Type 2 diabetes australia facts geography,what causes type 1 diabetes in young adults,ayurvedic remedies to cure diabetes wikihow,diet chart for diabetic for indian - PDF Review


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The editor and reviewers' affiliations are the latest provided on their Loop research profiles and may not reflect their situation at time of review. There is little consensus on the causes of the Indian diabetes epidemic, or on the appropriate public health policies by which the issue may be addressed. Most risk-alleles appear to exert similar directions and magnitudes effects in European and South Asian populations (17, 18), but it is important to consider whether this applies universally, and whether the frequency of such risk-alleles varies between populations. There is also some evidence that important shared risk-alleles may act differently among South Asians compared with other populations.
Collectively, these data indicate that the heightened diabetes risk of South Asians is very likely to include a genetic component, but it is likely to be relatively small.
More generally, the primary underlying mechanism is likely to comprise epigenetic effects, many of which originate in early life (the Developmental Origins of Adult Disease hypothesis), though some may continue to emerge in adolescence and later life. Nonetheless, it remains unknown why low birth weight and elevated diabetic risk should persist among populations of South Asian ancestry despite improvements in living standards, and across multiple generations after migration to more affluent environments.
The aim of this paper is to develop an evolutionary perspective on the elevated susceptibility to diabetes in South Asian populations. Type 2 diabetes is a condition in which failure to regulate blood glucose levels by the hormone insulin leads to tissue damage, elevated cardio-metabolic risk, and, in the absence of treatment, increased risk of premature death. While the thrifty phenotype hypothesis initially focused on the consequences of low birth weight, however, studies in Europeans show inverse dose–response associations of birth weight with later glucose tolerance across the range of birth weight, with similar associations evident for thinness (low ponderal index) and length at birth (34, 43, 57), although diabetes risk increases again at high birth weights in some populations (33).
Figure 2 illustrates the basic model, showing how the relationship between capacity and load on an immediate basis impacts the regulation of blood sugar levels.
Information on metabolic capacity and load could, therefore, help assess diabetes risk on a routine basis.
Support for this approach is shown in Figure 5, which presents data from an urban population at 21 years of age from Pune, west central India. Data from a number of other studies broadly support the link between stature and diabetic risk (Table 1), though there is uncertainty as to whether this elevated risk derives directly from early-life growth constraint, or its association with reduced muscle mass, resulting in poorer glucose tolerance during standard tests (68).
The capacity–load model offers a specific explanation for why reduced metabolic capacity has only led to an epidemic of diabetes and associated diseases in India in recent decades. More detailed studies provide substantial support for the capacity–load model of diabetes risk in South Asian populations.
A category of nondiabetic fasting hyperglycemia was defined only recently, by the ADA in 1997 [7] and adopted also by WHO in 1999 [8], and named impaired fasting glycemia (IFG). The prevalences of IGT and IFG in Europe and Asia were reported recently by the DECODE and the DECODA Study Groups [8,12]. The prevalence of IGR rose with age up to the 70s and 80s in most of the study cohorts [12] (Figure 3.7a,b). The ratio of prevalences of glucose abnormality between men and women has been estimated in many studies, but so far there has been no consistent trend [16,17]. The ratio of IGT to diabetes has been reported to decrease as prevalence of diabetes rises [17] and may have some predictive value in determining the stage of a glucose intolerance epidemic within a population [63]. Recent studies indicate that diabetes prevalence continues to increase even in developed countries. Prevalence, which reflects the accumulation of the patients at any given time, can be influenced by many factors such as an increase in the number of new cases and a reduction in the mortality attributed to the disease. Portada e indice > Los atolones occidentales de Pohnpei (Estados Federados de Micronesia).
This means that you will not need to remember your user name and password in the future and you will be able to login with the account you choose to sync, with the click of a button. This page doesn't support Internet Explorer 6, 7 and 8.Please upgrade your browser or activate Google Chrome Frame to improve your experience. One global study reported decreasing frequencies of type II diabetes risk-alleles with increasing geographical distance from Africa toward East Asia, suggesting a diabetes-protective consequence of migration (19).
