Food subsidies, nutrition transition, and dietary patterns in a remote Indian district

National Estimates of the Adult Diabetes Care Continuum in India, 2019-2021

Importance

Diabetes is widespread and treatable, but little is known about the diabetes care continuum (diagnosis, treatment, and control) in India and how it varies at the national, state, and district levels.

Objective

To estimate the adult population levels of diabetes diagnosis, treatment, and control in India at national, state, and district levels and by sociodemographic characteristics.

Design, Setting, and Participants

In this cross-sectional, nationally representative survey study from 2019 to 2021, adults in India from 28 states, 8 union territories, and 707 districts were surveyed for India's Fifth National Family Health Survey (NFHS-5). The survey team collected data on blood glucose among all adults (18-98 years) who were living in the same household as eligible participants (pregnant or nonpregnant female individuals aged 15-49 years and male individuals aged 15-54 years). The overall sample consisted of 1 895 287 adults. The analytic sample was restricted to those who either self-reported having diabetes or who had a valid measurement of blood glucose.

Exposures

The exposures in this survey study were district and state residence; urban vs rural residence; age (18-39 years, 40-64 years, or ≥65 years); sex; and household wealth quintile.

Main Outcomes and Measures

Diabetes was defined by self-report or high capillary blood glucose (fasting: ≥126 mg/dL [to convert to mmol/L, multiply by 0.0555]; nonfasting: ≥220 mg/dL). Among respondents who had previously been diagnosed with diabetes, the main outcome was the proportion treated based on self-reported medication use and the proportion controlled (fasting: blood glucose <126 mg/dL; nonfasting: ≤180 mg/dL). The findings were benchmarked against the World Health Organization (WHO) Global Diabetes Compact targets (80% diagnosis; 80% control among those diagnosed). The variance in indicators between and within states was partitioned using variance partition coefficients (VPCs).

Results

Among 1 651 176 adult respondents (mean [SD] age, 41.6 [16.4] years; 867 896 [52.6%] female) with blood glucose measures, the proportion of individuals with diabetes was 6.5% (95% CI, 6.4%-6.6%). Among adults with diabetes, 74.2% (95% CI, 73.3%-75.0%) were diagnosed. Among those diagnosed, 59.4% (95% CI, 58.1%-60.6%) reported taking medication, and 65.5% (95% CI, 64.5%-66.4%) achieved control. Diagnosis and treatment were higher in urban areas, older age groups, and wealthier households. Among those diagnosed in the 707 districts surveyed, 246 (34.8%) districts met the WHO diagnosis target, while 76 (10.7%) districts met the WHO control target. Most of the variability in diabetes diagnosis (VPC, 89.1%), treatment (VPC, 85.9%), and control (VPC, 95.6%) were within states, not between states.

Conclusions and Relevance

In this survey study, the diabetes care continuum in India is represented by considerable district-level variation, age-related disparities, and rural-urban differences. Surveillance at the district level can guide state health administrators to prioritize interventions and monitor achievement of global targets.

Farming the Edible Aquatic Snail Pomacea canaliculata as a Mini-Livestock

In the present paper, we describe the farming system of Pomacea canaliculata, an edible freshwater snail, as it is practiced by a farmer as mini-livestock in the vicinity of Andong in Korea. We visited the snail farm several times in the summer and winter of the year and conducted interviews with the farm manager using a semi-structured questionnaire. The farm is housed in polythene tunnels and uses a tank pen of trench type made up of propylene and measuring 1 m × 2 m × 0.5 m (length × width × height) in size. A regulated inflow of fresh water and outflow of used water was installed, with water level not exceeding 5 to 7 cm. As feed of snails, commercial fish feed is generally provided. The life cycle of the P. canaliculata might differ in captivity under the controlled environmental conditions than that of an individual in the wild environment. The farming system of snails, particularly P. canaliculata, does not involve high labor-intensive, high capital investment and also does not require high through-put cutting edge technology. In addition to providing nutrient-dense snail meat, establishing a snailery could therefore augment the economic condition of farmers in the poorer regions of the world and encourage sustainability and biodiversity conservation.

Abdominal obesity and metabolic syndrome in South Asians: prevention and management

INTRODUCTION

The prevalence of metabolic syndrome (MetS) and abdominal obesity are escalating in South Asian countries. It is well established that MetS is associated with increased risk for both Type 2 diabetes mellitus and cardiovascular diseases. South Asians have an increased risk of MetS due to a variety of factors including unhealthy lifestyle and their unique body composition.

AREAS COVERED

In this review, we discuss the prevalence, associated risk factors, and evidence-based preventive and curative strategies for MetS and abdominal obesity in South Asians. A literature search through PubMed®, Web of Science®, and Scopus® was performed for studies published before 31^st April 2021. A combination of the following keywords was used with the names of the individual South Asian countries: 'metabolic syndrome,' 'syndrome X,' 'abdominal obesity,' 'central obesity,' 'visceral obesity,' 'prevention,' and 'management.'

EXPERT OPINION

According to current evidence, MetS and abdominal obesity are highly prevalent among South Asians. Several risk factors, such as lifestyle, socio-demography, cultural, and body composition, are associated with MetS. Limited research shows culturally tailored lifestyle interventions are effective in preventing and managing MetS and abdominal obesity among South Asians.