6-12 May 2016 #807

More exercise, less soft drinks …

… most effective way to tackle an epidemic of diabetes sweeping Asian developing countries like Nepal
Sonia Awale in HONG KONG

Gopen Rai

The number of adults with diabetes worldwide has quadrupled in the past 35 years, according to a recent study, with most of the increase in Asian countries. Lifestyle changes, sugar-rich diets and genetic predisposition mean Nepal also faces an epidemic of the disease, researchers warn.

The study published last month in the journal The Lancet compared diabetes levels worldwide from 1980-2014 and found that low and middle-income countries had the biggest increase. The world average for diabetes prevalence is 9 per cent, and Nepal is nearly at the top of the list with incidence at 8.1 per cent.

“Rural to urban migration in Nepal has multiple impacts like decreased physical activity, shift to high energy diets leading to obesity and increasing the risk of diabetes,” explained Sanjib Sharma of the B P Koirala Institute of Health Sciences (BPKIHS) in Dharan, and a contributor to the study.

The number of people suffering from Type 2 diabetes in Nepal, particularly in urban areas, is growing alarmingly with more than ten times the prevalence rate in cities as in villages -- mainly due to sugar-rich diets and reduced exercise.

Genetics plays a role, and early life conditions can also determine whether a person will develop diabetes later in life, especially in countries with poor maternal and child healthcare.

“Inadequate nutrition during pregnancy and low birth weight of babies may increase diabetes prevalence in Nepal,” Sharma told Nepali Times by email. His research has shown that the prevalence of diabetes in Nepal is 8.1 per cent, with 1 per cent in rural areas and up to 14 per cent in cities. There are an estimated 2.5 million people with Type 2 diabetes in Nepal.

India and China currently have the highest numbers of diabetic patients, and also show the sharpest rise in total numbers with the disease. Studies suggest that South Asians are six times more likely to develop diabetes than the general population, with lifestyle and genetics the main factors.

Since South Asians are more genetically predisposed to diabetes, they also have to careful about other carbohydrate-rich foods. A recent Harvard School of Public Health study showed that a bowl of white rice packs as much sugar as two cans of soft drinks.

Another contributor to the study, Daniel Ho of the University of Hong Kong, said the main culprits were sugar-rich soft drinks and carbohydrate-rich diets. “Soft drinks have very high calories, and people aren’t even aware about the danger they pose,” he said.

All those extra calories coupled with generally declining physical activity are cited among the main reasons for the sharp increase in diabetes in Asia. An average Nepali consumes 30g of sugar per day in their diet, with a much higher consumption in urban areas. The World Health Organisation (WHO) cites 25g/day as the threshold safe limit for sugar consumption.

Sharma said it is more prudent and cheaper to prevent the disease by behavioural changes rather than treating it once diagnosed in a patient. “The greatest gains in public health in countries like Nepal will be derived not from breakthroughs in biomedical research but from changes in behaviour. Public awareness is needed to convince people about more exercise and reducing sugar consumption.”   China, India and Nepal could also learn from government policies to reduce the consumption of sugar-rich soft drinks. Mexico, for instance, passed an excise tax on sugar-sweetened beverages after it was found 72 per cent of the population was overweight. Just two years later, there was up to 12 per cent decline in the consumption of sweetened beverages in Mexico and a 17 per cent drop among poorer households, according to a recent study published in the British Medical Journal.

““We can draw parallels to tobacco control. Like tax on cigarettes, we can do something similar for sugary drinks like Mexico did,” said Ho.

As Nepal’s disease burden moves from infections to a greater prevalence of non-communicable diseases like diabetes, experts say it could use the proven effectiveness of community health programs by mobilising Female Community Health Volunteers (FCHVs) to spread awareness about the dangers of energy-rich diets and a sedentary lifestyle.

“For diabetes, too, we need simple approach of empowering grassroots health care providers like FCHVs,” said Sharma. “This will help detect and treat diabetes earlier, helping to prevent more serious complications that drain the country’s resources.”

For the first time ever, there are more obese people in the world than underweight. China now has overtaken both the US and UK in diabetes prevalence, with 9.4 per cent of its population diabetic. Even its overweight population is increasing, and has crossed 35 per cent. Similarly in Hong Kong, one third of people in the city are now overweight.

“People are moving to cities, consuming fast food and soft drinks, with minimum physical activity,” explained Ho. “Any policy that can increase physical activity can be useful, anything we can do to reduce obesity will be useful to prevent diabetes.”

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