Going beyond the genes of humans themselves, there is accumulating evidence for the role of the gut microbiome in influencing diabetes and obesity risk (30), and a recent meta-analysis highlighted distinctions between the gut microbiota of Indians and Bangladeshis compared with North Americans, which may have implications for chronic disease risk (31). Epigenetic influences are demonstrated for pre-conceptual and gestational nutritional and metabolic factors. Global heat map of mean birth weight, based on data from the World Health Organization (35). Why, for example, do South Asian populations have a higher ratio of fat to lean mass than most other populations, as described below?
These authors proposed that fetal and infant under-nutrition reduced growth of the pancreas and muscle tissue to protect the growing brain, at the cost of reduced glucose tolerance in adulthood (32). Low birth weight and malnutrition during early post-natal life are associated with beta-cell dysfunction (46–49), which impairs glucose tolerance.
For diabetes, the most relevant components of metabolic capacity are the function of the pancreas (responsible for producing insulin) and muscle mass (influencing glucose clearance rate), each of which is strongly contingent on fetal and infant growth (32, 59). Variability in the relationship between capacity and load over the longer-term then shapes the risk of developing diabetes (Figure 3).
Schematic diagram illustrating the basic capacity–load model of glycemic control, in which blood sugar levels rise in association with traits such as a high glycemic diet, sedentary behavior and, high levels of body fat, and decrease in proportion to the homeostatic capacity of the body, indexed by traits such as pancreatic beta-cell mass and muscle mass. The capacity–load model illustrated for the prospective risk of developing diabetes in three US cohorts. However, especially in low- and middle-income countries, data on birth weight are likely to be lacking in the vast majority of adult individuals. In this cohort, adjusting for weight, stature shows a dose–response negative association with plasma glucose at 120 min following administration of an oral glucose load. Associations between plasma glucose levels 120 min after administration of an oral glucose load, a marker of glucose intolerance, with height adjusted for weight, and weight adjusted for height in an urban Indian population at the age of 21 years.
Reported risk of type 2 diabetes in men, women, or sexes combined, or gestational diabetes in women, associated with tall stature. If metabolic load remains relatively low, through the consumption of traditional diets and maintenance of high physical activity levels, then it will not outstrip metabolic capacity, and conditions such as diabetes should not manifest. Numerous studies have shown that, compared to Europeans, Indians are not only shorter but also have reduced levels of lean mass (93–95). It seems to be highest at 30–39 years of age (70–80%), and lowest in the elderly (around 40%) [10,12].
It was introduced by consensus to define impaired glucose homeostasis intermediate between diabetes and normal glucose homeostasis and to be analogous to impaired glucose tolerance (IGT), but without any epidemiologic evidence of possible risks associated with it.
In most of the study populations, the prevalence of IGR was less than 15% at 30–59 years of age and between 15 and 30% after 60 years of age.
The increase was graded with aging in Chinese, Japanese, and Singaporean populations, as observed in Europeans, but not in Indians where the prevalence of IGR started to increase by the age of 30–39 years and did not change much with increasing age.
In the DECODE study, we found there is a clear pattern in the prevalence of postload hyperglycemia and the prevalence of fasting hyperglycemia by sex [10].
When the ratio is high but the prevalence of diabetes is low, the early stage of a diabetes epidemic may be occurring [17].


A series of studies in the southern Indian city of Chennai showed a steady increase in the prevalence of diabetes in the Indian population.
There is evidence that mortality in diabetes has declined in men in the United States [83].Thus, a rise in prevalence could be a result of an improved survival of diabetic subjects.
El atolon tenia una poblacion de 357 habitantes en 1962 y en 2007 moraban 372 personas, aunque actualmente varios centenares de nukuorenses viven en Pohnpei. Un reciente proyecto, ha establecido un criadero de ostras perliferas que ha permitido incrementar los ingresos de los islenos.
La agricultura es de subsistencia, con plantaciones de arboles del pan, taros, plataneras y cocoteros. Cerca del extremo norte del deshabitado atolon, hay un islote arenoso y sin vegetacion de aproximadamente 1,8 metros de altura. Cada estado tiene su propia cultura e idiosincrasia, aunque los cuatro comparten algunos aspectos sociologicos comunes (clanes y grandes familias) y todos han sufrido la colonizacion previa de espanoles, alemanes, japoneses y norteamericanos.
Hasta el ano 2001, las ayudas norteamericanas constituian la mayor fuente de ingresos de la FSM. Otros alimentos notables son los cocos, el taro, los boniatos, las limas, el pescado, los cangrejos, las almejas y el cerdo, pero el alimento por excelencia de la federacion es el yam.
