Dietary patterns and practices in rural eastern Uganda: Implications for prevention and management of type 2 diabetes

Food consumption patterns, seasonal dietary diversity, and factors affecting food intake in rural Eastern Uganda: A mixed-methods cross-sectional study

This mixed-methods cross-sectional study examines food consumption patterns, dietary diversity, and factors affecting food intake and malnutrition in the rural Mbale District in Eastern Uganda, during both wet and dry seasons. Participants (n = 100; 66% females) completed a food frequency questionnaire identifying foods and beverages consumed in the preceding 12 months. Individual interviews (n = 8) were conducted with key workers. Analysis of seventeen food items revealed seasonal variations in carbohydrate and protein sources. During the dry season, staples like matooke (mashed boiled plantains) and sweet and Irish potatoes were affected, while protein-rich foods such as beans and groundnuts saw increased consumption in the wet season. Fruit and vegetable intake also rose during the wet season. The main causes of malnutrition that emerged from the interviews were the lack of knowledge about food and nutrition, financial struggles, climate impact, and cultural beliefs. The last theme covered strategies to combat malnutrition. Although carbohydrate intake remains consistent throughout seasons due to reliance on posho (maize flour porridge) and cassava, variations in the number of meals and protein sources, particularly beans and groundnuts, were observed. Both of these, being the primary protein sources in rural households' diets, are highly susceptible to climate fluctuations. This may pose significant implications for food security, as heightened climate instability may impede their production. Solutions to combat malnutrition discussed by the interviewees include education, employment, family planning, and healthcare improvements. Professionals emphasise the need for comprehensive approaches to address these complex issues. In addition, data on food consumption during the dry and wet seasons should be collected as a difference in food consumption during the seasons may become more prominent with the need to implement tailored interventions.

Knowledge, perceptions and practices towards diabetes risk in sub-Saharan Africa: a mixed-methods scoping review

OBJECTIVE

To synthesise current evidence on knowledge, perceptions and practices towards type 2 diabetes risk in sub-Saharan Africa.

DESIGN

Mixed-methods scoping review, which included 101 studies (seventy-three quantitative, twenty qualitative and eight mixed methods) from seven electronic databases.

SETTING

Sub-Saharan Africa, 2000-2023.

PARTICIPANTS

Men and women without diabetes with mean ages ranging from 20 to 63 years.

RESULTS

The majority of participants in most studies knew the three main diabetes modifiable risk factors - excess weight, unhealthy diet and physical inactivity. However, most people with excess weight in almost all studies underestimated their weight. Further, the self-described ideal body weight was between midpoint of normal weight and the upper limits of overweight in most quantitative studies and was described as not too skinny but not too fat in qualitative studies. In the majority of studies, participants reported low engagement in weight control, high regular sugar intake, and low regular fruit and vegetable intake but moderate to high engagement in physical activity. Barriers to reducing diabetes risk were social (e.g. societal perceptions promoting weight gain) and environmental (e.g. limited affordability of healthy foods, high accessibility of Western diets and lack of physical activity facilities).

CONCLUSION

There is a need for multicomponent type 2 diabetes prevention interventions that increase knowledge of identifying diabetes risk (e.g. what constitutes excess weight) and create social and physical environments that support healthy lifestyles (e.g. societal perceptions that promote healthy living, increased availability and affordability of healthy foods and physical activity facilities).

Prevalence and correlates of pre-diabetes in Sub-Saharan Africa using Demographic and Health Survey Data: a cross-sectional study

OBJECTIVE

The objective is to investigate the prevalence of pre-diabetes in Namibia and South Africa and to determine sociodemographic correlates of disease using population data.

DESIGN

Cross-sectional study.

SETTING

Demographic and Health Survey for emerging (Namibia) and established (South Africa) economies in Sub-Saharan Africa collected laboratory data that allowed determination of pre-diabetes status.

PARTICIPANTS

3141 adults over age 18 from the 2013 Namibia survey, weighted to a population of 2176, and 4964 adults over age 18 from the 2016 South Africa survey, weighted to a population of 4627 had blood glucose/glycated haemoglobin (HbA1c) and diabetes information were included in the analysis.

OUTCOME MEASURES

Pre-diabetes was defined as not being diagnosed with diabetes and having a blood sugar measurement of 100-125 mg/dL in Namibia or an HbA1c measurement of 5.7%-6.4%. Logistic models were run for each country separately, with pre-diabetes as the outcome and a series of sociodemographic variables (age, gender, urban/rural residence, number of children, employment status, wealth index, education level, and ethnicity (in South Africa) or religion (in Namibia)) entered as variables to investigate the independent relationship of each.

