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Chatterjee R, Davenport CA, Vickery EM, Johnson KC, Kashyap SR, LeBlanc ES, Nelson J, Dagogo-Jack S, Pittas AG, Hughes BD. Effect of intratrial mean 25(OH)D concentration on diabetes risk, by race and weight: an ancillary analysis in the D2d study. Am J Clin Nutr 2023; 118:59-67. [PMID: 37001590 PMCID: PMC10447481 DOI: 10.1016/j.ajcnut.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Higher serum 25-hydroxyvitamin D [25(OH)D] is associated with lower type 2 diabetes risk. 25(OH)D varies due to skin pigmentation and weight. OBJECTIVES This analysis aims to determine whether the effect of vitamin D differs among people of color and those with overweight/obesity (who have higher diabetes risk) compared with individuals who are White or have normal weight. METHODS The D2d study is a randomized clinical trial in people with prediabetes that tested the effects of daily vitamin D3 4000 IU vs. placebo on diabetes risk (median followup 2.5 y). We compared baseline and intratrial mean 25(OH)D concentrations, defined as the mean of all available annual 25(OH)D values, among groups defined by self-reported race and body mass index (BMI). We used Cox proportional hazards models to assess the associations between intratrial mean 25(OH)D and diabetes risk by race- and BMI-based groups. RESULTS Asian (n=130), Black (n=616), and White (n=1616) participants were included. Both baseline and intratrial mean 25(OH)D concentrations differed significantly by race groups (both P < 0.001) and were lower in Asian and Black vs. White participants, and in those with higher vs. lower BMI adjusted for race (both P < 0.001). Compared with those with lower concentrations, Black and White participants with intratrial mean 25(OH)D ≥ 40 ng/mL had significantly reduced diabetes risk [HR (95% CI): Black: 0.51 (0.29, 0.92); White: 0.42 (0.30, 0.60)] and with a similar reduction in diabetes risk among Asian participants: 0.39 (0.14, 1.11). Compared with those with lower concentrations, participants with baseline BMI < 40 kg/m2 who achieved intratrial mean 25(OH)D concentrations ≥ 40 ng/mL had a significantly reduced diabetes risk. There was no statistically significant interaction between intratrial 25(OH)D and race or between intratrial 25(OH)D and BMI on diabetes risk. CONCLUSIONS Among people with prediabetes, particularly for Black and White race groups and those with BMI < 40 kg/m2, the optimal 25(OH)D concentration may be ≥ 40 ng/mL to optimize diabetes-prevention efforts. This trial was registered at clinicaltrials.gov as NCT01942694.
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Affiliation(s)
- Ranee Chatterjee
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States.
| | - Clemontina A Davenport
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, United States
| | - Ellen M Vickery
- Division of Endocrinology, Diabetes and Metabolism, Tufts Medical Center, Boston, MA, United States
| | - Karen C Johnson
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Sangeeta R Kashyap
- Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic, Cleveland, OH, United States
| | - Erin S LeBlanc
- Kaiser Permanente Center for Health Research NW, Portland, OR, United States
| | - Jason Nelson
- BERD Center, Tufts Medical Center, Boston, MA, United States
| | - Samuel Dagogo-Jack
- Division of Endocrinology, Diabetes and Metabolism, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Anastassios G Pittas
- Division of Endocrinology, Diabetes and Metabolism, Tufts Medical Center, Boston, MA, United States
| | - Bess Dawson Hughes
- Division of Endocrinology, Diabetes and Metabolism, Tufts Medical Center, Boston, MA, United States; Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, United States
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Mahadevan M, Bose M, Gawron KM, Blumberg R. Metabolic Syndrome and Chronic Disease Risk in South Asian Immigrants: A Review of Prevalence, Factors, and Interventions. Healthcare (Basel) 2023; 11:healthcare11050720. [PMID: 36900725 PMCID: PMC10000781 DOI: 10.3390/healthcare11050720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/21/2023] [Accepted: 02/26/2023] [Indexed: 03/05/2023] Open
Abstract
South Asians (SAs) are among the fastest-growing ethnic groups in the U.S. Metabolic syndrome (MetS) is a condition that is characterized by multiple health factors that increase the risk for chronic diseases, such as cardiovascular disease (CVD) and diabetes. MetS prevalence among SA immigrants ranges from 27-47% in multiple cross-sectional studies using different diagnostic criteria, which is generally higher compared to other populations in the receiving country. Both genetic and environmental factors are attributed to this increased prevalence. Limited intervention studies have shown effective management of MetS conditions within the SA population. This review reports MetS prevalence in SAs residing in non-native countries, identifies contributing factors, and discusses ways to develop effective community-based strategies for health promotion targeting MetS among SA immigrants. There is a need for more consistently evaluated longitudinal studies to facilitate the development of directed public health policy and education to address chronic diseases in the SA immigrant community.
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Affiliation(s)
- Meena Mahadevan
- Department of Nutrition and Food Studies, Montclair State University, Montclair, NJ 07043, USA
- Correspondence: ; Tel.: +1-973-655-7574
| | - Mousumi Bose
- Department of Nutrition and Food Studies, Montclair State University, Montclair, NJ 07043, USA
| | | | - Renata Blumberg
- Department of Nutrition and Food Studies, Montclair State University, Montclair, NJ 07043, USA
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Misra R, Madhavan SS, Dhumal T, Sambamoorthi U. Prevalence and factors associated with diagnosed diabetes mellitus among Asian Indian adults in the United States. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001551. [PMID: 36963049 PMCID: PMC10021922 DOI: 10.1371/journal.pgph.0001551] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/10/2023] [Indexed: 02/05/2023]
Abstract
Higher prevalence of diabetes mellitus (DM) has been documented among South Asians living in the United States. However, combining the south Asian subgroups into one category masks the heterogeneity in the diagnosed DM, after controlling for known protective and risk factors. We assessed the association of Asian Indian ethnicity to diagnosed DM using a nationally representative sample of 1,986 Asian Indian adults in the US compared to 109,072 Non-Hispanic Whites (NHWs) using disaggregated data from the National Health Interview Survey (2012-2016) (NHIS). 2010 US census figures were used for age-sex standardization. Age-sex adjusted prevalence of DM was 8.3% in Asian Indians as compared to 5.8% in NHW. In adjusted multivariable logistic regression models, Asian Indians had higher odds ratios of reporting diagnosed DM compared to NHWs (AOR = 1.39, 95% CI: 1.12, 1.71). This association remained strong and significant even after controlling for other risk factors in the model (AOR = 1.47, 95% CI: 1.16, 1.85). Results suggest a favorable socio-economic profile of Asian Indians was not protective on diagnosed DM. In addition, they were more likely to have diagnosed DM due to higher prevalence of obesity despite healthier behaviors of smoking and exercise.
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Affiliation(s)
- Ranjita Misra
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, West Virginia, United States of America
| | - Suresh S Madhavan
- College of Pharmacy, University of North Texas System, Denton, Texas, United States of America
| | - Trupti Dhumal
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, United States of America
| | - Usha Sambamoorthi
- College of Pharmacy, University of North Texas System, Denton, Texas, United States of America
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Guo Y, Gao J, Liu Y, Jia Y, An X, Zhang X, Su P. An examination of causal associations and shared risk factors for diabetes and cardiovascular diseases in the East Asian population: A Mendelian randomization study. Front Endocrinol (Lausanne) 2023; 14:1132298. [PMID: 36909309 PMCID: PMC9999111 DOI: 10.3389/fendo.2023.1132298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/09/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND One of the major contributors to disability and mortality among diabetics is cardiovascular disease (CVD), with coronary artery disease (CAD) as the most prevalent type. However, previous studies have provided controversial evidence linking diabetes to other types of CVDs, such as atrial fibrillation (AF). In addition, the risk factors that predispose people to the risk of diabetes and its complications differ across ethnicities, but the disease risk profiles in the East Asian population have been less investigated. METHODS The causal association between type 2 diabetes (T2D) and two types of CVDs (i.e., AF and CAD) in the East Asian population was first studied using Mendelian randomization (MR) analyses. Next, we examined the causal effect of 49 traits on T2D and CAD to identify their separate and shared risk factors in East Asians. A causal mediation analysis was performed to examine the role of T2D in mediating the relationship between the identified shared risk factors and CAD. RESULTS T2D was causally associated with CAD, but not AF, in East Asians. A screening of the risk factors indicated that six and 11 traits were causally associated with T2D and CAD, respectively, with suggestive levels of evidence. Alkaline phosphatase (ALP) was the only trait associated with both T2D and CAD, as revealed by the univariable MR analyses. Moreover, the causal association between ALP and CAD no longer existed after adjusting T2D as a covariable in the causal mediation study. CONCLUSION Our study highlights the risk profiles in the East Asian population, which is important in formulating targeted therapies for T2D and CVDs in East Asians.
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Affiliation(s)
- Yulin Guo
- *Correspondence: Yulin Guo, ; Pixiong Su,
| | | | | | | | | | | | - Pixiong Su
- *Correspondence: Yulin Guo, ; Pixiong Su,
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Shah MK, Naing S, Kurra N, Weber MB, Islam N, Ali MK, Narayan KMV. A culturally adapted, social support-based, diabetes group visit model for Bangladeshi adults in the USA: a feasibility study. Pilot Feasibility Stud 2022; 8:18. [PMID: 35074000 PMCID: PMC8785445 DOI: 10.1186/s40814-022-00974-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Interventions focused on weight loss can prevent, delay, and improve management of type 2 diabetes (T2D). However, implementation of these programs is challenging in diverse populations. South Asians have higher risk for T2D, yet to date, there have been limited programs for this community in the USA. The aim of this project was to develop and test the feasibility of a tailored group visit model for Bangladeshis with type 2 diabetes (T2D) or prediabetes based in primary care. Design Mixed-methods single-arm feasibility study. Setting An academic health center-based primary care clinic in Atlanta, Georgia. Participants Bangladeshi adults > 18 years old with T2D or prediabetes Methods In conjunction with a community-academic board, we conducted focus groups to tailor an existing evidence-based curriculum to a culturally acceptable intervention. Fourteen participants enrolled in the 16-week program focusing on healthy diet, exercise, and weight loss. The primary feasibility outcomes were number of sessions attended and participant satisfaction with the intervention. Weight, blood pressure, cholesterol, and HbA1C were measured at beginning and end of study. Participants were asked to evaluate each session on level of satisfaction. One tailed paired t tests were used to test significance of pre-post changes in outcomes. Results Key themes from the formative focus groups (n = 50) were closely tied to sociocultural beliefs and included: dietary patterns, physical activity perceptions, and healthcare access concerns. In the intervention, 10 of 14 participants had baseline and follow-up data. Participant attendance averaged 50%. Statistically significant reductions in mean weight (− 2%, 95%CI: − 3.1, 0.2 kg), systolic/diastolic blood pressure (− 12.7 mmHg [95%CI: − 23.2, − 2.2]/− 3.7 mmHg [95%CI: − 7.6, − 0.1], respectively), and triglycerides (− 62.6 mg/dl, 95%CI: − 123.1, − 2.0) were noted. Overall, participants reported high levels of satisfaction with the program. Conclusion A lifestyle program based in primary care is feasible and acceptable for Bangladeshi immigrants. Larger studies testing the effectiveness of group programs, in primary care, to improve cardiometabolic factors are important. Trials registration ClinicalTrials.gov; NCT03861546. Registered 28 February 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-00974-9.
