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Investigating the type 2 diabetes epidemic and contributing lifestyle factors in the State of Kuwait: an evolutionary mismatch perspective

Abstract

Diabetes mellitus is a complex, multifactorial group of chronic metabolic diseases falling under the umbrella of non-communicable diseases. In the State of Kuwait, the prevalence of diabetes mellitus is 22.4% among men and 14.4% among women over the age of twenty. Type 2 diabetes mellitus (T2DM) is the dominant phenotype of diabetes mellitus, accounting for approximately 90% of cases. Various modifiable factors, including overweight and obesity, low physical activity levels, and unhealthy dietary habits, affect T2DM risk. Hence, behavioral modification could be an invaluable disease prevention and management strategy. Public knowledge of T2DM management in Kuwait, however, remains limited, particularly concerning lifestyle factors. Investigating T2DM and the contributing lifestyle factors through an evolutionary mismatch perspective offers a unique, relatively unexplored perspective on T2DM prevention and management. That said, the sedentary lifestyle and dietary patterns in Kuwait—characterized by low physical activity levels, high ultra-processed food consumption, and traditional low-fiber dishes—stand in stark contrast to ancestral human behaviors. Environmental conditions and economic prosperity act as mediators of these behaviors and must be addressed to sustain lifestyle modifications. To overcome these challenges, utilizing air-conditioned public spaces, such as large shopping malls, may facilitate increased physical activity. Likewise, incorporating fiber-rich foods into existing eating habits, such as consuming a Middle Eastern salad or lentil soup as an appetizer, could promote healthier dietary patterns. While further research is needed to refine T2DM prevention and management strategies, these recommendations may contribute to a healthier future for Kuwait.

Investigating the type 2 diabetes epidemic and contributing lifestyle factors in the State of Kuwait: an evolutionary mismatch perspective

2025.03.20

Wesley Kuijpers

Investigating the type 2 diabetes epidemic and contributing lifestyle factors in the State of Kuwait: an evolutionary mismatch perspective

