Dietary intake and habits of South Asian immigrants living in Western countries

Associations between diet quality and migraine headaches: a cross-sectional study

AIMS

We evaluated associations between diet quality and migraine outcomes.

METHODS

The current work represented a cross-sectional study on 262 patients with migraine (20-50 y). Diet quality was assessed using the standard healthy eating index 2015 (HEI-2015) and alternative healthy eating index 2010 (AHEI-2010). A validated 168-item food frequency questionnaire was used to assess dietary intake. Migraine outcomes included clinical factors (severity, duration, frequency, and disability related to migraine) and serum nitric oxide (NO). Associations between diet quality indices and migraine outcomes were evaluated using linear regressions, and β and 95% corresponding confidence interval (CI) were reported.

RESULTS

HEI-2015 was inversely associated with migraine frequency (β = -4.75, 95% CI: -6.73, -2.76) in patients with the highest HEI scores (third tertile) vs. those with the lowest scores (first tertile) after adjusting for relevant confounders. AHEI-2010 was inversely associated with migraine frequency (β = -3.67, 95% CI: -5.65, -1.69) and migraine-related disability (β = -2.74, 95% CI: -4.79, -0.68) in adjusted models. Also, AHEI-2010 was inversely associated with migraine severity in patients in the second vs. first tertile (β = -0.56; 95% CI: -1.08, -0.05). We detected no associations between diet quality and NO levels (All P > 0.14).

CONCLUSIONS

Improved diet quality may be associated with favorable migraine outcomes (lower headache frequency, severity, and migraine-related disability). Future studies are required to confirm and delineate the causal mechanisms of our observations.

Social inequalities in pregnancy metabolic profile: findings from the multi-ethnic Born in Bradford cohort study

BACKGROUND

Lower socioeconomic position (SEP) associates with adverse pregnancy and perinatal outcomes and with less favourable metabolic profile in nonpregnant adults. Socioeconomic differences in pregnancy metabolic profile are unknown. We investigated association between a composite measure of SEP and pregnancy metabolic profile in White European (WE) and South Asian (SA) women.

METHODS

We included 3,905 WE and 4,404 SA pregnant women from a population-based UK cohort. Latent class analysis was applied to nineteen individual, household, and area-based SEP indicators (collected by questionnaires or linkage to residential address) to derive a composite SEP latent variable. Targeted nuclear magnetic resonance spectroscopy was used to determine 148 metabolic traits from mid-pregnancy serum samples. Associations between SEP and metabolic traits were examined using linear regressions adjusted for gestational age and weighted by latent class probabilities.

RESULTS

Five SEP sub-groups were identified and labelled 'Highest SEP' (48% WE and 52% SA), 'High-Medium SEP' (77% and 23%), 'Medium SEP' (56% and 44%) 'Low-Medium SEP' (21% and 79%), and 'Lowest SEP' (52% and 48%). Lower SEP was associated with more adverse levels of 113 metabolic traits, including lower high-density lipoprotein (HDL) and higher triglycerides and very low-density lipoprotein (VLDL) traits. For example, mean standardized difference (95%CI) in concentration of small VLDL particles (vs. Highest SEP) was 0.12 standard deviation (SD) units (0.05 to 0.20) for 'Medium SEP' and 0.25SD (0.18 to 0.32) for 'Lowest SEP'. There was statistical evidence of ethnic differences in associations of SEP with 31 traits, primarily characterised by stronger associations in WE women e.g., mean difference in HDL cholesterol in WE and SA women respectively (vs. Highest-SEP) was -0.30SD (-0.41 to -0.20) and -0.16SD (-0.27 to -0.05) for 'Medium SEP', and -0.62SD (-0.72 to -0.52) and -0.29SD (-0.40 to -0.20) for 'Lowest SEP'.

CONCLUSIONS

We found widespread socioeconomic differences in metabolic traits in pregnant WE and SA women residing in the UK. Further research is needed to understand whether the socioeconomic differences we observe here reflect pre-conception differences or differences in the metabolic pregnancy response. If replicated, it would be important to explore if these differences contribute to socioeconomic differences in pregnancy outcomes.