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Affiliation(s)
- Megha K Shah
- Department of Family and Preventive Medicine, Emory University School of Medicine, 4500 N. Shallowford Rd. Dunwoody, Atlanta, GA, 30338, USA.
| | - Sukyi Naing
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, USA
| | - Nithin Kurra
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, USA
| | - Mary Beth Weber
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, USA
| | - Nadia Islam
- Division of Population Health, New York University Grossman School of Medicine, New York City, USA
| | - Mohammed K Ali
- Department of Family and Preventive Medicine, Emory University School of Medicine, 4500 N. Shallowford Rd. Dunwoody, Atlanta, GA, 30338, USA.,Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, USA
| | - K M Venkat Narayan
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, USA
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Ge Q, Li M, Xu Z, Qi Z, Zheng H, Cao Y, Huang H, Duan X, Zhuang X. Comparison of different obesity indices associated with type 2 diabetes mellitus among different sex and age groups in Nantong, China: a cross-section study. BMC Geriatr 2022; 22:20. [PMID: 34979974 PMCID: PMC8725504 DOI: 10.1186/s12877-021-02713-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/09/2021] [Indexed: 01/03/2023] Open
Abstract
Background Obesity is associated with type 2 diabetes mellitus (T2DM). However, the obesity index that is most closely related to type 2 diabetes remains controversial. Therefore, the aim of this study was to compare the associations of five anthropometric indices (body mass index [BMI], body adiposity index, waist circumference [WC], waist-to-hip ratio, and waist-to-height ratio [WHtR]) with T2DM among Chinese adults divided into four groups according to sex and age. Methods A total of 4007 adult participants (1669 men and 2338 women) were included in the study. Odds ratios (ORs) and 95% confidence intervals were used with binary logistic regression models to estimate the risk of T2DM for each obesity index. Furthermore, we compared the area under the receiver operating characteristic curve (AUC) of each obesity index for the criterion of T2DM under the influence of risk factors. Results WC had the highest OR (3.211 and 1.452) and AUC (0.783 and 0.614) in both age groups of men. However, WHtR (OR = 2.366, AUC = 0.771) and BMI (OR = 1.596, AUC = 0.647) were the optimal criteria for predicting T2DM among females in the 18–59 and ≥ 60 years age groups, respectively. Conclusions This study suggests that there is a positive association between obesity-related anthropometric indices and T2DM in different sex and age groups. WC appears to be the optimal anthropometric index for predicting T2DM in men. The optimal obesity indices related to T2DM were WHtR and BMI for women aged 18–59 and ≥ 60 years, respectively.
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Affiliation(s)
- Qiwei Ge
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, No 9 Seyuan Road, Nantong, Jiangsu, 226019, China
| | - Min Li
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, No 9 Seyuan Road, Nantong, Jiangsu, 226019, China
| | - Zhengcheng Xu
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, No 9 Seyuan Road, Nantong, Jiangsu, 226019, China
| | - Zhigang Qi
- Nantong Chongchuan District Center for Disease Control and Prevention, Nantong, Jiangsu, 226000, China
| | - Huiyan Zheng
- Nantong Chongchuan District Center for Disease Control and Prevention, Nantong, Jiangsu, 226000, China
| | - Yuxin Cao
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, No 9 Seyuan Road, Nantong, Jiangsu, 226019, China
| | - Hao Huang
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, No 9 Seyuan Road, Nantong, Jiangsu, 226019, China
| | - Xiaoyang Duan
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, No 9 Seyuan Road, Nantong, Jiangsu, 226019, China
| | - Xun Zhuang
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, No 9 Seyuan Road, Nantong, Jiangsu, 226019, China.
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Chernov C, Wang L, Thorpe LE, Islam N, Freeman A, Trinh-Shevrin C, Kanchi R, Perlman SE. Cardiovascular Disease Risk Factors Among Immigrant and US-Born Adults in New York City. Public Health Rep 2021; 137:537-547. [PMID: 33909521 PMCID: PMC9109518 DOI: 10.1177/00333549211007519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Immigrant adults tend to have better health than native-born adults despite lower incomes, but the health advantage decreases with length of residence. To determine whether immigrant adults have a health advantage over US-born adults in New York City, we compared cardiovascular disease (CVD) risk factors among both groups. METHODS Using data from the New York City Health and Nutrition Examination Survey 2013-2014, we assessed health insurance coverage, health behaviors, and health conditions, comparing adults ages ≥20 born in the 50 states or the District of Columbia (US-born) with adults born in a US territory or outside the United States (immigrants, following the National Health and Nutrition Examination Survey) and comparing US-born adults with (1) adults who immigrated recently (≤10 years) and (2) adults who immigrated earlier (>10 years). RESULTS For immigrant adults, the mean time since arrival in the United States was 21.8 years. Immigrant adults were significantly more likely than US-born adults to lack health insurance (22% vs 12%), report fair or poor health (26% vs 17%), have hypertension (30% vs 23%), and have diabetes (20% vs 11%) but significantly less likely to smoke (18% vs 27%) (all P < .05). Comparable proportions of immigrant adults and US-born adults were overweight or obese (67% vs 63%) and reported CVD (both 7%). Immigrant adults who arrived recently were less likely than immigrant adults who arrived earlier to have diabetes or high cholesterol but did not differ overall from US-born adults. CONCLUSIONS Our findings may help guide prevention programs and policy efforts to ensure that immigrant adults remain healthy.
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Affiliation(s)
- Claudia Chernov
- Division of Epidemiology, New York City Department of Health and
Mental Hygiene, Long Island City, NY, USA,Claudia Chernov, MPH, New York City
Department of Health and Mental Hygiene, Division of Epidemiology, 42-09 28th
St, WS 07-88, Long Island City, NY 11101, USA;
| | - Lisa Wang
- Division of Epidemiology, New York City Department of Health and
Mental Hygiene, Long Island City, NY, USA
| | - Lorna E. Thorpe
- Department of Population Health, New York University School of
Medicine, New York, NY, USA
| | - Nadia Islam
- Department of Population Health, New York University School of
Medicine, New York, NY, USA
| | - Amy Freeman
- Department of Population Health, New York University School of
Medicine, New York, NY, USA
| | - Chau Trinh-Shevrin
- Department of Population Health, New York University School of
Medicine, New York, NY, USA
| | - Rania Kanchi
- Department of Population Health, New York University School of
Medicine, New York, NY, USA
| | - Sharon E. Perlman
- Division of Epidemiology, New York City Department of Health and
Mental Hygiene, Long Island City, NY, USA
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Padela AI, Duivenbode R, Saunders MR, Quinn M, Koh E. The impact of religiously tailored and ethically balanced education on intention for living organ donation among Muslim Americans. Clin Transplant 2020; 34:e14111. [PMID: 33063912 DOI: 10.1111/ctr.14111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 01/02/2023]
Abstract
We tested the efficacy of religiously tailored and ethically balanced education upon living kidney organ donation intent among Muslim Americans. Pre-post changes in participant stage of change, preparedness, and likelihood judged efficacy. Among 137 participants, mean stage of change toward donation appeared to improve (0.59; SD ± 1.07, P < .0001), as did the group's preparedness to make a donation decision (0.55; SD ± 0.86, P < .0001), and likelihood to donate a kidney (0.39; SD ± 0.85, P < .0001). Mean change in likelihood to encourage a loved one, a co-worker, or a mosque community member with ESRD to seek a living donor also increased (0.22; SD ± 0.84, P = .0035, 0.23; SD ± 0.82, P = .0021, 0.33; SD ± 0.79, P < .0001 respectively). Multivariate ordered logistic regression models revealed that gains in biomedical knowledge regarding organ donation increased odds for positive change in preparedness (OR = 1.20; 95% CI 1.01-1.41, P = .03), while increasing age associated with lower odds of positive change in stage of change (OR = 0.98, 95% CI 0.96-0.998, P = .03), and prior registration as an organ donor lowered odds for an increase in likelihood to donate a kidney (OR = 0.22; 95% CI 0.08-0.60, P = .003). Our intervention appears to enhance living kidney donation-related intent among Muslim Americans [Clinicaltrials.gov number: NCT04443114].
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Affiliation(s)
- Aasim I Padela
- Initiative on Islam and Medicine, University of Chicago, Chicago, IL, USA.,Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Rosie Duivenbode
- Initiative on Islam and Medicine, University of Chicago, Chicago, IL, USA
| | - Milda R Saunders
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Michael Quinn
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Elizabeth Koh
- Initiative on Islam and Medicine, University of Chicago, Chicago, IL, USA
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Mathew Joseph N, Misra R, Wang J. Mediating Role of Acculturation and Lifestyle Behaviors on Cardiometabolic Risk Among a National Sample of U.S. Asian Indians. J Immigr Minor Health 2019; 22:727-735. [PMID: 31485817 DOI: 10.1007/s10903-019-00930-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Asian Indians are the third largest and fastest growing Asian subgroup in the U.S. and have high risks for diabetes and cardiovascular disease. This study explored the mediating role of lifestyle behaviors on the relationship between acculturation and cardiometabolic risk factors among Asian Indians using the Diabetes in Indian Americans national study. The cross-sectional study sample comprised 1038 randomly selected adult Asian Indians in seven U.S. sites. Acculturation was assessed using the Acculturation Scale for Southeast Asians. Diet and lifestyle behaviors were measured using the Health-Promoting Lifestyle Profile II subscales. Path analyses with bootstrap methods were conducted. Dietary behavior significantly mediated the relationship between acculturation and HbA1C (β = 0.004, p = 0.047), and physical activity mediated the relationship between acculturation and HDL (β = 0.08, p = 0.011). Other mediation models were not significant (p > 0.05). Mediating factors besides lifestyle behaviors should be explored in future studies.
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Affiliation(s)
- Nitha Mathew Joseph
- Department of Undergraduate Studies, Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Ave, Houston, TX, 77030, USA.
| | - Ranjita Misra
- Department of Social and Behavioral Sciences, Robert C. Byrd Health Sciences Center, School of Public Health, West Virginia University, Morgantown, WV, 26506-9190, USA
| | - Jing Wang
- School of Nursing, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., MC 7950, San Antonio, TX, 78229, USA
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Khan RMM, Chua ZJY, Tan JC, Yang Y, Liao Z, Zhao Y. From Pre-Diabetes to Diabetes: Diagnosis, Treatments and Translational Research. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E546. [PMID: 31470636 PMCID: PMC6780236 DOI: 10.3390/medicina55090546] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/16/2019] [Accepted: 08/23/2019] [Indexed: 12/14/2022]
Abstract
Diabetes, a silent killer, is one of the most widely prevalent conditions of the present time. According to the 2017 International Diabetes Federation (IDF) statistics, the global prevalence of diabetes among the age group of 20-79 years is 8.8%. In addition, 1 in every 2 persons is unaware of the condition. This unawareness and ignorance lead to further complications. Pre-diabetes is the preceding condition of diabetes, and in most of the cases, this ultimately leads to the development of diabetes. Diabetes can be classified into three types, namely type 1 diabetes, type 2 diabetes mellitus (T2DM) and gestational diabetes. The diagnosis of both pre-diabetes and diabetes is based on glucose criteria; the common modalities used are fasting plasma glucose (FPG) test and oral glucose tolerance test (OGTT). A glucometer is commonly used by diabetic patients to measure blood glucose levels with fast and rather accurate measurements. A few of the more advanced and minimally invasive modalities include the glucose-sensing patch, SwEatch, eyeglass biosensor, breath analysis, etc. Despite a considerable amount of data being collected and analyzed regarding diabetes, the actual molecular mechanism of developing type 2 diabetes mellitus (T2DM) is still unknown. Both genetic and epigenetic factors are associated with T2DM. The complications of diabetes can predominantly be classified into two categories: microvascular and macrovascular. Retinopathy, nephropathy, and neuropathy are grouped under microvascular complications, whereas stroke, cardiovascular disease, and peripheral artery disease (PAD) belong to macrovascular complications. Unfortunately, until now, no complete cure for diabetes has been found. However, the treatment of pre-diabetes has shown significant success in preventing the further progression of diabetes. To prevent pre-diabetes from developing into T2DM, lifestyle intervention has been found to be very promising. Various aspects of diabetes, including the aforementioned topics, have been reviewed in this paper.
