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Asekenye et al. | Journal of Clinical and Translational Research 2023; 9(6): 398-413 399
microvascular and macrovascular complications, which could degradation of adipocytes. Altogether, the nanophytosome is a
lead to poor quality of life or/and death. [4]. In 2016, the World potent carrier for transporting GI phytochemicals to prevent an
Health Organization (WHO) reported that 2.2 million deaths early stage of type 2 diabetes mellitus (T2DM) [20]. In Africa,
registered worldwide were attributed to high blood glucose levels leafy vegetables are not just an important component in the
and the largest number occurred in middle-income countries. The traditional diet, they also make the greatest proportion of it due to
most worrying part is that, more than half of these deaths are their abundance and the fact that the leaves are the first vegetable
premature [5]. Globally, as of 2019, hyperglycemia was prevalent plant part to mature and harvested compared to the flowers,
by an estimate of 7.5% (374 million) and was projected to increase fruits, and seeds [21-24]. For the last 15 years, Solanaceae,
to 8% (444 million) by 2030 and 8.6% (548 million) by 2045 [6]. Amaranthaceae, and Malvaceae have been and are still the most
In Africa, the prevalence of hyperglycemia (measured by impaired predominant families that contain indigenous leafy vegetables in
glucose tolerance) was estimated to rise from 42.9 million (8.3%) Uganda (43.4%, 15.5%, and 11.6%, respectively). Species such
in 2017 to 108.6 million (9.5%) in 2045 [7]. Uganda has been as Amaranthus dubius Mart. Ex Thell., Phaseolus vulgaris L.,
reported to have prevalence of diabetes mellitus at 2%, and it is Cucurbita maxima D., Vigna unguiculata (L.) Walp., and Cleome
higher in urban areas and in the male gender. Considering sub- gynandra L. were grown for majorly food security, income
regions of the country, the western sub-region was reported to generation, and nutrition purposes [22,24,25] till recently. In
have the highest prevalence (3.3%) of hyperglycemia compared Uganda, studies to investigate their chemical composition for
to the eastern (0.8%) and central sub-region (1.6%) [8]. The the acclaimed disease prevention and treatment purposes are
national prevalence is relatively low, therefore, presenting an optimistically on a rise [24,26,27]. However, a direct influence
opportunity for prevention and management of hyperglycemia. of consumption of these vegetables (as part of the traditional
The discovery of insulin and other hypoglycemic drugs have diet) on management and treatment of high blood sugar has
certainly not only reduced mortality from complications scantly been looked at. Therefore, this research contributes to
originating from hyperglycemia but also reduced morbidity. this gap by documenting the regional (Ankole and Teso sub-
However, these drugs have been shown to possess inherent regions) consumption of the most frequently eaten vegetables
limitations and side effects which have on their own claimed and prevalence of hyperglycemia in these sub-regions of Uganda.
lives of the diabetic patients [9-11]. Having long seen that
hyperglycemia is a result of abnormal metabolism [12], which 2. Methods
in itself, is a reflection from defects in insulin secretion or/and
insulin action [3], the causal factors are a heterogeneous group 2.1. Study area
of genetic and environmental factors including diet, endocrine, The study was carried out in Ankole and Teso sub-regions of
and autonomic nervous system dysfunction [2]. The diet factor Uganda (Figure 1). The community survey was done in sampled
implicated in the cause of hyperglycemia presents an opportunity sub-counties of the sampled districts in the sub-regions. There
through consumption of appropriate vegetables, as both secondary were five districts sampled from the north, east, south, west, and
prevention measure (to make up for the down side of the current central parts in each sub-region, and four sub-counties from each
anti-hyperglycemia therapies), and a primary prevention measure district sampled from the northern, eastern, southern, and western
(to reduce the risk of its onset), and altogether prevent and control parts in each districts. During the survey, information on the
hyperglycemia [13-16]. The plant-based food we consume often frequently eaten vegetables, their consumption, and fasting blood
contains many sterol-based bioactive compounds [17]. It is well- glucose (FBG) levels were collected.
documented that these compounds could effectively manage
the processes of insulin metabolism and cholesterol regulation. 2.2. Ankole sub-region of Uganda
Insulin resistance followed by hyperglycemia often results
in oxidative stress level enhancement and increased reactive Ankole sub-region is located in south-western part of Uganda,
oxygen species production. At the molecular level, these changes with geographical coordinates of latitude: 0° 29’ 59.99’’ N and
induce apoptosis in pancreatic cells and, hence, lead to insulin longitude: 30° 29’ 59.99’ E. Most of its ten districts (based on
insufficiency [17]. Globally, vegetables are among the numerous the 2014 national census enumerated areas) lie at about 1806 m
plant adjuncts indispensable for a balanced diet since they charge above sea level and they are: Bushenyi, Buhweju, Mitooma
dietary fiber, phytochemicals, vitamins, and minerals that are https://en.wikipedia.org/wiki/Bushenyi_District, Rubirizi,
all correlated with improved gastrointestinal health and reduced Sheema, Ntungamo, Mbarara, Kiruhura, Ibanda, and Isingiro
risk of ailments such as hyperglycemia [13,18,19]. Gymnema district. However, the selected representative study sub-counties
inodorum (GI) is a leafy green vegetable found in the northern in the representative districts of the region are as follows; Ibanda
region of Thailand. A GI leaf extract has been developed as a district (Nyamarebe, Rukiri, Kizuzi, and Bisheshe sub-counties),
dietary supplement for metabolic diabetic control [20]. However, Kiruhura district (Buremba, Sanga, Kashongi, and Kinoni sub-
the active compounds in the GI leaf extract are relatively non- counties), Mbarara district (Rubindi, Bagumba, Rubayo and
polar [20]. The phospholipid component of phytosomes slightly Bubaare sub-counties), Rubirizi district (Rutoto, Magambo,
interfered with the anti-insulin-resistant effects of the GI extract Kirugu, and Kyabakara sub-counties), and Ntugamo district
by decreasing the glucose uptake activity and increasing the lipid (Ngoma, Rwekiniro, Itojo, and Rukoni sub-counties).
DOI: http://dx.doi.org/10.18053/jctres.09.202306.23-00096