'We know what he likes, even if he doesn't know': how the children of South Asian immigrants characterize and influence the diets of their parents

Foreign-born (first-generation) South Asians face a growing diet-related chronic disease burden. Little is known about whether the adult US-born (second-generation) children of South Asian immigrants can provide unique insights as changemakers in their parents' dietary behaviors. This study aims to assess how second-generation South Asians describe and influence the dietary behaviors of their parents. Between October and November 2020, 32 second-generation South Asians [mean age 22.4 (SD 2.9), 53% female] participated in online interviews centered around factors involved in their (and their parents) eating behaviors. Thematic analysis revealed three types of parental dietary drivers (socioecological factors that impact the dietary choices of parents): goal-oriented (i.e., parents' dietary intentionality), capacity-related (e.g., environmental barriers) and sociocultural (cultural familiarity, religion and traditions). Participants described three major mechanisms of influence: recommending new foods, cooking for parents, and bringing new foods home. These influences primarily occurred in the household and often involved participants leveraging their own nutritional knowledge and preferences to expand dietary diversity and healthier behaviors among their parents. Evidence suggests that second-generation South Asians may act as powerful agents of dietary change within their households and can provide novel insights to help address and overcome sociocultural, linguistic, and other structural barriers to better understanding and intervening in the health of the South Asian community.

Call for Cultural and Language-Concordant Diabetes Care, Nutrition Education, and Self-Management for South Asian Individuals Living in the US

Ethnic South Asian Americans have the highest relative risk of type 2 diabetes mellitus in the US. Culturally tailored and language-concordant diabetes care and nutrition interventions can potentially promote South Asian diabetes management and disease progression. From our perspective, the extent of their use and evaluation in the US settings remains limited. This Perspective characterizes and evaluates the necessity and outcomes of culturally and linguistically adapted lifestyle interventions targeted toward type 2 diabetes mellitus indicators among South Asian individuals in the US. Suggestions for how this education could be modified include emphasizing the cultural and linguistic knowledge and self-awareness of diabetes educators and the sociological and historical factors that influence the cultural and linguistic orientation of diabetes care professionals and their clients. Such strategies could ensure better diabetes education and self-management among South Asian individuals.

Looking Across and Within: Immigration as a Unifying Structural Factor Impacting Cardiometabolic Health and Diet

Introduction

Immigration has been identified as an important social determinant of health (SDH), embodying structures and policies that reinforce positions of poverty, stress, and limited social and economic mobility. In the public health literature with regard to diet, immigration is often characterized as an individual-level process (dietary acculturation) and is largely examined in one racial/ethnic subgroup at a time. For this narrative review, we aim to broaden the research discussion by describing SDH common to the immigrant experience and that may serve as barriers to healthy diets.

Methods

A narrative review of peer-reviewed quantitative, qualitative, and mixed methods studies on cardiometabolic health disparities, diet, and immigration was conducted.

Results

Cardiometabolic disease disparities were frequently described by racial/ethnic subgroups instead of country of origin. While cardiovascular disease and obesity risk differed by country of origin, diabetes prevalence was typically higher for immigrant groups vs United States (US)-born individuals. Common barriers to achieving a healthy diet were food insecurity; lack of familiarity with US food procurement practices, food preparation methods, and dietary guidelines; lack of familiarity and distrust of US food processing and storage methods; alternative priorities for food purchasing (eg, freshness, cultural relevance); logistical obstacles (eg, transportation); stress; and ethnic identity maintenance.

Conclusions

To improve the health of immigrant populations, understanding similarities in cardiometabolic health disparities, diet, and barriers to health across immigrant communities-traversing racial/ethnic subgroups-may serve as a useful framework. This framework can guide research, policy, and public health practices to be more cohesive, generalizable, and meaningfully inclusive.

Identification and Management of Atherosclerotic Cardiovascular Disease Risk in South Asian Populations in the U.S

South Asians (SAs, individuals with ancestry from Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka) are among the fastest growing ethnic subgroups in the United States. SAs typically experience a high prevalence of diabetes, abdominal obesity, and hypertension, among other cardiovascular disease risk factors, which are often under recognized and undermanaged. The excess coronary heart disease risk in this growing population must be critically assessed and managed with culturally appropriate preventive services. Accordingly, this scientific document prepared by a multidisciplinary group of clinicians and investigators in cardiology, internal medicine, pharmacy, and SA-centric researchers describes key characteristics of traditional and nontraditional cardiovascular disease risk factors, compares and contrasts available risk assessment tools, discusses the role of blood-based biomarkers and coronary artery calcium to enhance risk assessment and prevention strategies, and provides evidenced-based approaches and interventions that may reduce coronary heart disease disparities in this higher-risk population.

