Understanding type 2 diabetes in Malawi

Researchers at the University of Glasgow are collaborating with Malawian scientists to try to find out why some people in Malawi develop type 2 diabetes – even though many are slim and highly active.

Worldwide, diabetes is on the rise with almost 400 million people living with the disease – a figure that is predicted to rise to about 600 million in 2035. It’s also an expensive disease to treat, accounting for over 10% of worldwide healthcare budgets, with almost £500 billion spent on diabetes worldwide in 2014.

A collaborative research project between The University of Glasgow, Malawi Epidemiology and Intervention Research Unit, and the Malawi College of Medicine has received £186,588 from the Global Challenges Research Fund to develop new approaches to prevent type 2 diabetes in Malawi, where death rates from the disease are five times higher than in the UK.

A shift from rural to urban living and lifestyle changes mean that non-communicable diseases such as diabetes are emerging as pressing problems in Africa.

A shift from rural to urban living and lifestyle changes mean that non-communicable diseases such as diabetes are emerging as pressing problems in Africa.

Jason Gill, Professor of Cardiometabolic Health at the University of Glasgow, is leading the year-long project, which will seek to understand why some people in Malawi are at high risk of developing type 2 diabetes despite not being overweight and being highly physically active – 90% of the population achieve WHO activity guidelines.

People in Malawi are not only active but obesity prevalence is still relatively low – although it is rising – with only 2% of men obese and 13% of women. More than 40% of type 2 diabetes patients in the country are normal weight.

Professor Gill said: “If factors other than obesity and activity are major drivers of the problem, interventions primarily focussed on weight loss and increased physical activity that we use in the UK may not be the most effective solutions.
“We think that childhood undernutrition, lower muscle mass and strength, and long-term exposure to infections and inflammation could contribute to the Malawi paradox.
“These factors could lower a person’s capacity to buffer the effects of adverse lifestyle factors and lead to increased diabetes risk at low body weight.”

Professor Gill added: “Malawi needs to find interventions that work for prevention of diabetes. These could include introducing more protein into diets, which is currently low in protein. Protein needs are higher when inflammation is high and protein is also needed to build muscle. We need to understand how to do in this in the context of food availability and cultures in Malawi.
“Diet could be made less inflammatory by introducing a Mediterranean-type diet adapted to Malawi. This kind of diet, rich in olive oil, fruit and vegetables, legumes, fish and white meat, has been shown to reduce diabetes incidence by about half in a European context. We are investigating whether we can do something similar with foods that are readily available in Malawi.”
The project will recruit 50 people with ‘pre-diabetes’ from both rural and urban Malawi and 50 healthy control participants. It will measure dietary intake, body composition, grip strength, physical activity levels, cardiometabolic risk profile, gut microbiota and inflammatory markers.

Malawian and UK social scientists will also work together to understand the reasons why Malawians at risk of developing diabetes eat the foods they eat, and what they know about diabetes and its risk factors.
The investigating team is working with the Government of Malawi, clinicians and health organisations and community and patient groups to develop a plan to achieve effective nutritional diabetes interventions.