Rural and urban differences in lifestyle behaviors: a baseline survey among type II diabetic patients in an integrated nutritional supports program to combat obesity

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Abu Naim Mohammad Bazlur Rahim
A.K. Obidul Huq
Farjana Anzin


Lifestyle behaviors, Type-II Diabetes, Obesity, Integrated nutritional supports, Baseline survey


Background and aims: Recently, the prevalence of type II diabetes and obesity has increased in both rural and urban communities. The aim of this work is to investigate the lifestyle behaviors including food consumption, physical exercise and sleep duration among type II diabetic patients in an integrated nutritional support program in rural and urban settings in Bangladesh. Methodology: A baseline cross-sectional study was conducted among 512 rural and 712 urban type-II diabetes patients from two different communities. Information about the participants’ socio-economic and dietary patterns, duration of physical exercise, duration of sleep and body mass index (BMI) measurement were collected by related appropriate techniques. Data were analyzed by SPSS software. Results: The prevalence of obesity (BMI≥30) among the type-II diabetic patients was significantly different between the two community settings (rural 60.9% vs. urban 69.2%). Food consumption for the energy-giving, processed foods and beverages groups significantly differs from the rural and urban settings. However, consumption of body-building and protective foods in both communities was lowered compared to the present dietary guidelines and did not show significant differences. The average contribution of different food groups’ consumption was: energy giving 69.8% and 60.1%, body-building 12.4% and 13.3%, and protective foods 13.7% and 11.2% respectively for the rural and urban populations. Both males and females slept less than the recommended hours, without any significant variations among the rural and urban lifestyles. The duration of physical exercise was significantly (p <0.05), differed in both settings and the mean duration of physical exercise per day was 32 ±9 minutes in the rural and 23±7 minutes in the urban area. Conclusions: Imbalanced lifestyles through poor food consumption patterns, insufficient sleep and physical exercise may predispose to type II diabetes and obesity, therefore, proper nutrition education programs should be developed concerning lifestyle behaviors.