Dietary Characteristics and Influencing Factors on Chinese Immigrants in Canada and the United States: A Scoping Review

Background: Chinese immigrants are an integral part of Canadian and American society. Chinese immigrants believe diet to be an important aspect of health, and dietary behaviours in this population have been associated with changes in disease risk factors and disease incidence. This review aims to summarize the characteristics of the dietary behaviours of Chinese immigrants and the associated influencing factors to better inform individual, clinical, and policy decisions. Methods: This scoping review was written in accordance with PRISMA guidelines. MEDLINE, PsychINFO, CINAHL, AgeLine, ERIC, ProQuest, Nursing and Allied Health Database, PsychARTICLES, and Sociology Database were utilized for the literature search. Articles were included if they explored dietary or nutritional intake or its influencing factors for Chinese immigrants to Canada or the United States. Results: A total of 51 papers were included in this review. Among Chinese immigrants in Canada and the United States, the intake of fruits and vegetables, milk and alternatives, and fiber were inadequate against national recommendations. Chinese immigrants showed increased total consumption of food across all food groups and adoption of Western food items. Total caloric intake, meat and alternatives intake, and carbohydrate intake increased with acculturation. Individual factors (demographics, individual preferences, and nutritional awareness), familial factors (familial preferences and values, having young children in the family, and household food environment), and community factors (accessibility and cultural conceptualizations of health and eating) influenced dietary behaviours of Chinese immigrants. Discussion and Conclusion: Efforts should be undertaken to increase fruit, vegetable, and fibre consumption in this population. As dietary acculturation is inevitable, efforts must also be undertaken to ensure that healthy Western foods are adopted. It is important for healthcare providers to remain culturally sensitive when providing dietary recommendations. This can be achieved through encouragement of healthy ethnocultural foods and acknowledgement and incorporation of traditional health beliefs and values into Western evidence-based principles where possible.

Healthy Eating Index Scores, Body Mass Index and Abdominal Obesity Among Asian Americans: NHANES 2011-2018

Objective

Obesity rates are increasing among Asian Americans so, the objective of this study was to examine associations between Healthy Eating Index scores (a measure of adherence to the Dietary Guidelines for Americans (DGAs)) and body mass index (BMI) and waist circumference (measure of abdominal obesity) among Asian American adults.

Methods

Included in these analyses were Asian Americans ≥20 years from the National Health and Nutrition Examination Survey (2011-18) who had: (1) two 24 h diet recalls to calculate HEI and HEI subcomponent scores, (2) height and weight data to calculate BMI overweight ≥25 kg/m2 and obese ≥ 30kg/m (2), and (3) waist circumference data (high risk ≥ 80 cm for women and ≥ 90 cm for men; n = 1024 women and n = 904 men). Multinomial logistic regression models were run with BMI as the outcome and logistic regression models were run with waist circumference as the outcome, controlling for age, income, marital status, education, and physical activity.

Results

Among women, a diet with greater adherence to the DGAs for total fruit, fatty acids and total protein was associated with lower likelihood of developing obesity, but a diet with greater adherence to the DGAs in terms of whole grains and sodium (i.e., lower sodium intake) was associated with a higher likelihood of obesity. Among men, greater adherence to the DGAs for fatty acids was associated with a lower likelihood of obesity but greater adherence to the DGAs in terms of whole grains and sodium (i.e., lower sodium intake) was associated with a greater likelihood of obesity.

Conclusions

Future research is needed to examine associations between consumption of specific foods and beverages and how they are associated with BMI and waist circumference among Asian American adults. Furthermore, there is a need culturally relevant obesity prevention interventions for Asian American adults, especially interventions that take into consideration cultural food norms of specific Asian American subgroups.

