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Ethno-Med, 3(2): 127-131 (2009)
Some Salient Points in Type 2 Diabetes Prevalence in Rural Bengal
Rangadhar Pradhan, B. Dinesh Kumar and Analava Mitra* School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur 721 302, West Bengal, India Telephone: 091-03222 282220; Fax : 091-03222 282221, E-mail: *<email@example.com>
KEYWORDS Type 2 diabetes. Prevalence. Rural Bengal. ABSTRACT Diabetes mellitus is a complex metabolic disorder characterized by failure to properly utilize glucose and other metabolites in the body causing spillover of these substances in the urine, mainly due to relative or absolute deficiencies of insulin secretions by the β- cells of the pancreas. Our observations indicates that prevalence of diabetes in rural Bengal is in between 3.5% - 5.7%. Religion wise prevalence in rural Bengal shows Muslims have lowest prevalence (4.8%) and it is highest in Hindus (5.4%) while Christians (5.1%) in between. Analysis of Food intake patterns show the prevalence of diabetes is more in meat eaters (7.2%). It is most in pork eaters (7.6%), intermediate in chicken eaters (6.4%) and lowest in those who take goat/sheep (6.1%). In vegetarians it is 5.8% and in fish eaters it is 5.2%. Other factors, such as migration from one place to another, food intake habit, exercises have a great role in type 2 diabetes management.
INTRODUCTION The word “diabetes” is derived from the Greek word “diabainein” which means “to pass through”. It is characterized by an excess of sugar in the blood and urine associated with hunger, thirst and gradual loss of weight due to inadequate insulin action. Insulin is a hormone, which regulates carbohydrate and triglyceride metabolism, through its action at several sites (Rahman and Zaman 1989). As per Wild et al. (2004) incidence of diabetes in India will increase by 195% in 2025 and the sufferers will be young age individuals. Type 2 diabetes along with its forerunner Impaired Glucose Tolerance (IGT) is a result of Insulin Resistance (IR) and is commonly associated with Obesity, hypertension, Coronary Artery Disease (CAD) and Dyslipidaemia. The disease is affecting at an alarming rate to both rural and urban populations in India (Mohan et al. 1996 and 2001; Ramachandran et al. 1990 and 2003). The most common cause of mortality in these patients is CVD, accounting for at least 50% of deaths according to the World Health Organization Multinational Study of Vascular Diseases in Diabetes (Morrish et al. 2001). Hypertension is estimated to contribute from 35% to 75% of diabetic complications (Kirpichnikov and Sowers 2001). Findings from the MRFIT indicated that systolic blood pressure along with serum cholesterol and smoking are significant predictors
of CVD mortality in men with or without diabetes (Stamler et al. 1993). Incidence of diabetes is more on the Southern parts of the country and least in the eastern parts. Nearly 12 per cent of the adult population in Delhi, nearly 10 per cent in Mumbai, 12.5% in Bangalore, 13.5% in Chennai and near 16% in Hyderabad are patients of diabetes. The incidence of diabetes has increased in Hyderabad with an average of 16 % above the age of 25, as compared to 5% in other cities and world average of 3%. However, in rural areas the incidence is 5% less (Ramachandran et al. 2001). PREVALENCE OF DIABETES IN BENGAL Our observations indicates that prevalence in rural Bengal is in between 3.5% - 5.7%. Three districts of West Bengal have high prevalence of diabetes-Howrah (13.2%), Kolkata (12%) and Burdwan (8.7%). Prevalence is comparatively low in Purulia (2.7%), Bankura (3.0%), Dinajpur East (3.6%) and West (3.5%). The prevalence can be described as with the following sub-heads. Religion Religion wise prevalence in rural Bengal shows Muslims have lowest prevalence (4.8%) and it is highest in Hindus (5.4%) while Christians (5.1%) in between. In the Muslims-those who
