Obesity and Diabetes in an Indigenous “Vadda” Population of Rural Sri Lanka

ORIGINAL ARTICLE DOI: http://doi.org/10.4038/sjdem.v6i2.7309

OBESITY AND DIABETES IN AN INDIGENOUS “VADDA” POPULATION OF RURAL SRI LANKA

Kande Vidanalage C1, Adhikariwatthage D2

1Base Hospital, Elpitiya, 2General hospital, Ampara.

ABSTRACT

Indroduction: Economic development and the associated lifestyle changes have led to a rise in prevalence of diabetes among adult population of Sri Lanka. A Similar lifestyle changes are observed among indigenous population (Vadda) population of Sri Lanka. However, there is limited data available regarding prevalence of diabetes among Vadda population in Sri Lanka. This study was conducted to determine the prevalence of type 2 diabetes, impaired fasting glycaemia (IFG) and obesity among rural indigenous Vedda population of Sri Lanka.

Methods: A cluster sampling of 91 subjects above 18 years of age in an indigenous community were investigated. Fasting plasma glucose, blood pressure, height, weight, and abdominal circumference were measured and BMI were calculated.

Results: The prevalence of type 2 diabetes among Vadda population was 2.19% and IFG was 5.49 %. The prevalence of overweight and obesity among males were 15% and 2.5% and 19.6% and 3.9% among females. Prevalence of obesity and diabetes among Vadda population were very much lower compared to the general population of the country. However, almost one third of this population is below the BMI of 18.5kgm-2.

Conclusions: The prevalence of obesity and diabetes among Vadda community is very much lower compared the rural population of Sri Lanka. However, underweight problem is still a concern.

Key words: Indigenous population, Vadda, Diabetes mellitus, obesity, Sri Lanka

INTRODUCTION is believed to be related to pre university of Colombo in 2011, only historic communities of the country 10% this population is involved in and have being living in Sri Lanka for Paddy farming and 50% of these Obesity and the associated type 2 a longer period than the current main families are involved in Chena diabetes are two major global health communities such as Sinhalese, cultivation (a form of slash and burn problems. The recent epidem- Tamils and Muslims. Currently, it is cultivation) and 15% work as manual iological data suggest that the estimated that there are about 10, 000 laborers mainly on adjacent villages incidence of diabetes is rising (1) and Vaddas living in small clusters as the main form of employment (3). the south Asian countries have a scattered over central and eastern Currently, Vaddas are among the parts of Sri Lanka. They have their poorest communities of the country. very high incidence of type 2 diabetes (2). According to a study own unique culture, language, Traditionally, they had only two main done in 2005 covering seven religion and rituals. Their habitat is meals per a day and even today only provinces, the prevalence of diabetes within or adjacent to forest areas of about 65% of families eat 3 meals a and any form of dysgycaemia in Sri the country. They are traditionally day and 52% of families had income Lanka was 10.3% (9.4–11.2%) and hunter gatherers who lived on by less than Sri Lankan Rupee 5000 21.8% (20.5–23.1%) respectively. hunting small animals, mainly deers ($40) a month. and monkeys for food and gathering Vadda is a common term used to yams and honey from the forest. With the transition from hunter describe the indigenous population gatherers to more farming com- of Sri Lanka. This tribal community According to survey done by munity, their dietary patterns have