The interaction between glycemic index, glycemic load, and the genetic variant ADIPOQ T45G (rs2241766) in the risk of colorectal cancer: a case-control study in a Korean population

PURPOSE

The glycemic index (GI), glycemic load (GL), and adiponectin level contribute to glycemic response and insulin sensitivity in the body. Studies have shown that tumor development is related to glycemic disorders; however, the results are contradictory. We aimed to investigate the association of GI and GL with colorectal cancer (CRC) risk in a Korean population and their possible interactions with the genetic variant ADIPOQ T45G.

METHODS AND RESULTS

A case-control study including 2096 participants with 695 CRC cases was conducted. The results showed that diets with high GI or GL were significantly associated with an increased risk of CRC [odds ratio (OR) = 5.44, 95% confidence interval (CI) 3.85-7.68; OR = 4.43, 95% CI 3.18-6.15, respectively; all p-trends < 0.001]. Moreover, even with a low-GI and low-GL diet, G/G genotype carriers may have 2.93-fold and 3.77-fold higher risk of rectal cancer compared to carriers of other genotypes (T/T + T/G), (OR = 2.93, 95% CI 1.01-8.59, p-interaction = 0.011 for GI; OR = 3.77, 95% CI 1.46-9.77, p-interaction = 0.025 for GL).

CONCLUSIONS

Overall, our study suggests positive associations of GI and GL with CRC risk. Moreover, the associations of GI and GL with rectal cancer risk could be modified by ADIPOQ T45G in a Korean population. Further studies with larger sample sizes are needed to confirm our findings.

Mustard oil and cardiovascular health: Why the controversy?

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in the United States (US) and worldwide. Among South Asians living in the US, ASCVD risk is four-fold higher than the local population. Cardioprotective dietary patterns necessitate replacement of dietary saturated fats with healthier oils such as canola, corn, olive, soybean, safflower, and sunflower oil. Mustard oil is a liquid oil that is low in saturated fat and is popular in South Asia.It contains a large proportion of erucic acid, a fatty acid associated with myocardial lipidosis in rodents. This evidence prompted the US Food and Drug Administration (FDA) to ban the use of mustard oil for cooking. However, Australia, New Zealand and the European Union (27 countries) have established upper limits for tolerable intake of mustard oil. In contrast mustard oil is one of the most popular cooking oils in Asia, particularly in India where it is recommended as a heart-healthy oil by the Lipid Association of India (LAI). The conflict between various guidelines warrants clarification, particularly because use of mustard oil in cooking is increasing among both Americans and Indian immigrants in the US, despite the FDA ban on human consumption of mustard oil. Hence, we endeavored to: (1) Review current evidence regarding potentially harmful versus beneficial effects of cooking with mustard oil, (2) Clarify the basis for disparities between the FDA ban on human consumption of mustard oil and dietary recommendations from the LAI and other groups, and (3) Provide practical suggestions for Indians and other South Asians who are accustomed to consuming mustard oil on ways to incorporate alternate heart-healthy oils (E.g. Canola, Olive, Sunflower, Soybean oil) in the diet while enhancing flavor and texture of food. A new FDA review is recommended on the safety limits of erucic acid because 29 countries have allow limited amounts of mustard oil (erucic acid) for human consumption and also because there are some health benefits that have been reported for mustard oil in humans.

Associations between rice consumption, arsenic metabolism, and insulin resistance in adults without diabetes

Rice consumption is an important source of arsenic exposure. Little has known about the impact of rice consumption on arsenic metabolism, which is related to insulin resistance. In this study, we examined the associations between rice consumption and arsenic metabolism, and between arsenic metabolism and insulin resistance in non-diabetic U.S adults who participated in the National Health and Nutrition Examination Survey (NHANES) 2003-2016. Rice consumer was defined as ≥0.25 cups of cooked rice/day. HOMA2-IR was calculated using HOMA2 Calculator software based on participant's fasting glucose and insulin values. Urinary arsenic concentrations below limits of detection were imputed first, and then arsenic metabolism (the proportions of inorganic arsenic (iAs), monomethylarsonate (MMA), and dimethylarsinate (DMA) to their sum) were calculated (expressed as iAs%, MMA%, and DMA%). Using the leave-one-out approach, rice consumers compared with non-consumers had a 1.71% (95% CI: 1.12%, 2.29%) higher DMA% and lower MMA% when iAs% fixed; a 1.55% (95% CI: 0.45%, 2.66%) higher DMA% and lower iAs% when MMA% fixed; and a 1.62% (95% CI: 0.95%, 2.28%) higher iAs% and lower MMA% when DMA% fixed, in multivariable adjustment models. With every 10% decrease in MMA%, the geometric mean ratio of HOMA2-IR was 1.06 (95% CI: 1.03,1.08) and 1.05 (95% CI: 1.02, 1.09) when DMA% and iAs% was fixed, respectively; however, the associations were attenuated after adjusting for body mass index. In stratified analysis, we found that lower MMA% was associated with higher HOMA2-IR in participants with obesity: a 10% increase in iAs% with a 10% decrease in MMA% was associated with higher HOMA2-IR with the geometric mean ratio of 1.05 (95% CI: 1.01, 1.09). Our findings suggest that rice consumption may contribute to lower MMA% that was further associated with higher insulin resistance, especially in individuals with obesity. Future prospective studies are needed to confirm our results in different populations.

