Spoiler: the answer is famine. Manmade famine.

February 4, 2024 9:50 PM

How British colonialism increased diabetes in south Asians (SLYT)

See also:

Wikipedia on the famines caused by colonialism

Diabetes in India today

posted by splitpeasoup (4 comments total)

I'm going to attempt to tease apart some data....

In the Wikipedia link in the OP, it says that according to the 2019 National Diabetes and Diabetic Retinopathy Survey by the Ministry of Health in India, the prevalence of diabetes was found to be 11.8% in people over the age of 50. I found the text of the study on PubMed. They constructed a representative sample of 63,000 individuals and had a 90% response rate. Patients were identified as diabetic either from a prior diagnosis, or from on-the-spot Random Blood Sugar test exceeding 200 mg/dL. Among those identified as being in a diabetic state, 32.7% of people were previously undiagnosed.

Compare this to Malaysia (my own country), where the prevalence of diabetes in those over 50 is a shocking 36%. This is from the 2019 study, National Health and Morbidity Survey 2019. A representative cross section of 18,500 individuals was constructed throughout every state in Malaysia, and their survey received a 90% response rate. In the survey, a nurse administered a fasting glucose test to each participant: they found 18.3% of the total population had a fasting blood glucose exceeding 7 mmol/L which indicates a diabetic state. About 50% of people identified as being in a diabetic state were previously undiagnosed.

There were some notable correlations. Of the 18.3% prevalence in the general population, there were large differences by state - Negeri Sembilan (33.2%) and Perlis (32.9%) were highest, while Sabah (9.8%) and Sarawak (13.1%) were lowest.

No gender difference was found, and no difference was found between urban or rural population.

There was a moderate income effect - highest rate among households earning below RM1,000 (25.4%) and lowest among households earning above RM10,000 (13.7%) - which follows the trend for education - no formal education (28.7%) versus tertiary educated (12.7%)

There was an ethnic component - highest among Indians (31.4%), then Malays (21.6%) then Chinese (15.1%) and lastly Bumiputera Sabah and Sarawak (12.3%).

This last one might be most telling, as it could serve as evidence that famine affected Indians migrating to Malaysia have elevated risk of diabetes relative to other ethnicities.

Or it might just be caused by the numerous confounding effects and cross-correlations that exist in the data, there's no way to tell without someone going deeper into the data. Also, not to say other countries didn't suffer food deprivation, my various ancestors fled the famines in China.

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Unfortunately, mothers who develop gestational diabetes will affect the metabolism of their baby, increasing the risk their baby will develop diabetes later in life as well. This is an example of a disorder that can be passed down generations even without a genetic component.

Rice is terrible from a blood glucose point of view, I have sometimes wondered - while greatly enjoying a bowl of rice - if the Chinese had adapted over thousands of years to be able to eat rice without getting diabetes? Or if major famines and food insecurity in fact made the Chinese more susceptible to diabetes, but it's only with the recent affluence and emergence of soft drink and junk food that tipped everyone's bodies over the edge into a health crisis.
posted by xdvesper at 12:00 AM on February 5 [4 favorites]

Rice is terrible from a blood glucose point of view, I have sometimes wondered - while greatly enjoying a bowl of rice - if the Chinese had adapted over thousands of years to be able to eat rice without getting diabetes? Or if major famines and food insecurity in fact made the Chinese more susceptible to diabetes, but it's only with the recent affluence and emergence of soft drink and junk food that tipped everyone's bodies over the edge into a health crisis.

It's only recently that polished (hulled) rice/white rice became affordable for people who weren't nobility.

Rice that hasn't been hulled/polished has much lower Glycaemic Index.
posted by chariot pulled by cassowaries at 12:07 AM on February 5 [7 favorites]

The original study seems to be this paper: The Susceptibility of South Asians to Cardiometabolic Disease as a Result of Starvation Adaptation Exacerbated During the Colonial Famines by Mubin Syed, Feras Deek and Azim Shaikh.
posted by TheophileEscargot at 3:33 AM on February 5 [2 favorites]

IMHO the actual evidence that colonialism increased diabetes in south asia is.... pretty thin (at least according to the evidence here). My guess is this is what you get when you have health researchers studying what is essentially a political and historical phenomenon.
posted by MisantropicPainforest at 8:20 AM on February 5