4%) of diabetes. polyunsaturated fat intake was about 46% and monounsaturated fat intake was about 69%. Fat intake is about 10% while protein intake is 10-15%.128 RANGADHAR PRADHAN. A diet composed of 60-65% carbo- hydrate.5: 3: 2 respectively It is being observed by analyzing the data of 7600 volunteers (obtained from different hospitals and health centers of West Midnapur District) of which 1560 was Muslim.35% fat. however. twice a day.8%) while eating in chairs and tables show increase in the prevalence (9. Our observation show eating in squatting position reduces the prevalence (3. The exact cause of this is unknown. 25. the prevalence of diabetes is less in Muslim and the ratio in Hindu. 60% of lipids must be of vegetal origin with a monounsaturated/ polyunsaturated ratio of 1:1 (Iafusco 2006). The particular posture of Muslim worship may have some role. Consumption of more of carbohydrates lead to diabetes and our study shows 80% or more of carbohydrates lead to more of diabetes. those who prays once a day. Diet and Food Intake Pattern Analysis of Food intake patterns show the prevalence of diabetes is more in meat eaters (7.1%).9%). In vegetarians it is 5. B. The data obtained from 500 rural volunteers and analyzed by the method suggested by Rangana (1986) presented in Table 1 (Food Constituents as Consumed by Semi Urban and Rural People). Fiber intake was about 30-40%. Intake of carbohydrates lower than 80% show not much increase in diabetes prevalence. thrice a day and five times a day are 9: 7: 5.2%).5%).4%) and lowest in those who take goat/sheep (6.6%). Animal and vegetal proteins shall be in a 1:1 ratio.8%). Ontogenetic models by Dilman (1989) show that with aging. Of the tribes in Midnapur West Table 1: Food constituents as consumed by semi urban and rural people Total Income per family per month <1000 1000-5000 >5000 SemiUrban or Rural Semi Urban Rural Semi Urban Rural Semi Urban Rural Protein (%) 10-12 10-15 15-20 10-15 25 10-15 Fat (%) 10 10-15 15-20 10-15 20-25 10-15 Carbohydrate (%) 80 65-75 70-80 65-75 50-65 65-75 Approximate calorie 1600 1800 2000 2000 2250 2250 . The ratio in non-prayers.7%) and in those who pray three times or less it is highest (4. It has been observed that while estimating serum insulin values (radio-immunoassay) of several Muslim volunteers maintaining identical conditions repeated stooping exercises increase serum insulin values by 18-22% (Mitra 2008). DINESH KUMAR AND ANALAVA MITRA pray 5 times prevalence is least (4.8%) while it is highest in those who take coconut oil or groundnut oil (6. Supplementing the diet with fresh fruits that supply potassium and other minerals improve insulin resistance and those whose diet are supplemented with seasonal fruits show reduction in diabetic prevalence (3. in four times it is intermediate (4. This might be due to selection of low cost food materials capable of supplying necessary food components and energy required for normal activities (Mitra 2008). Ghafoarunissa (1996) indicates that fat intake depends on income while our studies in rural Bengalee population show no such relationship. The above data for further analysis revealed saturated fat intake was about 6-8% except in higher income semi-urban population where it was about 15-18%. Rural Bengal diet is chiefly composed of carbohydrates about 80-90% (Mitra and Bhattacharya 2005). intermediate in chicken eaters (6. hypothalamus fails like a failing rheostat.8% and in fish eaters it is 5. in mustard oil consumers it is 5. and 10-20% protein. Complex carbohydrate shall be used in diet.2%. Diabetes in Tribal and Non tribal Population Studies with diabetic population in tribal and non-tribal show an overall ratio of tribal: nontribal 7:18. It is most in pork eaters (7. Muslim and Christian being 13:8: 10. which takes longer duration for digestion and absorption and reduces the prevalence of diabetes.2%).6%. with limited or no alcohol consumption is ideal to reduce diabetic prevalence (Mitra and Bhattacharya 2006a). 5200 being Hindu and the rest Christian. showed that the diet did not have a strong relationship compared to the level of income in the rural population. In the vegetarians those who consume ghee it is least (3.
