Dietary Patterns and Diabetes Risk in African Pastoralist Communities (www.kiu.ac.ug)

Type 2 diabetes (T2D) is emerging as a significant health concern among African pastoralist communities,
historically known for low rates of non-communicable diseases due to their physically active lifestyles and traditional
diets. However, recent shifts toward sedentary living and the adoption of calorie-dense, processed foods have
disrupted these metabolic advantages, increasing vulnerability to diabetes and related disorders. This review
investigates the evolving relationship between dietary patterns and diabetes risk in pastoralist populations across
sub-Saharan Africa. It explores the nutritional composition of traditional diets, the health impacts of nutrition
transitions, and the broader sociocultural, environmental, and genetic factors influencing these shifts. Evidence from
emerging epidemiological studies highlights rising rates of obesity, glucose intolerance, and insulin resistance in
semi-urbanized and sedentary pastoralists. The review emphasizes the need for culturally tailored public health
strategies, community-based metabolic monitoring, and integration of traditional and modern healthcare systems.
It also identifies key research gaps, including the need for longitudinal studies, nutrigenomics, and microbiome
research to better inform diabetes prevention in these transitioning populations.

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https://doi.org/10.59298/NIJSES/2025/63.16000

Dietary Patterns and Diabetes Risk in African Pastoralist
Communities
Nagm Eldeen Mohamed Abbker Idreis
Paediatrics Kampala International University Teaching Hospital Ishaka

ABSTRACT
Type 2 diabetes (T2D) is emerging as a significant health concern among African pastoralist communities,
historically known for low rates of non-communicable diseases due to their physically active lifestyles and traditional
diets. However, recent shifts toward sedentary living and the adoption of calorie-dense, processed foods have
disrupted these metabolic advantages, increasing vulnerability to diabetes and related disorders. This review
investigates the evolving relationship between dietary patterns and diabetes risk in pastoralist populations across
sub-Saharan Africa. It explores the nutritional composition of traditional diets, the health impacts of nutrition
transitions, and the broader sociocultural, environmental, and genetic factors influencing these shifts. Evidence from
emerging epidemiological studies highlights rising rates of obesity, glucose intolerance, and insulin resistance in
semi-urbanized and sedentary pastoralists. The review emphasizes the need for culturally tailored public health
strategies, community-based metabolic monitoring, and integration of traditional and modern healthcare systems.
It also identifies key research gaps, including the need for longitudinal studies, nutrigenomics, and microbiome
research to better inform diabetes prevention in these transitioning populations.
Keywords: Pastoralist communities, type 2 diabetes, dietary patterns, nutrition transition, African health.

