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Western diets and Indian genetics, a ticking time bomb of diabetes

India is facing a diabetes crisis. Western dietary habits, particularly the increased consumption of junk food, are becoming increasingly common in the country. This, combined the genetic predisposition for diabetes, is laying the groundwork for a public health crisis which will see an estimated 134.3 million people suffering with diabetes in India by 2045. India’s fast food industry is fighting furiously to stop rules which might slow the onslaught.

The potential scale of this crisis seems to be fuelling growing popular support for a public interest lawsuit requesting junk food be banned from sale in and around schools.  

Obese people are at significantly greater risk of health conditions such as heart disease and diabetes

The case, filed by the non-profit Uday Foundation in 2010 prompted government action. In 2015, a committee picked by the Food Safety and Standards Authority of India (FSSAI)  issued guidelines which would have banned the sale of potato chips, sugar sweetened beverages, ready-to-eat noodles and chocolates within 500 yards of schools. These measures were approved by a two-judge bench in the Delhi High Court  to be implemented within three months. This ruling was however, never put into place. Instead, the FSSAI put in place another committee to review the case.

The latest incarnation of the ruling, suggested by the same committee, instead proposes a tax on junk food, a prevention of advertising during children’s television programmes, and a requirement to note processed food on the label. Such measures are being contested and lobbied against by India’s rapidly emerging fast food industry – one which is enjoying a robust recovery post-demonetisation and is expected to be worth $27.57 billion by 2020.

Indian people have been shown to have a predisposition to diabetes. This is due to a number of genes that are common amongst the population that are risk factors for developing the disease. These genes have been uncovered in genome wide association studies among the Indian population, and may, at least in part, explain higher rates of diabetes in India. However, this does not dismiss the role that lifestyle issues such as poor diet play in the development of type 2 diabetes.

Social changes are also playing a significant role. Historically Indians have eaten a diet rich in healthy foods such as fruit and vegetables, as well as often working manual jobs. Both of these factors are known to help prevent diabetes. However, as a larger population shifts to a sedentary lifestyle and begins to consume more readily available processed food, the combination of genetic and lifestyle risk factors have caused a surge in diabetes cases.

The average age of onset of diabetes in India occurs between 25 and 34, nearly two decades before the age of onset in western nations. This indicates a considerable role for the genetic risk factor present in the Indian population.

Lifestyle risk factors are now more prevalent in India than ever before. Obesity, in particular, is on the rise in India. Since 1990, the percent of people in India who are overweight or obese has almost tripled from 6.4 per cent to 18.8 percent, according to data from the Institute for Health Metrics and Evaluation at the University of Washington.  Coupled with the genetic predisposition to diabetes there is potential for a continued — and significant — rise in prevalence amongst the population. Government policies will be required to stem a surge in disease numbers. Curbing the prevalence of unhealthy food may be a necessary first step.

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