In a small mining town in Limpopo, young people are showing worrying signs of diseases that were once thought to affect only older adults, including type 2 diabetes, high blood pressure, high cholesterol, obesity and insulin resistance.
But this is not unique to Limpopo or South Africa, writes Themba Titus Sigudu in The Conversation. It reflects a global trend, where young adults in many low- and middle-income countries are increasingly experiencing early-onset metabolic diseases due to rapid urbanisation, lifestyle changes, unhealthy diets and reduced physical activity.
He writes:
The World Health Organisation says non-communicable diseases now account for 75% of all non-pandemic-related deaths globally. Also, 82% of premature deaths before age 70 occur in low- and middle-income countries.
I’m a public health researcher specialising in epidemiology, metabolic health, infectious diseases and environmental health, and in a study conducted by me and my colleagues in the town of Lephalale, we found that many young adults there have abnormal cholesterol levels.
They also have reduced sensitivity to insulin, a condition known as insulin resistance.
Both are key risk factors for type 2 diabetes and heart disease.
Our findings suggest that these health problems are appearing much earlier in life than expected. This is particularly concerning in communities undergoing rapid social and economic change, where access to health services and screening programmes remains limited.
New jobs, new lifestyles
Lephalale, formerly known as Ellisras, offers a window into these transitions. Once a quiet rural area, it has changed rapidly over the past two decades. It is now the site of expanding mining and industrial activities, driven by the growth of coal-mining operations and the development of power stations.
This industrial growth has attracted thousands of workers from surrounding provinces and neighbouring countries, bringing new economic opportunities. It is also reshaping daily life.
Increasingly, residents are doing sedentary work and eating energy-dense diets, including fast food. These lifestyle transitions make Lephalale an important setting for studying emerging health risks in young adults.
Long hours sitting at work and reduced physical activity create fertile ground for metabolic disorders. When people eat more processed, high-fat, high-sugar foods and move less, the body begins storing excess energy as fat.
Over time, this can lead to weight gain, elevated blood glucose and abnormal cholesterol levels. These changes make it harder for the body to regulate insulin, causing insulin resistance, the first step towards type 2 diabetes.
Also, inactivity and poor diet increase unhealthy cholesterol and triglycerides (types of fat in the blood), raising the risk of heart disease. In rapidly transitioning communities, these health shifts can happen quickly.
Non-communicable diseases such as diabetes, hypertension and heart disease are now among the leading causes of death in South Africa. In 2020, diabetes was reported to be the second biggest underlying cause of death in South Africa, accounting for 6.6% of all deaths.
Our research
We examined 781 young adults aged 18 to 29 living in Lephalale as part of a long-running study. We have been tracking health patterns in this community since 1992.
Participants provided fasting blood samples that were analysed for glucose, insulin and cholesterol levels. We grouped them into diabetic and non-diabetic categories based on clinical definitions used by the American Diabetes Association.
The results were striking:
Diabetic participants had significantly higher total cholesterol, low-density lipoprotein (the “bad” cholesterol) and triglycerides, and lower levels of high-density lipoprotein (the “good” cholesterol) than their non-diabetic peers.
More than half (52.7%) of the diabetic group had high total cholesterol, compared with 23% of non-diabetic participants.
Insulin resistance, when the body needs more insulin to manage blood sugar, was also much higher among diabetics.
Even some non-diabetic participants showed early signs of these metabolic changes.
Unhealthy cholesterol patterns and poor insulin sensitivity tend to occur together, each making the other worse. This combination sets the stage for early heart disease, stroke and diabetes.
Why young adults?
Most public-health strategies focus on older adults because that’s when chronic diseases usually become visible.
But our research adds to growing evidence that the seeds of non-communicable diseases are planted early, often in young adulthood or even adolescence.
Young adults in rural or semi-urban areas may seem healthy, yet many are already developing risks due to diet changes, stress and limited exercise opportunities. The modernisation of small towns, while positive economically, brings hidden health costs.
