Diabetes crisis and bothersome surge in incidence: Taking a further look at the ‘Pre-FOAD Hypothesis’ and ‘Interventional Inequity’
Dear Editor
Diabetes is reportedly soaring to unacceptable levels in the UK from recently published data[1,2]. About 5 million people are reportedly affected with Diabetes with Type 2 Diabetes increasing among those under 40 years old and even more in ‘Areas of High Levels of Deprivations’[1]. It is suggested that there should be a greater push for the reduction in the rates of Obesity and enforcement of limiting the Advertising of Junk Foods to children as these possibly contribute to the ‘Diabetes Crisis’[2].
The link between ‘Obesity Reduction’ and ‘Diabetes Reduction’ is salutary and instructive. Previous ‘Communications’[3-5] suggested that several ‘Obesity Reduction Interventions’ were not effective as ‘Obesity Persisted as a Public Health Challenge and Epidemic Health Emergency’. Some of these ‘Obesity Reduction Interventions’ include, among others: Healthy Eating with ChooseMyPlate/ MyFoodPlate/ FoodPyramid Websites and Improved Healthful Exercises, Healthy Living/ Lifestyle, Healthy Weight Reduction (Not ‘Dieting’!), Community Programmes, State/ Government Efforts and Programmes and, not the least, Regular Tips for Parents[6-10].
This Author disposed the problem of ‘Interventional Inequity’ with the ‘Obesity Reduction Interventions’ as they did not address the ‘Fundamental Prevention of Obesity’ and, therefore, advocated a ‘Look at the ‘Pre-FOAD Hypothesis’’[11]. Therefore, a ‘Strategic Programmatic Link’ of ‘Diabetes Reduction’ with ‘Obesity Reduction’ must, of necessity and as an urgent imperative, address and include the ‘Pre-FOAD Hypothesis’; this then is the call for a ‘Further Look at the ‘Pre-FOAD Hypothesis’. Previous ‘Communications’[12-16] detailed the Developmental Origins of Health and Disease Hypothesis (DOHAD Hypothesis) and the Foetal Origins of Adult Diseases Hypothesis (FOAD Hypothesis) as the possible ‘Programmatic Pillars’ for the ‘Obesity Challenge Interventions’ hinging on the nexus with the ‘Metabolic Syndrome’ with ‘Components’ easily recounted with the Acronym ‘DOHIDIMS’: ‘Diabetes, Obesity, Hypertension, Ischaemic Heart Disease, Dyslipidaemia, Insulin Resistance Syndrome in the Metabolic Syndrome’[12].
A previous Communication’[11] distilled matters relating to the ‘Obesity Health Challenge’ and unearthed the ‘Aetiology’ and ‘Prevention’ with the suggestion that much attention and resources had not been proportionately focused on the ‘Role/ Contribution’ of ‘Exclusive and Optimal Breastfeeding (EBF-OBF)’. This may be regarded as the ‘Obesity Interventional Inequity’[11] which needed to be addressed by greater ‘Attention and Resources’ being deployed and focused on the ‘EBF-OBF Dyad’ as a Child Survival Intervention. This was disposed as the justification for the ‘Pre-FOAD Hypothesis’ as a ‘Panacea’ for the ‘Interventional Inequity’. Exclusive Breastfeeding (EBF) is the ‘Starting Locus’ for the ‘Pre-FOAD Hypothesis’ as disposed in detail previously[11,12,17].
Back to the ‘Diabetes Crisis’, it is reported that 4.3 million people in the UK have Diabetes with 850, 000 yet to be diagnosed and 2.4 million at high-risk of developing Type 2 Diabetes[1]. Of the cases of Diabetes, 90% are reportedly Type 2 Diabetes, 8% Type 1 and the ‘Others’ represent 2%. The NHS Diabetes Prevention Programme should take cognizance of the ‘Pre-FOAD Hypothesis’ for a more ‘Holistic and Comprehensive Diabetes Reduction Intervention’. By addressing the ‘Pre-FOAD Hypothesis’ as a ‘Missing Link’, the ‘Obesity Interventional Inequity’ will be eclipsed with ‘Productive Programmatic Impact’.
