開発途上地域における糖尿病にみる健康教育の重要性 : インドネシア・パプア州の症例より

Abstract

The importance of addressing lifestyle disease in remote area has been emphasized along with rapid modernization. In March 2012, medical survey was conducted in Bade, Papua in Indonesia, a town near river with a rapid development of market economy from traditional lifestyle. Through the survey of 119 community-living adults, we revealed 6% of the diabetic participants and 11% of impaired glucose tolerance. We observed drastic dietary shift in staple food (sago to rice) and a strong belief about healthy diet which is the misunderstood thought that rice is the healthiest food. The case involves a 69-year-old woman who was eating only rice with sprinkled sugar (occasionally with fruits) for past 2 years. Blood tests revealed her diabetic state (HbA1c:7.0%), dyslipidemia (HDL-cholesterol, 21mg/dl; LDL-cholesterol, 51mg/dl; triglyceride, 146mg/dl), and anemic state with low hemoglobin concentration:8.4g/dl, due to an iron-deficient diet. Her body mass index was 34kg/m3; height, 157cm; weight, 84kg; waist, 120cm. Nutritional assessment showed her total energy intake was 1907kcal/day, with very low protein intake. The woman's family was relatively rich in this community; therefore, her food choice was related to poor health-related knowledge and not monetary issues. She strongly believed that rice was the only food that could improve her health. Thus, education as well as treatment is very important for lifestyle-related diseases, especially for elderly people in remote areas without adequate information.