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• W2003023661 abstract "To the Editor: The incidence of diabetes mellitus (DM) is increasing fast, especially in developing countries, with economic globalization.1 In developing countries, the nutrition transition paradox also has emerged with the phenomenon of the development of underweight and obesity in poor people.2 Once thought of as a disorder of affluent people, DM is set to join malaria as a disease of poverty.3 Nevertheless, there has been no report on the association between economic status, obesity, and DM diagnosed according to the oral glucose tolerance test (OGTT) in community-dwelling older people. In this study, the close association between low economic status and glucose intolerance was shown, notwithstanding the low prevalence of obesity in people of low economic status. OGTT was performed in 235 Laotians aged 60 and older (male:female 96:139, mean age 69.9) (64.7% of all eligible subjects) living in the rural village of Lahanam (total population 4,233, population aged ≥60 363) in Savannakhet Province in Laos in 2005.4 According to the criteria of the World Health Organization, DM (fasting blood sugar (FBS) ≥126 mg/dL or 2-hour plasma glucose (PG) ≥200 mg/dL), impaired glucose tolerance (IGT) (FBS 110–125 mg/dL or 2-hour PG 140–199 mg/dL), and normal glucose tolerance (NGT) (FBS <110 mg/dL and 2-hour PG <140 mg/dL) were defined using OGTT. Household economic status was classified according to a wealth ranking, divided by local authorities, into three groups (low (n=43), moderate (n=168) and high (n=24)) according to possessions (e.g., house style, size of field, domestic animals).5 The prevalence of DM or IGT was 51.2% (DM 27.9%; IGT 23.3%), 28.0% (DM 14.9%, IGT 13.1%), and 37.5% (DM 20.8%, IGT 16.7%) for people of low, moderate, and high economic status, respectively (Figure 1). The low economic group had a higher prevalence of DM/IGT (51.2%) than the moderate economic group (28.0%) (chi-square test, P=.004) and a higher prevalence of DM (27.9%) than the moderate economic group (14.9%) (P=.045). There was no difference in the prevalence between the high and moderate economic groups. Prevalence of diabetes mellitus (DM) or impaired glucose tolerance (IGT) with and without obesity according to economic status in elderly subjects in a rural area in Laos (diagnosed according to 75 g oral glucose tolerance test according to World Health Organization criteria). **P=.004, prevalence of DM/IGT according to the chi-square test (reference group: moderate economic status). Obesity: body mass index (BMI) ≥25.0. All subjects with DM/IGT had a significantly higher prevalence (24.4%) of obesity (body mass index (BMI) ≥25.0) than those with NGT (14.0%) (P=.049). The prevalence of obesity was 4.9%, 19.5%, and 25.0% in the low, moderate, and high economic status groups, respectively. The prevalence of DM/IGT combined with obesity was 2.3%, 9.5%, and 8.3% in subjects of low, moderate, and high economic status, respectively. The prevalence of obesity was much lower (4.5%) in subjects with DM/IGT of low economic status than in those of moderate economic status (34.0%) (Figure 1). To clarify the association between economic status, obesity, and DM/IGT, we calculated the odds ratio of economic status for DM/IGT using the confounding factor of obesity with adjustment for age and sex using multiple logistic regression analysis. Compared with the moderate economic group, the odds ratio of the low economic group for DM/IGT was 3.2 (P=.001) and that of the high economic group was 1.1. The odds ratio of obesity for DM/IGT was 2.5 (P=.01) compared with nonobesity. According to the above results, low economic status and obesity were independent factors associated with DM/IGT. DM/IGT was common, but obesity was rare in the group with low economic status in this rural area. The elderly of low economic itself may have a high risk for suffering DM/IGT because of their lifestyle; some hypotheses for this are suggested. The first is the unbalanced diet of sticky rice, which has more calories than ordinary rice, with cheo (local pepper sauce) and a paucity of other foods. The second is the hypothesis of “fetal origins of disease,” which postulates that early undernutrition causes an irreversible differentiation of the metabolic system, which may, in turn, increase the risk of DM in adulthood or old age.2 Poor old people in rural areas may be vulnerable to IGT/DM because of those causes and others. Recently, energy-dense foods with more sugar and fats are available near this rural area. Obesity was associated with DM/IGT especially in people of moderate or high economic status in this study. The area may be under siege from nutritional transition with economic globalization. For the prevention of obesity and DM/IGT in vulnerable people, especially those of low economic status, it is important to recognize that, not only high, but also low economic status may be a risk factor for DM, and the causes in each of them should be pursued to prevent DM and its complications. Conflict of Interest: Kiyohito Okumiya received funding for Project 4-2 from the Research Institute for Humanity and Nature from Japanese Ministry of Education, Science and Culture. The study was also supported by the overseas grant-in-aid of the Ministry of Health, Labor and Welfare, Japan. The editor in chief has determined that the authors have no conflict of interest related to this manuscript. Author Contributions: Kiyohito Okumiya, Masayuki Ishine, Tiengkham Pongvongsa Boungnong Boupha, and Kozo Matsubayashi conceived and designed the project. All authors participated in the medical survey in Laos. Kiyohito Okumiya and Kozo Matsubayashi were engaged in analysis and interpretation of data and preparation of the manuscript. Sponsor's Role: None." @default.
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• W2003023661 date "2007-12-01" @default.
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• W2003023661 title "THE CLOSE ASSOCIATION BETWEEN LOW ECONOMIC STATUS AND GLUCOSE INTOLERANCE IN ELDERLY SUBJECTS IN A RURAL AREA IN LAOS" @default.
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• W2003023661 doi "https://doi.org/10.1111/j.1532-5415.2007.01408.x" @default.
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