Volume 6, No. 2, August 2016 12 changed quite remarkably with time Weights were measured with light were considered having abdominal and now their diet mainly consists clothes without shoes using a obesity (7). of carbohydrates such as Maize, calibrated weighing scale. The height Kurakkan, Rice and yams and was measured while the subject Data were analyzed with SPPSS 10.5 legumes such as Cow pea in standing in erect posture vertically software. Prevalence of diabetes and addition to the small quantity of touching a wall looking horizontally. pre-diabetes were calculated and the protein they gather by hunting The WHO protocol for measuring prevalence of obesity according to monkeys, deer, wild boar and waist circumference was adopted and BMI and abdominal obesity was monitor lizards. This gradual the measurement was made at the calculated and compared with transition from hunting community approximate midpoint between the national values. to a farming community has made lower margin of the last palpable rib them less active and to eat more and the top of the iliac crest with a carbohydrates. This lifestyle shift plastic tape (4). RESULTS seems to have dramatic cons- equences for the prevalence of Using aseptic precaution, 5ml of obesity and diabetes in this venous blood was taken for fasting There were 91 adults in the study community. The objective of this plasma glucose using aseptic population consisting of 40 (43.5%) study was to study the prevalence of precautions and plasma glucose levels males and 51 (56.1%) females. The obesity and diabetes among the were assessed by the glucose oxidase average age (95% confidence interval) indigenous (Vadda) population of (enzymatic oxidation) method. Fast- of the study population was 45.5 Sri Lanka. ing blood sugar of more than 127 (44.35-46.65) years. The mean ages of mg/dl and 100-126 mg/dl were used the females and the males were 42.9 to diagnose diabetes and impaired (38.5-47.2) years and 48.8 (44.8-52.7) STUDY DESIGN AND METHODS fasting glucose (IFG) respectively (5). years respectively. The mean height and weight of the males were 160 cm The BMI levels were calculated This study was conducted in (156.5-163.5 cm) and 53 kg (50.9 - according to WHO risk categories for February 2013 and the study 56.51 kg). The mean height and the Asian BMI (6). BMI of less than 18.5 population was selected from a weight of females were 150.2 cm kg/m2 was considered as unde- remote village called Pollebedda (147.4-152.9 cm) and 47.0 kg (44.2- rweight, a BMI of 18.5–23 kg/m2 was inside the Galoya national wildlife 49.4 kg) respectively. On average, the considered as increasing but sanctuary, which is about 300 females were 10.4 cm shorter acceptable risk, a BMI of 23–27.5 kilometers from Colombo, in the compared to males. The body mass kg/m2 as increased risk and a BMI of Ampara district, eastern province of index males and females were 20.21 27.5 kg/m2 or higher as high risk. -2 -2 -2 Sri Lanka. According to government kgm (19-21.3 kgm ) and 20.4 kgm -2 statistics, there were 455 families with (19.31-21.49 kgm ) respectively. The The abdominal circumference was a total population of 2407 including females were marginally obese than classified according International children (1506 males and 901 males (Table 1). These values were Diabetes Federation criteria for ethnic lower compared to national values of females) in this village. With the or country-specific values for waist assistance of the head of the BMI for males and females, which are circumferences and the waist -2 -2 indigenous clan and the cultural 21.1 kgm (20.9–21.3 kgm ) and 22.3 circumference of males more than 90 -2 -2 officer of the District secretariat, 25 kgm (22.1–22.4 kgm ) respectively cm and females more than 80 cm houses were selected for the study. (8).

All the adults in those houses, age more than 25 years were included in the study.

Each house was visited on the day Table 1: Mean Age, Height and Weight of the population previous to the study and they were informed about the objectives of the Males (n=40) Females (n=51) study and the procedural details Mean age (years), 95% 48.8 (44.8-52.7) 42.9(38.5-47.2) including overnight fasting and CI venesection for blood sampling. Mean height (cm), 95% 160 (156.5-163.5) 150 (147.4-152.9) After obtaining informed consent, CI they were kept fating after 10 p.m. A Mean weight (kg), 95% 53(50.9-56.6) 47.0(44.2-49.4) team of nurses and doctors of CI General Hospital Ampara volu- Mean BMI (kgm-2), 95% 20.21(19-21.3) 20.4 (19.3-21.49) nteered to visit the houses and to CI, 95% CI collect blood samples and anthr- Mean abdominal 79.9 (77.0-82.7) 82 .2 (79.5-84.8) opometric data on the following day. circumference (cm), 95% None of the adults refused consent CI for the study.

Sri Lanka Journal of Diabetes, Endocrinology and Metabolism Table 2: Prevalence (percentage) of overweight obesity and abdominal obesity in study population and Sri Lanka

Study population Sri Lanka

Male Female Male Female BMI 23-27.5 15% 19.6% 22.6% 28% BMI> 27.5 2.5% 3.9% 7.2% 11.3%

Central Obesity* 12.5% 27.5% 16.5% 36.6%

*abdominal circumference >90cm in males and > 80cm in males

OBESITY Table 3: Percentage of adult Vaddas with BMI values <15, 15-18.4 and more than 18.5 in three different studies According to the proposed World Study Number BMI<15 BMI 15-18.4 BMI >18.5 Health Organization cut-off values of year BMI for Asians, there were only 15% M F M F M F M F overweight and 2.5% obese males in this Vadda population. Although it 1971- 13 08 0% 0% 46% 38% 54% 62% was not statistically significant, the 1973* incidence of overweight (19.6%) and 1993- 52 64 6% 12% 50% 59% 44% 29% obesity (3.9 %) problems were 1994* slightly higher among females of this 2013 40 51 5% 4% 25% 23% 70% 71% community. However, the prevalence of obesity and overweight problem among Vadda population is lower than that of the national figures 8.7% of prevalence in the rural habits and the level of activity during (Table 2) for both males and females population of Sri Lanka according to daily activates, the prevalence on (8). the Sri Lanka Diabetes, Cardiovas- non-communicable diseases were

