Nutrition and its link with diabetes in Asian Indians: Challenges and Solutions
Keywords:
Nutrition
Abstract
Diabetes rates in Indians have reached epidemic proportions. The main drivers of this epidemic are unhealthy eating habits and physical inactivity. Epidemiological studies and various clinical trials have shown the significance of diet in the prevention as well as management of type 2 diabetes (T2D). The diet of Indians consists predominantly of refined cereal grains (like white rice or refined wheat), which contribute to half of the daily calories. Hence, the dietary glycemic load of Indian diets is very high and this is associated with a higher risk of diabetes. Indian diets are also low in vegetables, fruits and monounsaturated fatty acids adding to the risk of T2D. The quality and quantity of carbohydrates and fats need to be addressed if we are to prevent diabetes. Our group recently demonstrated the benefits of brown rice (whole grain) and cashew nut consumption with respect to reduction in cardio-metabolic risk factors. Changing the food environment by creating healthier food choices and making them available, accessible and affordable through various policy driven nutrition programs is an important step. Collaboration with agricultural and food scientists could help to develop healthier cereals and other food products. Health care professionals play a vital role in bringing about behavioral changes in the population helping them to choose right foods in the right quantity. This, combined with increasing physical activity, could help to halt, or at least slow down, the epidemic of T2D in Indians.
References
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intake and self-reported diabetes among adult men and
women in India BMC Pub Heal 13 706-719
Al-Shoumer K A and Al-Essa T M (2015) Is there a relationship
between vitamin D with insulin resistance and diabetes
mellitus? World J Diab 6 1057-1064
Anjana R M, Sudha V, Nair D H, Lakshmipriya N, Deepa M,
Pradeepa R, Shanthirani C S, Subhashini S, Malik V,
Unnikrishnan R and Binu V S (2015) Diabetes in Asian
Indians-how much is preventable? Ten-year follow-up of
the Chennai Urban Rural Epidemiology Study (CURES142)
Diab Res Clin Practice 109 253-261
Anjana R M, Deepa M, Pradeepa R, Mahanta J, Narain K, Das
H K, Adhikari P, Rao P V, Saboo B, Kumar A and Bhansali
A (2017) Prevalence of diabetes and prediabetes in 15
states of India: results from the ICMR–INDIAB
population-based cross-sectional study The Lancet Diab
& Endocrinology 55 85-596
Anjana R M, Pradeepa R, Das A K, Deepa M, Bhansali A, Joshi
S R, Joshi P P, Dhandhania V K, Rao P V, Sudha V and
Subashini R(2014) Physical activity and inactivity patterns
in India–results from the ICMR-INDIAB study (Phase1)
[ICMR-INDIAB-5] Int J Behavioral Nutrition and
Physical Activity 1126-37
Anjana M, Sandeep S, Deepa R, Vimaleswaran KS, Farooq S and
Mohan V (2004) Visceral and central abdominal fat and
anthropometry in relation to diabetes in Asian Indians
Diab Care 27 2948-2953
Basu S, Dahiya N and Bachani D (2017) Sugar and fat taxes as
means to halt obesity and prevent lifestyle diseases:
Opportunities and challenges in the Indian context Int J
Noncomm Diseases 2 p. 5660
Burden M L, Samanta A, Spalding D and Burden A C (1994) A
comparison of the glycaemic and insulinaemic effects of
an Asian and a European meal Pract Diab 11 208-211
Dehghan M, Mente A and Zhang X (2017) Associations of fats
and carbohydrate intake with cardiovascular disease and
mortality in 18 countries from five continents (PURE): A
prospective cohort study Lancet 390 2050-2062
Dwarkanath P, Muthayya S, Thomas T, Vaz M, Parikh P, Mehra
R and Kurpad A V (2009) Polyunsaturated fatty acid
consumption and concentration among South Indian
women during pregnancy Asia Pac J Clin Nutr 18 389-394
Ghafoorunissa (1996) Fats in Indian diets and their nutritional
and health implications Lipids 31 S287-291
Gulati S, Misra A and Pandey R M (2017) Effect of Almond
Supplementation on Glycemia and Cardiovascular Risk
Factors in Asian Indians in North India with Type 2
Diabetes Mellitus: A 24-Week Study Metabolic syndrome
and related disorders 1598-105
FAO-WHO (2010) Fats and Fatty Acids in Human Nutrition.