REFERENCES
1. Diabetes UK. Number of people living with diabetes in the UK tops 5 million for the first time. Apr 2023. https://www.diabetes.org.uk/about_us/news/number-people-living-diabetes-....
2. Wise J. Diabetes cases in UK reach all time high, charity warns. BMJ 2023; 381:p848
3. Rodgers A, Woodward A, Swinburn B, Dietz WH. Prevalence trends tell us what did not precipitate the US Obesity epidemic. Lancet Public Health 2018; 3:e162-163. PMID 29501260
4. Finucane MM, Stevens GA, Cowan MJ, Global burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Body Mass Index). National, regional and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 2011; 377:557-67.
5. Skinner AC, Ravabakht SN, Skelton JA, Perrin EM, Armstrong SC. Prevalence of obesity and severe obesity in US children, 1999-2016. Pediatrics 2018; 141:e20173459.
6. Hill JO, Peters JC. Environmental contributors to the Obesity epidemic. Science 1998; 280:1371-1374.
7. World Health Organization. Obesity: preventing and managing the global epidemic. Geneva: WHO; 1998.
8. Jeffrey RW. Public health strategies for obesity treatment and prevention. Am J Health Behav 2001; 25:252-259.
9. Campbell K, Waters E, O’Meara S, Summerbell C. Interventions for preventing obesity in Children. Cochrane Library, Issue 2. CD001871. Oxford: Update Software; 2002.
10. Crawford D. Population strategies to prevent obesity. BMJ 2002; 325 (7367):728-729.
11. Eregie C.O. Obesity as a Public Health Emergency: A look at the ‘Pre-FOAD Hypothesis’ as a Panacea for the ‘Interventional Inequity’. https://www.bmj.com/content/366/bmj.l5463/rr-0 of 4th October 2019
12. Eregie CO. Programming the End from before the Beginning: Juxtaposing Technology with the ‘TEA Triad’. 106th Inaugural Lecture, University of Benin, Benin City, Nigeria. University of Benin Press; 17th December 2009.
13. Barker DJ. The developmental origins of adult disease. J Am Coll Nutr 2004; 23:588S95S
14. Armitage JA, Poston L, Taylor PD. Developmental origins of obesity and the metabolic syndrome: the role of maternal obesity. Front Horm Res 2008; 36:73-84
15. Calkins K, Devasker SU. Foetal origins of adult disease. Curr Probl Pediatr Adolesc Health Care 2011; 41 (6):158-176
16. World Health Organization. Launch of the Healthy Life Trajectories Initiative (HeLTI): an International DOHaD Research Collaboration. WHO; Geneva; 2017
17. Eregie CO. Breastmilk, Breastmilk Substitutes (Including Infant Formula) and Infant Microbiome: Still more Justification for the Prohibition of Advertisement of Breastmilk Substitutes (BMS). https://www.bmj.com/content/364/bmj.l1279/rr-6 of 4th April 2019.
Professor Charles Osayande Eregie,
MBBS, FWACP, FMCPaed, FRCPCH (UK), Cert. ORT (Oxford), MSc (Religious Education), FAMedS, FIPMD, FIMC, CMC, CMS
Professor of Child Health and Neonatology, University of Benin, Benin City, Nigeria.
Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria.
UNICEF-Trained BFHI Master Trainer,
ICDC-Trained in Code Implementation,
*Technical Expert/ Consultant on the FMOH-UNICEF-NAFDAC Code Implementation Project in Nigeria,
*No Competing Interests.
Competing interests:
No competing interests
09 May 2023
Charles O. EREGIE
MEDICAL DOCTOR
Professor of Child Health and Neonatology, University of Benin and Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria
Institute of Child Health, College of Medical Sciences, University of Benin, Benin City, Nigeria.