RESULTS

The weighted prevalence of pre-diabetes was 18.7% in Namibia and 70.1% in South Africa. Rural residence was independently associated with higher odds of pre-diabetes in Namibia (1.47, 95% CI 1.05 to 2.06), while both younger age (0.98, 95% CI 0.97 to 0.99) and urban residence (0.80, 95% CI 0.66 to 0.99) were independently associated with odds of pre-diabetes in South Africa.

CONCLUSIONS

The prevalence of pre-diabetes was 18.7% in Namibia and 70.1% in South Africa. Correlates of pre-diabetes differed between the two countries with rural residents having higher odds of pre-diabetes in Namibia and urban residents with higher odds in South Africa. Aggressive interventions, including population level education and awareness programmes, and individual level education and lifestyle interventions that account for country-specific contextual factors are urgently needed to prevent progression to diabetes.

Oral Health Survey in Burundi; Evaluation of the Caries Experience in Schoolchildren Using the DMFT Index

Background and objectives: There are no data on oral health in the population of Burundi. This study aimed to describe the oral health status of schoolchildren in Burundi using the dmft/DMFT index for the first time. Materials and methods: The study was designed as a cross-sectional population-based epidemiological survey. The survey was designed according to the WHO methodology for oral health surveys. Oral examinations were conducted in school rooms using a dental mirror, probe, and headlight. The following characteristics of primary dentition status were recorded: decayed (d/D), missing (m/M), and filled (f/F) teeth, and the dmft/DMFT (d + m + f t/D + M + F T) index was calculated for each subject. Quantitative and qualitative variables were represented by measures of position and variability. One-way ANOVA was used to assess differences between parametric variables. Logistic regression was performed for total caries experience and gender, age groups, living area, and geographical provinces. Results: A total of 1902 children were examined, 1007 (52.94%) six-year-olds and 895 (47.06%) in the older group. The dmft/DMFT and subgroups were statistically significantly different in terms of age groups, living areas, and geographical regions (dmft/DMFT d-subgroup and D-subgroup p < 0.01), but only for DMFT for sex. The ORs estimated by logistic regression by total caries experience showed a protective effect for 12 year old subjects and those living in southern provinces, an OR of 0.52 (95%CI 0.43-0.64) and an OR of 0.26 (95%CI 0.21-0.32), respectively. Conclusions: Dental caries in African countries, including Burundi, remains a major problem affecting the general health and wellbeing of the population. Tackling untreated caries requires a multifaceted approach, including strengthening oral health infrastructure, promoting oral health education, providing affordable dental services, and encouraging healthier eating habits.

Burden and correlates of significant liver fibrosis among HIV-infected and uninfected adults in urban Uganda

Introduction

Following chronic inflammation and other disease specific factors, the risk of liver disease is believed to be higher among HIV-infected patients than in the general population despite shared risk factors. Understanding this differentiated burden and its drivers will inform policy and priority populations for intervention.

Methods

This was a cross sectional study among 516 adults attending care clinics in Kampala Uganda. Significant liver fibrosis (SLF) was defined as liver stiffness measurement ≥7.2 KPa identified by Fibroscan®. Data analyses were stratified by HIV status and we performed logistic regression performed to identify correlates.

Results

The prevalence of SLF was higher among HIV un-infected patients ((24% Vs 14%; p0.004). Overall HIV-uninfected patients were more likely to be overweight and or obese, with elevated serum cholesterol levels. Elevated measurement of fatty change in the liver (CAP scores >248 dB/m) was associated with SLF among HIV un-infected patients (OR 2.3 CI (1.0-5.2); p = 0.046). Low nadir CD4 counts (200cell/mm3) was predictive of SLF among HIV-infected patients (OR 3.3 CI (1.0-10.7); p = 0.05).

Conclusion

The prevalence of SLF was unexpectedly higher among HIV un-infected than HIV affected patients attending care clinics in urban Uganda. This observed burden is most likely driven by non-alcoholic fatty liver disease (NAFLD) resulting from metabolic syndrome.

