Development of nutritional strategies for diabetes prevention in Malawian adults at high diabetes risk

制定糖尿病高危马拉维成年人预防糖尿病的营养策略

• 批准号: MC_PC_MR/R019428/1
• 负责人: Jason Gill
• 金额: $ 25.47万
• 依托单位: University of Glasgow
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2018
• 资助国家: 英国
• 起止时间: 2018 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MC_PC_MR%2FR019428%2F1
• 关键词: Development; nutritional; strategies; diabetes; prevention

Low- and middle-income countries, such as Malawi, are currently faced with disparate nutritional challenges such as childhood and adult malnutrition alongside increasing levels of obesity. On top of this, people in Malawi (and wider sub-saharan Africa (SSA)) are exposed to repeated infections and inflammation. Together these contribute to the rising levels of non-communicable diseases, such as diabetes, in these countries. Rates of death from diabetes in SSA are 5 times higher than in high-income countries, and the disease is placing substantial burdens of fragile health systems. It also has important economic consequences as it largely affects working age adults. It is therefore important to develop strategies to prevent diabetes in Malawi and wider SSA. What is also becoming clear is that people who get diabetes in Malawi are very different from White Europeans in high-income countries. For example, whereas in high-income countries people who get diabetes are likely to be obese (BMI over 30 kg/m2) and inactive, in Malawi over 90% of the population meet physical activity guidelines and are often normal weight. This discrepancy may be explained by differences in nutrition, particularly in early life, and infection burden which come together to cause a low level of muscle mass and strength in people from Malawi. Indeed muscle size and strength are lower in people in Malawi compared to high income countries such as the UK and United States: this is important, as low muscle mass and strength have been shown to increase the risk of diabetes. A detailed exploration of nutritional habits, body composition and inflammation burden in people at risk of diabetes in Malawi is currently lacking. Such data are needed before we can develop appropriate interventions to prevent diabetes in this population. In high-income countries lifestyle interventions are focused on weight loss (via decreasing food intake) and increases in physical activity, which are unlikely to be effective in Malawi where people are already very active and normal weight. It may be the case, therefore, that nutritional strategies such as increasing protein intake or altering the diet to help reduce inflammation may be more effective in Malawi. Indeed some preliminary data has shown protein intake to be generally very low in Malawi. In this proposal we will carry out detailed measurements of nutritional intake, body composition and infection burden in people in Malawi at risk of diabetes and compare these to a healthy Malawian population and with available data from databases in other African countries and high-income countries (e.g. United Kingdom and United States). This will allow us to identify where best to target interventions, e.g. at increasing muscle mass via increases in protein intake. Following this, in the same population, we will explore normal nutritional practices and knowledge of diabetes with an aim to identify areas where beneficial intervention may be possible. Thirdly, we will form a network of people and organisations who will be key in facilitating any developed intervention. Together these will allow us to develop potential theories of change for new nutritional interventions to reduce diabetes risk in Malawi. This work will lead to the future development of new nutritional approaches to prevent diabetes in the Malawian population focused on increasing muscle mass and reducing inflammation.

马拉维等低收入和中等收入国家目前面临着不同的营养挑战，如儿童和成人营养不良以及肥胖症日益严重。最重要的是，马拉维（以及更广泛的撒哈拉以南非洲（SSA））的人们暴露于反复感染和炎症。这些因素共同导致这些国家的糖尿病等非传染性疾病发病率上升。撒哈拉以南非洲的糖尿病死亡率是高收入国家的5倍，这种疾病给脆弱的卫生系统带来了沉重的负担。它还具有重要的经济后果，因为它在很大程度上影响到工作年龄的成年人。因此，重要的是制定战略，以预防糖尿病在马拉维和更广泛的撒南非洲。越来越清楚的是，马拉维的糖尿病患者与高收入国家的白色欧洲人非常不同。例如，在高收入国家，患有糖尿病的人可能肥胖（BMI超过30 kg/m2）且不活动，而在马拉维，超过90%的人口符合体育活动指南，通常体重正常。这种差异可能是由于营养差异，特别是在早期生活中，以及感染负担的差异，这些因素共同导致马拉维人的肌肉质量和力量水平较低。事实上，与英国和美国等高收入国家相比，马拉维人的肌肉大小和力量较低：这很重要，因为低肌肉质量和力量已被证明会增加患糖尿病的风险。目前缺乏对马拉维糖尿病风险人群的营养习惯、身体成分和炎症负担的详细探索。在我们制定适当的干预措施以预防这一人群的糖尿病之前，需要这些数据。在高收入国家，生活方式干预措施的重点是减肥（通过减少食物摄入）和增加体育活动，这在马拉维不太可能有效，因为马拉维的人们已经非常活跃，体重正常。因此，在马拉维，增加蛋白质摄入量或改变饮食以帮助减少炎症等营养策略可能更有效。事实上，一些初步数据显示，马拉维的蛋白质摄入量普遍很低。在本提案中，我们将对马拉维有糖尿病风险的人群的营养摄入量、身体成分和感染负担进行详细测量，并将其与健康的马拉维人口以及其他非洲国家和高收入国家（例如英国和美国）数据库中的可用数据进行比较。这将使我们能够确定最佳干预措施的目标，例如通过增加蛋白质摄入量来增加肌肉质量。在此之后，在同一人群中，我们将探索正常的营养实践和糖尿病知识，旨在确定可能进行有益干预的领域。第三，我们将建立一个人员和组织网络，这些人员和组织将是促进任何成熟干预措施的关键。这些将使我们能够为新的营养干预措施开发潜在的变化理论，以降低马拉维的糖尿病风险。这项工作将导致未来开发新的营养方法，以预防马拉维人口中的糖尿病，重点是增加肌肉质量和减少炎症。

项目成果

"I see salt everywhere": A qualitative examination of the utility of arts-based participatory workshops to study noncommunicable diseases in Tanzania and Malawi.

“我到处都看到盐”：对基于艺术的参与式研讨会的实用性研究，以研究坦桑尼亚和马拉维的非传染性疾病。

• DOI: 10.1371/journal.pgph.0000927
• 发表时间: 2022
• 期刊: PLOS global public health

" I see salt everywhere ": A qualitative examination of the utility of arts-based participatory workshops to study noncommunicable diseases in Tanzania and Malawi

“我到处都看到盐”：对坦桑尼亚和马拉维以艺术为基础的参与式研讨会研究非传染性疾病的效用进行定性检验

• DOI: 10.1101/2022.07.29.22278150
• 发表时间: 2022
• 作者: Bissett M

Qualitative study of practices and attitudes towards physical activity among prediabetic men and women in urban and rural Malawi.

• DOI: 10.1136/bmjopen-2021-058261
• 发表时间: 2023-01-17
• 期刊: BMJ OPEN
• 影响因子: 2.9
• 作者: Banda, Jethro;Bunn, Christopher;Crampin, Amelia C.;Gill, Jason M. R.;Gray, Cindy M.
• 通讯作者: Gray, Cindy M.