Rapid Response:
Diabetes crisis and bothersome surge in incidence: Taking a further look at the ‘Pre-FOAD Hypothesis’ and ‘Interventional Inequity’
Dear Editor
Diabetes is reportedly soaring to unacceptable levels in the UK from recently published data[1,2]. About 5 million people are reportedly affected with Diabetes with Type 2 Diabetes increasing among those under 40 years old and even more in ‘Areas of High Levels of Deprivations’[1]. It is suggested that there should be a greater push for the reduction in the rates of Obesity and enforcement of limiting the Advertising of Junk Foods to children as these possibly contribute to the ‘Diabetes Crisis’[2].
The link between ‘Obesity Reduction’ and ‘Diabetes Reduction’ is salutary and instructive. Previous ‘Communications’[3-5] suggested that several ‘Obesity Reduction Interventions’ were not effective as ‘Obesity Persisted as a Public Health Challenge and Epidemic Health Emergency’. Some of these ‘Obesity Reduction Interventions’ include, among others: Healthy Eating with ChooseMyPlate/ MyFoodPlate/ FoodPyramid Websites and Improved Healthful Exercises, Healthy Living/ Lifestyle, Healthy Weight Reduction (Not ‘Dieting’!), Community Programmes, State/ Government Efforts and Programmes and, not the least, Regular Tips for Parents[6-10].
This Author disposed the problem of ‘Interventional Inequity’ with the ‘Obesity Reduction Interventions’ as they did not address the ‘Fundamental Prevention of Obesity’ and, therefore, advocated a ‘Look at the ‘Pre-FOAD Hypothesis’’[11]. Therefore, a ‘Strategic Programmatic Link’ of ‘Diabetes Reduction’ with ‘Obesity Reduction’ must, of necessity and as an urgent imperative, address and include the ‘Pre-FOAD Hypothesis’; this then is the call for a ‘Further Look at the ‘Pre-FOAD Hypothesis’. Previous ‘Communications’[12-16] detailed the Developmental Origins of Health and Disease Hypothesis (DOHAD Hypothesis) and the Foetal Origins of Adult Diseases Hypothesis (FOAD Hypothesis) as the possible ‘Programmatic Pillars’ for the ‘Obesity Challenge Interventions’ hinging on the nexus with the ‘Metabolic Syndrome’ with ‘Components’ easily recounted with the Acronym ‘DOHIDIMS’: ‘Diabetes, Obesity, Hypertension, Ischaemic Heart Disease, Dyslipidaemia, Insulin Resistance Syndrome in the Metabolic Syndrome’[12].
A previous Communication’[11] distilled matters relating to the ‘Obesity Health Challenge’ and unearthed the ‘Aetiology’ and ‘Prevention’ with the suggestion that much attention and resources had not been proportionately focused on the ‘Role/ Contribution’ of ‘Exclusive and Optimal Breastfeeding (EBF-OBF)’. This may be regarded as the ‘Obesity Interventional Inequity’[11] which needed to be addressed by greater ‘Attention and Resources’ being deployed and focused on the ‘EBF-OBF Dyad’ as a Child Survival Intervention. This was disposed as the justification for the ‘Pre-FOAD Hypothesis’ as a ‘Panacea’ for the ‘Interventional Inequity’. Exclusive Breastfeeding (EBF) is the ‘Starting Locus’ for the ‘Pre-FOAD Hypothesis’ as disposed in detail previously[11,12,17].