Rome: FAO Food and Nutrition Paper # 91 Report of an
Expert Consultation. Geneva. p. 17
Krishnaswamy K, Vaidya R, Rajagopal G, Sudha V (2016) Die
962 S Shobana et al.
(2016) Availability, affordability, and consumption of fruits
and vegetables in 18 countries across income levels: findings
from the Prospective Urban Rural Epidemiology (PURE)
study Lancet Glob Health 4 e695-e703
Misra A, Sharma R, Gulati S, Joshi S R, Sharma V, Ibrahim A,
Joshi S, Laxmaiah A, Kurpad A, Raj R K and Mohan V
(2011 a) Consensus dietary guidelines for healthy living
and prevention of obesity, the metabolic syndrome,
diabetes, and related disorders in Asian Indians Diab Tech
Therap 13 683-694
Misra A, Pandey R M, Devi J R, Sharma R, Vikram N K and
Khanna N (2001) High prevalence of diabetes, obesity
and dyslipidaemia in urban slum population in northern
India Inter J Obes 25 1722-1729
Misra A, Khurana L, Isharwal S and Bhardwaj S (2008) South
Asian diets and insulin resistance Brit J Nutr 101 465-473
Misra A, Singhal N and Khurana L (2010) Obesity, the metabolic
syndrome, and type 2 diabetes in developing countries:
role of dietary fats and oils J Am Coll Nutr 29 289S-301S
Misra A, Singhal N, Sivakumar B, Bhagat N, Jaiswal A and
Khurana L (2011b) Nutrition transition in India: Secular
trends in dietary intake and their relationship to diet related
non communicable diseases J Diab 3 278-292
Mohan V, Radhika G, Sathya R M, Tamil S R, Ganesan A and
Sudha V (2009) Dietary carbohydrates, glycaemic load,
food groups and newly detected type 2 diabetes among
urban Asian Indian population in Chennai, India (Chennai
Urban Rural Epidemiology Study 59) Brit J Nutr 102 1498-
1506
Mohan V, Spiegelman D, Sudha V, Gayathri R, Hong B, Praseena
K, Anjana R M, Wedick N M, Arumugam K, Malik V and
Ramachandran S (2014) Effect of brown rice, white rice,
and brown rice with legumes on blood glucose and insulin
responses in overweight Asian Indians: a randomized
controlled trial Diab Tech Therap 16317-325
Mohan V, Anjana R M, Gayathri R, Ramya Bai M, Lakshmipriya
N, Ruchi V, Balasubramaniyam K K, Jakir M M, Shobana
S, Unnikrishnan R and Krishnaswamy K (2016) Glycemic
index of a novel high-fiber white rice variety developed in
India—A randomized control trial study Diab Tech Therap
18 164-170
Mohan V, Gayathri R, Jaacks L M, Lakshmipriya N, Anjana R
M, Spiegelman D, Jeevan R G, Balasubramaniam K K,
Shobana S, Jayanthan M and Gopinath V (2018) Cashew
Nut Consumption Increases HDL Cholesterol and Reduces
Systolic Blood Pressure in Asian Indians with Type 2
Diabetes: A 12-Week Randomized Controlled Trial J
Nutrition 148 63-69
Narasimhan S, Nagarajan L, Vaidya R, Gunasekaran G, Rajagopal
G, Parthasarathy V, Unnikrishnan R, Anjana R M, Mohan
V and Sudha V (2016) Dietary fat intake and its association
with risk of selected components of the metabolic
syndrome among rural South Indians Indian J End
Metabolism 20 47-54
Narayan S, Lakshmipriya N, Vaidya R, Bai M R, Sudha V,
Krishnaswamy K, Unnikrishnan R, Anjana R M and
Mohan V (2014) Association of dietary fiber intake with
serum total cholesterol and low density lipoprotein
cholesterol levels in Urban Asian-Indian adults with type
2 diabetes Ind J End Met 18 624-630
NNMB (2012) National Institute of Nutrition. Dietary Guidelines
for Indians – A Manual. 2nd ed. Hyderabad: National
Institute of Nutrition
NCD Risk Factor Collaboration (2016) Worldwide trends in
diabetes since 1980: a pooled analysis of 751 populationbased
studies with 4· 4 million participants The Lancet
387 1513-1530
Popkin B M (2015) Nutrition transition and the global diabetes
epidemic Curr Diab reports 15 64-84
Popkin B M, Adair L S and Ng S W (2012) Global nutrition