Without early detection, these individuals may enter middle age already carrying high risk of health problems. This will put pressure on health systems that are already stretched.
What makes this community unique?
Lephalale may be changing, but it still lacks many of the urban services, infrastructure and health resources found in South Africa’s big cities.
Health resources are scarce, and screening for cholesterol or insulin resistance is rare. Public clinics focus on infectious diseases like HIV or TB. Silent metabolic disorders go unnoticed until symptoms appear.
Our study shows that rapid industrialisation without parallel investment in public-health education and preventive services risks creating a generation of young adults who are chronically unwell by their 30s.
What can be done? Three priorities stand out:
Early screening and prevention
Regular cholesterol and glucose testing should be part of routine primary-care visits, especially for adults under 30. Mobile health campaigns, school outreach and workplace screenings could help identify those at risk.
Community-based education
Local awareness campaigns must make the link between diet, physical activity and metabolic health easy to understand. They should show, for example, how frequent consumption of fried or sugary foods contributes to cholesterol build-up and insulin resistance.
Healthy-environment policies
Urban planners and municipalities can support healthy lifestyles by ensuring there are safe spaces for exercise. They must also limit marketing of unhealthy foods, and encourage availability of affordable, nutritious options.
Similar “health-in-all-policies” approaches have shown success in other countries. such as Finland’s long-running HiAP strategy, which reduced cardiovascular disease rates and improved population health outcomes.
Young people should be in peak health. Without intervention, today’s young adults risk becoming tomorrow’s chronic-disease patients, burdening families, workplaces and health systems.
Themba Titus Sigudu – Lecturer, University of the Witwatersrand
Study details
Associations between high cholesterol and insulin sensitivity in diabetic versus non-diabetic among young adults in Lephalale, Limpopo Province
Themba Titus Sigudu, Thandiwe Ntomfuthi Mkhatshwa, Kotsedi Daniel Monyeki, Moloko Matshipi.
Published in Frontiers in Endocrinology on 25 September 2025
Background
The rising global burden of diabetes mellitus and associated metabolic disorders disproportionately affects low and middle-income countries, with dyslipidemia being a key contributor to cardiovascular risk in insulin-resistant individuals. Limited data exist on population-specific associations between cholesterol levels and insulin sensitivity among young adults in transitioning African communities.
Methods
This cross-sectional study analysed 781 young adults (18–29 years) from the Ellisras Longitudinal Study in Lephalale, South Africa. Participants were stratified by diabetic status using ADA criteria. Fasting blood samples assessed glucose, insulin (HOMA-IR), and lipid profiles. Multivariable linear regression evaluated cholesterol-HOMA-IR associations, adjusted for confounders.
Results
Diabetics (n=169) showed significantly higher total cholesterol (5.1 vs. 4.3 mmol/L), LDL-C (3.2 vs. 2.6 mmol/L), triglycerides (1.8 vs. 1.1 mmol/L), and lower HDL-C (1.0 vs. 1.2 mmol/L) than non-diabetics (all p<0.001). Dyslipidemia prevalence was 2–3 times higher in diabetics (e.g., 52.7% vs. 23.2% for high total cholesterol). HOMA-IR correlated positively with total cholesterol (β=0.42, p<0.001), LDL-C (β=0.38, p<0.001), and triglycerides (β=0.47, p<0.001), and inversely with HDL-C (β=−0.51, p<0.001).
Conclusion
Young diabetic adults in Lephalale exhibit pronounced dyslipidemia and insulin resistance, with strong lipid-HOMA-IR associations. Findings highlight the need for early metabolic screening and targeted interventions in transitioning African communities to mitigate future cardio metabolic risk.
See more from MedicalBrief archives:
SA facing diabetes ‘pandemic’ as cases soar among young people
At least 60% of Africa’s diabetes goes undiagnosed – global report
Obese, overweight South Africans costing the country billions of rands
Childhood obesity tied to early, serious health issues – SA study