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Affiliation(s)
- Radia Marium Modhumi Khan
- School of Chemical and Biomedical Engineering, Nanyang Technological University, 62 Nanyang Drive, Singapore 637459, Singapore
| | - Zoey Jia Yu Chua
- School of Physical and Mathematical Sciences, Nanyang Technological University, 21 Nanyang Link, Singapore 637371, Singapore
| | - Jia Chi Tan
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, Singapore 637551, Singapore
| | - Yingying Yang
- Tongji University School of Medicine, Shanghai 201204, China
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 65 Solna, Sweden
| | - Zehuan Liao
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, Singapore 637551, Singapore.
- Department of Microbiology, Tumor, and Cell Biology (MTC), Karolinska Institutet, Biomedicum, Solnavägen 9, SE-17177 Stockholm, Sweden.
| | - Yan Zhao
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, Singapore 637551, Singapore.
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Gor B, Nepal VP, Dongardive R, Dorai VK, Pande M. Is Socioeconomic Advantage Associated With Positive Health Behaviors and Health Outcomes Among Asian Indians? Health Serv Res Manag Epidemiol 2019; 6:2333392819830371. [PMID: 30891469 PMCID: PMC6416674 DOI: 10.1177/2333392819830371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 01/16/2019] [Indexed: 01/21/2023] Open
Abstract
Objective The South Asian Health Needs Assessment was conducted to collect health status information on the rapidly growing Asian Indian (AI) community in the Houston area. Many were highly educated and reported high income levels, factors usually associated with better health outcomes. This study examined the relationship between socioeconomic advantage and the health behaviors and health outcomes of AIs. Methods We analyzed cross-sectional survey data from a convenience sample of 1416 AIs. Income was categorized as low, medium, and high. Descriptive statistics were generated by income categories and weighted multinomial regression analyses were conducted to examine the association of income with health behaviors and outcomes, adjusting for age, sex, health insurance, and years in the United States. Results Income was positively associated with better self-rated health, higher body mass index, moderate physical activity, having shingles vaccine, and cervical cancer screening. Income was inversely associated with perceived stress and heart disease. However, income was not significantly associated with alternative therapies, cigarette smoking, alcohol consumption, self-reported overweight/obesity, fruit and vegetable consumption, diabetes, high blood pressure, high cholesterol and screening for breast, prostate, and colon cancer. Conclusions Socioeconomic advantage was not consistently associated with positive health outcomes or desired health behaviors among AIs. We speculate that other factors, including cultural beliefs and acculturation may also impact health behaviors and health outcomes in this group. Further studies examining the influence of these variables on health behaviors and health outcomes are warranted.
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Affiliation(s)
| | | | | | - V K Dorai
- Indian American Cancer Network, Houston, TX, USA
| | - Mala Pande
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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12
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Suvarna P, Shruti K, Maruti D, Charudatta J. Diabetes in the Kokan region of India. World J Diabetes 2019; 10:37-46. [PMID: 30697369 PMCID: PMC6347652 DOI: 10.4239/wjd.v10.i1.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/20/2018] [Accepted: 01/04/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND BKL Walawalkar Hospital is situated near the village of Dervan in the Kokan region of the state of Maharashtra in India. A survey of 2200 surrounding villages showed 51.8% adults had body mass index (BMI) below <18.5 kg/m2 and only 4.5% were overweight. A survey of 11521 adolescent girls from rural schools showed 64% prevalence of thinness. In the same region, government survey reported the prevalence of diabetes around 7%, and 70% prevalence of leanness. This reinforced the fact that the overall population of Kokan is lean. Hence, we decided to investigate body composition of diabetic people from our hospital clinic by carrying out a clinic-based case control study.
AIM To study body composition of diabetics in a rural clinic of Kokan.
METHODS In a case-control study, 168 type 2 diabetic patients (102 men) attending the outpatient department at a rural hospital and 144 non-diabetic controls (68 men) in the Chiplun area of the Kokan region were recruited. History of diabetes (age of onset, duration), anthropometric measurements (height, weight, waist and hip circumference) were recorded. Body composition was measured by bioimpedance using the TANITA analyzer.
RESULTS More than 45% of diabetic subjects had a 1st degree family history of diabetes, and more than 50% had macrovascular complications. The average BMI in diabetic subjects was 24.3 kg/m2. According to World Health Organization standards, prevalence of underweight was 8% and that of normal BMI was around 50%. Underweight and normal diabetic subjects (men as well as women) had significantly lower body fat percentage, higher muscle mass percentage, lower visceral fat and lower basal metabolic rate when compared to their overweight counterparts.
CONCLUSION The diabetic population in Kokan has near normal body composition, and BMI has considerable limitations in assessing body composition and it also lacks sensitivity for assessing risk for diabetes in this population. High prevalence of family history of diabetes may point towards genetic predisposition. Leanness is an inherent characteristic of this population and its metabolic significance needs further investigations with a larger sample size.
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Affiliation(s)
- Patil Suvarna
- Department of Medicine, BKL Walawalkar Hospital and Rural Medical College, Sawarde, Taluka-Chiplun, Maharashtra 415606, India
| | - Kadam Shruti
- Department of Medicine, BKL Walawalkar Hospital and Rural Medical College, Sawarde, Taluka-Chiplun, Maharashtra 415606, India
| | - Desai Maruti
- Statistics Unit, Regional Centre for Adolescent Health and Nutrition, BKL Walawalkar Hospital and Rural Medical College, Taluka-Chiplun, Maharashtra 415606, India
| | - Joglekar Charudatta
- Statistics Unit, Regional Centre for Adolescent Health and Nutrition, BKL Walawalkar Hospital and Rural Medical College, Taluka-Chiplun, Maharashtra 415606, India
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Venkatesh S, Weatherspoon LJ. Reliability and Validity of an Asian Indian Dietary Acculturation Measure (AIDAM). HEALTH EDUCATION & BEHAVIOR 2018; 45:908-917. [PMID: 29848138 DOI: 10.1177/1090198118775479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dietary acculturation (adopting the eating patterns/practices of the host environment) of individuals who relocate to another country could be a risk factor for diet-related chronic diseases. A reliable and validated measure for the assessment of dietary acculturation may facilitate understanding of the relationship between dietary acculturation and diet-related chronic diseases in various nonnative populations. We aimed to determine the reliability and validity of a culturally sensitive Asian Indian Dietary Acculturation Measure (AIDAM) for Asian Indians. A cross-sectional survey was administered via Qualtrics Research Suite to 191 Asian Indian adults in the United States. The web survey consisted of AIDAM, a food frequency questionnaire consisting of Asian Indian (AI-FFQ) and non-Indian (NI-FFQ) foods and participant sociodemographic questions. Reliability and validity were examined through a polytomous Rasch model. Except for one item that was excluded due to misfit, 50 items were stable. The root mean square error was .08 for all the items, and the item and person reliabilities were .98 and .88, respectively. AIDAM was positively related to NI-FFQ ( r = .265) and negatively related to AI-FFQ ( r = -.432) based on correlations and linear regressions ( p < .001). Our preliminary analysis showed the AIDAM to have good reliability and validity when tested with a sample of Asian Indians in the United States. Further large studies with Asian Indians using AIDAM are needed to support our findings. This tool can be used by health professionals and researchers to determine the level of dietary acculturation as well as diet quality implications when assessing risk for diet-related diseases.
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Kwon SC, Patel S, Choy C, Zanowiak J, Rideout C, Yi S, Wyatt L, Taher MD, Garcia-Dia MJ, Kim SS, Denholm TK, Kavathe R, Islam NS. Implementing health promotion activities using community-engaged approaches in Asian American faith-based organizations in New York City and New Jersey. Transl Behav Med 2018; 7:444-466. [PMID: 28547738 DOI: 10.1007/s13142-017-0506-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Faith-based organizations (FBOs) (e.g., churches, mosques, and gurdwaras) can play a vital role in health promotion. The Racial and Ethnic Approaches to Community Health for Asian Americans (REACH FAR) Project is implementing a multi-level and evidence-based health promotion and hypertension (HTN) control program in faith-based organizations serving Asian American (AA) communities (Bangladeshi, Filipino, Korean, Asian Indian) across multiple denominations (Christian, Muslim, and Sikh) in New York/New Jersey (NY/NJ). This paper presents baseline results and describes the cultural adaptation and implementation process of the REACH FAR program across diverse FBOs and religious denominations serving AA subgroups. Working with 12 FBOs, informed by implementation research and guided by a cultural adaptation framework and community-engaged approaches, REACH FAR strategies included (1) implementing healthy food policies for communal meals and (2) delivering a culturally-linguistically adapted HTN management coaching program. Using the Ecological Validity Model (EVM), the program was culturally adapted across congregation and faith settings. Baseline measures include (i) Congregant surveys assessing social norms and diet (n = 946), (ii) HTN participant program surveys (n = 725), (iii) FBO environmental strategy checklists (n = 13), and (iv) community partner in-depth interviews assessing project feasibility (n = 5). We describe the adaptation process and baseline assessments of FBOs. In year 1, we reached 3790 (nutritional strategies) and 725 (HTN program) via AA FBO sites. Most AA FBOs lack nutrition policies and present prime opportunities for evidence-based multi-level interventions. REACH FAR presents a promising health promotion implementation program that may result in significant community reach.
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Affiliation(s)
- S C Kwon
- Department of Population Health, NYU School of Medicine, 550 First Avenue, VZN, 8th Floor, New York, NY, USA
| | - S Patel
- Department of Population Health, NYU School of Medicine, 550 First Avenue, VZN, 8th Floor, New York, NY, USA.
| | - C Choy
- Department of Population Health, NYU School of Medicine, 550 First Avenue, VZN, 8th Floor, New York, NY, USA
| | - J Zanowiak
- Department of Population Health, NYU School of Medicine, 550 First Avenue, VZN, 8th Floor, New York, NY, USA
| | - C Rideout
- Department of Population Health, NYU School of Medicine, 550 First Avenue, VZN, 8th Floor, New York, NY, USA
| | - S Yi
- Department of Population Health, NYU School of Medicine, 550 First Avenue, VZN, 8th Floor, New York, NY, USA
| | - L Wyatt
- Department of Population Health, NYU School of Medicine, 550 First Avenue, VZN, 8th Floor, New York, NY, USA
| | - M D Taher
- Department of Population Health, NYU School of Medicine, 550 First Avenue, VZN, 8th Floor, New York, NY, USA
| | | | - S S Kim
- Korean Community Services of Metropolitan NY, Inc., New York, NY, USA
| | - T K Denholm
- Korean Community Services of Metropolitan NY, Inc., New York, NY, USA
| | | | - N S Islam
- Department of Population Health, NYU School of Medicine, 550 First Avenue, VZN, 8th Floor, New York, NY, USA
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Ardeshna DR, Bob-Manuel T, Nanda A, Sharma A, Skelton WP, Skelton M, Khouzam RN. Asian-Indians: a review of coronary artery disease in this understudied cohort in the United States. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:12. [PMID: 29404358 DOI: 10.21037/atm.2017.10.18] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Coronary artery disease (CAD) is a major cause of cardiovascular death worldwide. Prevalence of CAD is highly variable among different races. Asian Indians have been noted to have the highest CAD rates and the conventional risk factors fail to explain this difference completely. Asian Indians constitute a fifth of the global population, and the higher rates of CAD in this population constitute a major health challenge. There have been studies in the early 2000s that investigate the risk factors in this population; however, very few studies have been done since then that explore the higher CAD rates in Asian Indians. This is a comprehensive and current review of the known risk factors for CAD in Asian Indians and strategies physicians should consider relieving this burden.