This would predict a lower genetic risk in South Asians relative to Europeans, which is contrary to the empirical scenario of their higher diabetes prevalence. Further work may shed more light on how the genes of other species impact human metabolism in population-specific ways. Understanding the origins of the Indian phenotype may have implications for designing effective strategies to reduce chronic disease risk among people of South Asian ancestry worldwide.
The strongest risk factor was obesity, considered the dominant cause in around 80% of cases (39). They therefore highlighted the additional contribution of development to variability in diabetes risk.
This susceptibility to glucose intolerance is exacerbated by subsequent catch-up growth in early childhood, which elevates adiposity and promotes insulin resistance (50–52). The most relevant components of metabolic load are adiposity, dietary glycemic load, and sedentary lifestyle, all of which perturb normal glycemic control and promote chronic inflammation, deleterious to beta-cell function (60, 61). Both decreasing metabolic capacity and increasing metabolic load independently increase the risk of glucose intolerance and overt diabetes.
A solution to this dilemma is to obtain data on traits that are strongly correlated with birth weight.
A recent meta-analysis of studies reporting relative risk of diabetes in relation to shorter stature that included a subset of the studies in Table 1 found a significant association among women but not men (69). This scenario is consistent with data from various populations characterized by relatively short stature, indicating low birth weight, which maintained traditional lifestyles through the twentieth century and demonstrated negligible rates of diabetes (89–91).
For example, Figure 6 illustrates the association between age and lean mass adjusted for height in South Asian and European children and adolescents from London, UK.
The only exception was seen in European women where the proportion of undiagnosed diabetic cases was around 40–45% in all age groups. Since the introduction of the category of IFG, prospective studies have examined the relationship between IFG and future morbidity and mortality with a comparison to IGT, and shown that the risk of cardiovascular disease (CVD) morbidity and mortality is higher for IGT than for IFG [44–47].Thus far the data are scarce on the risk of progression to diabetes in subjects with IFG as compared with those with normal fasting glucose or those with IGT. The prevalence of IGT increased linearly with age, but the prevalence of IFG did not (Figure 3.6). The peak prevalences of IGR were not different among different populations, but the age- specific prevalence of IGR was higher in Indians than in Chinese and Japanese at 30–49 years of age for both men and women.
Undiagnosed diabetes and IFG defined by isolated fasting hyperglycemia was more common in men than in women at 30–69 years of age, whereas the prevalence of isolated postload hyperglycemia was higher in women than in men and was particularly high in the elderly population [10]. However, studies also show an increasing trend in diabetes incidence due to the increase in obesity and decrease in exercise.
Suele haber mar gruesa, especialmente cuando la corriente de marea es fuerte (la vaciante alcanza los 6 nudos); el paso no debe intentarse excepto en el repunte de la marea. Nukuoro es una isla remota, carece de aerodromo y se comunica por medio de un barco que visita la isla de forma irregular cada pocos meses. No se conoce que ocurrio, a posteriori, con el capitan Tosiuki Hiachi, pero sabemos que tuvo dos hijos con una nukuorense. Parece seguro que los kapingas o kirinenses, como se llaman a si mismos los habitantes de Kapingamarangi, provienen de migraciones de la Polinesia occidental. Por omision, estos dos atolones no figuraban en el tratado firmado con el Imperio Aleman y, en teoria, siguen perteneciendo a Espana. Se trata de “monedas petreas”, grandes discos (generalmente de calcita) de hasta cuatro metros de diametro con un agujero en el centro. Este versatil tuberculo herbaceo (se puede comer asado, al vapor, cocido, frito, rustido y ahumado) puede alcanzar proporciones gigantescas. The molecular basis of type 2 diabetes is polygenic: over 100 genes have already been associated with the condition, with the magnitude of effect of each gene typically very small (16).
Conversely, another study identified diabetes risk-alleles in South Asian populations that were not associated with diabetes risk in European populations (20). Low birth weight and weight at 1 year have been associated in a number of studies with subsequent diabetes risk, though the risk may also increase at higher birth weight (33, 34). A similar scenario may apply to many other ethnic groups from low- and middle-income countries, which typically have elevated rates of diabetes relative to Europeans living in high-income settings (38). We show that height and physique can act as reliable markers of metabolic capacity, and illustrate how this applies to the contemporary South Asian phenotype.