References

See all references
  1. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: re- sults from the international diabetes federation diabetes at- las, 9th edition. Diabetes Res Clin Pract. 2019;157:107843. doi: 10.1016/j.diabres.2019.107843
  2. Alkandari A, Alarouj M, Elkum N, Sharma P, Devararjan S, Abu-Farha M, et al. Adult diabetes and prediabetes preva- lence in Kuwait: data from the cross-sectional Kuwait dia- betes epidemiology program. J Clin Med. 2020;9(11):3420. doi: 10.3390/jcm9113420
  3. Bommer C, Sagalova V, Heesemann E, Manne-Goehler J, Atun R, Barnighausen T, et al. Global economic burden of diabetes in adults: projections from 2015 to 2030. Diab Care. 2018;41(5):963–70. doi: 10.2337/dc17-1962
  4. Abouzid M R, Ali K, Elkhawas I, Elshafei S M. An overview of diabetes mellitus in Egypt and the significance of integrat- ing preventive cardiology in diabetes management. Cureus. 2022;14(7):e27066. doi: 10.7759/cureus.27066
  5. Blair M. Diabetes mellitus review. Urol Nurse. 2016;36(1):27–36. doi: 10.7257/1053-816X.2016.36.1.27
  6. Katsarou A, Gudbjornsdottir S, Rawshani A, Dabelea D, Bonifacio E, Anderson B J, et al. Type 1 diabetes mellitus. Nat Rev Dis Primers. 2017;3:17016. doi: 10.1038/nrdp.2017.16
  7. Barlovic DP, Tikkanen H, Groop PR. Physical activity in the prevention of development and progression of kidney disease in type 1-diabetes. Curr Diab Rep. 2019;19(7):41. doi: 10.1007/s11892-019-1157-y
  8. Reed J, Bain S, Venkatwarlu K. A Review of current trends with type 2 diabetes epidemiology, aetiology, pathogenesis, treatments and future perspectives. Diabetes Metab Syndr Obes. 2021;14(8):3567–602. doi: 10.2147/DMSO.S319895
  9. Kahn SE, Cooper ME, Del Prato S. Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. Lancet. 2014;383(9922):1068–83. doi: 10.1016/S0140-6736(13)62154-6
  10. Chen L, Magliano DJ, Zimmer PZ. The worldwide epi- demiology of type 2 diabetes mellitus—present and fu- ture perspectives. Nat Rev Endocrinol. 2011;8(4):228–36. doi: 10.1038/nrendo.2011.183
  11. Aune D, Norat T, Leitzmann M, Tonstad S, Vatten LJ. Phys- ical activity and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis. Eur J Epidemiol. 2015;30(7):529–42. doi: 10.1007/s10654-015-0056-z
  12. DuanMJ,VinkePC,NavisG,CorpeleijnE,DekkerLH.Ultra- processed food and incident type 2 diabetes: studying the un- derlying consumption patterns to unravel the health effects of this heterogeneous food category in the prospective Life- lines cohort. BMC Med. 2022;20(1):7. doi: 10.1186/s12916- 021-02200-4
  13. Kerkadi A, Sadig AH, Bawadi H, Al-Thani AM, Al-Chetachi W, Akram A, et al. The relationship between lifestyle factors and obesity indices among adolescents in qatar. Int J Enviro Res Public Health. 2019;16(22):4428. doi: 10.3390/ijerph16224428
  14. Al-Asi T. Overweight and obesity among Kuwait oil com- pany employees: a cross-sectional study. Occup Med. 2003;53(7):431–5. doi: 10.1093/occmed/kqg110
  15. Delahanty LM, Dalton KM, Porneala B, Chang Y, Goldman VM, Levy D, et al. Improving diabetes outcomes through lifestyle change—a randomized controlled trial. Obesity. 2015;23(9):1792–9. doi: 10.1002/oby.21172
  16. Gluckman PD, Low FM, Bukijas T, Hanson MA, Beedle AS. How evolutionary principles improve the understanding of human health and disease. Evol Appl. 2011;4(2):249–63. doi: 10.1111/j.1752-4571.2010.00164.x
  17. Lea AJ, Clark AG, Dahl AW, Devinsky O, Garcia AR, Golden CD, et al. Applying an evolutionary mismatch framework to understand disease susceptibility. PLoS Biol. 2023;21(9):e3002311. doi: 10.1371/journal.pbio.3002311
  18. Ling C, Bacos K, Rönn T. Epigenetics of type 2 diabetes mel- litus and weight change—a tool for precision medicine? Nat Rev Endocrinol. 2022;18(7):433–48. doi: 10.1038/s41574- 022-00671-w
  19. Al-Adsani MS, Abdulla KA. Reasons for hospitalisations in adults with diabetes in Kuwait. Int J Diabetes Mellit. 2011;3(1):65–9. doi: 10.1016/j.ijdm.2011.01.008