transition and the pandemic of obesity in developing
countries Nutr Rev 70 3-21
Popkin B M (2009) Reducing meat consumption has multiple
benefits for the world’s health Arch Internal Med 23 169
543-545
Radhika G, Van Dam R M, Sudha V, Ganesan A and Mohan V
(2009) Refined grain consumption and the metabolic
syndrome in urban Asian Indians (CURES 57) Metabolism
58 675-681
Radhika G, Sudha V, Sathya R M, Ganesan A and Mohan V
(2008) Association of fruit and vegetable intake with
cardiovascular risk factors in urban south Indians Brit J
Nutr 99 398-405
Radhika G, Ganesan A, Sathya R M, Sudha V and Mohan V
(2009) Dietary carbohydrates, glycemic load and serum
high-density lipoprotein cholesterol concentrations among
South Indian adults Eur J Clin Nutr 63 413-421
Radhika G, Sathya R M, Ganesan A, Saroja R, Vijayalakshmi P,
Sudha V and Mohan V (2011) Dietary profile of urban
adult population in South India in the context of chronic
disease epidemiology (CURES-68) Pub Health Nutr 14
591-598
Raheja B S, Sadikot S M, Phatak R B and Rao M B (1993)
Significance of the n 6/n 3 ratio for insulin action in diabetes
Ann New York Acad Sci 683 258-271
Rajendran K, Manikandan S, Nair L D, Karuthodiyil R,
Nutrition and Reduction of Diabetes Risk 963
Vijayarajan N, Gnanasekar R, Kapil V V and Mohamed A
S (2015) Serum chromium levels in type 2 diabetic patients
and its association with glycaemic control J Clin Diag Res
9 OC05
Ramachandran A, Snehalatha C, Mary S, Mukesh, B, Bhaskar A
D and Vijay V (2006) The Indian Diabetes Prevention
Programme shows that lifestyle modification and
metformin prevent type 2 diabetes in Asian Indian subjects
with impaired glucose tolerance (IDPP-1) Diabetologia
49 289-297
Ramachandran P (2011) Nutrition transition in India Bulletin of
the Nutrition Foundation of India 32 1-8
Satija A, Hu F B, Bowen, L, Bharathi, A V, Vaz M, Prabhakaran,
D, Reddy K S, Ben-Shlomo Y, Smith G D, Kinra S and
Ebrahim S (2015) Dietary patterns in India and their
association with obesity and central obesity Pub Heal
Nutr 183031-3041
Shankar P, Ahuja S and Sriram K (2013) Non-nutritive sweeteners:
review and update Nutr 291293-1299
Shobana S, Selvi R P, Kavitha V, Gayathri N, Geetha G, Gayathri
R, Parthasarthy V, Balasubramaniam K G, Vaidya R, Sudha
V and Anjana R M (2018) Development and evaluation of
nutritional, sensory and glycemic properties of finger millet
(‘Eleusine coracana L.) based food products Asia Pac J
Clin Nutr 2 78-92
Shrivastava U, Misra A, Mohan V, Unnikrishnan R and Bachani
D (2017) Obesity, diabetes and cardiovascular diseases in
India: public health challenges Curr Diab Rev 13 65-80
Sowmya N, Lakshmipriya N, Arumugam K, Venkatachalam S,
Vijayalakshmi P, Ruchi V, Geetha G, Anjana R M, Mohan
V, Krishnaswamy K and Sudha V (2016) Comparison of
dietary profile of a rural south Indian population with the
current dietary recommendations for prevention of noncommunicable
diseases (CURES 147) Ind J Med Res 144
112-128
Viswanathan M and Mohan V (1991) Dietary management of
Indian vegetarian diabetics Bulletin Nutr Found of India
238 130-5c
Weber M B, Ranjani H, Staimez L R, Anjana R M, Ali M K,
Narayan K V and Mohan V (2016) The stepwise approach
to diabetes prevention: results from the D-CLIP
randomized controlled trial Diab Care 39 1760-1767
Wasir J S and Misra A (2004) The metabolic syndrome in Asian
Indians: impact of nutritional and socio-economic transition
in India Metabolic Syndrome and related disorders 2 pp
14-23
Yajnik C S, Deshpande S S and Jackson A A (2008) Vitamin B12
and folate concentrations during pregnancy and insulin
resistance in the offspring: The Pune Maternal Nutrition
Study Diabetologia 1 51 29-38.