Regional Variations of Insulin Secretion and Insulin Sensitivity in Japanese Participants With Normal Glucose Tolerance

Purpose: Regional differences in dietary patterns in Asian countries might affect the balance of insulin response and sensitivity. However, this notion is yet to be validated. To clarify the regional differences in the insulin response and sensitivity and their relationship to nutrients, we compared the insulin secretory response during an oral glucose tolerance test in Japanese participants. Methods: This observational retrospective cohort study analyzed the data from participants with normal glucose tolerance (NGT) from four distinct areas of Japan with regard to the food environment: Fukushima, Nagano, Tokushima, and Okinawa based on data available in the Japanese National Health Insurance database. Results: Although the glucose levels were comparable among the four regions, the insulin responses were significantly different among the regions. This difference was observed even within the same BMI category. The plot between the insulin sensitivity index (Matsuda index) and insulin_AUC/glucose_AUC or the insulinogenic index showed hyperbolic relationships with variations in regions. The indices of insulin secretion correlated positively with fat intake and negatively with the intake of fish, carbohydrate calories, and dietary fiber. Conclusions: We found that significant regional differences in insulin response and insulin sensitivity in Japanese participants and that nutritional factors may be linked to these differences independently of body size/adiposity. Insulin response and insulin sensitivity can vary among adult individuals, even within the same race and the same country, and are likely affected by environmental/lifestyle factors as well as genetic traits.

The incidence trends of liver cirrhosis caused by nonalcoholic steatohepatitis via the GBD study 2017

Nonalcoholic steatohepatitis (NASH) has rapidly become the most common cause of chronic liver diseases. We aimed to explore the incidence and distribution characteristics of NASH by sex, region and sociodemographic index (SDI). We collected data, including sex and region, on NASH-related liver cirrhosis from the 2017 GBD study. The age-standardized incidence rates (ASRs) and estimated annual percentage changes (EAPCs) were used to estimate the incidence trend and distribution characteristics. Globally, the incidence of liver cirrhosis caused by NASH increased from 178,430 cases in 1990 to 367,780 cases in 2017, an increase of approximately 105.56%. The ASR of NASH increased by an average of 1.35% per year (95% CI 1.28–1.42). Meanwhile, large differences in the ASR and the EAPC were observed across regions. The middle-high SDI region had the highest increase among all five SDI regions, followed by middle SDI region. In addition, Eastern Europe, Andean Latin America and Central Asia showed a more significant growth trend of ASR. In contrast, the high SDI region demonstrated the slowest increasing trend of ASR, and the high-income Asia Pacific demonstrated a decreasing trend among the 21 regions. Liver cirrhosis has caused a huge and rising health burden in many countries and regions. In addition, with the growth of obesity, population and aging, NASH might replace viral hepatitis as the most important cause of liver cirrhosis in the near future. Therefore, appropriate interventions are needed in coming decades to realize early diagnosis and prevention of NASH-related liver cirrhosis.