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Affiliation(s)
- Devarshi R Ardeshna
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Tamunoinemi Bob-Manuel
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Amit Nanda
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Arindam Sharma
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - William Paul Skelton
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Rami N Khouzam
- Department of Internal Medicine, Division of Cardiology, University of Tennessee Health Science Center, Memphis, TN, USA
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Misra R, Balagopal P, Raj S, Patel TG. Vegetarian Diet and Cardiometabolic Risk among Asian Indians in the United States. J Diabetes Res 2018; 2018:1675369. [PMID: 29670913 PMCID: PMC5835256 DOI: 10.1155/2018/1675369] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/22/2017] [Indexed: 02/07/2023] Open
Abstract
Research studies have shown that plant-based diets confer cardiovascular and metabolic health benefits. Asian Indians (AIs) in the US (who have often followed plant-based diets) have elevated risk for chronic diseases such as diabetes, metabolic syndrome, and obesity suggesting ethnic vulnerability that imply genetic and/or lifestyle causative links. This study explored the association between this ethnic group and diabetes, obesity, and metabolic syndrome after controlling for demographics, acculturation, family history of diabetes, and lifestyle and clinical risk factors. The sample comprised of 1038 randomly selected adult AIs in seven US sites. Prevalence and metabolic syndrome was estimated, and obesity was calculated using the WHO Asian criteria. Multivariate analysis included multinomial logistic regression. The mean age and length of residency in the US were 47 and 18.5 years, respectively. The majority of respondents were vegetarians (62%) and educated. A vegetarian lifestyle was associated with females, food label users, respondents with poor/fair current health status, less acculturated, and those who reported their diet had not changed after coming to the US. Vegetarian status was a protective factor and lowered the risk for diabetes but not for metabolic syndrome and obesity in the regression model. Results provide a firm basis for educational programs.
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Affiliation(s)
- Ranjita Misra
- WVU Public Health Training Center, 3313A, Robert C. Byrd Health Science Center, West Virginia University, Morgantown, WV 26506-9190, USA
| | - Padmini Balagopal
- Clinical Nutritionist, Early Intervention, 1901 JFK Blvd, Philadelphia, PA 19103, USA
| | - Sudha Raj
- Department of Public Health, Food Studies and Nutrition, 562 Falk College, Syracuse, NY 13244, USA
| | - Thakor G. Patel
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Anand SS, Gupta M, Teo KK, Schulze KM, Desai D, Abdalla N, Zulyniak M, de Souza R, Wahi G, Shaikh M, Beyene J, de Villa E, Morrison K, McDonald SD, Gerstein H. Causes and consequences of gestational diabetes in South Asians living in Canada: results from a prospective cohort study. CMAJ Open 2017; 5:E604-E611. [PMID: 28800568 PMCID: PMC5621966 DOI: 10.9778/cmajo.20170027] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The reasons for the increased risk of gestational diabetes among South Asian women are not well understood. We sought to identify the determinants of gestational diabetes and its impact on newborn health in a prospective birth cohort of South Asian women and their babies. METHODS As part of the South Asian Birth Cohort (START) prospective birth cohort study in Ontario, we recruited 1012 South Asian women with singleton pregnancies in the second trimester of pregnancy between July 11, 2011, and Nov. 10, 2015. We collected health information and physical measurements and administered an oral glucose tolerance test. Birth weight and skinfold thickness measurements were obtained from their newborns, and cord blood glucose and insulin levels were measured. RESULTS The incidence of gestational diabetes was 36.3% (95% confidence interval [CI] 33.3%-39.3%); the age-standardized rate was 40.7%. Factors associated with gestational diabetes included maternal age (odds ratio [OR] 1.08 [95% CI 1.04-1.12]), family history of diabetes (OR 1.65 [95% CI 1.26-2.17]), prepregnancy weight (OR 1.025 [95% CI 1.01-1.04]) and low diet quality (OR 1.57 [95% CI 1.16-2.12]). Maternal height was protective against gestational diabetes (OR 0.97 [95% CI 0.95-0.99]). The population attributable risk due to prepregnancy body mass index and low diet quality was 37.3%. Compared to newborns of women without gestational diabetes, those of women with gestational diabetes had a significantly higher birth weight (3267 [standard error (SE) 23] g v. 3181 [SE 17] g, p = 0.005), greater skinfold thickness (11.7 [SE 0.1] mm v. 11.2 [SE 0.1] mm, p = 0.007) and lower insulin sensitivity (glucose/insulin ratio 0.092 [SE 0.009] mmol/pmol v. 0.129 [SE 0.006] mmol/pmol, p = 0.001). INTERPRETATION The modifiable risk factors of prepregnancy weight and low diet quality accounted for 37% of the population attributable risk of gestational diabetes in our cohort. Intervention studies to lower prepregnancy weight and to prevent gestational diabetes among South Asian women in high-income countries are needed.
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Affiliation(s)
- Sonia S Anand
- Affiliations: Departments of Medicine (Anand, Teo, Zulyniak, Gerstein), Health Research Methods, Evidence and Impact(Shaikh, de Souza, Beyene), Pediatrics(Wahi, Morrison) and Obstetrics and Gynecology(McDonald), McMaster University; Population Health Research Institute (Anand, Teo); Hamilton Health Sciences (Anand, Teo, Schulze, Desai, Abdalla), Hamilton, Ont.; Canadian Cardiovascular Research Network (Gupta), Brampton, Ont.; Peel Public Health (de Villa), Mississauga, Ont
| | - Milan Gupta
- Affiliations: Departments of Medicine (Anand, Teo, Zulyniak, Gerstein), Health Research Methods, Evidence and Impact(Shaikh, de Souza, Beyene), Pediatrics(Wahi, Morrison) and Obstetrics and Gynecology(McDonald), McMaster University; Population Health Research Institute (Anand, Teo); Hamilton Health Sciences (Anand, Teo, Schulze, Desai, Abdalla), Hamilton, Ont.; Canadian Cardiovascular Research Network (Gupta), Brampton, Ont.; Peel Public Health (de Villa), Mississauga, Ont
| | - Koon K Teo
- Affiliations: Departments of Medicine (Anand, Teo, Zulyniak, Gerstein), Health Research Methods, Evidence and Impact(Shaikh, de Souza, Beyene), Pediatrics(Wahi, Morrison) and Obstetrics and Gynecology(McDonald), McMaster University; Population Health Research Institute (Anand, Teo); Hamilton Health Sciences (Anand, Teo, Schulze, Desai, Abdalla), Hamilton, Ont.; Canadian Cardiovascular Research Network (Gupta), Brampton, Ont.; Peel Public Health (de Villa), Mississauga, Ont
| | - Karleen M Schulze
- Affiliations: Departments of Medicine (Anand, Teo, Zulyniak, Gerstein), Health Research Methods, Evidence and Impact(Shaikh, de Souza, Beyene), Pediatrics(Wahi, Morrison) and Obstetrics and Gynecology(McDonald), McMaster University; Population Health Research Institute (Anand, Teo); Hamilton Health Sciences (Anand, Teo, Schulze, Desai, Abdalla), Hamilton, Ont.; Canadian Cardiovascular Research Network (Gupta), Brampton, Ont.; Peel Public Health (de Villa), Mississauga, Ont
| | - Dipika Desai
- Affiliations: Departments of Medicine (Anand, Teo, Zulyniak, Gerstein), Health Research Methods, Evidence and Impact(Shaikh, de Souza, Beyene), Pediatrics(Wahi, Morrison) and Obstetrics and Gynecology(McDonald), McMaster University; Population Health Research Institute (Anand, Teo); Hamilton Health Sciences (Anand, Teo, Schulze, Desai, Abdalla), Hamilton, Ont.; Canadian Cardiovascular Research Network (Gupta), Brampton, Ont.; Peel Public Health (de Villa), Mississauga, Ont
| | - Nora Abdalla
- Affiliations: Departments of Medicine (Anand, Teo, Zulyniak, Gerstein), Health Research Methods, Evidence and Impact(Shaikh, de Souza, Beyene), Pediatrics(Wahi, Morrison) and Obstetrics and Gynecology(McDonald), McMaster University; Population Health Research Institute (Anand, Teo); Hamilton Health Sciences (Anand, Teo, Schulze, Desai, Abdalla), Hamilton, Ont.; Canadian Cardiovascular Research Network (Gupta), Brampton, Ont.; Peel Public Health (de Villa), Mississauga, Ont
| | - Michael Zulyniak
- Affiliations: Departments of Medicine (Anand, Teo, Zulyniak, Gerstein), Health Research Methods, Evidence and Impact(Shaikh, de Souza, Beyene), Pediatrics(Wahi, Morrison) and Obstetrics and Gynecology(McDonald), McMaster University; Population Health Research Institute (Anand, Teo); Hamilton Health Sciences (Anand, Teo, Schulze, Desai, Abdalla), Hamilton, Ont.; Canadian Cardiovascular Research Network (Gupta), Brampton, Ont.; Peel Public Health (de Villa), Mississauga, Ont
| | - Russell de Souza
- Affiliations: Departments of Medicine (Anand, Teo, Zulyniak, Gerstein), Health Research Methods, Evidence and Impact(Shaikh, de Souza, Beyene), Pediatrics(Wahi, Morrison) and Obstetrics and Gynecology(McDonald), McMaster University; Population Health Research Institute (Anand, Teo); Hamilton Health Sciences (Anand, Teo, Schulze, Desai, Abdalla), Hamilton, Ont.; Canadian Cardiovascular Research Network (Gupta), Brampton, Ont.; Peel Public Health (de Villa), Mississauga, Ont
| | - Gita Wahi
- Affiliations: Departments of Medicine (Anand, Teo, Zulyniak, Gerstein), Health Research Methods, Evidence and Impact(Shaikh, de Souza, Beyene), Pediatrics(Wahi, Morrison) and Obstetrics and Gynecology(McDonald), McMaster University; Population Health Research Institute (Anand, Teo); Hamilton Health Sciences (Anand, Teo, Schulze, Desai, Abdalla), Hamilton, Ont.; Canadian Cardiovascular Research Network (Gupta), Brampton, Ont.; Peel Public Health (de Villa), Mississauga, Ont
| | - Mateen Shaikh
- Affiliations: Departments of Medicine (Anand, Teo, Zulyniak, Gerstein), Health Research Methods, Evidence and Impact(Shaikh, de Souza, Beyene), Pediatrics(Wahi, Morrison) and Obstetrics and Gynecology(McDonald), McMaster University; Population Health Research Institute (Anand, Teo); Hamilton Health Sciences (Anand, Teo, Schulze, Desai, Abdalla), Hamilton, Ont.; Canadian Cardiovascular Research Network (Gupta), Brampton, Ont.; Peel Public Health (de Villa), Mississauga, Ont
| | - Joseph Beyene
- Affiliations: Departments of Medicine (Anand, Teo, Zulyniak, Gerstein), Health Research Methods, Evidence and Impact(Shaikh, de Souza, Beyene), Pediatrics(Wahi, Morrison) and Obstetrics and Gynecology(McDonald), McMaster University; Population Health Research Institute (Anand, Teo); Hamilton Health Sciences (Anand, Teo, Schulze, Desai, Abdalla), Hamilton, Ont.; Canadian Cardiovascular Research Network (Gupta), Brampton, Ont.; Peel Public Health (de Villa), Mississauga, Ont
| | - Eileen de Villa
- Affiliations: Departments of Medicine (Anand, Teo, Zulyniak, Gerstein), Health Research Methods, Evidence and Impact(Shaikh, de Souza, Beyene), Pediatrics(Wahi, Morrison) and Obstetrics and Gynecology(McDonald), McMaster University; Population Health Research Institute (Anand, Teo); Hamilton Health Sciences (Anand, Teo, Schulze, Desai, Abdalla), Hamilton, Ont.; Canadian Cardiovascular Research Network (Gupta), Brampton, Ont.; Peel Public Health (de Villa), Mississauga, Ont
| | - Katherine Morrison
- Affiliations: Departments of Medicine (Anand, Teo, Zulyniak, Gerstein), Health Research Methods, Evidence and Impact(Shaikh, de Souza, Beyene), Pediatrics(Wahi, Morrison) and Obstetrics and Gynecology(McDonald), McMaster University; Population Health Research Institute (Anand, Teo); Hamilton Health Sciences (Anand, Teo, Schulze, Desai, Abdalla), Hamilton, Ont.; Canadian Cardiovascular Research Network (Gupta), Brampton, Ont.; Peel Public Health (de Villa), Mississauga, Ont
| | - Sarah D McDonald
- Affiliations: Departments of Medicine (Anand, Teo, Zulyniak, Gerstein), Health Research Methods, Evidence and Impact(Shaikh, de Souza, Beyene), Pediatrics(Wahi, Morrison) and Obstetrics and Gynecology(McDonald), McMaster University; Population Health Research Institute (Anand, Teo); Hamilton Health Sciences (Anand, Teo, Schulze, Desai, Abdalla), Hamilton, Ont.; Canadian Cardiovascular Research Network (Gupta), Brampton, Ont.; Peel Public Health (de Villa), Mississauga, Ont
| | - Hertzel Gerstein
- Affiliations: Departments of Medicine (Anand, Teo, Zulyniak, Gerstein), Health Research Methods, Evidence and Impact(Shaikh, de Souza, Beyene), Pediatrics(Wahi, Morrison) and Obstetrics and Gynecology(McDonald), McMaster University; Population Health Research Institute (Anand, Teo); Hamilton Health Sciences (Anand, Teo, Schulze, Desai, Abdalla), Hamilton, Ont.; Canadian Cardiovascular Research Network (Gupta), Brampton, Ont.; Peel Public Health (de Villa), Mississauga, Ont
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Gupta SS, Aroni R, Teede H. Experiences and Perceptions of Physical Activity Among South Asian and Anglo-Australians With Type 2 Diabetes or Cardiovascular Disease: Implications for Clinical Practice. QUALITATIVE HEALTH RESEARCH 2017; 27:391-405. [PMID: 27469974 DOI: 10.1177/1049732316660690] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Research indicates that there are worryingly low levels of physical activity among South Asians compared with Anglo-Australians with type 2 diabetes and/or cardiovascular disease (CVD). We compared perceptions, barriers, and enablers of physical activity in these groups. We used a qualitative design, conducting in-depth, semistructured iterative interviews in Victoria with 57 South Asian and Anglo-Australian participants with either type 2 diabetes or CVD. While both groups exhibited knowledge of the value of physical activity in health maintenance and disease management, they wished for more specific and culturally tailored advice from clinicians about the type, duration, and intensity of physical activity required. Physical activity identities were tied to ethnic identities, with members of each group aspiring to meet the norms of their culture regarding engagement with physical activity as specific exercise or as incidental exercise. Individual personal exercise was deemed important by Anglo-Australians whereas South Asians preferred family-based physical activity.