intake and self-reported diabetes among adult men and
women in India BMC Pub Heal 13 706-719
Al-Shoumer K A and Al-Essa T M (2015) Is there a relationship
between vitamin D with insulin resistance and diabetes
mellitus? World J Diab 6 1057-1064
Anjana R M, Sudha V, Nair D H, Lakshmipriya N, Deepa M,
Pradeepa R, Shanthirani C S, Subhashini S, Malik V,
Unnikrishnan R and Binu V S (2015) Diabetes in Asian
Indians-how much is preventable? Ten-year follow-up of
the Chennai Urban Rural Epidemiology Study (CURES142)
Diab Res Clin Practice 109 253-261
Anjana R M, Deepa M, Pradeepa R, Mahanta J, Narain K, Das
H K, Adhikari P, Rao P V, Saboo B, Kumar A and Bhansali
A (2017) Prevalence of diabetes and prediabetes in 15
states of India: results from the ICMR–INDIAB
population-based cross-sectional study The Lancet Diab
& Endocrinology 55 85-596
Anjana R M, Pradeepa R, Das A K, Deepa M, Bhansali A, Joshi
S R, Joshi P P, Dhandhania V K, Rao P V, Sudha V and
Subashini R(2014) Physical activity and inactivity patterns
in India–results from the ICMR-INDIAB study (Phase1)
[ICMR-INDIAB-5] Int J Behavioral Nutrition and
Physical Activity 1126-37
Anjana M, Sandeep S, Deepa R, Vimaleswaran KS, Farooq S and
Mohan V (2004) Visceral and central abdominal fat and
anthropometry in relation to diabetes in Asian Indians
Diab Care 27 2948-2953
Basu S, Dahiya N and Bachani D (2017) Sugar and fat taxes as
means to halt obesity and prevent lifestyle diseases:
Opportunities and challenges in the Indian context Int J
Noncomm Diseases 2 p. 5660
Burden M L, Samanta A, Spalding D and Burden A C (1994) A
comparison of the glycaemic and insulinaemic effects of
an Asian and a European meal Pract Diab 11 208-211
Dehghan M, Mente A and Zhang X (2017) Associations of fats
and carbohydrate intake with cardiovascular disease and
mortality in 18 countries from five continents (PURE): A
prospective cohort study Lancet 390 2050-2062
Dwarkanath P, Muthayya S, Thomas T, Vaz M, Parikh P, Mehra
R and Kurpad A V (2009) Polyunsaturated fatty acid
consumption and concentration among South Indian
women during pregnancy Asia Pac J Clin Nutr 18 389-394
Ghafoorunissa (1996) Fats in Indian diets and their nutritional
and health implications Lipids 31 S287-291
Gulati S, Misra A and Pandey R M (2017) Effect of Almond
Supplementation on Glycemia and Cardiovascular Risk
Factors in Asian Indians in North India with Type 2
Diabetes Mellitus: A 24-Week Study Metabolic syndrome
and related disorders 1598-105
FAO-WHO (2010) Fats and Fatty Acids in Human Nutrition.