While in non-tribes it is most in middle-income group (3.4 8.5 prevalence of diabetes in those who perform regular exercises is very low (1.6%).6 5.6 9. Fasting blood sugar and serum insulin values (Boehinger Manheim 1983) of these ladies are low with increase in insulin sensitivity.6 7. Those engaged in professional trades it is highest in drivers (4.9%). in a selective pocket of Midnapur West where a group of residents from Vidarbha migrated. Table 2: Diabetic prevalence of tribes and non-tribes in different districts of West Bengal Name of district Midnapur East Midnapur West 24 parganas North 24 parganas South Burdwan Jalpaiguri Dinagpur East Dinagpur West Kolkata Malda Durjeeling Coochbehar Bankura Purulia Murshidabad Birbhum Hoogli Nadia Howrah Tribe 2. highest in high-income group (5. at a speed of 5 km/hour 1.8 5.8%). Table 2 shows the respective prevalence in different districts of West Bengal. at a speed of 4 km/hour 2.8 2. carotene. 2005) and change over to coconut oil/ mustard oil shows that beneficial effect is retained for 5-7 years and then declines (Mitra and Bhattacharya 2006c).9 4.8 14. riboflavin.6% respectively.2%. Similarly our study with an ethnic group taking 10-12 banyan leaves/day shows reduction in diabetes prevalence (3. niacin and ascorbic acid.2 4. They also take a large amount of Bhang.4 6.6%.9 3. The prevalence of diabetes is less in them (2.7 3.2%) in comparison with other groups in the area (4. China-rose contains Cyanidin diglucoside. thiamin. Some Interesting Observed Data The pandas at a famous Lord Shiva temple place take about 1 kg/day of sweets yet the prevalence of diabetes is very low in them (0. cooled and taken four times a day as a vitalizer.9 3. In a selective group in West Midnapur some people.6 8.6 7.6 9. Walking Walking benefits in the insulin resistance syndrome and our study shows walking for 1 hour at a speed of 6 kilometers/hour produces maximum benefit (Mitra and Bhattacharya 2006b).6%) comparing with other santhal groups (4.0%.2%). They are closely followed. In a selective group in West Midnapur some people use Putranjibi leaves (Putranjiva roxburghii). The nontribal persons in the same area show a diabetic prevalence of 4.3%). 14-15 leaves are boiled with 500 cc of water till it is being reduced to half and filtered to remove the residue.3 5. Herbal Remedies Our study with a tribal group that is taking 21 tulsi leaves a day shows that the group is free of diabetes and atherosclerotic disorders.0 4.2 4. Economic condition in tribes has a direct relationship with diabetic prevalence.1 3.2%). particularly young ladies take young buds of china-rose (Hibiscus) 3-4/day and it is a religious practice daily before worship.4 2. The . It is also being observed that some Santhals residing in Midnapur West are using Gurmur leaves daily (56/day) as anti-diabetic measures.2 4.6 2.6 4.5 3.7%) and occupation wise it is highest in clerical grades (3. Those who perform walking for 1 hour at a speed of 3 km/ hour show a prevalence of 2.3 3.1 4.6 4.SOME SALIENT POINTS IN TYPE 2 DIABETES PREVALENCE IN RURAL BENGAL 129 santhals are affected most (4. The polyphenols and other anti-oxidants in tulsi are having anti-diabetic effects (Mitra and Bhattacharya 2007).7 2.9%).7%) (Mitra 2007). In Vidarbha the edible oil consumed by them is flax oil while after migration the oil medium is changed to coconut oil/ mustard oil. Lodhas least (2.6 8.4 5.4 6.2 Non-tribe 5.4 12. The Migration A study is being conducted by us. Beneficial changes in blood biochemistry of Type 2 diabetes patients due to walking are also being observed (Mitra and Bhattacharya 2006b).85%). It is being observed that both fasting blood sugar and serum insulin values (Boehinger Manheim 1983) are reduced with increased insulin sensitivity.6 2. The study conducted by us shows that flax oil consumption protects against insulin resistance syndrome (Mitra et al.7% and at a speed of 6km/hour 1.6 7.2 4.
