Food & Nutrition Update

World Diabetes Day 2011: Act on Diabetes. Now.

World Diabetes Day is the primary global awareness campaign of the diabetes mellitus and is held on November 14 of each y e a r. I t w a s introduced in 1991 by the International Diabetes Federation and the World Health Organization in response to the alarming rise of diabetes around the world. World Diabetes Day, on the 14th November every year, has grown from humble beginnings to become a globallycelebrated event to increase awareness about diabetes. Comprising hundreds of campaigns, activities, screenings, lecture, meetings and more, World Diabetes Day is proving internationally effective in spreading the message about diabetes. Why is November 14th World Diabetes Day? November 14th is a significant date in the diabetes calendar because it marks the birthday of the man who co-discovered insulin, Frederick Banting. Banting discovered insulin in 1922, a life-saving treatment for diabetes patients alongside Charles Best. World Diabetes Day is internationally recognised and is now an official United Nations Day. World Diabetes Day became an official United Nations Day in 2007 with the passage of United Nation Resolution 61/225. The campaign draws attention to issues of paramount importance to the diabetes world and keeps diabetes firmly in the public spotlight. This year sees the second of a five-year campaign that will address the growing need for diabetes education and prevention programmes. The World Diabetes Day 2011 campaign marks the third year of the International Diabetes Federation's five-year focus on "Diabetes education and prevention," the theme chosen for the period 2009-2013. The year 2011 is a milestone year for the over 300 million people living with diabetes. WHO estimates that more than 346 million people worldwide have diabetes. This number is likely to be more than double by 2030 without intervention. Almost 80% Theme for World Diabetes Day

November 2011 Volume 2 Issue 11 Price : Rs. 30

of diabetes deaths occur in low- and middle-income countries.

Each year World Diabetes Day is centred on a theme related to diabetes. Topics covered in the past have included diabetes and human rights, diabetes and lifestyle, and the costs of diabetes. Recent themes include: 2005: Diabetes and Foot Care 2006: Diabetes in the Disadvantaged and the Vulnerable 2007-2008: Diabetes in Children and Adolescents 2009-2013: Diabetes Education and Prevention The slogan chosen for this year's campaign is: Act on Diabetes. Now. Where is World Diabetes Day celebrated? World Diabetes Day is celebrated worldwide by the over 200 member associations of the International Diabetes Federation in more than 160 countries and territories, all Member States of the United Nations, as well as by other associations and organizations, companies, healthcare professionals and people living with diabetes and their families. Five key messages have been developed to inform the outputs and deliverables of the 2011 campaign: Diabetes kills: 1 person every 8 seconds, 4 million people a year Diabetes doesn't discriminate: all ages, rich and poor, all countries Diabetes can no longer be ignored: 4 million lives lost a year,1 million amputations a year, millions lost in income and productivity Life-saving care, a right not a privilege: education, medicines, technologies Choose Health: demand healthy food and environments, keep active, eat well. You can make a difference.

The World Diabetes Day logo The World Diabetes Day logo is the blue circle - the global symbol for diabetes which was developed as part of the Unite for Diabetes awareness campaign. The logo was adopted in 2007 to mark the passage of the United Nations World Diabetes Day Resolution. The significance of the blue

circle symbol is overwhelmingly positive. Across cultures, the circle symbolizes life and health. The colour blue reflects the sky that unites all nations and is the colour of the United Nations flag. The blue circle signifies the unity of the global diabetes community in response to the diabetes pandemic.