Back to the ‘Diabetes Crisis’, it is reported that 4.3 million people in the UK have Diabetes with 850, 000 yet to be diagnosed and 2.4 million at high-risk of developing Type 2 Diabetes[1]. Of the cases of Diabetes, 90% are reportedly Type 2 Diabetes, 8% Type 1 and the ‘Others’ represent 2%. The NHS Diabetes Prevention Programme should take cognizance of the ‘Pre-FOAD Hypothesis’ for a more ‘Holistic and Comprehensive Diabetes Reduction Intervention’. By addressing the ‘Pre-FOAD Hypothesis’ as a ‘Missing Link’, the ‘Obesity Interventional Inequity’ will be eclipsed with ‘Productive Programmatic Impact’.
REFERENCES
1. Diabetes UK. Number of people living with diabetes in the UK tops 5 million for the first time. Apr 2023. https://www.diabetes.org.uk/about_us/news/number-people-living-diabetes-....
2. Wise J. Diabetes cases in UK reach all time high, charity warns. BMJ 2023; 381:p848
3. Rodgers A, Woodward A, Swinburn B, Dietz WH. Prevalence trends tell us what did not precipitate the US Obesity epidemic. Lancet Public Health 2018; 3:e162-163. PMID 29501260
4. Finucane MM, Stevens GA, Cowan MJ, Global burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Body Mass Index). National, regional and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 2011; 377:557-67.
5. Skinner AC, Ravabakht SN, Skelton JA, Perrin EM, Armstrong SC. Prevalence of obesity and severe obesity in US children, 1999-2016. Pediatrics 2018; 141:e20173459.
6. Hill JO, Peters JC. Environmental contributors to the Obesity epidemic. Science 1998; 280:1371-1374.
7. World Health Organization. Obesity: preventing and managing the global epidemic. Geneva: WHO; 1998.
8. Jeffrey RW. Public health strategies for obesity treatment and prevention. Am J Health Behav 2001; 25:252-259.
9. Campbell K, Waters E, O’Meara S, Summerbell C. Interventions for preventing obesity in Children. Cochrane Library, Issue 2. CD001871. Oxford: Update Software; 2002.
10. Crawford D. Population strategies to prevent obesity. BMJ 2002; 325 (7367):728-729.
11. Eregie C.O. Obesity as a Public Health Emergency: A look at the ‘Pre-FOAD Hypothesis’ as a Panacea for the ‘Interventional Inequity’. https://www.bmj.com/content/366/bmj.l5463/rr-0 of 4th October 2019
12. Eregie CO. Programming the End from before the Beginning: Juxtaposing Technology with the ‘TEA Triad’. 106th Inaugural Lecture, University of Benin, Benin City, Nigeria. University of Benin Press; 17th December 2009.
13. Barker DJ. The developmental origins of adult disease. J Am Coll Nutr 2004; 23:588S95S
14. Armitage JA, Poston L, Taylor PD. Developmental origins of obesity and the metabolic syndrome: the role of maternal obesity. Front Horm Res 2008; 36:73-84
15. Calkins K, Devasker SU. Foetal origins of adult disease. Curr Probl Pediatr Adolesc Health Care 2011; 41 (6):158-176
16. World Health Organization. Launch of the Healthy Life Trajectories Initiative (HeLTI): an International DOHaD Research Collaboration. WHO; Geneva; 2017
17. Eregie CO. Breastmilk, Breastmilk Substitutes (Including Infant Formula) and Infant Microbiome: Still more Justification for the Prohibition of Advertisement of Breastmilk Substitutes (BMS). https://www.bmj.com/content/364/bmj.l1279/rr-6 of 4th April 2019.
Professor Charles Osayande Eregie,
MBBS, FWACP, FMCPaed, FRCPCH (UK), Cert. ORT (Oxford), MSc (Religious Education), FAMedS, FIPMD, FIMC, CMC, CMS
Professor of Child Health and Neonatology, University of Benin, Benin City, Nigeria.
Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria.
UNICEF-Trained BFHI Master Trainer,
ICDC-Trained in Code Implementation,
*Technical Expert/ Consultant on the FMOH-UNICEF-NAFDAC Code Implementation Project in Nigeria,
*No Competing Interests.
Competing interests: No competing interests