DIABETES - PRICE OF PROGRESS
From: Dr. Jai Maharaj (usenet_at_mantra.com)
Date: 08/01/04
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Date: Sun, 01 Aug 2004 21:07:32 GMT
Diabetes: price of progress
Changed lifestyle and food habits of a rural population
have increased the incidence of diabetes three fold in 14
years. First proof that lifestyle does not insulate the
rural population.
By R. Prasad
The Hindu
Thursday, July 15, 2004
GIVE A villager a motorised transport, electricity, piped
water supply, television, and food containing more of
carbohydrate, protein and fat. "The chances are that the
villager will invariably be afflicted with diabetes,"
said, Dr. A. Ramachandran, Managing Director of the
Chennai based M.V. Hospital for Diabetes. While progress
is welcome, what comes with it unasked are the diseases
of urbanised lifestyle. "The transition from a typical
rural to urban lifestyle carries its own baggage of
problems. Diabetes is one of them. It is a disease of
progress," he explained.
He should know better. A study of a rural area 40 kms
from Chennai in 1989 showed the prevalence of diabetes
hovering around 2.20 per cent. Typical of a rural area
where manual labour, physical exercise and low
fat/carbohydrate food ruled. The incidence has now shot
up to 6.36 per cent when the disease prevalence was
studied after a span of 14 years.The village is still
typically rural but has all the fringes of an urbanised
setting," he explained.
The study proves conclusively what was widely believed.
Changes in lifestyle and food habits have gone a long way
in increasing the incidence level. For instance, women
were found to confine themselves to household work and
shun manual work that was very common 14 years ago.
Similarly, food habits changed from ragi and vegetables
to carbohydrate and fat filled food. Add to this, better
facilities — like motorised transport and piped water —
which mimic urban life. And the concoction has proved an
ideal setting for diabetes prevalence to shoot up.
"But even here the prevalence is a meagre 2.80 per cent
in those who are still engaged in strenuous physical
activity compared to 48.3 per cent living a near
sedentary life," Dr. Ramachandran pointed out. Lack of
physical exercise and consumption of fat filled food have
had a telling effect on the Body Mass Index (BMI) of both
the sexes. In the case of men, the BMI had increased from
17.60 to 20.70, waist girth from 71.4 to 79.9 in a span
of 14 years.
Though a BMI of 20.7 is much lower than the international
cut off level of 25 to be labelled as obese, studies have
conclusively proved that Indians with BMI of over 23 are
obese. It has been conclusively proved that even small
changes in the BMI could tilt the balance. "This is
basically because we have higher upper-body adiposity
even when we have lean body mass," Dr. Ramachandran
explained.
To the uninitiated, Indians have a high propensity to
develop higher upper-body adiposity, particularly central
obesity. And central obesity (in the form of huge paunch)
is strongly associated with glucose intolerance than
generalised obesity. For a given BMI, Indians have a
higher degree of central adiposity. Blame it on central
obesity, Indians are prone to become diabetic even when
not obese in the literal sense.
This predisposition to accumulate fat in the central
region of the body (in the stomach region) is in the form
of visceral fat. And visceral fat, in contrast to
subcutaneous fat, does more damage as it leads to insulin
resistance. In other words, it prevents the intake of
glucose by the cells. "But we have found that
subcutaneous fat is also responsible for developing
insulin resistance," he clarified. The study involved
studying the role of visceral and subcutaneous fat non-
diabetics using CAT scans.
According to Dr. Ramachandran, insulin resistance is a
characteristic feature of Indians. And for any given BMI,
Indians tend to have higher insulin levels, indicating
the pronounced insulin resistance (peripheral). "Insulin
resistance tends to worsen with small increase in weight
and lack of physical activity," he elaborated.
Studies done have conclusively shown that even
individuals with ideal BMI tend to have body fat
comparable to overweight westerners. The low muscle-mass
and excess body fat contribute greatly to the propensity
to develop diabetes. Hence any weight gain even within
the ideal levels of body mass index can put the person at
risk. The instance of villagers studied by Dr.
Ramachandran who are well below 23 (BMI) is a classic
example.
There is a silver lining though. If an incremental
increase in body weight tends to put the individual at
risk (of developing diabetes), small loss in weight does
wonders. It reduces the risk appreciably. It works both
ways.
More at:
http://www.hindu.com/seta/2004/07/15/stories/2004071500151400.htm
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"And a man's foes shall be they of his own
household.
- Matthew 10:34-36.
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