Dietary Risk Factors and Eating Behaviors in Peripheral Arterial Disease (PAD)

Dietary risk factors play a fundamental role in the prevention and progression of atherosclerosis and PAD (Peripheral Arterial Disease). The impact of nutrition, however, defined as the process of taking in food and using it for growth, metabolism and repair, remains undefined with regard to PAD. This article describes the interplay between nutrition and the development/progression of PAD. We reviewed 688 articles, including key articles, narrative and systematic reviews, meta-analyses and clinical studies. We analyzed the interaction between nutrition and PAD predictors, and subsequently created four descriptive tables to summarize the relationship between PAD, dietary risk factors and outcomes. We comprehensively reviewed the role of well-studied diets (Mediterranean, vegetarian/vegan, low-carbohydrate ketogenic and intermittent fasting diet) and prevalent eating behaviors (emotional and binge eating, night eating and sleeping disorders, anorexia, bulimia, skipping meals, home cooking and fast/ultra-processed food consumption) on the traditional risk factors of PAD. Moreover, we analyzed the interplay between PAD and nutritional status, nutrients, dietary patterns and eating habits. Dietary patterns and eating disorders affect the development and progression of PAD, as well as its disabling complications including major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Nutrition and dietary risk factor modification are important targets to reduce the risk of PAD as well as the subsequent development of MACE and MALE.

The complex challenge of governing food systems: The case of South African food policy

International experience reveals that food policy development often occurs in silos and offers few tangible mechanisms to address the interlinked, systemic issues underpinning food and nutrition insecurity. This paper investigated what South African government policies cover in terms of different aspects of the food system, who is responsible for them, and how coordinated they are. Policy objectives were categorized into seven policy domains relevant to food systems: agriculture, environment, social protection, health, land, education, economic development, and rural development. Of the ninety-one policies reviewed from 1947-2017, six were identified as being "overarching" with goals across all the domains. About half of the policies focused on agriculture and the environment, reflecting an emphasis on agricultural production. Policies were formulated and implemented in silos. As a result, learning from implementation, and adjusting to improve impact has been limited. Particularly important is that coordination during implementation, across these complex domains, has been partial. In order to achieve its stated food and nutrition outcomes, including Sustainable Development Goal (SDG) 2, South Africa needs to translate its policies into tangible, practical plans and processes guided by effective coordination and alignment. Key recommendations are practically to align policies to a higher-level "food goal", establish better coordination mechanisms, consolidate an effective monitoring and evaluation approach to address data gaps and encourage learning for adaptive implementation. Actively engaging the existing commitments to the SDGs would draw stated international commitments together to meet the constitutional commitment to food rights into an overarching food and nutrition security law.

Which BMI for Diabetes Patients is Better? From the View of the Adipose Tissue Macrophage-Derived Exosome

PURPOSE

Diabetes, as a group of metabolic diseases, can elevate blood glucose, thus leading to the development of life-threatening complications. It is difficult to define the outcome for diabetics with different BMI. This review will illustrate the adipose tissue macrophage-derived exosome in the diabetics with different BMI.

PATIENTS AND METHODS

Insulin resistance in peripheral tissues can cause diabetes. The peripheral tissues include liver, muscle, or the adipose depots. Communication between these organs is fatal to the maintenance of glucose homeostasis. This review will illustrate this communication. Obesity is closely linked with diabetes. There are different changes in fat distribution in diabetic patients. Adipose tissue macrophages can secrete various hormones, including adiponectin, leptin, resistin and other classical cytokines, such as TNF-α and IL-6. Studies illustrated that exosomes from the adipose tissue, can modulate inter-organ cross-talk by regulating gene expression in other tissues.

RESULTS

Adipose tissue macrophages exosomes links thin and fat individuals in the development of diabetes.

CONCLUSION

The molecular pathways initiated by exosomes such as miRNA in the situations of metabolic stress could help us gain a deeper knowledge of the pathophysiology of diabetes.

The Sensory Profiles of Flatbreads Made from Sorghum, Cassava, and Cowpea Flour Used as Wheat Flour Alternatives

Sorghum, cowpea, and cassava are underutilised gluten-free sources of flour that have the potential to be used in bread products in sub-Saharan Africa. Excessive wheat imports affect the economies of countries in sub-Saharan Africa, driving the search for wheat flour alternatives. To extend the use of sorghum, cowpea, and cassava flours toward bread production, it is vital that the sensory properties of these flours are better understood. A trained sensory panel evaluated and described the sensory properties of flatbread models prepared from red non-tannin sorghum, fractions (whole and dehulled) of two cowpea varieties, cassava starch, and designated flour composites. The composites were prepared using cassava starch and sorghum flour at 0%, 35%, and 70%, respectively, with 30% cowpea flour. The addition of sorghum intensified sorghum aroma in flatbread, while cowpea flours contributed a beany flavour. Flatbreads from cassava-cowpea composites had a chewier and rubberier mouthfeel, an intense fermented aroma and flavour, and a sour aftertaste compared to single flours, but were most similar to the wheat flatbread, with a residual beany flavour. Information from this study can guide food product developers toward developing new bread products from sorghum, cassava, and cowpea composite flours, thereby moving Africa towards a more sustainable food system. Further research on the effects of the sensory characteristics on consumer liking of the flatbreads is needed.

