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New Delhi, India

Singhal N.,University of Delhi | Sivakumar B.,National Health Research Institute | Bhagat N.,Fortis Escorts Hospital | Jaiswal A.,Long Island Jewish Medical Center | Khurana L.,National Diabetes
Journal of Diabetes | Year: 2011

India is facing an "epidemic" of diet-related non-communicable diseases (DR-NCDs), along with widely prevalent undernutrition resulting in substantial socioeconomic burden. The aim of this paper is to review secular trends in food groups and nutrient intake, and implications for DR-NCDs in India so as to understand optimal choices for healthy diets for the prevention of DR-NCDs. The literature search was carried out in PubMed (National Library of Medicine, Bethesda, MD, USA) and Google Scholar search engines up to April 2011. A manual search for all other references, national and medical databases was also carried out. Nutrition transition over the past 30years (1973-2004), has resulted in a 7% decrease in energy derived from carbohydrates and a 6% increase in energy derived from fats. A decreasing intake of coarse cereals, pulses, fruits and vegetables, an increasing intake of meat products and salt, coupled with declining levels of physical activity due to rapid urbanization have resulted in escalating levels of obesity, atherogenic dyslipidemia, subclinical inflammation, metabolic syndrome, type2 diabetes mellitus, and coronary heart disease in Indians. Studies also suggest that adverse perinatal events due to maternal nutritional deprivation may cause low-birth weight infants, which, coupled with early childhood "catch-up growth", leads to obesity in early childhood, thus predisposing to NCDs later in life. In view of rapidly increasingly imbalanced diets, a multisectoral preventive approach is needed to provide balanced diets to pregnant women, children and adults, and to maintain a normal body weight from childhood onwards, to prevent the escalation of DR-NCDs in India. © 2011 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Blackwell Publishing Asia Pty Ltd.

Gupta N.,Childrens Hospital of Michigan | Gupta N.,Rochester College | Goel K.,Rochester College | Goel K.,Wayne State University | And 2 more authors.
Endocrine Reviews | Year: 2012

Rapidly changing dietary practices and a sedentary lifestyle have led to increasing prevalence of childhood obesity (5-19 yr) in developing countries recently: 41.8% in Mexico, 22.1% in Brazil, 22.0% in India, and 19.3% in Argentina. Moreover, secular trends indicate increasing prevalence rates in these countries: 4.1 to 13.9% in Brazil during 1974-1997, 12.2 to 15.6% in Thailand during 1991-1993, and 9.8 to 11.7% in India during 2006-2009. Important determinants of childhood obesity include high socioeconomic status, residence in metropolitan cities, female gender, unawareness and false beliefs about nutrition, marketing by transnational food companies, increasing academic stress, and poor facilities for physical activity. Childhood obesity has been associated with type 2 diabetes mellitus, the early-onset metabolic syndrome, subclinical inflammation, dyslipidemia, coronary artery diseases, and adulthood obesity. Therapeutic lifestyle changes and maintenance of regular physical activity through parental initiative and social support interventions are the most important strategies in managing childhood obesity. Also, high-risk screening and effective health educational programs are urgently needed in developing countries. © 2012 by The Endocrine Society.

Shrivastava U.,National Diabetes
Nutrients | Year: 2013

Obesity and dyslipidemia are emerging as major public health challenges in South Asian countries. The prevalence of obesity is more in urban areas than rural, and women are more affected than men. Further, obesity in childhood and adolescents is rising rapidly. Obesity in South Asians has characteristic features: high prevalence of abdominal obesity, with more intra-abdominal and truncal subcutaneous adiposity than white Caucasians. In addition, there is greater accumulation of fat at "ectopic" sites, namely the liver and skeletal muscles. All these features lead to higher magnitude of insulin resistance, and its concomitant metabolic disorders (the metabolic syndrome) including atherogenic dyslipidemia. Because of the occurrence of type 2 diabetes, dyslipidemia and other cardiovascular morbidities at a lower range of body mass index (BMI) and waist circumference (WC), it is proposed that cut-offs for both measures of obesity should be lower (BMI 23-24.9 kg/m2 for overweight and ≥25 kg/m2 for obesity, WC ≥80 cm for women and ≥90 cm for men for abdominal obesity) for South Asians, and a consensus guideline for these revised measures has been developed for Asian Indians. Increasing obesity and dyslipidemia in South Asians is primarily driven by nutrition, lifestyle and demographic transitions, increasingly faulty diets and physical inactivity, in the background of genetic predisposition. Dietary guidelines for prevention of obesity and diabetes, and physical activity guidelines for Asian Indians are now available. Intervention programs with emphasis on improving knowledge, attitude and practices regarding healthy nutrition, physical activity and stress management need to be implemented. Evidence for successful intervention program for prevention of childhood obesity and for prevention of diabetes is available for Asian Indians, and could be applied to all South Asian countries with similar cultural and lifestyle profiles. Finally, more research on pathophysiology, guidelines for cut-offs, and culturally-specific lifestyle management of obesity, dyslipidemia and the metabolic syndrome are needed for South Asians. © 2013 by the authors; licensee MDPI, Basel, Switzerland.