INTRODUCTION
African pastoralist communities have for generations thrived in some of the continent’s most ecologically
challenging regions. Notable among these are the Maasai of Kenya and Tanzania, the Fulani of West Africa, and the
Somali pastoralists of the Horn of Africa [1]. These groups have historically practiced nomadic or semi-nomadic
lifestyles centered around livestock herding. Their livelihoods and diets are intricately tied to their animals,
primarily cattle, goats, and camels [2]. The pastoralist diet is traditionally rich in animal-derived products such as
meat, milk, and blood, and often supplemented with wild or cultivated plant-based foods depending on seasonal
availability [3]. Despite their high intake of saturated fats and proteins from animal sources, these communities
have historically reported remarkably low incidences of non-communicable diseases (NCDs), especially metabolic
disorders such as type 2 diabetes mellitus (T2DM), obesity, and cardiovascular diseases [4-10]. Anthropological
and nutritional studies have often highlighted the paradox that while these populations consume diets that, by
Western standards, might be considered unhealthy, they tend to maintain lean body mass, active lifestyles, and low
blood pressure, contributing to a low risk of metabolic diseases. These outcomes have been attributed to several
factors, including high physical activity, genetic adaptations, seasonal food availability, and overall dietary balance
[11-14]. In recent decades, pastoralist communities across Africa have experienced profound changes in their
dietary patterns and lifestyles, marking a departure from traditional ways of life. This shift, commonly referred to
as the “nutrition transition,” involves a gradual movement away from high-fiber, nutrient-dense traditional diets
and physically active, nomadic livelihoods toward more sedentary behaviors and the increased consumption of
calorie-dense, processed foods [15-18]. One of the primary drivers of this transition is sedentarization, where
pastoralists are compelled to abandon their migratory practices due to restrictive land policies, conflicts, or
NEWPORT INTERNATIONAL JOURNAL OF SCIENTIFIC AND EXPERIMENTAL SCIENCES
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environmental degradation. This change reduces physical activity and limits access to traditional food sources like
fresh milk and meat. Climate change further compounds this problem by diminishing pastureland and water
availability, thereby weakening livestock-based food security [19-23]. Additionally, growing urbanization and
market integration expose pastoralists to readily available processed foods, sugary beverages, and refined grains.
Social influences such as education, media exposure, and cultural assimilation also shift food preferences toward
Western-style diets [24-30]. Together, these dynamics are contributing to rising rates of non-communicable
diseases, particularly type 2 diabetes, among populations previously considered metabolically resilient. This
emerging health burden poses significant challenges for under-resourced healthcare systems in pastoral regions,
necessitating urgent public health interventions, culturally sensitive education programs, and policies aimed at
preserving traditional, healthful dietary practices [31-33].
Despite the evidence of dietary and lifestyle transformations among African pastoralists, there remains a significant
gap in understanding the impact of these changes on the prevalence and risk factors of type 2 diabetes. Most national
health surveys either exclude pastoralist communities or do not adequately capture the nuances of their nutritional
and lifestyle transitions [34-35]. Moreover, there is limited culturally sensitive research that integrates local
knowledge systems and sociocultural practices into diabetes prevention and control strategies.
Without targeted research and data, public health interventions may overlook the unique needs of these populations,
resulting in delayed diagnosis, inadequate health services, and increasing disease burden. If left unaddressed, the
current trajectory could lead to a silent diabetes epidemic among communities that have, until recently, maintained
relatively favorable health profiles despite challenging environments [34-36]. This study seeks to comprehensively
examine the complex relationship between nutritional transitions and the rising risk of type 2 diabetes among
African pastoralist communities, whose traditional lifestyles are undergoing rapid change. The specific objectives
are multifaceted, beginning with documenting both historical and contemporary dietary patterns among selected
pastoralist groups to establish a baseline understanding of nutritional shifts over time. Alongside this, the study
aims to assess changes in lifestyle factors, particularly physical activity levels, as communities experience
sedentarization and increased exposure to urban influences. Determining the current prevalence of type 2 diabetes
and its associated risk factors within these populations forms a critical objective, providing empirical evidence of the
health impacts resulting from these transitions. Additionally, the research will explore the perceptions, knowledge,
and attitudes of pastoralists toward both modern and traditional diets and their perceived health outcomes,
highlighting cultural dimensions that influence behavior and health decisions. Finally, the study intends to develop
culturally appropriate recommendations for diabetes prevention and health promotion, ensuring interventions are
context-sensitive and respectful of pastoralist traditions. The research questions guiding this inquiry focus on
understanding how dietary patterns and lifestyles have shifted over recent decades, identifying the primary drivers
of these changes, and establishing current diabetes prevalence rates. Moreover, it investigates how community
members perceive these transformations and seeks to uncover culturally relevant strategies to mitigate diabetes risk
effectively. This study holds profound significance for public health practitioners, policymakers, anthropologists,
and community leaders. It fills a critical knowledge gap by providing data on diabetes risk among historically low-
risk pastoralist populations, thereby promoting health equity and inclusion. The findings will elucidate the intricate
interplay between tradition, modernization, and health, essential for crafting interventions that respect cultural
practices while addressing emerging threats. By supporting the development of community-based prevention
strategies such as culturally informed nutrition education, mobile health services, and collaboration with local
leaders the study contributes to global efforts toward Sustainable Development Goal 3, aiming to ensure healthy
lives for all. Ultimately, its interdisciplinary approach sets a valuable precedent for future research on health
transitions in indigenous and rural African communities, emphasizing that effective disease prevention must
harmonize with cultural identity, economic livelihoods, and environmental realities [36-37].
Traditional Diets and Metabolic Health
Traditional pastoralist diets, rooted in centuries of subsistence living and cultural practices, are characterized by the
consumption of natural, unprocessed foods that offer unique benefits to metabolic health [12]. These diets are
primarily composed of milk and dairy products, which provide a rich source of healthy fats, proteins, and essential
micronutrients such as calcium, phosphorus, and vitamin B12. In many pastoralist communities, meat and animal
blood are also consumed, often during ceremonial events or specific seasons, offering dense sources of iron and
protein. Additionally, during periods of food scarcity or seasonal shifts, pastoralists rely on wild fruits, roots, and
medicinal herbs, which not only diversify nutrient intake but also contribute bioactive compounds with potential
anti-inflammatory and antioxidant properties. A key feature of these diets is the minimal intake of refined sugars
and processed carbohydrates, resulting in a low glycemic load and a diminished risk of insulin resistance and type 2