Diabetes is an impairment of blood glucose regulation

Professor Jean Claude Mbanya, President of the International Diabetes Federation (IDF), voiced concern: The data from the latest edition of the IDF Diabetes Atlas show that the epidemic is out of control. We are losing ground in the struggle to contain diabetes. No country is immune and no country is fully equipped to repel this common enemy. What are type 1 and type 2 diabetes? Type 1 diabetes cannot be prevented. It is an autoimmune disease in which the body destroys its own insulinproducing cells. People with type 1 diabetes require daily injections of insulin to survive. The majority of all diabetes is type 2 diabetes (85%-95%), which in many cases can be prevented. People with type 2 diabetes cannot use the insulin they produce effectively, but can often manage their condition through exercise and diet, although many go on to require medication, including insulin, to properly control blood glucose levels. It is estimated 60% or more of type 2 diabetes could be prevented. The prevalence of noninsulin dependent diabetes (Type 2) increases with age. Overall it is about six times more common than Type 1. Type 2 diabetes is closely associated with overweight or obesity and lack of exercise. Diabetes is a multifactorial disease. There is a strong family influence, though it may be partly because eating habits and body weight are influenced by family behavior. But the genetic factor is clear in some groups: the Pima Amerindians in North America and Micronesians in Nauru. When these people are obese (which most of them are these days) the incidence of diabetes (in older life) is over 50 %. Both type 1 and type 2 diabetes represent a serious health t h r e a t . Diabetes claims four million lives every year and is a leading c a u s e o f blindness, kidney failure, heart attack, stroke and amputation. Diabetes explodes worldwide Diabetes now affects seven percent of the world's adult population. The regions with the highest comparative prevalence rates are North America, where 10.2 % of the adult population have diabetes, followed by the Middle East and North Africa Region with 9.3%. The regions with the highest number of people living with diabetes are Western Pacific, where some 77 million people have diabetes and South East Asia with 59 million. India is the country with the most people with diabetes, with a current figure of 50.8 million, followed by China with 43.2 million. Behind them the United States (26.8 million); the Russian Federation (9.6 million); Brazil (7.6 million); Germany (7.5 million); Pakistan (7.1 million); Japan (7.1 million); Indonesia (7 million) and Mexico (6.8 million). When it comes to the percentage of adult population living with diabetes, the new data reveal the devastating i m p a c t o f diabetes across the Gulf Region, where five of the Gulf States are among the top ten c o u n t r i e s affected. The Pacific island nation of Nauru has the world's highest rate of diabetes, with almost a third of its adult population (30.9%) living with the disease. It is followed by the United Arab Emirates (18.7%); Saudi Arabia (16.8%); Mauritius (16.2%); Bahrain (15.4%); Reunion (15.3%); Kuwait (14.6%); Oman (13.4%); Tonga (13.4%) and Malaysia (11.6%). Increasing economic burden Diabetes has become a development issue. IDF predicts that diabetes will cost the world economy at least US$376 billion in 2010, or 11.6% of total world healthcare expenditure. By 2030, this number is

About Editor : This News Letter is compiled by Dr. Kavitha R. Reddy. She has a doctorate in Food Science from CFTRI, Mysore and a Masters in Food and Nutrition from ANGRAU. She worked at Wageningen Agricultural University, The Netherlands and Whistler Center for Carbohydrate Research, Purdue University, USA before returning to India. She has authored several popular and scientific articles and also a cookbook. Dr. Reddy worked as a Nutrition Consultant for national and international organizations for several years. Presently she is In-charge Nutrition at "NutriTech Consulting Services Pvt. Ltd.".

projected to exceed US$490 billion. More than 80% of diabetes spending is in the world's richest countries and not in the poorer countries, where over 70 percent of people with diabetes now live. The United States accounts for $198 billion or 52.7% of total diabetes spending worldwide. India, which has the largest diabetes population, spends US$2.8 billion or 1% of the global total. The diagnosis of diabetes in a low or middle-income country can often drag entire families into poverty. The world needs to invest in integrated health systems that can diagnose, treat, manage and prevent diabetes, said Professor Nigel Unwin, who leads the team of experts behind the IDF Diabetes Atlas. Governments also need to invest in actions outside the formal health sector, particularly in promoting healthier diets and physical activity, to reduce obesity and the risk of type 2 diabetes. Without effective prevention diabetes will overwhelm health

systems and hinder economic growth. Integrating plans for the prevention of diabetes into national health systems and policy frameworks is an important part of the response. IDF warns that many health systems worldwide are not yet equipped to handle the extent of the diabetes threat, and that failure to take action will have serious consequences. The epidemic represents nothing short of a global health emergency, said IDF President Mbanya. It is alarming that world leaders stand by while the diabetes fuse slowly burns. The serious impact on families, countries and economies continues with little resistance. Governments, aid agencies and the international community must take concerted action to defuse the threat now, before the diabetes time bomb explodes.

Journal Abstract

Dietary fats and prevention of type 2 diabetes

different types of fats to prevent diabetes. The authors say mechanisms underlying the relation between dietary fatty acids and incidence of diabetes are still unclear, but the traditional view has been that dietary fat quality mainly affects cell membrane FA composition and, consequently, cell membrane function [1]. The FA composition of cell membranes is thought to alter several cellular functions, including membrane fluidity, ion permeability, and insulin receptor binding/affinity; functions affected by translocation of glucose transporters interacting with second messengers [2]. Such alterations could, in turn, affect tissue and whole body insulin sensitivity. The authors conclude that available data from controlled intervention studies suggest beneficial effects on insulin sensitivity when saturated fatty acids (SFA) and trans fatty acids (TFA) are replaced with monounsaturated fatty acids (MUFA) or poly unsaturated fatty acids (PUFA). Outcomes from observational studies using serum biomarkers of dietary fat intake or dietary questionnaires are consistent with those from controlled studies of insulin sensitivity; both suggest that replacing SFA and TFA with PUFA will lower the risk of type 2 diabetes. More controlled long-term studies with sufficient power are needed to identify the optimal dietary FA composition to reduce risk of type 2 diabetes.