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Affiliation(s)
- Sabrina S Gupta
- 1 School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- 2 School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Rosalie Aroni
- 1 School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- 3 School of Medicine, Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Australia
| | - Helena Teede
- 4 Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- 5 Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia
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Patel RM, Misra R, Raj S, Balasubramanyam A. Effectiveness of a Group-Based Culturally Tailored Lifestyle Intervention Program on Changes in Risk Factors for Type 2 Diabetes among Asian Indians in the United States. J Diabetes Res 2017; 2017:2751980. [PMID: 28168201 PMCID: PMC5266805 DOI: 10.1155/2017/2751980] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 11/15/2016] [Accepted: 11/22/2016] [Indexed: 01/24/2023] Open
Abstract
This study used an experimental, pretest-posttest control group repeated measures design to evaluate the effectiveness of a community-based culturally appropriate lifestyle intervention program to reduce the risk for type 2 diabetes (T2DM) among Gujarati Asian Indians (AIs) in an urban community in the US. Participants included 70 adult AIs in the greater Houston metropolitan area. The primary outcomes were reduction in weight and hemoglobin A1c (HbA1c) and improvement in physical activity. Participants were screened for risk factors and randomly assigned to a 12-week group-based lifestyle intervention program (n = 34) or a control group (n = 36) that received standard print material on diabetes prevention. Participants also completed clinical measures and self-reported questionnaires about physical activity, social, and lifestyle habits at 0, 3, and 6 months. No significant baseline differences were noted between groups. While a significant decline in weight and increase in physical activity was observed in all participants, the intervention group lowered their HbA1c (p < 0.0005) and waist circumference (p = 0.04) significantly as compared to the control group. Findings demonstrated that participation in a culturally tailored, lifestyle intervention program in a community setting can effectively reduce weight, waist circumference, and HbA1c among Gujarati AIs living in the US.
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Affiliation(s)
- Rupal M. Patel
- School of Physical Therapy, Texas Woman's University, 6700 Fannin Street, Houston, TX 77030, USA
| | - Ranjita Misra
- Department of Social & Behavioral Sciences, Room No. 3313A, Robert C Byrd Health Science Center, School of Public Health, West Virginia University, Morgantown, WV 26506-9190, USA
| | - Sudha Raj
- Department of Public Health, Food Studies and Nutrition, The David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, USA
| | - Ashok Balasubramanyam
- Department of Medicine, Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX, USA
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The association of duration of residence in the United States with cardiovascular disease risk factors among South Asian immigrants. J Immigr Minor Health 2016; 17:781-90. [PMID: 24380928 DOI: 10.1007/s10903-013-9973-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
South Asians are disproportionately impacted by cardiovascular disease (CVD). Our objective was to examine the association between duration of residence in the US and CVD risk factors among South Asian adult immigrants. Multivariate logistic regression analyses using pooled data from the 2005, 2007, 2009 California Health Interview Surveys. Duration of residence in the US < 15 years was significantly associated with overweight/obese BMI (OR 0.59; 95% CI 0.35, 0.98 for 5 to < 10 years), daily consumption of 5+ servings of fruits/vegetables (OR 0.37; 95% CI 0.15, 0.94 for 10 to < 15 years), and sedentary lifestyle (OR 2.11; 95% CI 1.17, 3.81 for 10 to < 15 years) compared with duration of residence ≥ 15 years after adjusting for illness burden, healthcare access, and socio-demographic characteristics. Duration of residence was not significantly associated with other CVD risk factors. Duration of residence is an important correlate of overweight/obesity and other risk factors among South Asian immigrants.
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Kraker J, Viswanathan SK, Knöll R, Sadayappan S. Recent Advances in the Molecular Genetics of Familial Hypertrophic Cardiomyopathy in South Asian Descendants. Front Physiol 2016; 7:499. [PMID: 27840609 PMCID: PMC5083855 DOI: 10.3389/fphys.2016.00499] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/12/2016] [Indexed: 12/14/2022] Open
Abstract
The South Asian population, numbered at 1.8 billion, is estimated to comprise around 20% of the global population and 1% of the American population, and has one of the highest rates of cardiovascular disease. While South Asians show increased classical risk factors for developing heart failure, the role of population-specific genetic risk factors has not yet been examined for this group. Hypertrophic cardiomyopathy (HCM) is one of the major cardiac genetic disorders among South Asians, leading to contractile dysfunction, heart failure, and sudden cardiac death. This disease displays autosomal dominant inheritance, and it is associated with a large number of variants in both sarcomeric and non-sarcomeric proteins. The South Asians, a population with large ethnic diversity, potentially carries region-specific polymorphisms. There is high variability in disease penetrance and phenotypic expression of variants associated with HCM. Thus, extensive studies are required to decipher pathogenicity and the physiological mechanisms of these variants, as well as the contribution of modifier genes and environmental factors to disease phenotypes. Conducting genotype-phenotype correlation studies will lead to improved understanding of HCM and, consequently, improved treatment options for this high-risk population. The objective of this review is to report the history of cardiovascular disease and HCM in South Asians, present previously published pathogenic variants, and introduce current efforts to study HCM using induced pluripotent stem cell-derived cardiomyocytes, next-generation sequencing, and gene editing technologies. The authors ultimately hope that this review will stimulate further research, drive novel discoveries, and contribute to the development of personalized medicine with the aim of expanding therapeutic strategies for HCM.
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Affiliation(s)
- Jessica Kraker
- Department of Internal Medicine, Heart, Lung and Vascular Institute, Division of Cardiovascular Health and Sciences, University of Cincinnati College of Medicine Cincinnati, OH, USA
| | - Shiv Kumar Viswanathan
- Department of Internal Medicine, Heart, Lung and Vascular Institute, Division of Cardiovascular Health and Sciences, University of Cincinnati College of Medicine Cincinnati, OH, USA
| | - Ralph Knöll
- AstraZeneca R&D Mölndal, Innovative Medicines and Early Development, Cardiovascular and Metabolic Diseases iMedMölndal, Sweden; Integrated Cardio Metabolic Centre, Karolinska Institutet, Myocardial Genetics, Karolinska University Hospital in HuddingeHuddinge, Sweden
| | - Sakthivel Sadayappan
- Department of Internal Medicine, Heart, Lung and Vascular Institute, Division of Cardiovascular Health and Sciences, University of Cincinnati College of Medicine Cincinnati, OH, USA
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Riley L, Mili S, Trinh-Shevrin C, Islam N. Using Qualitative Methods to Understand Physical Activity and Weight Management Among Bangladeshis in New York City, 2013. Prev Chronic Dis 2016; 13:E87. [PMID: 27390073 PMCID: PMC4951079 DOI: 10.5888/pcd13.160077] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION South Asians experience high rates of cardiovascular disease and type 2 diabetes, coupled with low rates of reported physical activity. We report findings from a qualitative sub-study that was conducted in 2013 among Bangladeshi immigrants in New York City to understand factors that affect physical activity practices and weight management in this community. METHODS Qualitative study participants were recruited from community-based settings. Sex-specific focus groups were conducted by trained community health workers. Proceedings were audio-recorded for translation and transcription and coded using a constant comparative approach. Data were coded using Atlas.ti software. RESULTS Six focus groups were completed with a final sample of 67 participants (63% male, 37% female). Mean participant age was 42 years; mean years of residence in the United States was 12. Key themes that emerged were beliefs about modesty and sex-separated facilities that may prevent women from engaging in physical activity. Distinctions were made between men and women about what constitutes exercise versus physical activity; religious prayer was considered to be health-promoting because of the movement involved. Other important themes that emerged were cultural dietary practices and evolving conceptions of healthy weight. CONCLUSION Tailored interventions that take into account the cultural context of this growing community are needed. Findings may also provide insight into barriers to health promotion experienced by other US Muslim communities, which are growing rapidly.
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Affiliation(s)
| | - Saima Mili
- New York University, School of Medicine, Department of Population Health, New York, New York
| | - Chau Trinh-Shevrin
- New York University, School of Medicine, Department of Population Health, New York, New York
| | - Nadia Islam
- New York University, School of Medicine, Department of Population Health, 227 East 30th St, 8F, New York, NY 10016.
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Giebel C, Challis D, Worden A, Jolley D, Bhui KS, Lambat A, Purandare N. Perceptions of self-defined memory problems vary in south Asian minority older people who consult a GP and those who do not: a mixed-method pilot study. Int J Geriatr Psychiatry 2016. [PMID: 26217913 DOI: 10.1002/gps.4337] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE South Asian older adults access services for mental health problems and dementia less than other older people in the UK, unlike for physical health problems. This pilot study investigated how South Asians with self-defined memory problems, with and without GP consultation, construe the symptoms, causes, consequences and treatment of the condition. METHODS Participants were recruited through community centres, their networks and memory clinics in Greater Manchester. The newly developed Barts Explanatory Model Inventory for Dementia (BEMI-D) was administered to 33 (18 M, 15 F) older South Asians aged 65 or above with memory problems in English, Gujarati or Urdu. Furthermore, cognition, executive function and depression were assessed. RESULTS Perceptions of dementia varied by GP consultation for memory problems. A greater proportion of older adults without a consultation considered memory problems to be given by God, saw acceptance of fate as an alternative treatment and did not identify medical support as appropriate. Forgetfulness and loss of social meaning were identified as symptoms of dementia more by those with a consultation. Higher levels of diabetes, heart disease and depression were found in those without a consultation. CONCLUSIONS Differences in perceptions may influence the decision about consulting a GP. Similarly, consultation for memory problems appears linked to extent physical health problems and mental health consultation (depression). These variations reported on a small scale in this pilot study suggest the need to explore the impact of perceptions on rates of GP consultation, so as to improve timely diagnosis and access to appropriate services.
