had different glycaemic profiles; women had higher mean 2hPG levels, despite lower fasting levels. It appeared that the higher 2hPG levels for women related to lesser height and may be a consequence of using a fixed glucose load in the OGTT, irrespective of body size.

Relationships between undernutrition prevalence among children and adult women at national and subnational level

OBJECTIVES

The objective of this study is to analyze the relationships between undernutrition prevalence rates among children and adults, both at the level of countries and at the level of smaller geographical subunits within countries (districts, provinces). Results are considered of relevance for evaluation and proper usage of anthropometric information in poverty and food security assessment.

DESIGN

Anthropometric information on both children and adults, as reported in the Demographic and Health Surveys, has been the primary source of data. In addition, data published by WHO, FAO, and data from some country specific reports have been used. The final analysis is based on data from 289 subnational geographical units divided over 56 countries in Africa, Asia and Latin America. Ordinary least squares has been used for regression analysis and F-tests for testing differences of variances.

RESULTS

At the level of countries, results reveal a strong positive relationship between undernutrition prevalence rates among children and adults. At the level of smaller geographical units, high levels of undernutrition in adult women are almost invariably associated with high levels of undernutrition in children. At the same time, however, low or intermediate levels of undernutrition among adult women are no guarantee that undernutrition levels among children are also low or moderate.

CONCLUSION

At the level of countries, information on undernutrition prevalence in children can be considered a proximate of the overall nutritional and food security conditions in a country. At the level of smaller geographical units, relationships are less straightforward, and are hypothesized to depend, at least partially, on the relative importance of food and nonfood factors in the causation of undernutrition.

Obesity and undernutrition and cardiovascular risk factors in rural and urban Gambian communities

OBJECTIVES

This study documented the prevalence of and cardiovascular risk factors associated with obesity and undernutrition in the Gambia.

METHODS

Adults (> or =15 years; N = 5373) from rural and urban areas completed a questionnaire; their height, weight, and waist and hip circumferences were measured, and their cardiovascular risk factors were assessed.

RESULTS

Prevalence of undernutrition (body mass index < 18 kg/m(2)) was 18.0%; all strata of society were affected. Prevalence of obesity (body mass index > or =30 kg/m(2)) was 4.0% but was higher (32.6%) among urban women 35 years or older. Cardiovascular risk factors were more prevalent among obese participants.

CONCLUSIONS

Undernutrition coexists with obesity, demonstrating a "double burden of disease." Differential interventions should focus on high-risk groups; prevention needs a multisectorial approach.

Prevalence of diabetes mellitus and impaired glucose tolerance in a group of urban adults in Nigeria

This survey was undertaken to determine the prevalence of diabetes mellitus and impaired glucose tolerance in a group of urban adults in Ibadan, Nigeria. A total of 998 subjects randomly selected from five main ministries and departments in the Government Secretariat participated in the survey. Each subject was asked to fast overnight and ingested 75 g of glucose dissolved in 250 mL of water after answering a questionnaire. Relevant anthropometric measurements such as weight, height, waist and hip diameters, and blood pressure also were taken. After 2 hours, of blood was drawn and plasma glucose concentration measured. Diagnosis of diabetes or impaired glucose tolerance was based on 1985 World Health Organization (WHO) cut-off values. Blood glucose results were available in 875 subjects. Seven subjects were found to be diabetic for a prevalence of 0.8%, with the majority (5 subjects) being newly diagnosed. Nineteen were found to have impaired glucose tolerance for a prevalence of 2.2%. There were no sex differences between the two groups. All of the newly diagnosed diabetics were asymptomatic. Multivariate analysis revealed that subjects with a family history of diabetes, higher body mass index, and higher systolic blood pressure had higher blood glucose levels. The prevalence of diabetes in this survey is lower than rates reported in recent surveys in Nigeria that used less stringent criteria and different methodologies. The rate is comparable to that of a Tanzanian study that used WHO criteria. However, the rate of impaired glucose tolerance in this study, first to be reported in Nigeria, is lower than that obtained in the Bantu population.

