A globally-estimated 537 million adults between the ages of 20 and 79 are living with diabetes, with more than 75% living in middle to low-income countries.
This figure is expected to rise steadily in the coming years, with the International Diabetes Federation recently acknowledging it’s one of this century’s fastest-growing global health crises.
Of these adults, about 90 million live in Southeast Asia. In 2021, Malaysia ranked fifth in the Western Pacific, with 4.4 million adults battling diabetes. The top four countries were, in order, China, Indonesia, Japan and Thailand.
This public health concern prompted Malaysia’s Ministry of Health to develop the National Strategic Plan for Non-Communicable Diseases (2016-2025), with one of its targets being to halt the rise in obesity and diabetes.
Dietary intervention is one of the cornerstones of diabetes management. However, the adherence to lifestyle recommendations given to individuals with diabetes in Malaysia remains poor, and is an area that requires active investigation and novel solutions.
Another critical issue is the rise in pre-diabetes in Malaysia, with analysis showing its stands at 11.6%.
While it’s imperative to prevent diabetes to avoid future complications, it’s also beneficial for reducing the individual and national economic burden in terms of healthcare expenses. Therefore, it’s critical that measures are taken to prevent pre-diabetes from progressing to overt diabetes.
Local studies show individuals with pre-diabetes are at greater risk of having poor diet quality.
Nutritional interventions are pivotal in preventing pre-diabetes from advancing. These strategies ranged from specific nutrient supplements, to combined diets incorporating an amalgamation of food types.
Our review of dietary interventions for pre-diabetes found two-thirds of the studies focused on one food group or selected food type rather than combination diets such as low-fat or low-carbohydrate diets.
The poorer diet quality of pre-diabetic Malaysians, and the lack of evidence on effective local intervention programs in this group, is a great concern.
An all-encompassing dietary regimen also lacks feasibility when considering inter-individual variability. This phenomenon can be attributed to differences in gut microbiota, genetic polymorphisms for intestinal transport proteins, and various host factors such as age, sex and metabolic status. Hence, a “one-size-fits-all” approach to dietary management of pre-diabetes may not be favourable.
We also found that one-third of the interventions focused on providing dietary education rather than a closed experimental setting with strict observers.
Commonly administered by a registered dietitian or nutritionist, these education-based interventions involved multiple follow-ups and regular dietary reviews to ensure compliance. The implementation of nutritional education has the potential to exert not only long-term health impacts on participants, but also reflect real-world feasibility – an aspect not usually seen in non-educational nutritional interventions.
Considering the severe diabetes burden in Malaysia, it’s becoming more apparent that the pre-diabetic state represents a golden opportunity for preventive strategies.
The poorer diet quality of pre-diabetic Malaysians, and the lack of evidence on effective local intervention programs in this group, is a great concern.
Moving forward, stakeholders, including the Ministry of Health, non-governmental organisations, nutrition researchers, and healthcare professionals, may need to explore potential interventions focusing on dietary and lifestyle strategies suitable for local communities.