The environmental etiology of type 2 diabetes appears strongly mediated by oxidative stress, which, on the one hand, provokes insulin resistance (53, 54), and, on the other hand, contributes to beta-cell damage and eventual deficiency in insulin secretion (55, 56). Numerous studies have demonstrated positive associations between birth weight and rankings of height and lean mass throughout the life course (59, 62–64), including in Indian populations (65). Conversely, independent of stature, glucose tolerance is negatively associated with body weight, a simple index of metabolic load. Interestingly, the authors suggested that the relationship between diabetes risk and short stature was stronger among populations of Asian and Australian origin than among Africans and Europeans.
It is the superimposition of high metabolic load associated with urbanization (sedentary behavior, diets high in fats and refined carbohydrates) on the background of low metabolic capacity that is predicted to lead to metabolic dysfunction (92).
There is a substantial reduction in lean mass relative to height in the South Asian sample at all ages. A few studies, which have examined the issue, agree that the risk of developing diabetes is high in subjects with either IFG or IGT and highest in those with both IFG and IGT, as compared with subjects with normal fasting and normal 2-h glucose [48–52]. The increase in the prevalence of undiagnosed diabetes and IGR in the elderly population resulted mainly from the proportionately larger increase in postload hyperglycemia than in fasting hyperglycemia. In the urban populations the prevalence was higher than in the rural populations aged 40–69 years in men and 50–59 years in women in the Chinese and Japanese populations (Figure 3.7). The concordance for IFG and IGT was very poor in all populations, particularly in Asians [10,12,54–56]. In the DECODA study, sex difference was not as clear as in Europe.The prevalence of IFG also seems higher in Chinese and Japanese men than in women, whereas it was higher in Indian women than in men.


The ratio of IGR to diabetes declined when the prevalence of diabetes increased in both Asian and European populations.
During the last two decades a considerable amount of information has been obtained from China.
Sobre este curioso tema, me remito al excelente y completisimo articulo publicado por mi paisano Josep en el blog "Encaramado a la red". Existen cinco tipos principales: Mmbul, Gaw, Ray y Reng, siendo esta ultima de solo 30 cm de diametro.
We employ data from modern cohorts to support the model and the interpretation that elevated diabetic risk among Indian populations results from the high metabolic load imposed by westernized lifestyles acting on a baseline of low metabolic capacity. Emigrant populations of Indians in high-income countries have higher diabetes rates than other ethnic groups (13), and this difference remains if adjustment is made for classic risk factors (14). Studies are increasingly testing the hypothesis that population-specific risk-alleles contribute to the elevated prevalence of diabetes in South Asians, but current evidence is limited, and the findings vary according to the investigative approach used.
It may be that the relationship is weaker in the former as BMI represents a different quantity and distribution of body fat (25, 29).
Consistent with the hypothesis that early growth retardation increases diabetes risk, birth weight in India is among the lowest globally (Figure 1) (35), and variability in maternal phenotype and birth weight have been associated with elevated diabetes risk in Indian birth cohorts (36, 37). Then, using archeological and historical evidence, we argue that long- and short-term chronic energy stress and low dietary protein availability have induced major downward trends in metabolic capacity, indexed by decreasing stature and lean mass. The highest risk of diabetes is, therefore, found in those born small who lead a particularly unhealthy adult lifestyle, promoting the development of abdominal obesity.
Weight and height during infancy are also predictive of adult stature and lean mass (59) This means that adult height can act as a valuable proxy for growth during fetal life and infancy and, hence, for metabolic capacity. Overall, this evidence justifies the use of stature as a simple marker of metabolic capacity in populations across time and geography. At present neither IFG nor IGT is considered a clinical entity, but as a risk category for the future development of diabetes [53].
The difference in the prevalence pattern in different ethnic groups may not be completely explained by living environments and geographic locations, suggesting that genetic differences also play a role. The finding that postload hyperglycemia was more prevalent in the elderly in Europe and Asia is consistent with the report from NHANES III [57]. IGT was more prevalent in Chinese and Japanese women than in men, but such a difference was not observed in Indians [12]. Studies conducted in China between 1980 and 1990 consistently show low diabetes prevalence rates of approximately 1.5% or less, even in urban populations such as in Shanghai in 1980 [68–71]. Hay una escuela de 4 aulas, pero los ninos mayores de 14 anos deben viajar a Pohnpei para asistir a la escuela secundaria.