  20. Al-Adsani MS, Moussa MAA, Al-Jasem LI, Al-Hamad NM. The level and determinants of diabetes knowledge in Kuwaiti adults with type 2-diabetes. Diabetes Metab. 2009;35(2):121–8. doi: 10.1016/j.diabet.2008.09.005
  21. Al-Haqan AA, Al-Taweel DM, Awad A, Wake DJ. Pharmacists’ attitudes and role in diabetes management in Kuwait. Med Princ. Pract. 2017;26(1):273–9. doi: 10.1159/000456088
  22. Al-Hussaini M, Mustafa S. Adolescents’ knowledge and awareness of diabetes mellitus in Kuwait. Alexan J Med. 2016;52(1):61–6. doi: 10.1016/j.ajme.2015.04.001
  23. Menke A, Casagrande S, Avilés-Santa LM, Cowie CC. Factors Associated with being unaware of having diabetes. Diabetes Care. 2017;40(5):55–6. doi: 10.2337/dc16-2626
  24. Abdella N, AL-Arouj M, Al-Nakhi A, Al-Assoussi A, Moussa M. Non-insuline-depdendent diabetes in Kuwait: prevalence rates and associated risk factors. Diabetes Res Clin Pract. 1998;42(3):187–96. doi: 10.1016/S0168-8227(98)00104-1
  25. Chandrasekaran P, Weiskirchen R. The role of obesity in type 2 diabetes mellitus—an overview. Int J Mol Sci. 2024;25(3):1882. doi: 10.3390/ijms25031882
  26. Qin L, Knol MJ, Corpoleijn E, Stolk RP. Does Physical ac- tivity modify the risk of obesity for type 2 diabetes: a review of epidemiological data. Eur J Epidemiol. 2010;25(1):5–12. doi: 10.1007/s10654-009-9395-y
  27. Forouhi NG. Embracing complexity: making sense of diet, nutrition, obesity and diabetes. Diabetologia. 2023;66(2):786–99. doi: 10.1007/s00125-023-05873-z
  28. Al-Baho A, Al-Naar A, Al-Shuaib H, Panicker JK, Gaber S. Levels of physical activity among Kuwaiti adults and perceived barriers. Open Public Health J. 2016;9(1):77–87. doi: 10.2174/1874944501609010077
  29. Garashi N, Al-Kandari J, Nieto M. Age related changes in physical activity and incidence of non-communicable dis- eases in a sample of Kuwaiti adults. Health. 2021;13(5):505– 25. doi: 10.4236/health.2021.135039
  30. Al-Ozairi E, Alsaeed D, Al-Roudhan D, Voase N, Pell JP, Ho FK, et al. A comparison of physical activity, muscle strength, and sleep between people with type 2 diabetes in Kuwait and the UK: a cross-sectional study. Front Endocrinol. 2022;13:1067227. doi: 10.3389/fendo.2022.1067227
  31. Al-Lahou BMS, Ausman LM, Peñalvo JL, Huggins GS, Al-Hooti S, Al-Zenki S, et al. Dietary patterns associated with the prevalence of cardiovascular disease risk factors in Kuwaiti adults. J Acad Nutr Diet. 2020;120(3):424–36. doi: 10.1016/j.jand.2019.09.012
  32. Al-Amiri HA, Al-Otaibi JA, Al-Foudari MY, Bin Heji AH. The nutritive value of selected commonly consumed Kuwaiti dishes. Int J Food Sci Nutr. 2009;60(8):668–76. doi: 10.3109/09637480802002408
  33. Alkazemi D, Salmean Y. Fruit and vegetable intake and barriers to their consumption among university students in Kuwait: a cross-sectional survey. J Environ Public Health. 2021;2021:9920270. doi: 10.1155/2021/9920270
  34. Smith U. Dietary fibre, diabetes and obesity. Int J Obes. 1987;11(1):27–31. doi: 10.3109/00365528709095871
  35. Shi L. Sociodemographic characteristics and individual health behaviors. South Med J. 1998;91(10):933–41. PMID: 9786288
  36. Pang YY, Pang RJH, Chen PY. Behavioral epigenetics: perspectives based on experience-dependent epigenetic inheritance. Epigenomes. 2019;3(3):18. doi: 10.3390/epigenomes3030018
  37. Powledge TM. Behavioral epigenetics: how nurture shapes nature. BioScience. 2011;61(8):588–92. doi: 10.1525/bio.2011.61.8.4
  38. Al-AhmadB,Vicedo-CabreraAM,ChenK,GarshickE,Bern- stein AS, Schwartz J, et al. Climate change and health in Kuwait: temperature and mortality projections under differ- ent climatic scenarios. Environ Res Lett. 2022;17(7):074001. doi: 10.1088/1748-9326/ac7601
  39. Benjamin K, Donnelly TT. Barriers and facilitators influenc- ing the physical activity of arabic adults: a literature review. Avicenna. 2013;8(1):1–16. doi: 10.5339/avi.2013.8
  40. Al-Ajmi FF, Loveday D. Indoor thermal conditions and ther- mal comfort in air-conditioned domestic buildings in the dry- desert climate of Kuwait. Build Environ. 2010;45(3):704–10. doi: 10.1016/j.buildenv.2009.08.018
