Current Diabetes Reviews - Volume 13, Issue 5, 2017

Background: India is undergoing rapid nutrition transition concurrent with an increase in obesity, metabolic syndrome, and type 2 diabetes (T2DM). There is a shift from a healthy traditional home-cooked high-fiber, low-fat, low-calorie diet, towards increasing consumption of packaged, ready-to-eat foods which are calorie-dense and contain refined carbohydrates, high fat, salt and sugar; and less fiber. Although fats and oils have been an integral part of our diets, there is a change in the pattern of consumption, in terms of both quality and quantity. Methods: A literature search was conducted using the terms “fats, oil consumption in India, effects of vegetable oils, obesity and T2DM in Indians” in the medical search database PubMed (National Library of Medicine, Bethesda, MD, USA) from 1966 to June 2016. A manual search of the relevant quoted references was also carried out from the retrieved articles. Data have also been taken from nutritional surveys in India and worldwide, websites and published documents of the World Health Organization, the Food and Agricultural Organization, National Sample Survey Organization and websites of industries related to oil production. Conclusion: Increasing use of saturated fat, low intake of n-3 poly unsaturated fatty acids and increase in trans-fatty acids, along with increasing intake of dietary sugars has been noted in India. Most importantly, traditional false beliefs and unawareness about health effects of oils continues to be prevalent. Aggressive public health awareness programs coupled with governmental action and guidelines tailored for Indian population are required, to promote less consumption of fats and oils, use of healthy oils and fats, decreased intake of saturated fats and trans fatty acids, and increase intake of n-3 Poly-unsaturated fatty acids and mono-unsaturated fatty acids.

Introduction: Obesity among teenagers/adolescents and young adults is associated with significant adverse short and longer-term effects on health. To date, no narrative reviews have evaluated nutrition transition and its contribution to the obesity epidemic among adolescents and young adults in the South Asian (SA) region. Method: Data were retrieved by a four-stage systematic search process. A search of the online PubMed/Medline, SciVerse Scopus and Web of Science databases was performed. The age groups were defined as follows; teenage:13-19 years, adolescence:10-18 years and young adult:19-24 years. Results: Among teenagers/adolescents, the prevalence of overweight ranged from 11.0% (Sri Lanka) to 19.0% (India), while obesity ranged from 2.4% (Sri Lanka) to 11.0% (Pakistan). In young adults, prevalence of overweight ranged between 7.9% (Nepal) to 15.0% (Pakistan), while obesity showed a much wider variation (0.005%[Nepal] - 22.8%[India]). Nutritional risk factors associated with overweight/obesity among SAs of this age group included reduced fruit and vegetable consumption, a total vegetarian diet, consumption of fast food and soft drinks, and skipping breakfast. Other contributing factors identified were: adding extra salt to meals, eating meals outside of the home, frequently visiting restaurants and eating while watching television. Daily milk/yoghurt consumption and a family supper have shown a protective effect against overweight/obesity. Conclusion: Overweight and obesity are common amongst teenagers/adolescents and young adults of the SA region. Several food types and habits were identified as being associated with overweight/obesity in this population. Identifying common protective and contributory factors is very important for the development of a shared regional preventive strategy.

Introduction: Nutrition transition is an adverse outcome of rapid economic development and globalization. The present review documents the pattern of nutrition and health transition among different food groups leading to the growing global and national epidemic of non-communicable diseases (NCDs). Method: Studies published in various national and international journals were searched using PubMed and Google Scholar search engines from the year 2000 to 2015. Literature was reviewed to gather data pertaining to nutrition and health transition and economic burden of non-communicable disease (NCDs). Results: Diets are changing globally towards higher intakes of simple and refined carbohydrates (including sugar), fat and lower intake of complex carbohydrates. The upsurge of co-morbidities arising from nutrition transition is a serious threat worldwide especially in developing countries like India, which in turn poses a huge impact on economic development of the nation. Conclusion: Better awareness and encouragement of using healthier diet option can help to combat the epidemic of NCDs in the developing world.

Introduction: Currently, the developing countries are afflicted with the dual burden of disease - non-communicable diseases (NCDs) becoming a major public health challenge. It is projected that in near future, NCDs will account for nearly 70% of the mortality in developing world. Caused due to lifestyle related factors, there is an upsurge in the incidence of overweight/obesity, cardiovascular diseases, type 2 diabetes mellitus, cancers, respiratory diseases and mental illnesses. Appropriate dietary practices, increased physical activity, weight management, abstinence from tobacco/substance use and alcohol abuse play an important role in their prevention and management. This narrative review highlights the role of various dietary components - both nutrient and non-nutrient, in the prevention and risk reduction of NCDs. Method: It is a comprehensive overview of various experimental researches, observational studies, clinical trials, epidemiological studies, pooled/meta-analyses and reviews carried out globally, particularly the developing nations. Studies were retrieved by an extensive search of the online PubMed/Medline, SciVerse Scopus databases using individual/combination of several keywords like non-communicable diseases, energy, various nutrients, sugar sweetened beverages, functional foods, tea, coffee, spices/condiments/herbs, animal foods, nuts and oil seeds, physical activity, dietary practices, cancer, cardiovascular diseases, T2DM, respiratory diseases, lifestyle modifications, tobacco, smoking, alcohol and public health approaches. The review also highlights several preventive approaches for curbing NCDs in the developing world with special emphasis on dietary factors. Conclusion: Since the occurrence of NCDs is marked by a cumulative effect of various risk factors, urgent collective actions are needed to avert/prevent the same effectively.