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diabetes. The high levels of physical activity associated with herding and daily survival, combined with intermittent
periods of food scarcity, may have driven metabolic adaptations that enhance insulin sensitivity and support lean
body composition. As such, traditional pastoralist diets offer valuable insights into nutritional patterns that support
metabolic resilience and long-term health [13].
Dietary Transitions and Risk Factors
As pastoralist communities increasingly undergo sedentarization and become more integrated into market
economies, significant changes in dietary habits are emerging, marking a critical phase of the global "nutrition
transition [14]." Traditionally, these communities relied on nutrient-dense, animal-based diets rich in milk, meat,
and blood, combined with physically active lifestyles centered around livestock herding and seasonal mobility.
However, modernization, urban proximity, and market access have introduced a growing dependence on
Westernized diets characterized by refined carbohydrates such as white rice, maize meal, and bread, along with
highly processed foods and sugar-sweetened beverages. This shift has led to a marked reduction in the consumption
of traditional foods that once provided high-quality proteins and healthy fats. As a result, many pastoralist
populations are now experiencing increased rates of obesity, dyslipidemia, and glucose intolerance, key risk factors
for the development of type 2 diabetes and other non-communicable diseases. Compounding the dietary changes is
a decline in physical activity, as sedentarization reduces the energy demands of daily life. These combined factors
have dramatically altered the metabolic profile of these communities, placing them at heightened risk for chronic
diseases previously uncommon in their populations. Addressing these transitions requires culturally tailored public
health strategies that promote balanced diets and physical activity while respecting traditional practices [15].
Cultural and Genetic Considerations
Cultural and genetic considerations play a pivotal role in understanding the dietary habits and diabetes risk among
pastoralist populations. Genetically, many pastoralist communities such as those in East Africa have evolved unique
adaptations like lactase persistence, allowing them to digest lactose in adulthood. This adaptation historically
supported the consumption of large quantities of milk, a dietary cornerstone in pastoralist societies, and was well-
suited to their physically active, low-carbohydrate lifestyle. However, in the context of modern nutritional
transitions characterized by increased consumption of refined carbohydrates and sugars, these genetic traits may no
longer offer the same protective benefits. In fact, the shift toward sedentary living and processed foods may
exacerbate metabolic risks despite traditional dietary adaptations [16]. Culturally, milk and dairy products are
deeply ingrained not only as nutritional staples but also as symbols of wealth, identity, and well-being. This cultural
attachment promotes continued high dairy intake, which may confer some cardiovascular benefits due to its bioactive
compounds, but could also contribute to lipid imbalances if unaccompanied by dietary diversity or moderation.
Additionally, cultural perceptions of body weight, health, and illness, such as valuing larger body sizes or mistrusting
formal healthcare, can further shape health-seeking behaviors, dietary choices, and ultimately, susceptibility to
conditions like diabetes [17].
Evidence from Epidemiological Studies
Evidence from epidemiological studies increasingly points to a concerning rise in diabetes prevalence among
pastoralist populations who were traditionally considered low-risk due to their physically active lifestyles and
traditional diets. Emerging data from East African communities, such as the Maasai in Kenya and Tanzania and the
Afar in Ethiopia, highlight significant metabolic changes as these groups undergo nutritional and lifestyle
transitions [18]. For instance, individuals who have adopted more modern, market-based diets often rich in refined
carbohydrates, sugars, and processed foods tend to exhibit higher fasting blood glucose levels and greater insulin
resistance compared to their counterparts who maintain traditional dietary practices. Additionally, semi-urban or
sedentary pastoralists are experiencing increased rates of central obesity, a key risk factor for type 2 diabetes,
compared to fully nomadic individuals. These findings suggest a shift in disease burden linked to dietary
westernization, reduced physical activity, and increasing market integration. Importantly, while these cross-
sectional studies provide valuable snapshots, they fall short of establishing definitive causality. There remains a
pressing need for more robust, longitudinal, and community-specific epidemiological studies to track metabolic
changes over time, identify modifiable risk factors, and develop culturally appropriate interventions. Such evidence
is critical to designing public health strategies that can mitigate the rising tide of diabetes in these transitioning
populations.
Public Health Implications and Future Research Directions in Addressing Diabetes Risk among
Pastoralist Communities
Addressing the rising diabetes risk among pastoralist communities requires a multifaceted public health strategy
grounded in cultural sensitivity and scientific evidence. Central to this effort is the implementation of culturally