We attribute this low metabolic capacity to the low birth weight characteristic of Indian populations, which is associated with short stature and low lean mass in adult life. Furthermore, the effect of FTO appears to be environment dependent among South Asians, resulting in a much stronger relationship with obesity and diabetes among urban relative to rural populations (22, 25).
These traits, and their life-course emergence, are strongly associated with the elevated diabetes risk experienced among contemporary Indians exposed to the rapid lifestyle changes accompanying urbanization. Importantly, these data support a key prediction of the model, namely that the diabetic risk elicited by low birth weight is relatively low in the absence of metabolic load, but greatly exacerbated in the presence of a high metabolic load. Likewise, although accurate assessment of adult body composition is not feasible on a routine basis, BMI or waist circumference adjusted for height can act as simple markers of metabolic load, as can behavioral markers, such as physical inactivity. Below, we use this approach to reconstruct potential trends in metabolic capacity over lengthy time periods in the history of India.
Each represents a metabolic state intermediate between normal glucose homeostasis and diabetic hyperglycemia, and they were combined and defined formally as impaired glucose regulation (IGR) by WHO Consultation in 1999 [8]. Thus, the prevalence of undiagnosed diabetes and IGR would be underestimated to a large extent, especially in female and elderly populations, if only fasting glucose determination were used. Sex differences in the prevalence of diabetes and IGR depend on how the prevalence was estimated, by fasting or by postload hyperglycemia, on the age distributions, and on the ethnic groups.
Over the same time period, an increase of 86% in the prevalence of obesity defined by BMI ?30 kg m?2 was observed in men, which was much higher than the increase of 38% in women. The San Antonio Heart Study revealed an increasing secular trend in the 7- to 8-year incidence of T2DM occurring from 1987 to 1996 in Mexican American and non-Hispanic Whites [85]. Using stature as a marker of metabolic capacity, we review archeological and historical evidence to highlight long-term declines in Indian stature associated with adaptation to several ecological stresses.
In other words, the elevated susceptibility to diabetes in South Asian populations can be attributed to rapid increases in metabolic load exposing the long-term decline in metabolic capacity. The primary purpose of population-based testing for blood glucose is to detect previously undiagnosed diabetes and IGR in order to apply early intervention to reduce the serious diabetic complications and to prevent progression from IGT to diabetes as demonstrated by the recent diabetes prevention trials [58–62].
Asian Indians, who have a very high risk of diabetes, show abnormalities in fasting glucose values at an earlier age than other populations. In a Danish study of a 60-year-old cohort over a 22-year period an increase of 58% in men and 21% in women in the prevalence of diabetes was observed, which was fully explained by a concurrent increase in BMI [80].
Therefore, both increased incidence and decreased mortality among diabetic subjects have contributed to the increased trend in the prevalence of diabetes.
La mayoria fueron traidas hace muchos anos de las islas Palau y algunas vinieron de Nueva Guinea.
Underlying causes may include increasing population density following the emergence of agriculture, the spread of vegetarian diets, regular famines induced by monsoon failure, and the undermining of agricultural security during the colonial period. Studies undertaken in the late 1990s, however, indicate sharply rising prevalence rates in China [72–74] and the rates estimated at the beginning of the current century show that diabetes in an urban Chinese population in mainland China [75] is already as prevalent as in Hong Kong and Taiwan in the mid 1990s (Figure 3.9) [76–78]. Rising trends in the prevalence of diabetes and obesity have also been reported in other European countries [81,82]. The reduced growth and thin physique that characterize Indian populations elevate susceptibility to truncal obesity, and increase the metabolic penalties arising from sedentary behavior and high glycemic diets. In 2007, the prevalence of T2DM in China was almost 10% indicating a three-fold increase in three decades [27]. In addition to the increase in obesity, reduced physical activity resulting from changes in work-related activity and sedentary lifestyle has contributed to the rising trend in T2DM. Improving metabolic capacity may require multiple generations; in the meantime, efforts to reduce the metabolic load will help ameliorate the situation. It Turkey, the prevalence of T2DM doubled during a 12-year interval from 1998 to 2010 [24].
The prevalence of both diabetes and its microvascular complications in a Pacific Island population (20 years or older) of Western Samoa was examined in 1978 and 1991 [31].



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