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Current Issues International Health and Diabetes
Figure 1: Prevalence of Diabetes in 2007 and validated physical activity questionnaires to demonstrate this
Projections for 2025, with Projected Percent Changes
urbanization gradient,
12,13
as well as the increased risk for diabetes
associated with reduced physical activity levels.
14
There are no studies
that have used objective assessment of physical activity; neither are99.4
100
there any studies that have documented temporal trends of physical
80.3 activity levels in communities using comparable methods. The adoption
80
and use of the World Health Organization (WHO) STEPS Global Physical
67
64.1
Activity Questionnaire for surveillance of habitual physical activity by
60
53.2
many SSA countries
15
will hopefully provide some answers in the near
46.5
44.5
40.5
future about trends in population levels of physical activity, despite the
40
32.7
limitations of self-reported physical activity.28.3
24.5
18.7
20
16.2
10.4
The difficulty of assessing diet and nutritional data in free-living
81.4% 48.4%80.1% 43.4% 101.7%20.6% 76.3%
individuals makes this as challenging as collecting physical activityNumber of people with diabetes (millions)
0
AFR EMME EUR NA SACA SEA WP
data in many resource-limited countries. Studies in South African
2007 2025
blacks have shown a trend of increasing consumption of fat and
AFR = Africa; EMME = Eastern Mediterranean and Middle East; EUR = Europe; NA = North
decreasing consumption of carbohydrates in both urban and rural
America; SACA = South and Central America; SEA = South-East Asia; WP = Western Pacific.
areas.
16
However, the notion of increased consumption of fat as a1
Source: International Diabetes Federation Diabetes Atlas.
marker of urbanization and westernization of the African diet was not
Figure 2: Prevalence of Type 2 Diabetes in confirmed in our own studies, in which we found the highest
Cameroon, 1994–2003
consumption of fat in rural Cameroonians compared with urban
Cameroonians, black Jamaicans, and blacks in Manchester.
17
We
9
postulated that the excess consumption of fats in the rural area is
8
more than compensated for by very high levels of physical activity.
7
Whatever the interplay in the lifestyle factors, there has clearly been
6 a remarkable increase in the prevalence of obesity in many African
communities. Abubakari et al.
18
pooled data from studies in west
5
African adults and showed that the prevalence of obesity has more
4
than doubled in urban regions from 7 to 15% over the 15-year period
Prevalence (%)
3
from 1990 to 2004. Women and urban dwellers had a significantly
2
higher prevalence of obesity compared with men and rural dwellers,
1 respectively. Similar results have been reported in other African
populations.
16,19
Data from repeated surveys in the same areas
0
1994 1998 2003
in Cameroon over a 10-year period showed an overall increase in
Urban men Urban women Rural men Rural women
prevalence of overweight and obesity in the rural site (increase of
7
Prevalence standardized according to new world population distribution.
54% in women and 82% in men) and of central obesity in the urban
site (increase of 32% in women and 190% in men).
20
The public health
estimate, even considering the effect HIV/AIDS is going to have on challenge posed by obesity in these populations is far from over as
reducing the size of the adult population that is at greatest risk for excess weight is perceived positively as a sign of wealth, with a
developing diabetes, since with increasing access to antiretroviral positive association between socioeconomic status and obesity seen
chemotherapy the region would probably witness an increase in people in developing countries in contrast to the negative association in
developing antiretroviral therapy (ART)-induced glucose intolerance. developed countries. The stigma associated with HIV-related weight
Our data in Cameroonian adults based on two cross-sectional surveys loss only further aggravates the social perception of slim body size.
over a 10-year period (1994–2004) revealed an almost 10-fold increase
in diabetes prevalence (see Figure 2).
7
Most of the classic risk factors The prevalence of diabetes increases with age. However, the majority of
have been reported to be associated with diabetes in Africans. people living with diabetes in SSA countries are in the 45–64-year-old
However, a lot of these papers are based on empirical evidence or age group, in contrast to developed countries, where the highest
poorly measured lifestyle exposure. Urbanization, resulting in increased prevalence of diabetes is in those 65 years of age and above
21
(see
levels of physical inactivity and high-fat diets, has been described as Figure 3). This underscores the point that the economic burden of
the major driver of increasing levels of obesity and diabetes. Many diabetes in developing countries will be compounded by its effect on
studies have shown a distinct rural–urban increased risk for obesity the working age group.
and diabetes,
8,9
with a lengthier stay in the urban environment
conferring a higher risk.
10,11
Even though the idea of lower physical Morbidity and Mortality
activity in urban areas compared with rural areas is intuitively plausible, SSA is currently struggling under a multiple disease burden that is not
most of the studies reporting physical activity levels have used very really getting lighter over the years. The emerging and increasing
crude questions to obtain these data. A few studies have used prevalence of obesity, diabetes, and non-communicable diseases is
16 US ENDOCRINOLOGY
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