it is intermediate in goat caregivers (5. Low density Lipoprotein (LDL) increases from November to February and reduces from March to august.4%).5%) and low in those who look after cows (3. Previous studies have shown both a strong and a weak relationship between obesity and Type 2 diabetes. The Grand Biological Clock. The two most important aspects are extent and duration. physical activities.3%) and highest in them looking after pigs (8. 31: 287291. Stud Ethno-Med. Instruction Sheets for Manual Assays. Seasonal changes with rural diet are reflected in Table 3. as Saturated fat: mono unsaturated fat: poly unsaturated fat : 7 : 12 : 11. Dilman VM 1989. REFERENCES Boehringer Mannheim 1983. This is in line with Maldharis (who take care of camels) in Rajasthan in whom diabetes prevalence is nil. Total cholesterol (TLC) is increased in the month of November to February and reduces from March to August. 2007). Our studies are intended to find out the changes in prevalence in different areas of rural Bengal in relation to different factors-economic. 1(1): 37-45. 77: 41-46. Acta Biomedica. Trends in Endocrinology and Metabolism. B. Obesity and Diabetes The most powerful risk factor for Type 2 diabetes or NIDDM is obesity. The high prevalence of diabetes in the Fiji Indian population cannot be explained on the basis of BMI.4%). Ghafoarunissa 1996. GmbH diagnostica. Lipids. 12: 225–9. Some Salient Points in Dietary and . Anti-diabetic Uses of Some Common Herbs in Tribal belts of Midnapur (West) district of Bengal. Diabetes mellitus and diabetes-associated vascular disease. 2006a). Sowers J 2001. Triglycerides (TG) increase from May to August and reduce from September to November. The only incorporation of bhang in the daily intake may have an anti-diabetic role and is to be explored by further studies. Changes in socio-economic pattern and life styles may be important in addition to susceptible genes for the causation. the chance of proliferation of the disease is less (Mitra et al. Mannheim: Germany. two-thirds or more of patients with diabetes are obese as compared with Type 2 diabetes subjects in India where obesity is not common. Fats in Indian diets and their Nutritional and health Implications. eating patterns. seasonal changes etc. Moscow: Mir Publishers. Inter-ethnic differences have to be accounted for (Mitra et al. High Density Cholesterol (HDL) is increased in the month of February to March and reduces from April to June. In the western world. Diet and physical activity in patients with type 1 diabetes. The prevalence of diabetes is high in those who look after horses in villages (7. religious. Mitra Analava 2008. Mitra Analava 2007. The exact causes are yet to be explored. Fasting Blood Sugar (FBS) increases rednees from January to April and reduces from May to October.130 RANGADHAR PRADHAN. Kirpichnikov D. Very Low density Lipoprotein (VLDL) increases from May to August and reduces from September to November. Iafusco D 2006. Lipid Biochemistry It can be observed that the lipid biochemistry of the patients fed with more fat (30%) did not change significantly. Comparison between Indians in Malaysia and South Africa show that the differences in diabetes prevalence in Indians abroad cannot be explained on the basis of adiposity. DINESH KUMAR AND ANALAVA MITRA Table 3: Effect on lipid profile of NIDDM patients (rural) fed with less fat and more carbohydrate in the diet (Normal rural Indian diet). A possible reason is the confounding influence of weight loss with onset of disease or with therapy. CONCLUSION Diabetes is a chronic disease increasing in explosive pattern in India and rural Bengal is not an exception to it. Time Dec Jan Feb Mar Apr May June July Aug Sep Oct Nov 0 1 2 3 4 5 6 7 8 9 10 11 TLC HDLC LDLC VLDLC TG 252 254 258 255 254 254 252 252 250 250 250 253 56 56 56 58 57 57 56 56 56 56 56 56 178 180 184 179 179 178 176 176 174 176 176 179 18 18 18 18 18 19 20 20 20 18 18 18 94 94 94 94 94 98 102 102 102 94 94 94 FBS 162 164 167 163 165 163 163 163 163 163 162 162 dietary patterns and life style are otherwise similar in them and nearby villagers. This can be concluded in general that even if the patients suffering from diabetes are fed with fat in the extent of 30% of the total quantity in the diet maintaining ADA guidelines.
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