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Type 2 diabetes and the double burden of malnutrition in rural south India: A mixed-methods examination of a public health crisis

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Title: Type 2 diabetes and the double burden of malnutrition in rural south India: A mixed-methods examination of a public health crisis
Author: Little, Matthew
Department: Department of Population Medicine
Program: Population Medicine
Advisor: Dewey, CateHumphries, Sally
Abstract: India is experiencing a nutrition transition characterized by shifting diets and physical activity patterns that are driving increased prevalence of obesity, type 2 diabetes, and the double burden of malnutrition (defined as co-occurring under- and over-nutrition). The objective of this research was to describe and determine factors associated with these phenomena in rural Tamil Nadu, India using a mixed methods (qualitative and quantitative) study design. In-depth interviews (n=61+54) and focus groups (n=8) assessed perceptions of diabetes, nutrition, and the local food environment. Randomly selected adults (n=753) participated in a socio-demographic survey, food frequency questionnaire, and bio-metric measurements (waist/hip circumference ratio [WHR], body mass index [BMI], blood hemoglobin, and oral glucose tolerance test). Age- and sex-standardized prevalences of health outcomes were: overweight, 34%; pre-diabetes, 9.5%; type 2 diabetes, 10.8%; underweight, 23%; and anemia, 47%. Prevalence of co-morbid anemia plus overweight was 22.6% in women and 12.0% in men, while prevalence of co-morbid anemia plus diabetes was 5.6% of men and women. Multivariable linear and logistic regressions were used to identify factors associated with health outcomes at p<0.05. Factors [odds ratios] associated with obesity included physical activity [0.8], wealth index [1.1], high caste [4.6], rurality index [0.4], and tobacco use [0.2]. Factors [ORs] associated with diabetes included physical activity [0.8], BMI [1.9], WHR [1.6], high caste [2.4], rurality index [0.8], and tobacco use [2.8]. Factors [ORs] associated with co-morbid   anemia and overweight included female sex [2.3], rurality index [0.7], high caste [0.7], wealth index [1.1], livestock ownership [0.5], and meat intake [0.8]. Factors [ORs] associated with co-morbid anemia and diabetes included age [1.1], rurality index [0.8], family history of diabetes [4.9], and BMI [2.1]. Local explanatory models of diabetes cited “poor diet”, “tension”, and “tradition” (family history). Illness narratives described “fear” and “loss of control” upon diagnosis with diabetes. Food environment characteristics affecting food choices and consumption included individual factors (age, gender), socio-economic factors (wealth, caste, religion), access to government entitlements, occupation, and media exposure. Results shed light on public health issues in rural India and carry implications for policy, practice, and future research.
URI: http://hdl.handle.net/10214/10454
Date: 2017-05
Rights: Attribution-NonCommercial-NoDerivs 2.5 Canada


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Attribution-NonCommercial-NoDerivs 2.5 Canada Except where otherwise noted, this item's license is described as Attribution-NonCommercial-NoDerivs 2.5 Canada