Influence of organizational and social contexts on the implementation of culturally adapted hypertension control programs in Asian American-serving grocery stores, restaurants, and faith-based community sites: a qualitative study

Hypertension affects a third of U.S. adults and is especially high among Asian American groups. The Racial and Ethnic Approaches to Community Health for Asian AmeRicans (REACH FAR) project delivers culturally adapted, evidence-based hypertension-related programs to Bangladeshi, Filipino, Korean, and Asian Indian communities in New York and New Jersey through 26 sites: ethnic grocery stores, restaurants, and Muslim, Christian, and Sikh faith-based organizations. Knowledge of the implementation mechanisms of culturally adapted programs is limited and is critical to inform the design and execution of such programs by and in community sites. We applied four categories of the Consolidated Framework for Implementation Research-intervention and individuals' characteristics, inner and outer setting-to analyze factors influencing implementation outcomes, that is, site leaders' perceptions about adopting, adapting, and sustaining REACH FAR. We conducted semistructured interviews with 15 leaders, coded them for implementation outcomes, and recoded them to identify contextual factors. Our findings show that REACH FAR resonated in sites where leaders perceived unhealthy diet and lifestyles in their communities (intervention characteristics), sites had historically engaged in health programs as a public-service mission (inner setting), and leaders identified with this mission (individuals' characteristics). Site leaders strived to adapt programs to respond to community preferences (outer setting) without compromising core objectives (inner setting). Leaders noted that program sustainability could be impeded by staff and volunteer turnover (inner setting) but enhanced by reinforcing programs through community networks (outer setting). The findings suggest that to facilitate implementation of culturally adapted health behavior programs through community sites, interventions should reinforce sites' organizational commitments and social ties.

Metagenomics Study Reveals Changes in Gut Microbiota in Centenarians: A Cohort Study of Hainan Centenarians

Several studies based on 16SrDNA analysis have revealed certain unique characteristics of gut microbiome in centenarians. We established a prospective cohort of fecal microbiota and conducted the first metagenomics-based study among centenarians. The objective was to explore the dynamic changes of gut microbiota in healthy centenarians and centenarians approaching end of life and to unravel the characteristics of aging-associated microbiome. Seventy-five healthy centenarians residing in three regions of Hainan participated in follow-up surveys and collection of fecal samples at intervals of 3 months. Data pertaining to dietary status, health status scores, cause of disease and death, and fecal specimens were collected for 15 months. Twenty participants died within 20 months during the follow-up period. The median survival time was 8-9 months (range, 1-17) and the mortality rate was 14.7% per year. The health status scores before death were significantly lower than those at 3 months before the end of the follow-up period [median score: 3 (range, 1-5), P < 0.05]. At this time, the participants mainly exhibited symptoms of anorexia and reduced dietary intake and physical activity. Metagenomics sequencing and analysis were carried out to characterize the gut microbiota changes in the centenarians during their transition from healthy status to death. Anosim analysis showed a significant change in gut microbiota from 7 months prior to death (R = 0.10, P = 0.02). All participants were grouped with 7 months before death as cut-off; no significant difference in α diversity was found between the two groups (P = 0.45). Semi-supervised monitoring and log rank sum analysis revealed significant changes in the abundance of ten bacterial species before death; of these, eight species were significantly reduced (Akkermansia muciniphila, Alistipes finegoldii, Alistipes shahii, Bacteroides faecis, Bacteroides intestinalis, Butyrivibrio crossotus, Bacteroides stercoris, and Prevotella stercorea) while two were significantly increased before death (Bifidobacterium longum and Ruminococcus bromii). Compared to centenarians in northern Italy, Hainan centenarians exhibited unique characteristics of gut microbiome. The abundance of ten bacterial species showed significant changes starting from 7 months before death. We speculate that these changes might occur before the clinical symptoms of deterioration in health status.

High dietary acid load score is not associated with the risk of metabolic syndrome in Iranian adults

Background and objective: The association between dietary acid load and metabolic syndrome (MetS) risk is not well-known. Therefore, we aimed to investigate the relationship between dietary acid load and the risk of MetS among Iranian adults. Methods: This cross-sectional study was carried out on 1430 Iranian adults. Dietary intakes were assessed using a validated food frequency questionnaire. Dietary acid load was estimated using potential renal acid load (PRAL) and net endogenous acid production (NEAP). MetS was defined according to the ATP-III criteria. The risk of MetS and its components was explored using logistic regression test. Results: Totally, 205 individuals were identified to have MetS. No significant association for MetS was found across the quartiles of PRAL and NEAP either in the crude model [Q4 PRAL: OR (95% CI): 0.94 (0.67-1.32), and NEAP: OR (95% CI): 0.88 (0.63-1.25)] or fully-adjusted model [Q4 PRAL: OR (95% CI): 0.90 (0.61-1.33), and NEAP: OR (95% CI): 1.05 (0.70-1.57)]. Amongst the components of MetS, higher scores of NEAP was associated with an increased risk of impaired blood sugar after adjustment for potential confounders [OR (95% CI): 1.35 (0.93-1.96)]. No significant association was found for other components either with PRAL or with NEAP. Conclusion: Our findings suggest no association between dietary acid load and MetS risk in Iranian adults. However, higher dietary acid load, measured by NEAP, but not PRAL, was associated with increased risk of impaired fasting blood sugar. Longitudinal studies are warranted to explore whether a diet low in potential acid load could reduce MetS risk.

