Food high in carbohydrates is cheap, whereas food that is high in fibre, and therefore healthier is more expensive, making this one of the contributing factors to the high prevalence of diabetes in India.
“Foods like fish, fruits and vegetables are more expensive, making this a social determinant in the rise of cases of diabetes. We have to find ways to cultivate healthier food and maybe provide them through government schemes to make them more affordable and accessible,” said Nihal Thomas, senior professor, department of endocrinology, diabetes and metabolism, Christian Medical College, Vellore.
Prof. Thomas was speaking at a press conference on June 30, to discuss two recent papers, of which he is one of the authors, ‘Global Inequity in Diabetes 1’ and ‘Global Inequity in Diabetes 2’, published in the medical journal The Lancet. Shivani Agarwal of the Albert Einstein College of Medicine, New York was the corresponding author of the paper. The other Indian contributor was Chittaranjan Yajnik of the KEM Hospital Research Centre, Pune
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Pointing to how our diet patterns have changed over the course of the past few decades, Prof. Thomas said healthier millets, once staple in rural parts of India, had now been replaced by polished rice. “The importance of millets cannot be overstated. The government must find ways to provide millets; it must provide incentives to fibre-rich food and disincentivise carbohydrate-rich food, while keeping in mind the livelihoods of stakeholders,” he said.
Historical determinants
While the high cost of healthy food was a current social determinant in the epidemic of diabetes in the country, Prof. Thomas also highlighted larger, historical determinants: colonisation and famines. Both these contributed to poor education, a lower socio-economic strata and reduced decision-making among women, all of which are now, he said, factors in the explosion of non-communicable diseases in the country.
Another factor was the thrifty phenotype: a correlation between low birthweight and the increased risk of developing type 2 diabetes. Low birthweight, Prof. Thomas said, generally came from several generations of malnutrition in the family and its reversal too, could take several generations. Low birthweight was found to be associated with smaller pancreas, increased fat and smaller muscles, which eventually led to an increased risk of diabetes as well as a higher risk of hypertension, as kidneys too, are found to be smaller in persons who had low birthweight . The good news, however, he said, was that with exercise, these patients too, could lose fat and improve muscle mass.
At present, the world has about 53 crore people with diabetes, and estimates indicate that this will rise to 130 crore by 2050, primarily in South Asia, including India, he said. And about half of all those who become diabetic will be obese, he said, stressing the need to tackle obesity as a primary therapeutic. Another important factor he highlighted was the need to screen young women, especially those contemplating marriage, as gestational diabetes, he said, was “an epidemic within the epidemic”.
Since about 40% of those with diabetes in India do not even know they have it and remain undiagnosed, regular screening was crucial, he said. This, alongside public awareness, policy changes and innovations in treatment that focused on the needs of Indians, could go a long way towards tackling the diabetes challenge, he said.