Rome: FAO Food and Nutrition Paper # 91 Report of an
Expert Consultation. Geneva. p. 17
Krishnaswamy K, Vaidya R, Rajagopal G, Sudha V (2016) Die
962 S Shobana et al.
(2016) Availability, affordability, and consumption of fruits
and vegetables in 18 countries across income levels: findings
from the Prospective Urban Rural Epidemiology (PURE)
study Lancet Glob Health 4 e695-e703
Misra A, Sharma R, Gulati S, Joshi S R, Sharma V, Ibrahim A,
Joshi S, Laxmaiah A, Kurpad A, Raj R K and Mohan V
(2011 a) Consensus dietary guidelines for healthy living
and prevention of obesity, the metabolic syndrome,
diabetes, and related disorders in Asian Indians Diab Tech
Therap 13 683-694
Misra A, Pandey R M, Devi J R, Sharma R, Vikram N K and
Khanna N (2001) High prevalence of diabetes, obesity
and dyslipidaemia in urban slum population in northern
India Inter J Obes 25 1722-1729
Misra A, Khurana L, Isharwal S and Bhardwaj S (2008) South
Asian diets and insulin resistance Brit J Nutr 101 465-473
Misra A, Singhal N and Khurana L (2010) Obesity, the metabolic
syndrome, and type 2 diabetes in developing countries:
role of dietary fats and oils J Am Coll Nutr 29 289S-301S
Misra A, Singhal N, Sivakumar B, Bhagat N, Jaiswal A and
Khurana L (2011b) Nutrition transition in India: Secular
trends in dietary intake and their relationship to diet related
non communicable diseases J Diab 3 278-292
Mohan V, Radhika G, Sathya R M, Tamil S R, Ganesan A and
Sudha V (2009) Dietary carbohydrates, glycaemic load,
food groups and newly detected type 2 diabetes among
urban Asian Indian population in Chennai, India (Chennai
Urban Rural Epidemiology Study 59) Brit J Nutr 102 1498-
1506
Mohan V, Spiegelman D, Sudha V, Gayathri R, Hong B, Praseena
K, Anjana R M, Wedick N M, Arumugam K, Malik V and
Ramachandran S (2014) Effect of brown rice, white rice,
and brown rice with legumes on blood glucose and insulin
responses in overweight Asian Indians: a randomized
controlled trial Diab Tech Therap 16317-325
Mohan V, Anjana R M, Gayathri R, Ramya Bai M, Lakshmipriya
N, Ruchi V, Balasubramaniyam K K, Jakir M M, Shobana
S, Unnikrishnan R and Krishnaswamy K (2016) Glycemic
index of a novel high-fiber white rice variety developed in
India—A randomized control trial study Diab Tech Therap
18 164-170
Mohan V, Gayathri R, Jaacks L M, Lakshmipriya N, Anjana R
M, Spiegelman D, Jeevan R G, Balasubramaniam K K,
Shobana S, Jayanthan M and Gopinath V (2018) Cashew
Nut Consumption Increases HDL Cholesterol and Reduces
Systolic Blood Pressure in Asian Indians with Type 2
Diabetes: A 12-Week Randomized Controlled Trial J
Nutrition 148 63-69
Narasimhan S, Nagarajan L, Vaidya R, Gunasekaran G, Rajagopal
G, Parthasarathy V, Unnikrishnan R, Anjana R M, Mohan
V and Sudha V (2016) Dietary fat intake and its association
with risk of selected components of the metabolic
syndrome among rural South Indians Indian J End
Metabolism 20 47-54
Narayan S, Lakshmipriya N, Vaidya R, Bai M R, Sudha V,
Krishnaswamy K, Unnikrishnan R, Anjana R M and
Mohan V (2014) Association of dietary fiber intake with
serum total cholesterol and low density lipoprotein
cholesterol levels in Urban Asian-Indian adults with type
2 diabetes Ind J End Met 18 624-630
NNMB (2012) National Institute of Nutrition. Dietary Guidelines
for Indians – A Manual. 2nd ed. Hyderabad: National
Institute of Nutrition
NCD Risk Factor Collaboration (2016) Worldwide trends in
diabetes since 1980: a pooled analysis of 751 populationbased
studies with 4· 4 million participants The Lancet
387 1513-1530
Popkin B M (2015) Nutrition transition and the global diabetes
epidemic Curr Diab reports 15 64-84
Popkin B M, Adair L S and Ng S W (2012) Global nutrition
transition and the pandemic of obesity in developing