Diet quality and risk factors for cardiovascular disease among South Asians in Alberta

South Asians have a higher prevalence of early onset cardiovascular disease risk compared with other populations. Dietary intake is a modifiable risk factor for cardiovascular disease. Dietary patterns in immigrants and successive generations of South Asians settled in Western countries undergo adaptions. Little is known about the dietary intake of South Asians in Alberta, thus the objective of the present study was to describe the dietary patterns among South Asians and their risks for cardiovascular diseases. A retrospective analysis of data collected from 140 South Asian adults participating in the Alberta’s Tomorrow Project was conducted. Dietary intake was assessed using a food frequency questionnaire and the Healthy Eating Index (HEI) was used an indicator of overall diet quality and adherence to dietary recommendations made by Health Canada. Central obesity (70%), hypercholesterolemia (27%), and hypertension (14%) were predominant health conditions observed in the study participants. About 56% and 44% of participants obtained moderate and poor HEI scores, respectively. The diet quality of the majority of participants was inadequate to meet macro- and micronutrient intake recommendations. The high prevalence of poor/moderate diet quality and pre-existing chronic health conditions across all body mass index groups is a cause for concern in this population.

Palliative care for older South Asian migrants: A systematic review

Objective

South Asian migrants have a higher burden of life-threatening diseases and chronic diseases compared to other ethnic groups. Yet, knowledge gaps remain around their palliative care needs in the host countries. The aim of the review was to present results from a systematic literature review of available international evidence on experiences with and perspectives on palliative care among older South Asian migrants, relatives, and healthcare providers.

Methods

A systematic review in accordance with PRISMA guidelines was conducted in February 2018, searching PubMed, CINAHL, PsychINFO, and EMBASE databases. PROSPERO #CRD42018093464. Studies included empirical research, providing international evidence on experiences and perspectives on palliative care of South Asian migrants and were published between 2000 and 2018. Thematic synthesis was used to analyze data.

Results

A total of 30 articles were included: qualitative (24), quantitative (5), and mixed methods (1). Three main themes were discovered: 1) palliative care practice within the family, 2) trust as a precondition of palliative care, and 3) the importance of knowledge and cultural competency. All the themes, to a greater or lesser extent, are related to access to and use of palliative care services by South Asian migrant families.

Significance of results

Involvement of family members in palliative care decision making could improve the satisfaction of South Asian migrant families toward the service. For example, Advanced Care Planning involving family members could be a possible way to engage family members in palliative care decision making. Supportive interventions, e.g. providing knowledge, aimed at patients and their family members might improve knowledge and increase awareness among South Asian migrant families of palliative care. Knowledge gained from this review could be implemented with other ethnic minority groups.

The influence of in vitro pectin fermentation on the human fecal microbiome

Pectin is a complex dietary fiber and a prebiotic. To investigate pectin-induced changes in the gut microbiome and their effects on the short chain fatty acids (SCFAs) production, we performed in vitro pectin fermentation using the feces of three Korean donors. The pectin degradations in all three donors were observed. While the donors displayed differences in baseline gut microbiota composition, commonly increased bacteria after pectin fermentation included Lachnospira, Dorea, Clostridium, and Sutterella. Regarding SCFAs, acetate levels rapidly increased with incubation with pectin, and butyrate levels also increased after 6 h of incubation. The results suggest that pectin fermentation increases bacterial species belonging to Clostridium cluster XIV (Lachnospira, Dorea, and Clostridium), with Lachnospira displaying the greatest increase. The results also confirm that pectin fermentation leads to the production of acetate and butyrate.