Clinical classification of diabetes in tropical west Africa

The objective of this work was to classify and describe the different types of diabetic patients detected in West Africa. In four health centres (three in Ivory Coast, one in Niger) 310 new cases were detected and followed up over 1 year. Classification was based on age at diagnosis, BMI, ketonuria, basal and stimulated C-peptide levels at inclusion, and response to antidiabetic therapy. In this population, males were predominant (sex ratio = 2.40), and random blood glucose levels very high at screening (mean +/- SE, 18.6 +/- 0.4 mmol/l). Only one case of fibrocalculous pancreatic diabetes and one possible case of diabetes mellitus related to malnutrition were detected. IDDM was diagnosed in 11.3% of the patients, half of them above 35 years. Leanness was observed in 59% of the patients with NIDDM. A dramatic decrease of fasting blood glucose was observed in all groups after 2 months of treatment, especially in NIDDM. As IDDM and non-obese NIDDM presented great similarities before treatment, even for C-peptide levels, a point score system is proposed to classify these two groups at baseline. In conclusion, it is confirmed that the form of diabetes previously defined as related to malnutrition is a very rare entity in black African populations. In contrast, African diabetes is characterised by the high proportion of NIDDM patients with low BMI, and reduced beta-cell function, rarely associated to ketonuria. This form of diabetes seems to be adequately controlled with oral hypoglycaemic drugs and/or diet in the year following diagnosis.

Fetal and infant growth and impaired glucose tolerance in adulthood: the "thrifty phenotype" hypothesis revisited

The epidemiological links observed between fetal and infant growth and impaired glucose tolerance in adult life that led to the formulation of the "thrifty phenotype" hypothesis have been confirmed by others in widely differing populations. The proposed nutritional basis of these links has been tested in an animal model in which rat dams were fed an isocaloric low-protein diet and the postweaning normally fed offspring were studied. Permanent changes in key hepatic enzymes of glycolysis and gluconeogenesis and reductions in both insulin and glucagon sensitivity of the liver have been observed. Glucose tolerance deteriorated more at age 15 months compared with controls but animals were not frankly diabetic. The longevity of offspring was affected positively when growth was retarded by postnatal protein restriction, but negatively when protein restriction during pregnancy was followed by cross-fostering of pups to normally fed dams with consequent "catch-up" growth. These effects were greatest in males. The thrifty phenotype hypothesis continues to provide a useful conceptual and experimental basis for the study of the aetiology of non-insulin-dependent diabetes.

Undiagnosed glucose intolerance in the community: the Isle of Ely Diabetes Project

The Isle of Ely Diabetes Project is a prospective population-based study of the aetiology and pathogenesis of Type 2 diabetes mellitus. Between 1990 and 1992, 1156 subjects aged between 40 and 65 years underwent a standard 75 g oral glucose tolerance test (OGTT). A total of 1122 individuals who were not known to have diabetes completed the test and were classified according to WHO criteria; 51 subjects (4.5%) had previously undiagnosed diabetes and 188 (16.7%) had impaired glucose tolerance. The subjects with newly diagnosed glucose intolerance were significantly older, more obese, and shorter than those with normal glucose tolerance. Blood pressure, cholesterol, triglyceride, and LDL-cholesterol concentrations were elevated and HDL-cholesterol levels were lower among those with abnormal rather than normal glucose tolerance. In multiple regression analyses stratified by gender and including age, body mass index, and the waist-hip ratio as covariates, there were significant differences between those with normal and abnormal glucose intolerance in blood pressure, triglyceride, and HDL-cholesterol, but not total or LDL-cholesterol. In both male and female subjects, height had a significant independent negative association with the plasma glucose at 120 min after administration of oral glucose (standardized beta coefficient = -0.12, p < 0.01).