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Affiliation(s)
- Clarissa Giebel
- Personal Social Services Research Unit, The University of Manchester, UK
| | - David Challis
- Personal Social Services Research Unit, The University of Manchester, UK.,Manchester Mental Health and Social Care Trust, UK
| | - Angela Worden
- Personal Social Services Research Unit, The University of Manchester, UK
| | - David Jolley
- Personal Social Services Research Unit, The University of Manchester, UK
| | - Kamaldeep Singh Bhui
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | | | - Nitin Purandare
- University of Exeter, UK.,Manchester Mental Health and Social Care Trust, UK
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Malik MO, Govan L, Petrie JR, Ghouri N, Leese G, Fischbacher C, Colhoun H, Philip S, Wild S, McCrimmon R, Sattar N, Lindsay RS. Ethnicity and risk of cardiovascular disease (CVD): 4.8 year follow-up of patients with type 2 diabetes living in Scotland. Diabetologia 2015; 58:716-25. [PMID: 25669630 DOI: 10.1007/s00125-015-3492-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 12/22/2014] [Indexed: 12/18/2022]
Abstract
AIMS/HYPOTHESIS Potential differences in cardiovascular risk by ethnicity remain uncertain. We evaluated the association of ethnicity with cardiovascular disease (CVD) incidence in a large cohort of people with type 2 diabetes living in Scotland. METHODS Data from Scottish Care Information-Diabetes (SCI-Diabetes) were linked to Scottish Morbidity Records (SMR01) and National Records of Scotland data for mortality for dates between 2005 and 2011. Of 156,991 people with type 2 diabetes with coded ethnicity, 121,535 (77.4%) had no CVD at baseline (White: 114,461; Multiple Ethnic: 2,554; Indian: 797; Other Asian: 319; Pakistani: 2,250; Chinese: 387; African-Caribbean: 301 and Other: 466) and were followed up (mean ± SD: 4.8 ± 2.3 years) for the development of fatal and non-fatal CVD. RESULTS During follow-up, 16,265 (13.4%) patients developed CVD (ischaemic heart or cerebrovascular diseases). At baseline, Pakistanis were younger and had developed diabetes earlier, had higher HbA1c and longer duration of diabetes, but had lower BP, BMI, creatinine, proportion of smokers and proportion on antihypertensive therapy than whites. The age and sex adjusted HRs for CVD were HR 1.31 (CI 1.17, 1.47), p < 0.001 in Pakistanis and HR 0.66 (CI 0.47, 0.92), p = 0.014 in Chinese compared with whites. Adjusting additionally for an area measure of deprivation, duration of diabetes, conventional CVD and other risk factors, the HR for Pakistanis (HR 1.45 [CI 1.14, 1.85], p = 0.002) was significantly higher, and that for Chinese (HR = 0.58 [CI 0.24, 1.40], p = 0.228) lower, compared with whites. CONCLUSIONS/INTERPRETATION Compared with whites with type 2 diabetes, those of Pakistani ethnicity in Scotland were at increased risk of CVD, whereas Chinese were at lower risk, with these differences unexplained by known risk factors.
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Affiliation(s)
- Muhammad Omar Malik
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow, Cardiovascular Research Centre, University of Glasgow, 126 University Place, G12 8TA, Glasgow, UK
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Abstract
The rising prevalence of diabetes in South Asians has significant health and economic implications. South Asians are predisposed to the development of diabetes due to biologic causes which are exacerbated by lifestyle and environmental factors. Furthermore, they experience significant morbidity and mortality from complications of diabetes, most notably coronary artery disease, cerebrovascular disease, and chronic kidney disease. Therefore, understanding the pathophysiology and genetics of diabetes risk factors and its associated complications in South Asians is paramount to curbing the diabetes epidemic. With this understanding, the appropriate screening, preventative and therapeutic strategies can be implemented and further developed. In this review, we discuss in detail the biologic and lifestyle factors that predispose South Asians to diabetes and review the epidemiology and pathophysiology of microvascular and macrovascular complications of diabetes in South Asians. We also review the ongoing and completed diabetes prevention and management studies in South Asians.
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Misra A, Ramchandran A, Jayawardena R, Shrivastava U, Snehalatha C. Diabetes in South Asians. Diabet Med 2014; 31:1153-62. [PMID: 24975549 DOI: 10.1111/dme.12540] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 04/24/2014] [Accepted: 06/25/2014] [Indexed: 12/23/2022]
Abstract
Economic, dietary and other lifestyle transitions have been occurring rapidly in most South Asian countries, making their populations more vulnerable to developing Type 2 diabetes and cardiovascular diseases. Recent data show an increasing prevalence of Type 2 diabetes in urban areas as well as in semi-urban and rural areas, inclusive of people belonging to middle and low socio-economic strata. Prime determinants for Type 2 diabetes in South Asians include physical inactivity, imbalanced diets, abdominal obesity, excess hepatic fat and, possibly, adverse perinatal and early life nutrition and intra-country migration. It is reported that Type 2 diabetes affects South Asians a decade earlier and some complications, for example nephropathy, are more prevalent and progressive than in other races. Further, prevalence of pre-diabetes is high, and so is conversion to diabetes, while more than 50% of those who are affected remain undiagnosed. Attitudes, cultural differences and religious and social beliefs pose barriers in effective prevention and management of Type 2 diabetes in South Asians. Inadequate resources, insufficient healthcare budgets, lack of medical reimbursement and socio-economic factors contribute to the cost of diabetes management. The challenge is to develop new translational strategies, which are pragmatic, cost-effective and scalable and can be adopted by the South Asian countries with limited resources. The key areas that need focus are: generation of awareness, prioritizing health care for vulnerable subgroups (children, women, pregnant women and the underprivileged), screening of high-risk groups, maximum coverage of the population with essential medicines, and strengthening primary care. An effective national diabetes control programme in each South Asian country should be formulated, with these issues in mind.
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Affiliation(s)
- A Misra
- Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India; Diabetes Foundation (India), New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India
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Elkum N, Al-Arouj M, Sharifi M, Behbehani K, Bennakhi A. Cardiovascular disease risk factors in the South Asian population living in Kuwait: a cross-sectional study. Diabet Med 2014; 31:531-9. [PMID: 24344774 DOI: 10.1111/dme.12386] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 09/24/2013] [Accepted: 10/22/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND High rates of diabetes and cardiovascular disease have been reported in South Asian immigrants in many countries. However, the prevalence and characteristics of cardiovascular disease risk factors among a South Asian population living in Kuwait have not yet been investigated. This study was therefore designed to estimate the prevalence of cardiovascular disease risk factors and determine whether they are independently associated with diabetes in such a population. METHODS A population-based cross-sectional study was conducted on 1094 South Asians (781 men and 313 women), mainly Indian and Pakistani (≥ 18 years of age), of whom 75.1% were Indians. Interviews were carried out, during which socio-demographic and anthropometric data were collected, followed by a physical examination and collection of fasting blood samples for laboratory investigations. Diabetes was defined by fasting plasma glucose ≥ 7 mmol/l, or being on treatment, and/or self-reported previously diagnosed Type 2 diabetes. RESULTS The prevalence of diabetes was 21.1%, with 3.4% of that percentage of people being newly diagnosed. Using BMI measurements, 24.0% of those who participated in the study were obese and 46.1% were overweight. Dyslipidaemia was found in 77.6% and hypertension in 44.8%. Advancing age (≥ 40 years), male gender, high LDL, high total cholesterol, hypertension and positive family history of diabetes were significantly associated with increased risk of diabetes. CONCLUSION Our study shows that the prevalence of cardiovascular disease risk factors in South Asian expatriates in Kuwait exceeds prevalence rates reported in their homeland and other countries. This may suggest the added stress of environmental factors on the development of cardiovascular disease risk factors in such populations. Specialized prevention programmes targeting such high-risk ethnic populations are paramount and need to be implemented.
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Affiliation(s)
- N Elkum
- Dasman Diabetes Institute, Kuwait City, Kuwait
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28
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The effect of migration on hypertension and other cardiovascular risk factors: A review. ACTA ACUST UNITED AC 2014; 8:171-91. [DOI: 10.1016/j.jash.2013.12.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 12/27/2013] [Accepted: 12/30/2013] [Indexed: 11/24/2022]
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Phan TP, Alkema L, Tai ES, Tan KHX, Yang Q, Lim WY, Teo YY, Cheng CY, Wang X, Wong TY, Chia KS, Cook AR. Forecasting the burden of type 2 diabetes in Singapore using a demographic epidemiological model of Singapore. BMJ Open Diabetes Res Care 2014; 2:e000012. [PMID: 25452860 PMCID: PMC4212579 DOI: 10.1136/bmjdrc-2013-000012] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 05/20/2014] [Accepted: 05/24/2014] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Singapore is a microcosm of Asia as a whole, and its rapidly ageing, increasingly sedentary population heralds the chronic health problems other Asian countries are starting to face and will likely face in the decades ahead. Forecasting the changing burden of chronic diseases such as type 2 diabetes in Singapore is vital to plan the resources needed and motivate preventive efforts. METHODS This paper describes an individual-level simulation model that uses evidence synthesis from multiple data streams-national statistics, national health surveys, and four cohort studies, and known risk factors-aging, obesity, ethnicity, and genetics-to forecast the prevalence of type 2 diabetes in Singapore. This comprises submodels for mortality, fertility, migration, body mass index trajectories, genetics, and workforce participation, parameterized using Markov chain Monte Carlo methods, and permits forecasts by ethnicity and employment status. RESULTS We forecast that the obesity prevalence will quadruple from 4.3% in 1990 to 15.9% in 2050, while the prevalence of type 2 diabetes (diagnosed and undiagnosed) among Singapore adults aged 18-69 will double from 7.3% in 1990 to 15% in 2050, that ethnic Indians and Malays will bear a disproportionate burden compared with the Chinese majority, and that the number of patients with diabetes in the workforce will grow markedly. CONCLUSIONS If the recent rise in obesity prevalence continues, the lifetime risk of type 2 diabetes in Singapore will be one in two by 2050 with concomitant implications for greater healthcare expenditure, productivity losses, and the targeting of health promotion programmes.
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Affiliation(s)
- Thao P Phan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Leontine Alkema
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Department of Statistics and Applied Probability, Faculty of Science, National University of Singapore, Singapore
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Division of Endocrinology, National University Hospital and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Kristin H X Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Qian Yang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Wei-Yen Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Ministry of Health, Singapore
| | - Yik Ying Teo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Department of Statistics and Applied Probability, Faculty of Science, National University of Singapore, Singapore
- Life Sciences Institute, National University of Singapore, Singapore
| | - Ching-Yu Cheng
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Singapore Eye Research Institute, Singapore
- Center for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore
| | - Xu Wang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Tien Yin Wong
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Singapore Eye Research Institute, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Department of Statistics and Applied Probability, Faculty of Science, National University of Singapore, Singapore
- Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
- Yale-NUS College, Singapore
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Bakker LEH, Sleddering MA, Schoones JW, Meinders AE, Jazet IM. Pathogenesis of type 2 diabetes in South Asians. Eur J Endocrinol 2013; 169:R99-R114. [PMID: 23939919 DOI: 10.1530/eje-13-0307] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The risk of developing type 2 diabetes mellitus (T2DM) is exceptionally high among both native and migrant South Asians. T2DM occurs more often and at a younger age and lower BMI, and the risk of coronary artery and cerebrovascular disease, and renal complications is higher for South Asians compared with people of White Caucasian descent. The high prevalence of T2DM and its related complications in South Asians, which comprise one-fifth of the total world's population, poses a major health and socioeconomic burden. The underlying cause of this excess risk, however, is still not completely understood. Therefore, gaining insight into the pathogenesis of T2DM in South Asians is of great importance. The predominant mechanism, in this ethnicity seems to be insulin resistance (IR) rather than an impaired β-cell function. In this systematic review, we describe several possible mechanisms that may underlie or contribute to the increased IR observed in South Asians.