  41. Banna S, Ottesen A, Al-Zougool B. Reasons why only Kuwaiti citizens drive electric vehicles despite being only a quarter of the population. World Electr Veh J. 2023;14(10):287. doi: 10.3390/wevj14100287
  42. Eggers GJ, Vogels N, Westerterp KR. Estimating historical changes in physical activity levels. Med J Aust. 2001;175(11– 12):635–6. doi: 10.5694/j.1326-5377.2001.tb143758.x
  43. Plaza-Diaz J, Izquierdo D, Torres-Martos A, Baig AT, Aquilera CM, Ruiz-Ojeda FJ. Impact of physical activ- ity and exercise on epigenome in skeletal muscle and ef- fects on systemic metabolism. Biomedicines. 2022;10(1):126. doi: 10.3390/biomedicines10010126
  44. Bunprajun T, Henriksen TI, Scheele C, Pedersen BK, Green JG. Lifelong physical activity prevents aging-associated insulin resistance in human skeletal muscle myotubes via increased glucose transporter expression. PLoS ONE. 2013;8(6):e66628. doi: 10.1371/journal.pone.0066628
  45. Saaed AA. Inflation and economic growth in Kuwait: 1985– 2005—evidence from co-integration and error correction model. Appl Econom Int Dev. 2008;7(1):143–55.
  46. Taha TH, Moussa MAA, Rashid AR, Fenech FF. Diabetes mellitus in Kuwait incidence in the first 29 years of life. Diabetologia. 1983;25(4):306–8. doi: 10.1007/BF00253190
  47. Zaghoul S, Al-Hooti SN, Al-Hamad N, Al-Zenki S, Alomarih H, Alaysan I, et al. Evidence for nutritional transition in Kuwait: over-consumption of macronutrients and obesity. Public Health Nutr. 2012;16(4):596–607. doi: 10.1017/S1368980012003941
  48. MusaigerAO.Nutritionaldisordersassociatedwithaffluence in Bahrain. Fam Practic. 1990;7(1):9–13. doi: 10.1093/fam- pra/7.1.9
  49. ZhangY,KutateladzeTG.Dietandtheepigenome.NatCom- mun. 2018;9(1):3375. doi: 10.1038/s41467-018-05778-1
  50. Dufault RJ, Adler KM, Carpenter DO, Gilbert SG, Crider RA. Nutritional epigenetics education improves diet and attitude of parents of children with autism or atten- tion deficit/hyperactivity disorder. World J Psychiatry. 2024;14(1):159–78. doi: 10.5498/wjp.v14.i1.159
  51. CuthbertsonCC,MooreCC,Sotress-AlvarezD,HeissG,Isasi CR, Mossavar-Rahmani Y, et al. Associations of steps per day and step intensity with the risk of diabetes: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Int J Behav Nutr Phys Act. 2022;19(1):46. doi: 10.1186/s12966- 022-01284-2
  52. Banach M, Lewek J, Surma S, Penson PE, Sahebar A, Martin SS, et al. The association between daily step count and all-cause mortality and cardiovascular mortality: a meta-analysis. Eur J Prev Cardiol. 2023;30(18):1975–85. doi: 10.1093/eurjpc/zwad229
  53. Chaudhry UAR, Wahlich C, Fortescue R, Cook DG, Knightly R, Harris R. The effects of step-count monitoring inter- ventions on physical activity: systematic review and meta- analysis of community-based randomized controlled tri- als in adults. Int J Behav Nutr Phys Act. 2020;17(1):129. doi: 10.1186/s12966-020-01020-8
  54. Davydenko M, Peetz J. Time grows on trees: The effect of nature settings on time perception. J Environ Psychol. 2017;54(12):20–6. doi: 10.1016/j.jenvp.2017.09.003
  55. Reynolds AN, Akerman AP, Mann J. Dietary fibre and whole grains in diabetes management: systematic re- view and meta-analyses. PLoS Med. 2020;17(3):e1003053. doi: 10.1371/journal.pmed.1003053
  56. Barber TM, Kabish S, Pfeiffer AFH, Weickert MO. The health benefits of dietary fibre. Nutrients. 2020;12(10):3209. doi: 10.3390/nu12103209
  57. Fernandez MA, Desroches S, Marquis M, Lebel A, Turcotte M, Provencher V. Promoting meal planning through mass media: awareness of a nutrition campaign among Cana- dian parents. Public Health Nutr. 2019;22(18):3349–59. doi: 10.1017/S1368980019002957
  58. Alibrahim A, AlRamadhan D, Johny S, Alhashemi M, Al- duwaisan H, Al-Hilal M. The effect of structured diabetes self-management education on type 2 diabetes patients at- tending a Primary Health Center in Kuwait. Diabetes Res Clin Pract. 2021;171:108567. doi: 10.1016/j.diabres.2020.108567