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1. Soon JM, Tee ES. Changing trends in dietary pattern and implications to food and nutrition security in Association of Southeast Asian Nations (ASEAN). Int J Nutr Food Sci 2014; 3(4): 259-269. doi: 10.11648/j.ijnfs.20140304.15.
2. Gibson E, Stacey N, Sunderland TC, Adhuri DS. Dietary diversity and fish consumption of mothers and their children in fisher households in Komodo District, eastern Indonesia. PLoS One 2020; 15(4): e0230777.
3. Cockx L, Colen L, De Weerdt J, Paloma GY. Urbanization as a driver of changing food demand in Africa: evidence from rural-urban migration in Tanzania. JRC Technical Reports. EUR 28756 EN European Commission, Luxembourg, 2019. doi:10.2760/515064.
4. Park JH, Moon JH, Kim HJ, Kong MH, Oh YH. Sedentary lifestyle: Overview of updated evidence of potential health risks. Korean J Fam Med 2020; 41(6): 365. doi: 10.4082/kjfm.20.0165.
5. Galy O, Paufique E, Nedjar-Guerre A, et al. Living in rural and urban areas of New Caledonia: impact on food consumption, sleep duration and anthropometric parameters among Melanesian adolescents. Nutrients 2020; 12(7): 2047. doi: 10.3390/nu12072047.
6. Naito R, Yun LW, Wan YC. Sleep deprivation and its associated factors among undergraduate students in Malaysia. Asia Pac J Public Health 2021; 33(5): 530-538. doi:10.1177/10105395211019930.
7. Zhu B, Shi C, Park CG, Zhao X, Reutrakul S. Effects of sleep restriction on metabolism-related parameters in healthy adults: A comprehensive review and meta-analysis of randomized controlled trials. Sleep Med Rev 2019; 45: 18-30. doi: 10.1016/j.smrv.2019.02.002.
8. Radcliffe PN, Whitney CC., Fagnant HS, et al. Severe sleep restriction suppresses appetite independent of effects on appetite regulating hormones in healthy young men without obesity. Physiol Behav 2021; 237: 113438. doi: 10.1093/cdn/nzaa063_070.
9. Ghannadiasl F. Associations between white blood cells count and obesity in apparently healthy young adults. Nutr Food Sci 2020; 50 (6): 1013-1019. doi: 10.1108/nfs-08-2019-0270.
10. Al Muktadir MH, Islam MA, Amin MN, et al. Nutrition transition–Pattern IV: Leads Bangladeshi youth to the increasing prevalence of overweight and obesity. Diabetes Metab Syndr : Clin Res Rev 2019: 13(3): 1943-1947. doi:10.1016/j.dsx.2019.04.034.
11. Hossain MS, Siddiqee MH, Ferdous S, et al. Is childhood overweight/obesity perceived as a health problem by mothers of preschool aged children in Bangladesh? A community level cross-sectional study. Int J Environ Res Pub Health 2019; 16(2): 202. doi: 10.3390/ijerph16020202.
12. Biswas T, Garnett SP, Pervin S, Rawal LB. The prevalence of underweight, overweight and obesity in Bangladeshi adults: Data from a national survey. PloS One 2017; 12(5): e0177395. doi: 10.1371/journal.pone.0177395.
13. Zamsad M, Banik S, Ghosh L. Prevalence of overweight, obesity and abdominal obesity in Bangladeshi university students: A cross-sectional study. Diabetes Metab Syndr : Clin Res Rev 2019; 13(1): 480-483. doi: 10.1016/j.dsx.2018.11.015.
14. Galaviz KI, Weber MB, Straus A, Haw JS, Narayan KV, Ali MK. Global diabetes prevention interventions: a systematic review and network meta-analysis of the real-world impact on incidence, weight, and glucose. Diabetes Care 2018; 41(7):1526-34. doi: 10.2337/dc17-2222.
15. Gong Q, Zhang P, Wang J, et al. Morbidity and mortality after lifestyle intervention for people with impaired glucose tolerance: 30-year results of the Da Qing Diabetes Prevention Outcome Study. Lancet Diabetes Endocrinol 2019; 7(6):452-61. doi: 10.1016/S2213-8587(19)30093-2.
16. Neufeld LM, Andrade EB, Suleiman AB, et al. Food choice in transition: adolescent autonomy, agency, and the food environment. The lancet 2021; 399 (10320): 185-197. doi: 10.1016/S0140-6736(21)01687-1.
17. de Brauw A, Waid J, Meisner CA, Akter F, Khan BF. Food systems for healthier diets in Bangladesh: Towards a research agenda. IFPRI Discussion Paper 1902; International Food Policy Research Institute (IFPRI): Washington, DC, USA, 2019. doi: 10.2499/p15738coll2.133549.
18. Dietary Guideline for Bangladesh (2013),
19. Huq, AKO. Human Nutrition and Applied Dietitics, A Text Book, Nutrition Information Cell, Dhaka 2012; 1, 197-205.
20. Islam MR, Trenholm J, Rahman A, Pervin J, Ekström EC, Rahman SM. Sociocultural influences on dietary practices and physical activity behaviors of rural adolescents—a qualitative exploration. Nutrients 2019; 11(12):2916. doi:10.3390/nu11122916.
21. Hayes JF, Balantekin KN, Altman M, Wilfley DE, Taylor CB, Williams J. Sleep patterns and quality are associated with severity of obesity and weight-related behaviors in adolescents with overweight and obesity. Child Obes. 2018; 14(1):11-7. doi: 10.1089/chi.2017.0148.
22. Aronne LJ, Nelinson DS, Lillo JL. Obesity as a disease state: a new paradigm for diagnosis and treatment. Clin cornerstone 2009; 9(4):9-29. doi: 10.1016/s1098-3597(09)80002-1.
23. Rolls BJ. The supersizing of America: portion size and the obesity epidemic. Nutrition today. 2003; 38(2):42-53. doi:10.1097/00017285-200303000-00004.
24. Andersen RE, Crespo CJ, Bartlett SJ, Cheskin LJ, Pratt M. Relationship of physical activity and television watching with body weight and level of fatness among children: results from the Third National Health and Nutrition Examination Survey JAMA; 279(12):938-42. doi: 10.1001/jama.279.12.938.
25. Wright SM, Aronne LJ. Causes of obesity. Abdominal Radiology 2012; 37(5): 730-732. doi: 10.1007/s00261-012-9862-x.
26. Rawal L, Jubayer S, Choudhury SR, et al. Community health workers for non-communicable diseases prevention and control in Bangladesh: a qualitative study. Global health research and policy, 2021; 6, 1-10. doi:10.1186/s41256-020-00182-z.
27. El Arifeen S, Christou A, Reichenbach L, et al. Community-based approaches and partnerships: innovations in health-service delivery in Bangladesh. The Lancet, 2013; 382(9909), 2012-2026. doi:10.1016/S0140-6736(13)62149-2.
28. Hu A. O, Bazlur Rahim A. N. M., Moktadir S. M, et al. Integrated nutritional supports for diabetic patients during COVID-19 infection: A comprehensive review. Current Diabetes Reviews, 2022;18(3), 52-60. doi:10.2174/1573399817666210301103233.
29. Jayawardena R, Sooriyaarachchi P, Chourdakis M, et al. Enhancing immunity in viral infections, with special emphasis on COVID-19: A review. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2020; 4(4), 367-382. doi:10.1016/j.dsx.2020.04.015.
30. Kolcu G, Kolcu M. I. B, Demir S, Gulle K. Evaluation of learning management system in medical education in time of COVID-19. Progress in Nutrition, 2020; 22 doi: 10.23751/pn.v22i2-S.10443.
31. WHO Consultation on Obesity: Preventing and Managing the Global Epidemic. Geneva, Switzerland: World Health Organization; 2000 WHO Technical Report Series 894.
32. Bingham SA, Nelson M, Paul AA, Haraldsdottir J, Loken EB, Van Staveren WA. Methods for data collection at an individual level. In Manual on methodology for food consumption studies 1988: 53-106. Oxford Univ. Press.
33. Kennedy G, Ballard T, Dop MC. Guidelines for measuring household and individual dietary diversity. Food and Agriculture Organization of the United Nations; 2011.
34. Nahar Q, Choudhury S, Faruque M, et al. Desirable dietary pattern for Bangladesh. Final Res. Results, 2013;15, 226-244.
35. Consensus Conference Panel, Watson NF, Badr MS et al. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 2015 15; 11(6):591-2. doi: 10.5665/sleep.4886.