Healthy Eating in Low-Income Rural Louisiana Parishes: Formative Research for Future Social Marketing Campaigns

High rates of obesity and chronic disease exist in the southeastern United States (US). Knowledge about the attitudes, beliefs, and barriers of the rural low-income Louisiana population regarding healthy eating is limited. Focus Group discussions based on the Theory of Planned Behavior (TPB) were conducted in rural parishes (N = 3) with low-income residents of Louisiana (N = 29). Grounded Theory methods and cross-case analysis were used. The participants were primarily single Black females of age 18–30 years who earned a high school diploma, were employed, and had children. Beliefs included healthy eating was physically beneficial, yet financial impacts and the low palatability of healthy foods were barriers. Professional resources for nutrition education were limited which led to reliance on friends, family, and the internet. Friends and family were positive and negative influences on eating choices. Control beliefs included the high prices and low palatability of healthy foods, the wide availability of Energy Dense Nutrient Poor (EDNP) foods, and low motivation to sustain eating behavior changes. Formative research to optimize campaign distribution channels may improve accessibility to social marketing support and healthy eating resources. Persuasive messages that address control beliefs are needed in social marketing campaigns for rural low-income Louisiana environments.

Socio-demographic and clinical characteristics of diabetes mellitus in rural Rwanda: time to contextualize the interventions? A cross-sectional study

BACKGROUND

Existing prevention and treatment strategies target the classic types of diabetes yet this approach might not always be appropriate in some settings where atypical phenotypes exist. This study aims to assess the socio-demographic and clinical characteristics of people with diabetes in rural Rwanda compared to those of urban dwellers.

METHODS

A cross-sectional, clinic-based study was conducted in which individuals with diabetes mellitus were consecutively recruited from April 2015 to April 2016. Demographic and clinical data were collected from patient interviews, medical files and physical examinations. Chi-square tests and T-tests were used to compare proportions and means between rural and urban residents.

RESULTS

A total of 472 participants were recruited (mean age 40.2 ± 19.1 years), including 295 women and 315 rural residents. Compared to urban residents, rural residents had lower levels of education, were more likely to be employed in low-income work and to have limited access to running water and electricity. Diabetes was diagnosed at a younger age in rural residents (mean ± SD 32 ± 18 vs 41 ± 17 years; p < 0.001). Physical inactivity, family history of diabetes and obesity were significantly less prevalent in rural than in urban individuals (44% vs 66, 14.9% vs 28.7 and 27.6% vs 54.1%, respectively; p < 0.001). The frequency of fruit and vegetable consumption was lower in rural than in urban participants. High waist circumference was more prevalent in urban than in rural women and men (75.3% vs 45.5 and 30% vs 6%, respectively; p < 0.001). History of childhood under-nutrition was more frequent in rural than in urban individuals (22.5% vs 6.4%; p < 0.001).

CONCLUSIONS

Characteristics of people with diabetes in rural Rwanda appear to differ from those of individuals with diabetes in urban settings, suggesting that sub-types of diabetes exist in Rwanda. Generic guidelines for diabetes prevention and management may not be appropriate in different populations.

Snapshots of Urban and Rural Food Environments: EPOCH-Based Mapping in a High-, Middle-, and Low-Income Country from a Non-Communicable Disease Perspective

A changing food environment is implicated as a primary contributor to the increasing levels of non-communicable diseases (NCDs). This study aimed to generate snapshots of selected external food environments to inform intervention strategies for NCD prevention in three countries: Uganda (low income), South Africa (middle income) and Sweden (high income), with one matched pair of urban-rural sites per country. Fifty formal and informal food retail outlets were assessed, and descriptive and comparative statistical analyses were performed. We found that formal food retail outlets in these countries had both positive and negative traits, as they were the main source of basic food items but also made unhealthy food items readily available. The Ugandan setting had predominantly informal outlets, while the Swedish setting had primarily formal outlets and South Africa had both, which fits broadly into the traditional (Uganda), mixed (South Africa) and modern (Sweden) conceptualized food systems. The promotion of unhealthy food products was high in all settings. Uganda had the highest in-community advertising, followed by South Africa and Sweden with the lowest, perhaps related to differences in regulation and implementation. The findings speak to the need to address contextual differences in NCD-related health interventions by incorporating strategies that address the food environment, and for a critical look at regulations that tackle key environment-related factors of food on a larger scale.