countries Nutr Rev 70 3-21
Popkin B M (2009) Reducing meat consumption has multiple
benefits for the world’s health Arch Internal Med 23 169
543-545
Radhika G, Van Dam R M, Sudha V, Ganesan A and Mohan V
(2009) Refined grain consumption and the metabolic
syndrome in urban Asian Indians (CURES 57) Metabolism
58 675-681
Radhika G, Sudha V, Sathya R M, Ganesan A and Mohan V
(2008) Association of fruit and vegetable intake with
cardiovascular risk factors in urban south Indians Brit J
Nutr 99 398-405
Radhika G, Ganesan A, Sathya R M, Sudha V and Mohan V
(2009) Dietary carbohydrates, glycemic load and serum
high-density lipoprotein cholesterol concentrations among
South Indian adults Eur J Clin Nutr 63 413-421
Radhika G, Sathya R M, Ganesan A, Saroja R, Vijayalakshmi P,
Sudha V and Mohan V (2011) Dietary profile of urban
adult population in South India in the context of chronic
disease epidemiology (CURES-68) Pub Health Nutr 14
591-598
Raheja B S, Sadikot S M, Phatak R B and Rao M B (1993)
Significance of the n 6/n 3 ratio for insulin action in diabetes
Ann New York Acad Sci 683 258-271
Rajendran K, Manikandan S, Nair L D, Karuthodiyil R,
Nutrition and Reduction of Diabetes Risk 963
Vijayarajan N, Gnanasekar R, Kapil V V and Mohamed A
S (2015) Serum chromium levels in type 2 diabetic patients
and its association with glycaemic control J Clin Diag Res
9 OC05
Ramachandran A, Snehalatha C, Mary S, Mukesh, B, Bhaskar A
D and Vijay V (2006) The Indian Diabetes Prevention
Programme shows that lifestyle modification and
metformin prevent type 2 diabetes in Asian Indian subjects
with impaired glucose tolerance (IDPP-1) Diabetologia
49 289-297
Ramachandran P (2011) Nutrition transition in India Bulletin of
the Nutrition Foundation of India 32 1-8
Satija A, Hu F B, Bowen, L, Bharathi, A V, Vaz M, Prabhakaran,
D, Reddy K S, Ben-Shlomo Y, Smith G D, Kinra S and
Ebrahim S (2015) Dietary patterns in India and their
association with obesity and central obesity Pub Heal
Nutr 183031-3041
Shankar P, Ahuja S and Sriram K (2013) Non-nutritive sweeteners:
review and update Nutr 291293-1299
Shobana S, Selvi R P, Kavitha V, Gayathri N, Geetha G, Gayathri
R, Parthasarthy V, Balasubramaniam K G, Vaidya R, Sudha
V and Anjana R M (2018) Development and evaluation of
nutritional, sensory and glycemic properties of finger millet
(‘Eleusine coracana L.) based food products Asia Pac J
Clin Nutr 2 78-92
Shrivastava U, Misra A, Mohan V, Unnikrishnan R and Bachani
D (2017) Obesity, diabetes and cardiovascular diseases in
India: public health challenges Curr Diab Rev 13 65-80
Sowmya N, Lakshmipriya N, Arumugam K, Venkatachalam S,
Vijayalakshmi P, Ruchi V, Geetha G, Anjana R M, Mohan
V, Krishnaswamy K and Sudha V (2016) Comparison of
dietary profile of a rural south Indian population with the
current dietary recommendations for prevention of noncommunicable
diseases (CURES 147) Ind J Med Res 144
112-128
Viswanathan M and Mohan V (1991) Dietary management of
Indian vegetarian diabetics Bulletin Nutr Found of India
238 130-5c
Weber M B, Ranjani H, Staimez L R, Anjana R M, Ali M K,
Narayan K V and Mohan V (2016) The stepwise approach
to diabetes prevention: results from the D-CLIP
randomized controlled trial Diab Care 39 1760-1767
Wasir J S and Misra A (2004) The metabolic syndrome in Asian
Indians: impact of nutritional and socio-economic transition
in India Metabolic Syndrome and related disorders 2 pp
14-23
Yajnik C S, Deshpande S S and Jackson A A (2008) Vitamin B12
and folate concentrations during pregnancy and insulin
resistance in the offspring: The Pune Maternal Nutrition
Study Diabetologia 1 51 29-38.
Published
2018-11-13
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