Although type 2 diabetes is determined primarily by lifestyle and genes, dietary composition may affect both its development and complications. Dietary fat is of particular interest because fatty acids influence glucose metabolism by altering cell membrane function, enzyme activity, insulin signaling, and gene expression. This paper focuses on the prevention of type 2 diabetes and summarizes the epidemiologic literature on associations between types of dietary fat and diabetes risk. It also summarizes controlled feeding studies on the effects of dietary fats on metabolic mediators, such as insulin resistance. Taken together, the evidence suggests that replacing saturated fats and trans fatty acids with unsaturated (polyunsaturated and/or monounsaturated) fats has beneficial effects on insulin sensitivity and is likely to reduce risk of type 2 diabetes. Among polyunsaturated fats, linoleic acid from the n-6 series improves insulin sensitivity. On the other hand, long-chain n-3 fatty acids do not appear to improve insulin sensitivity or glucose metabolism. In dietary practice, foods rich in vegetable oils, including non-hydrogenated margarines, nuts, and seeds, should replace foods rich in saturated fats from meats and fat-rich dairy products. Consumption of partially hydrogenated fats should be minimized. Additional controlled, long-term studies are needed to improve our knowledge on the optimal proportion of
Reference : Ulf Risrus, Walter C. Willett, and Frank B. Hu Prog Lipid Res. 2009 January ; 48(1): 4451. 2. Storlien LH, Pan DA, Kriketos AD, O'Connor J, Caterson ID, Cooney GJ, Jenkins AB, Baur LA. Skeletal muscle membrane lipids and insulin resistance. Lipids 1996;31 Suppl:S261265. 3. Ginsberg BH, Brown TJ, Simon I, Spector AA. Effect of the membrane lipid environment on the properties of insulin receptors. Diabetes 1981;30:773780.

Diabetes is an impairment to the processes that regulates blood glucose Type 1 is caused by a lack of insulin production Type 2 is caused by a failure of insulin to effectively regulate glucose levels

Principles of dietary treatment for diabetes

Type 1 insulin dependent diabetes (IDD) 1. Integrate and synchronise meals that is the metabolic load with the time(s) of action of the insulin treatment to minimise high peaks of blood glucose as well as episodes of hypoglycemia. The American Diabetic Association, recommended that the individuals food intake is used as a basis for integrating insulin therapy into the eating and exercise patterns. Patients of insulin therapy should eat at consistent times synchronised with the time action of the insulin preparation used. 2. Reduce saturated fat to 10 % of total energy or less. People with diabetes have an increased risk of coronary heart disease and this dietary modification may reduce the risk. 3. Salt intake should be kept low as diabetic people have an increased r i s k o f hypertension. 4. Ve r y m o d e r a t e intake of alcohol. Type 2 non insulin dependent diabetes (NIDD) 1. Try and stick to ideal weight by consuming the recommended calories and also follow regular Lentils Glycemic index 29 exercise routine recommended. About three quarters of type 2 diabetes are overweight or obese and weight Glycemic index is a measure of a food's ability to raise the level of blood glucose. Glycemic load is glycemic index adjusted for a standard serving size. reduction is the first line of dietary management. 2. Reduce saturated fat. 3. 4. 5. Emphasize low glycemic index foods. Keep salt intake low. Avoid excess alcohol.

What Is Glycemic Index? The Glycemic Index (GI) is a numerical scale used to indicate how fast and how high a particular food can raise our blood glucose (blood sugar) level. A food with a low GI will typically prompt a moderate rise in blood glucose, while a food with a high GI may cause our blood glucose level to increase above the optimal level.
Foods that have been shown to have low glycemic indices (55 or less) compared to glucose which is 100

Soybeans 18 Lentils 29 Bran 40 Bananas 53

Apples 36 Oranges 43 Milk 25-35

Rice, white 64 Wheat 45 Potatoes 70-90 Tomatoes 38

Fructose 20 Sucrose 60 Lactose 45

Importance of glycemic index and glycemic load Foods with lower g l y c e m i c responses are more desirable for people who are actively managing their blood glucose Soybeans Glycemic index 18 levels. That is people with prediabetes and diabetes. The lower glycemic response could mean less medication necessary to keep blood glucose levels in check.

Reference : Robert Wildman, 2009; The Nutritionist-Food, Nutrition, and Optimal Health, Second Edition; Routledge, Taylor and Francis Group, New York and London A.S. Truswell (2003); ABC of Nutrition; Fourth Edition. BMJ Publishing Group. BMA House Tavistock Square, London WC1H 9JR

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