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Affiliation(s)
- Leontine E H Bakker
- Department of General Internal Medicine and Endocrinology Walaeus Library, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
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Bharmal N, Kaplan RM, Shapiro MF, Kagawa-Singer M, Wong MD, Mangione CM, Divan H, McCarthy WJ. The association of religiosity with overweight/obese body mass index among Asian Indian immigrants in California. Prev Med 2013; 57:315-21. [PMID: 23769898 DOI: 10.1016/j.ypmed.2013.06.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 05/31/2013] [Accepted: 06/02/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The aim of this study was to examine the association between religiosity and overweight or obese body mass index among a multi-religious group of Asian Indian immigrants residing in California. METHODS We examined cross-sectional survey data obtained from in-language telephone interviews with 3228 mostly immigrant Asian Indians in the 2004 California Asian Indian Tobacco Survey using multivariate logistic regression. RESULTS High self-identified religiosity was significantly associated with higher BMI after adjusting for socio-demographic and acculturation measures. Highly religious Asian Indians had 1.53 greater odds (95% CI: 1.18, 2.00) of being overweight or obese than low religiosity immigrants, though this varied by religious affiliation. Religiosity was associated with greater odds of being overweight/obese for Hindus (OR 1.54; 95% CI: 1.08, 2.22) and Sikhs (OR 1.88; 95% CI: 1.07, 3.30), but not for Muslims (OR 0.69; 95% CI: 0.28, 1.70). CONCLUSIONS Religiosity in Hindus and Sikhs, but not immigrant Muslims, appears to be independently associated with greater body mass index among Asian Indians. If this finding is confirmed, future research should identify potentially mutable mechanisms by which religion-specific religiosity affects overweight/obesity risk.
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Affiliation(s)
- Nazleen Bharmal
- Department of Medicine, General Internal Medicine & Health Services Research, University of California, Los Angeles, CA, USA.
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Mukherjea A, Modayil MV. Culturally Specific Tobacco Use and South Asians in the United States. Health Promot Pract 2013; 14:48S-60S. [DOI: 10.1177/1524839913485585] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the past two decades, the United States has attracted large South Asian populations, who have imported tobacco products previously unique to the native subcontinent. South Asian cigarette use prevalence is consistently lower than other U.S. Asian subgroups; however, most surveys fail to capture smokeless products accurately. In part because of the pervasive use of popular smokeless cultural products resulting in greater population attributable risk of oral malignancies, many countries outside the United States have developed surveillance systems to capture these products and implemented effective population-level or community-based intervention strategies. This minority population in the United States continues to be “at risk” of suffering from a disproportionate burden of diseases, which are plausibly linked to the use of these products. The primary focus of this article is to provide an exhaustive literature review of tobacco use patterns and existing tobacco control strategies among South Asians in the United States. Framed within the social ecological model, the article suggests that there needs to be more detailed assessment of cultural tobacco products, a concurrent increase in cultural competencies of health care providers and provision of cessation resources outside the clinical setting. At the policy level, future efforts should adequately regulate these products and oversight must include such products in efforts to reduce rates of use. Concurrently, community-based efforts are needed to change social norms related to perceived health benefit and lack of stigma. This will help ensure that appropriately framed messages around use rates and burden of disease are addressed through culturally valued institutions and leaders.
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Affiliation(s)
| | - Mary V. Modayil
- California Tobacco Control Program, California Department of Public Health, Sacramento, CA, USA
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Patel VV, Rajpathak S, Karasz A. Bangladeshi immigrants in New York City: a community based health needs assessment of a hard to reach population. J Immigr Minor Health 2013; 14:767-73. [PMID: 22116745 DOI: 10.1007/s10903-011-9555-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
South Asians, particularly Bangladeshis, are one of the fastest growing immigrant groups in the U.S. Limited data exist regarding the health needs of Bangladeshis in the U.S. More data are needed to guide health intervention efforts for this community. To help address this gap, we conducted a community-based health needs assessment survey among women in a Bangladeshi population living in Bronx, NY. Community health promoters conducted a door-to-door household survey and collected data from 167 women, an approach that yielded a participation rate over 90%. Over half reported fair or poor health and 36.5% screened positive for risk of depression. Only 35% had engaged in physical activity over the past month. 60% reported never having received a pap smear. Using WHO guidelines for BMI, 74% were either overweight or obese. Age-standardized prevalence of type 2 diabetes and hypertension were 15.4 and 36.5% respectively. In a multivariable logistic regression model, age and percent lifetime in the U.S. were independently associated with having diabetes. Poor health behaviors and high prevalence of cardiovascular risk factors observed in this group suggest the need for early health promotion and prevention interventions.
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Affiliation(s)
- Viraj V Patel
- Department of Family Medicine, North Bronx Health Network, Bronx, NY, USA.
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Babakus WS, Thompson JL. Physical activity among South Asian women: a systematic, mixed-methods review. Int J Behav Nutr Phys Act 2012; 9:150. [PMID: 23256686 PMCID: PMC3542106 DOI: 10.1186/1479-5868-9-150] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 12/06/2012] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION The objective of this systematic mixed-methods review is to assess what is currently known about the levels of physical activity (PA) and sedentary time (ST) and to contextualize these behaviors among South Asian women with an immigrant background. METHODS A systematic search of the literature was conducted using combinations of the key words PA, ST, South Asian, and immigrant. A mixed-methods approach was used to analyze and synthesize all evidence, both quantitative and qualitative. Twenty-six quantitative and twelve qualitative studies were identified as meeting the inclusion criteria. RESULTS Studies quantifying PA and ST among South Asian women showed low levels of PA compared with South Asian men and with white European comparison populations. However making valid comparisons between studies was challenging due to a lack of standardized PA measurement. The majority of studies indicated that South Asian women did not meet recommended amounts of PA for health benefits. Few studies assessed ST. Themes emerging from qualitative studies included cultural and structural barriers to PA, faith and education as facilitators, and a lack of understanding of the recommended amounts of PA and its benefits among South Asian women. CONCLUSIONS Quantitative and qualitative evidence indicate that South Asian women do not perform the recommended level of PA for health benefits. Both types of studies suffer from limitations due to methods of data collection. More research should be dedicated to standardizing objective PA measurement and to understanding how to utilize the resources of the individuals and communities to increase PA levels and overall health of South Asian women.
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Affiliation(s)
- Whitney S Babakus
- School of Sport and Exercise Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Janice L Thompson
- School of Sport and Exercise Sciences, University of Birmingham, Birmingham, B15 2TT, UK
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Jain A, Mitchell S, Chirumamilla R, Zhang J, Horn IB, Lewin A, Huang ZJ. Prevalence of obesity among young Asian-American children. Child Obes 2012. [PMID: 23181917 DOI: 10.1089/chi.2011.0077] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Asian-American children are considered to be at low risk of obesity, but previous estimates have not distinguished between children from different Asian countries. We estimate the prevalence of obesity among Asian-American children by mother's country of origin, generational status, and family socioeconomic factors using a secondary analysis of the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) wave III (children ∼4 years old) dataset. METHODS The ECLS-B is a nationally representative study of children born in 2001 that oversampled births to Asian mothers. Asian ethnic categories included Chinese, Japanese, Filipino, Asian Indian, Korean, Vietnamese, and Other Asian/Pacific Islander. The primary outcome variable was weight status; overweight = BMI ≥85(th) and obese = BMI ≥95(th) percentile for age and gender. RESULTS Twenty-six percent [95% confidence interval (CI) 23.6-29.1] of Asian-American 4 year olds were overweight or obese, and 13% (95% CI 10.2-15.2) were obese. Chinese-American children were at lower risk of overweight or obesity (23.5%, 95% CI 18.4-29.5 ) compared to whites (36%, 95% CI 34.3-37.7); Asian-Indian 4 year olds had the lowest rates of overweight or obesity (15.6%, 95% CI 8.0-28.2) and were most likely to be underweight (10%, 95% CI 4.9-19.4). Among Asians,Vietnamese-American children had the highest rate of overweight or obesity (34.7%, 95% CI 0.6-52.3). CONCLUSIONS Vietnamese-American children are at elevated risk of obesity and overweight, whereas Chinese and Asian-Indian children are at low risk. After controlling for Asian ethnicity, maternal education, and household poverty status, Asian-American children whose mothers were born outside the United States were less likely to be obese [odds ratio = 0.55 (0.32-0.95), p = 0.03].
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Affiliation(s)
- Anjali Jain
- Lewin Group, 3130 Fairview Park Drive, Falls Church, VA 22042, USA.
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Garduño-Diaz SD, Khokhar S. Prevalence, risk factors and complications associated with type 2 diabetes in migrant South Asians. Diabetes Metab Res Rev 2012; 28:6-24. [PMID: 21591242 DOI: 10.1002/dmrr.1219] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
It is estimated that type 2 diabetes (T2D) currently affects about 246 million people worldwide, with South Asians, especially Indians, having both the largest number of cases and the fastest growing prevalence. South Asian ethnicity has been identified as a major risk factor for the development of T2D with central adiposity, insulin resistance and an unfavourable lipid profile being identified as predominant signals of alarm. Leading databases, including Web of Science, Medline, PubMed and Science Direct, were consulted and manual searches were conducted for cited references in leading diabetes-related journals. In all, 152 articles were included for the final assessment reported in this review. Genetic predisposition, central adiposity and unfavourable lifestyle, including physical inactivity and an unhealthy diet, were associated with the prevalence of T2D in migrant South Asians. 'Westernization', acculturation, socio-economic factors and lack of knowledge about the disease have also been identified as contributors to the development of T2D in this population. Higher prevalence of T2D in migrant South Asians may not be entirely attributed to genetic predisposition; hence, ethnicity and associated modifiable risk factors need further investigation. Preventive measures and appropriate interventions are currently limited by the lack of ethnic-specific cut-off points for anthropometric and biological markers, as well as by the absence of reliable methods for dietary and physical activity assessment. This article describes the prevalence rate, risk factors and complications associated with T2D in migrant South Asians living in different countries.
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Pollard TM. Ethnic Groups as Migrant Groups: Improving Understanding of Links Between Ethnicity/Race and Risk of Type 2 Diabetes and Associated Conditions. ANNUAL REVIEW OF ANTHROPOLOGY 2011. [DOI: 10.1146/annurev-anthro-081309-145719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Most members of minority ethnic/racial groups in affluent western societies are recent immigrants or immediate descendants thereof. The health implications of ethnic groups also being migrant groups are important but often not fully explored. Research demonstrating developmental influences on the risk of type 2 diabetes and associated conditions suggests that migrants will differ in disease risk compared with the general population. It also leads us to expect intergenerational differences in disease risk within many minority ethnic/racial groups. Differences in health behaviors between ethnic/racial groups are also expected to change over time following migration, including across generations, but do not necessarily follow a simple model of acculturation. Understanding the ways in which the biosocial heritage of migrant groups interacts over the long term with migrants' new environments is central to understanding differences in disease risk that are identified as ethnic or racial and also highlights heterogeneity in risk within ethnic groups.
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Affiliation(s)
- Tessa M. Pollard
- Department of Anthropology, Durham University, Durham, DH1 3LE, United Kingdom
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Smith AK, Ayanian JZ, Covinsky KE, Landon BE, McCarthy EP, Wee CC, Steinman MA. Conducting high-value secondary dataset analysis: an introductory guide and resources. J Gen Intern Med 2011; 26:920-9. [PMID: 21301985 PMCID: PMC3138974 DOI: 10.1007/s11606-010-1621-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 12/09/2010] [Accepted: 12/17/2010] [Indexed: 11/18/2022]
Abstract
Secondary analyses of large datasets provide a mechanism for researchers to address high impact questions that would otherwise be prohibitively expensive and time-consuming to study. This paper presents a guide to assist investigators interested in conducting secondary data analysis, including advice on the process of successful secondary data analysis as well as a brief summary of high-value datasets and online resources for researchers, including the SGIM dataset compendium ( www.sgim.org/go/datasets ). The same basic research principles that apply to primary data analysis apply to secondary data analysis, including the development of a clear and clinically relevant research question, study sample, appropriate measures, and a thoughtful analytic approach. A real-world case description illustrates key steps: (1) define your research topic and question; (2) select a dataset; (3) get to know your dataset; and (4) structure your analysis and presentation of findings in a way that is clinically meaningful. Secondary dataset analysis is a well-established methodology. Secondary analysis is particularly valuable for junior investigators, who have limited time and resources to demonstrate expertise and productivity.
