Alcohol consumption is an old practice among black Africans. Alcohol is prepared in different forms locally and consumed for different purposes. Some forms of locally made alcoholic beverages include palm wine, ‘ogogoro’, ‘burukutu’, ‘kai kai’ etc. Anecdotal report have cited some reasons for consuming alcohol to include: as medicine, to cure low mood, enhance performance, to increase breast milk flow, to be able to sleep well among other reasons. Unfortunately, alcohol has many disadvantages when compared with its advantages.
Alcohol acts in the pleasure area of the limbic system by altering the GABA and the dopamine neurotransmitter levels88. One gets enough pleasure or feeling of being in a high mood with a small quantity of alcohol, at the initial period of experimenting with alcohol88. As time goes on, one would require larger amount of alcohol to achieve the same level of pleasure, hence leading to alcohol abuse. At the point when one finds it difficult to cope unless one has taken alcohol, this is known as alcohol dependence88. Alcohol abuse has ruined many lives, jobs, families, caused accidents and chronic diseases, law breaking and encounter with law enforcement agents among others88. Some tools may be used in clinics to assess the level of alcohol misuse or abuse includes the CAGE questionnaire89. Where C
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stands for: Have you ever felt like cutting down on the quantity of alcohol you consumed? A stands for: Have you ever felt angry when people criticized your drinking? G stands for:
Have you ever felt guilty about your habit of drinking? While E stands for: Have you ever gotten up to take alcohol as first thing in the morning “eye opening” so as to have your nerves steadied? Any answer to two of the questions means positive response, hence needs further assessment 89. Moderate alcohol consumption improves insulin sensitivity, increase HDL cholesterol and adinopectin. While heavy alcohol on the other hand, result in excess calorie intake and obesity, increased triglyceride and pancreatitis 61. Some studies have found a U-shaped relationship between new cases of diabetes and alcohol consumption 68, 69, 61. This implies that non-drinkers, light drinkers and heavy drinkers have increased risk of diabetes unlike moderate drinkers that have decreased risk of diabetes68,69. Ekpenyong CE and colleagues in Nigeria and Aksu H in Turkey did not find any association between alcohol consumption and diabetes 26,32. Motola AA and colleagues in South Africa found independent association between alcohol consumption and type 2 diabetes60. In a meta–analysis of 15 cohort studies on alcohol consumption and development of type 2 diabetes by Koppes LLJ and colleagues, showed that thirty percent reduction in the risk of type 2 diabetes was observed in moderate alcohol consumers when compared with heavy alcohol consumers and abstainers. No risk reduction was observed in low and high BM1 categories 69. In New Zealand, a study showed a U-shaped relationship between alcohol consumption and incident cases of type 2 diabetes, impaired glucose tolerance and hypertension68. Moderate alcohol
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drinkers had lower risk of diabetes in normal and overweight subjects but higher risks of diabetes in obese individuals, even after adjusting for confounders 68. When one has multiple lifestyle behaviours (factors) that reduce development of type 2 diabetes, moderate alcohol consumption will further reduce the risk of developing diabetes by 40% when compared to abstention 70.
Many people in sub-Saharan Africa seem to be adopting western lifestyle which encourages sedentary lifestyle, at the same time not involving in regular exercise. This has helped in no small measure in fuelling diabetes epidemic. Some of the factors encouraging this type of life style include modernization of means of transportation, driving and time spent watching television among others61. Physical activity has been shown to reduce risk of diabetes 8,9, while sedentary lifestyle has an important association with diabetes through the mechanism of encouraging weight gain. Regular exercise may delay or prevent the progression of diabetes9. Weight reduction of 5-7% and moderate physical activity for at least 30 minutes each day (150 minutes per week) was found to lower the risk of developing diabetes by 58% in overweight people with pre-diabetes (impaired glucose) 71. The standard method of assessing physical activity is through assessing energy expenditure or metabolic equivalents (METs)8. Metabolic equivalent is the ratio of metabolic rate during a specific physical activity to a reference metabolic rate8. Physical activity has inverse association with type 2 diabetes 36, 72, 73. Cardio-respiratory fitness which is health–related component of physical fitness: moderate to high level cardiorespiratory fitness is associated with a lower
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risk of mortality from all–causes and cardiovascular diseases 8. It also seems to reduce the higher risk of associated with obesity, even though it does not seem to reduce it completely 8.
Cigarette smoking seems to be common among blacks especially in the younger population. Some of the reason people give for indulging in such lifestyle include peer group influence, to prevent cold, to reduce weight74. It is cheap and readily available. Smoking is not without its attendant health problems not only to the smokers but also to those around the smoker through the influence of secondary smoke 74. Studies have suggested that nicotine which is one of the active components of cigarette decreases insulin sensitivity causes pancreatitis, causes disorder of glucose and lipid metabolism75. It worsens diabetes by the above mechanism. Current smokers were observed to have 45% increased risk of diabetes compared with the non-smokers 61. These effects seemed to have a dose response relationship. Smoking more than 20 sticks of cigarette per day and a smoking duration of ≥ 40 years were associated with increased risk of diabetes76.
Cigarette smoking was associated with increased risk of type 2 diabetes. The risk increased with the number of sticks smoked per day 72, 73, 76, 77. This association was when smokers were compared with people who never smoked. There was a little difference in risk between light smokers and heavy smokers among the current smokers.
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CHAPTER THREE
3.0 MATERIALS AND METHOD