News Article
Site: www.biosciencetechnology.com

Nearly half of California adults, including one out of every three young adults, have either prediabetes — a precursor to type 2 diabetes — or undiagnosed diabetes, according to a UCLA study. The research provides the first analysis and breakdown of California prediabetes rates by county, age and ethnicity, and offers alarming insights into the future of the nation’s diabetes epidemic. Conducted by the UCLA Center for Health Policy Research and commissioned by the California Center for Public Health Advocacy, the study analyzed hemoglobin A1c and fasting plasma glucose findings from the National Health and Nutrition Examination Survey together with California Health Interview Survey data from over 40,000 respondents. The study estimates that some 13 million adults in California, or 46 percent, have prediabetes or undiagnosed diabetes, while another 2.5 million adults, or 9 percent, have already been diagnosed with diabetes. Combined, the two groups represent 15.5 million people — 55 percent of the state’s population. Because diabetes is more common among older adults, the study’s finding that 33 percent of young adults aged 18 to 39 have prediabetes is of particular concern. “This is the clearest indication to date that the diabetes epidemic is out of control and getting worse,” said Dr. Harold Goldstein, executive director of the health advocacy center. “With limited availability of healthy food in low-income communities, a preponderance of soda and junk food marketing, and urban neighborhoods lacking safe places to play, we have created a world where diabetes is the natural consequence. If there is any hope to keep health insurance costs from skyrocketing, health care providers from being overwhelmed and millions of Californians from suffering needlessly from amputations, blindness and kidney failure, the state of California must launch a major campaign to turn around the epidemic of type 2 diabetes.” The study estimates prediabetes rates by county, finding major disparities across the state, particularly among those aged 18 to 39. For those young adults, prediabetes rates ranged from lows of 26 percent in Lake County and 28 percent in San Francisco County to a high of 40 percent in rural Kings County and Imperial County. Racial and ethnic disparities are extremely pronounced. There are statistically higher prediabetes rates among young adult Pacific Islanders (43 percent), African Americans (38 percent), American Indians (38 percent), multiracial Californians (37 percent), Latinos (36 percent) and Asian Americans (31 percent) than among white young adults (29 percent), pointing to the need to focus additional prevention efforts in those communities. No demographic or region appeared to be free of the diabetes and prediabetes epidemics, as outlined in the policy brief. Complicating matters is the fact that many people do not get tested for prediabetes because the test often is not covered by insurance, particularly for those under the age of 45. And although there are effective interventions to help people control their weight and adopt a healthier lifestyle, these programs are often not be covered by insurers. “There are significant barriers not only to people knowing their status, but getting effective help,” said Dr. Susan Babey, lead author of the study and co-director of the UCLA Center for Health Policy Research’s Chronic Disease Program. “A simple blood test for diabetes should be covered by all insurers, as should the resources and programs that can make a real difference in stopping the progression of this terrible disease.” Prediabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diabetes diagnosis. Up to 30 percent of people with prediabetes will develop type 2 diabetes within five years, and as many as 70 percent of them will develop the disease in their lifetime. Diabetes is associated with dramatically increased risk of amputation, nerve damage, blindness, kidney disease, heart disease, hospitalization and premature death. Diabetes is one of America’s fastest-growing diseases and one of the most costly. Nationally, diabetes rates have tripled over the past 30 years. In C­­­­­­alifornia, the rate has increased by 35 percent since 2001. Nationally, annual medical spending for people with diabetes is almost twice that for people without diabetes. A person who is diagnosed with diabetes by age 40 will have lifetime medical spending that is $124,600 more than someone who is not. Three-quarters of that care is paid through Medicare and Medi-Cal, including $254 million in annual hospital costs that are paid by Medi-Cal alone. To avoid the progression from prediabetes to diabetes, the study’s authors recommend greater participation in the National Diabetes Prevention Program, as well as policy and other changes to increase screening and prevention and encourage healthy, active lifestyles. “For most people, type 2 diabetes is entirely preventable,” Dr. Goldstein said. “If Medi-Cal covered diabetes prevention programs and every health provider screened for prediabetes, we could prevent a large proportion of cases. In exchange for a proactive investment today, we can save billions of dollars in health care costs over the next five years and beyond, and save thousands of lives.”

Shrivastava U.,National Diabetes | Misra A.,National Diabetes
Diabetes Technology and Therapeutics | Year: 2014

Prevalence of diabetes continues to increase in urban areas, and escalation is discernible in semi-urban and rural areas. It is reported to affect Asian Indians a decade earlier compared with other populations, and complications (e.g., nephropathy) occur earlier and are severe and more prevalent than in other races. Because of these adverse features and suboptimal management practices, type 2 diabetes mellitus (T2DM) poses a huge health and economic burden to the country. Simple and culturally sensitive interventions for Asian Indians have been shown to be effective in prevention/amelioration of diabetes and other cardiovascular risk factors in multiple settings, among urban and rural residents, in migrants, and in those who are healthy or obese or have metabolic syndrome or T2DM. Furthermore, short-term intensive lifestyle intervention in children improves anthropometric and metabolic parameters. Finally, intervention with specific nutrient or oil substitution in Indian diets has been reported to produce benefit in multiple metabolic cardiovascular risk factors. There is, however, further need for conducting well-designed and planned intervention trials with robust outcome data at the primary and secondary levels. These trials must be culturally sensitive and should investigate cost-effective strategies. © Copyright 2014, Mary Ann Liebert, Inc. 2014.

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