Introduction: Optimal infant and young child feeding, which includes initiation of breastfeeding within one hour of birth, exclusive breastfeeding for first six months, age appropriate complementary feeding after six months along with continued breastfeeding for 2 years and beyond, is a public health intervention to prevent child morbidity, mortality and malnutrition [1]. In India, even though institutional delivery rates are increasing, only 44% women are able to breastfeed their babies within one hour of delivery. While 65% children are exclusively breast fed for the first six months, the median duration of breastfeeding is 24.4 months and complementary feeding rates are 50%. To achieve optimal IYCF practices, each woman should have access to a community based IYCF counseling support system. Efforts are therefore needed to upgrade skill based training of health workers and revive and update the Baby Friendly Hospital Initiative (BFHI). To promote and sustain breastfeeding amongst working women, it is essential to ensure adequate maternity leave, crèches at work place, flexible working hours, and provision of physical space for breast feeding at work place. It is imperative to also create public awareness about the dangers of bottle and formula feeding and to provide accurate information on the appropriate complementary food to be given to infants. Conclusion: In conclusion, India needs to make serious efforts to overcome malnutrition with not only prioritized IYCF policies but also their effective implementation in place.

Background: South Asians (SA) have a four to five fold higher risk for type 2 diabetes mellitus (T2DM) in comparison to other Asian migrant groups. Dietary patterns have been attributed as an important independent modifiable risk factor. Objective: The aim of this review is to document the dietary patterns of SA migrants in Western countries and to summarize the evidence for the association of dietary patterns with T2DM and its predisposing factors. Methods: Using key search words articles from 1990 onwards were sourced from MEDLINE Pro-Quest and PubMed (not MEDLINE) databases for this narrative review. Results: A significant shift in meal pattern with frequent dining out and eating fast foods, traditional festival foods and Western desserts and snacks was common among SA. Consumption of potatoes, dairy, oil, meat and fish increased and beans, lentils, fruits and vegetables decreased post-migration. “Animal protein” and “fried snacks, sweets and high-fat dairy” were associated with greater insulin resistance and lower HDL cholesterol. A “mixed” dietary pattern was associated with obesity and hypertension and a “western” dietary pattern was associated with overall risk for Metabolic Syndrome. A 70% increase in the odds of diabetes per standard deviation in gram of protein intake was also observed. Conclusion: Dietary patterns pave the way to develop diabetes and other obesity related diseases among SA as duration of residence increases. The first five years since migration maybe a window of opportunity to provide targeted interventions to ensure maintenance of healthy dietary habits.

Introduction: Diabetic neuropathy is a common complication of diabetes. It adversely affects the lives of most diabetics. It is the leading cause of non-traumatic limb amputation. Diabetic autonomic neuropathy can target any system and increases morbidity and mortality. Treatment begins with adequate glycemic control but despite this, many patients go on to develop neuropathy which suggests there are additional and unidentified, as yet, pathological mechanisms in place. Although several theories exist, the exact mechanisms are not yet established. Disease modifying treatment requires a more complete understanding of the mechanisms of disease. Pathways Involved: This review discusses the potential pathological mechanisms of diabetic neuropathy, including the polyol pathway, hexosamine pathway, protein kinase C, advanced glycation end product formation, polyADP ribose polymerase, and the role of oxidative stress, inflammation, growth factors and lipid abnormalities. Finally it focuses on how possible changes in glutamate signaling pathways fit into the current theories. Conclusion: Insights into the mechanisms involving gene expression in diabetic neuropathy can help pinpoint genes with altered expression. This will help in the development of novel alternative therapeutic strategies to significantly slow the progression of neuropathy in susceptible individuals and perhaps even prevention.

Background: Diabetes mellitus is a vastly prevalent metabolic disorder with escalating global health concerns. Particularly when mismanaged, chronic micro- and macrovascular complications may highly impair physiological systems while immunodeficiency disposes us to infection. Objective: We investigate infections, localized complications, and neoplasms of the genitourinary system secondary to the chronic complications of diabetes mellitus in males and females. Method: A comprehensive MEDLINE® search was guided using key words relevant to diabetes mellitus and the genitourinary system. Results: Pathogen-friendly environments may implicate the sequelae of urinary tract and genital mycotic infections, potentially generating necrosis, abscess, and other inflammatory complications, which may present concomitantly with neurogenic and/or vasculogenic dysfunction to further exacerbate an existing genitourinary condition. Manifestations of the adrenal, renal, and genital organs and tissues are discussed as they relate to vascular, immunodeficient, and other hyperglycemic complications of the diabetic state. Among those, chronic kidney disease and cystopathy are the most prevailing and detrimental. Though studies have connected diabetes to either an increased risk of developing or poor prognosis of bladder, renal, prostate, endometrial, and cervical cancers, the explicit biological relationships are as of yet inconclusive. Conclusion: Despite the availability of precise treatments to ameliorate most presently reviewed conditions, particularly urinary tract and genital mycotic infection-related sequelae, reversing permanent vascular damage remains a great challenge. Leading a healthier lifestyle and managing diabetes mellitus with a patient-centric approach from the outset are the most putative methods for preventing critical long-term genitourinary manifestations of diabetes mellitus.