cular Study (SLDSC) conducted in 7 very much lower in these As a measure of central obesity, provinces in 2007 (10). The pre- communities compared to the abdominal circumferences were valence of IFG in Vadda population general population. However, with measured and the mean waist is 5.5% (7.5% for males and 3.9% the lifestyle changes towards a circumference of the males was 79.9 for females), which is lower than the modern society has caused a major cm (77.0-82.7 cm) and 82.2 cm national figure for rural population shift in the prevalence of obesity, (79.5-84.8 cm) in females. This of Sri Lanka (8.6% for men and diabetes and IFG among these tribal indicates the higher prevalence of 7.7% for women) (Table 4). communities and this change is seen central obesity among females. There even among our indigenous were 12.5% males and 27.5% communities (3, 9). In the isolated females with central obesity (abdo- DISCUSSION Vadda community that we studied, minal circumference of more than 90 the prevalence of obesity, diabetes cm for males and more than 80 cm and IFG were still very much lower for females) indicating a higher Tribal communities who are used compared to rural population of Sri prevalence of central obesity among to simple lifestyles are prevalent Lanka. However, the underweight females of this tribal community. thought out the world. Due to the problem is still a concern. When compared with the national marked differences of their food figures (Table 2), prevalence of central obesity was very much lower among Vadda population (8). Table 4: Prevalence (percentage) of Diabetes Mellitus (DM) and Impaired Fasting Glucose (IFG) in study population

DIABETES AND IFG Study population General population The prevalence of diabetes among Male Female Total population Vadda population was 2.1%(2.5% of DM 2.5% 1.9% 2.1% 8.7% IFG 7.5% 3.9% 5.5% males and 1.9% of females). This fi- DM+IFG 10% 5.8% 7.6% gure is very much lower to the 8.7%

Volume 6, No. 2, August 2016 14 Although, diabetes is prevalent there is a lot to be done to improve 3. De Silva P. Punchihewa AG. among this indigenous community, the nutritional status of this Socio-Anthropological the prevalence is very much lower community. Research Project on Vedda compared to the national figures (3, Community in Sri Lanka. 9, 10). Due to the economic Due to the change in the lifestyle August 2011. Department of development and due to the mixing during the last few decades, there has Sociology University of Colo- up with the local community, the been a change in the prevalence of mbo Ministry of Culture and lifestyle of the Vadda population has diabetes and IFG among Vadda the Arts Government of Sri Lanka. changed during last few decades. population of other areas and it is http://www.researchgate.net Pollebedda, the village that we almost similar to prevalence in rural /publication/235335142_Soc studied is situated about 10 km away communities of Sri Lanka (10). These io from Mahaoya and it is the same findings highlight the importance of Anthropological_Research_P population that was described by Dr. early interventions in related to the rojecton_Vedda_Community R. L Spitell one of the three appropriate health promotion _in_Sri_Lanka. (Accessed surgeons working in the then interventions to avoid malnutrition 20/09/2015) General Hospital of Colombo, in his without creating a situation of over- 4. Nishida C, Ko GT, Kum- famous books Far-Off things (1933), nutrition for this indigenous anyika S. Body fat distribut- Savage sanctuary (1941) vanished community of Sri Lanka. ion and non-communicable trail (1950) where the white Sambar diseases in populations: over- Roams (1951) and Wild white Boy view of the 2008 WHO Exp- (1958). This population was CONCLUSIONS ert Consultation on Waist Ci- relatively isolated from other comm- rcumference and Waist-Hip unities as they live away from main Ratio. European Journal of Cl- roads in a wildlife sanctuary and Due to the rapid urbanization and inical Nutrition. 2010; 64: 2-5. considered unsafe to travel during the modern lifestyle, obesity and 5. Diagnosis and classification the last 30-year period due to the diabetes have become major health of diabetes mellitus. Diabetes Care. 2007; 30 Suppl 1: S42-7. civil war. Therefore, the life style of problems. However, the prevalence of obesity and diabetes are very 6. Appropriate body-mass index this community has change very little for Asian populations and its much lower among indigenous over the past three decades. The lack implications for policy and community of Sri Lanka. Although of environmental influence with the intervention strategies. Lancet economic development that we see there has been an improvement with (London, England). 2004; in other communities, is probably the prevalence of malnutrition and 363: 157-163. the reason for low incidence of underweight problem in this 7. Alberti KGMM, Zimmet P, diabetes and IFG in this community. community, it is a health concern Shaw J. Metabolic syndrome- Their active lifestyle could have been that needs to be addressed by the -a new world-wide definition. health authorities. another strong protective factor. 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