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appropriate nutritional education that emphasizes the value of traditional, unprocessed foods over increasingly
adopted high-calorie, low-nutrient diets [19]. Reinforcing positive dietary practices rooted in pastoral heritage can
help prevent metabolic disorders. Equally important is the integration of modern healthcare systems with traditional
health beliefs and practices to foster trust, improve uptake of preventive services, and ensure continuity of care.
Community-based initiatives should be empowered to monitor key metabolic health indicators such as blood glucose
levels, body mass index, and blood pressure, enabling early detection and intervention. Additionally, promoting
physical activity through support for sustainable pastoral livelihoods not only enhances metabolic health but also
reinforces cultural identity and resilience. Broader structural issues such as climate change, food insecurity, and
limited healthcare access must also be addressed through policies that improve infrastructure, support food systems,
and bolster health service delivery in remote regions.
In terms of research, several critical gaps remain. Longitudinal cohort studies are essential to understand the long-
term impact of dietary and lifestyle transitions on metabolic outcomes. Nutrigenomic research could reveal how
gene-diet interactions influence diabetes susceptibility in pastoralist populations. Interventional studies on
reintroducing traditional dietary patterns may offer practical strategies for prevention and reversal of early-stage
metabolic disorders [20]. Moreover, exploring gut microbiome diversity could uncover novel pathways linking
pastoralist diets to metabolic health, informing future public health interventions.
CONCLUSION
The rising risk of type 2 diabetes among African pastoralist communities marks a significant shift in the region's
public health landscape. Once protected by traditional diets and physically active lifestyles, these populations are
now increasingly exposed to processed foods, sedentarization, and environmental pressures, which collectively erode
their metabolic resilience. This review underscores the urgent need for culturally tailored interventions that
reinforce the health benefits of traditional diets while addressing the adverse effects of modernization. Strategies
must include nutrition education, integration of indigenous and modern healthcare systems, and promotion of active
pastoral livelihoods. Importantly, structural issues like climate variability, food insecurity, and limited healthcare
access must be tackled through systemic policy reforms. The review also highlights critical research gaps, including
the need for longitudinal studies, nutrigenomic research, and microbiome analysis, that must be addressed to guide
evidence-based interventions. By aligning public health responses with cultural values and scientific insights, we
can mitigate diabetes risk and support sustainable health outcomes for Africa’s pastoralist populations.
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CITE AS: Nagm Eldeen Mohamed Abbker Idreis (2025). Dietary Patterns and Diabetes Risk in
African Pastoralist Communities. NEWPORT INTERNATIONAL JOURNAL OF SCIENTIFIC
AND EXPERIMENTAL SCIENCES 6(3):1 -6 https://doi.org/10.59298/NIJSES/2025/63.16000