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Affiliation(s)
- Alexander K Smith
- Department of Medicine, University of California, San Francisco, CA, USA.
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Gupta LS, Wu CC, Young S, Perlman SE. Prevalence of diabetes in New York City, 2002-2008: comparing foreign-born South Asians and other Asians with U.S.-born whites, blacks, and Hispanics. Diabetes Care 2011; 34:1791-3. [PMID: 21715521 PMCID: PMC3142031 DOI: 10.2337/dc11-0088] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To describe diabetes prevalence in New York City by race/ethnicity and nativity. RESEARCH DESIGN AND METHODS Data were from the New York City 2002-2008 Community Health Surveys. Respondents were categorized on the basis of self-reported race/ethnicity and birth country: foreign-born South Asian (Indian subcontinent), foreign-born other Asian, U.S.-born non-Hispanic black, U.S.-born non-Hispanic white, and U.S.-born Hispanic. Diabetes status was defined by self-reported provider diagnosis. Multivariable models examined diabetes prevalence by race/ethnicity and birth country. RESULTS Prevalence among foreign-born South Asians was nearly twice that of foreign-born other Asians (13.6 vs. 7.4%, P = 0.001). In multivariable analyses, normal-BMI foreign-born South Asians had nearly five times the diabetes prevalence of comparable U.S.-born non-Hispanic whites (14.1 vs. 2.9%, P < 0.001) and 2.5 times higher prevalence than foreign-born other Asians (P < 0.001). CONCLUSIONS Evaluating Asians as one group masks the higher diabetes burden among South Asians. Researchers and clinicians should be aware of differences in this population.
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Affiliation(s)
- Leena S Gupta
- New York City Department of Health and Mental Hygiene, New York, NY, USA.
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Misra A, Sharma R, Gulati S, Joshi SR, Sharma V, Ibrahim A, Joshi S, Laxmaiah A, Kurpad A, Raj RK, Mohan V, Chandalia H, Krishnaswamy K, Boindala S, Gopalan S, Bhattiprolu SK, Modi S, Vikram NK, Makkar BM, Mathur M, Dey S, Vasudevan S, Gupta SP, Puri S, Joshi P, Khanna K, Mathur P, Krishnaswamy S, Madan J, Karmarkar M, Seth V, Passi SJ, Chadha D, Bhardwaj S. Consensus dietary guidelines for healthy living and prevention of obesity, the metabolic syndrome, diabetes, and related disorders in Asian Indians. Diabetes Technol Ther 2011; 13:683-94. [PMID: 21488798 DOI: 10.1089/dia.2010.0198] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
India is undergoing rapid nutritional transition, resulting in excess consumption of calories, saturated fats, trans fatty acids, simple sugars, salt and low intake of fiber. Such dietary transition and a sedentary lifestyle have led to an increase in obesity and diet-related non-communicable diseases (type 2 diabetes mellitus [T2DM], cardiovascular disease [CVD], etc.) predominantly in urban, but also in rural areas. In comparison with the previous guidelines, these consensus dietary guidelines include reduction in the intake of carbohydrates, preferential intake of complex carbohydrates and low glycemic index foods, higher intake of fiber, lower intake of saturated fats, optimal ratio of essential fatty acids, reduction in trans fatty acids, slightly higher protein intake, lower intake of salt, and restricted intake of sugar. While these guidelines are applicable to Asian Indians in any geographical setting, they are particularly applicable to those residing in urban and in semi-urban areas. Proper application of these guidelines will help curb the rising "epidemics" of obesity, the metabolic syndrome, hypertension, T2DM, and CVD in Asian Indians.
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Affiliation(s)
- Anoop Misra
- Fortis-CDOC Center of Excellence for Diabetes, Obesity Metabolic Diseases and Endocrinology, Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj, New Delhi 110070, India.
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Tirodkar MA, Baker DW, Makoul GT, Khurana N, Paracha MW, Kandula NR. Explanatory models of health and disease among South Asian immigrants in Chicago. J Immigr Minor Health 2011; 13:385-94. [PMID: 20131000 PMCID: PMC2905487 DOI: 10.1007/s10903-009-9304-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
To identify concepts of health and disease as part of a study on designing culturally-targeted heart disease prevention messages for South Asians. We conducted qualitative, semi-structured interviews in English, Hindi and Urdu with 75 respondents from a federally qualified health center and at a community center for South Asian immigrants in Chicago, Illinois. Age ranged from 20 to 70 years; 60% were women; 60% held advanced degrees; 70% migrated to the US in the last 10 years; and 60% of the interviews were in Hindi or Urdu. Concepts of health and disease fell into four domains: behavioral, physical, psycho-social and spiritual. Muslim participants consistently evoked spiritual factors such as faith and prayer. Women more frequently included performing home duties and positive affect in their concept of health. Men more frequently cited behavioral factors such as smoking and drinking as the cause of disease. Many South Asians have a holistic conceptualization of health and disease, incorporating spiritual, physical and psycho-social factors. Health promotion strategies aimed at South Asians in the US should take into account this holistic model of health and disease, while also recognizing that variations exist within South Asians, by gender and religion.
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Affiliation(s)
- Manasi A Tirodkar
- National Committee for Quality Assurance, Washington, DC 20005, USA.,
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Schooling CM, Hui LL, Ho LM, Lam TH, Leung GM. Cohort profile: 'children of 1997': a Hong Kong Chinese birth cohort. Int J Epidemiol 2011; 41:611-20. [PMID: 21224275 DOI: 10.1093/ije/dyq243] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- C Mary Schooling
- Life Course and Lifestyle Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
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Palaniappan LP, Araneta MRG, Assimes TL, Barrett-Connor EL, Carnethon MR, Criqui MH, Fung GL, Narayan KMV, Patel H, Taylor-Piliae RE, Wilson PWF, Wong ND. Call to action: cardiovascular disease in Asian Americans: a science advisory from the American Heart Association. Circulation 2010; 122:1242-52. [PMID: 20733105 DOI: 10.1161/cir.0b013e3181f22af4] [Citation(s) in RCA: 183] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kanaya AM, Wassel CL, Mathur D, Stewart A, Herrington D, Budoff MJ, Ranpura V, Liu K. Prevalence and correlates of diabetes in South asian indians in the United States: findings from the metabolic syndrome and atherosclerosis in South asians living in america study and the multi-ethnic study of atherosclerosis. Metab Syndr Relat Disord 2010; 8:157-64. [PMID: 19943798 DOI: 10.1089/met.2009.0062] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Individuals from South Asia have high diabetes prevalence despite low body weight. We compared the prevalence of diabetes among South Asian Indians with other U.S. ethnic groups and explored correlates of diabetes. METHODS This was a cross-sectional study of 150 South Asian Indians (ages 45-79) in California, using similar methods to the Multi-Ethnic Study of Atherosclerosis (MESA). Type 2 diabetes was classified by fasting plasma glucose (FPG) >or=126 mg/dL, 2-h postchallenge glucose >or=200 mg/dL, or use of hypoglycemic medication. RESULTS A total of 29% of Asian Indians had diabetes, 37% had prediabetes, and 34% had normal glucose tolerance. After full adjustment for covariates, Indians still had significantly higher odds of diabetes compared to whites and Latinos, but not significantly different from African Americans and Chinese Americans in MESA: Indians [odds ratio (OR), 1.0], whites [OR, 0.29; 95% confidence interval (CI), 0.17-0.49], Latinos (OR, 0.59; CI, 0.34-1.00) African Americans (OR, 0.77; CI 0.45-1.32), Chinese Americans (OR, 0.78, CI, 0.45-1.32). Variables associated with prediabetes or diabetes among Indians included hypertension, fatty liver, visceral adiposity, microalbuminuria, carotid intima media thickness, and stronger traditional Indian beliefs. CONCLUSIONS Indian immigrants may be more likely to have diabetes than other U.S. ethnic groups, and cultural factors may play a role, suggesting that this is a promising area of research.
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Affiliation(s)
- A M Kanaya
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, California 94115, USA.
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Misra A, Khurana L. Obesity-related non-communicable diseases: South Asians vs White Caucasians. Int J Obes (Lond) 2010; 35:167-87. [PMID: 20644557 DOI: 10.1038/ijo.2010.135] [Citation(s) in RCA: 267] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
South Asians are at higher risk than White Caucasians for the development of obesity and obesity-related non-communicable diseases (OR-NCDs), including insulin resistance, the metabolic syndrome, type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD). Rapid nutrition and lifestyle transitions have contributed to acceleration of OR-NCDs in South Asians. Differences in determinants and associated factors for OR-NCDs between South Asians and White Caucasians include body phenotype (high body fat, high truncal, subcutaneous and intra-abdominal fat, and low muscle mass), biochemical parameters (hyperinsulinemia, hyperglycemia, dyslipidemia, hyperleptinemia, low levels of adiponectin and high levels of C-reactive protein), procoagulant state and endothelial dysfunction. Higher prevalence, earlier onset and increased complications of T2DM and CHD are often seen at lower levels of body mass index (BMI) and waist circumference (WC) in South Asians than White Caucasians. In view of these data, lower cut-offs for obesity and abdominal obesity have been advocated for Asian Indians (BMI; overweight >23 to 24.9 kg m(-2) and obesity ≥ 25 kg m(-2); and WC; men ≥ 90 cm and women ≥ 80 cm, respectively). Imbalanced nutrition, physical inactivity, perinatal adverse events and genetic differences are also important contributory factors. Other differences between South Asians and White Caucasians include lower disease awareness and health-seeking behavior, delayed diagnosis due to atypical presentation and language barriers, and religious and sociocultural factors. All these factors result in poorer prevention, less aggressive therapy, poorer response to medical and surgical interventions, and higher morbidity and mortality in the former. Finally, differences in response to pharmacological agents may exist between South Asians and White Caucasians, although these have been inadequately studied. In view of these data, prevention and management strategies should be more aggressive for South Asians for more positive health outcomes. Finally, lower cut-offs of obesity and abdominal obesity for South Asians are expected to help physicians in better and more effective prevention of OR-NCDs.
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Affiliation(s)
- A Misra
- National Diabetes, Obesity, and Cholesterol Disorders Foundation (N-DOC), New Delhi, India.
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Jacob M, Cho L. Asian Americans and cardiometabolic risk why and how to study them. J Am Coll Cardiol 2010; 55:974-5. [PMID: 20202513 DOI: 10.1016/j.jacc.2009.08.086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 08/26/2009] [Indexed: 12/23/2022]
Affiliation(s)
- Miriam Jacob
- Cleveland Clinic, Department of Cardiovascular Medicine, Cleveland, Ohio, USA
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Mishra SK, Sarkar S, Mukhopadhyay S, Mukhopadhyay B. Hypertension and its correlates in two communities of dissimilar genetic ancestry in Sikkim, India. Ann Hum Biol 2009; 37:23-43. [PMID: 19852677 DOI: 10.3109/03014460903213837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Oza-Frank R, Narayan KMV. Overweight and diabetes prevalence among US immigrants. Am J Public Health 2009; 100:661-8. [PMID: 19608956 DOI: 10.2105/ajph.2008.149492] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We estimated the prevalence of overweight and diabetes among US immigrants by region of birth. METHODS We analyzed data on 34 456 US immigrant adults from the National Health Interview Survey, pooling years 1997 to 2005. We estimated age- and gender-adjusted and multivariable-adjusted overweight and diabetes prevalence by region of birth using logistic regression. RESULTS Both men (odds ratio [OR] = 3.3; 95% confidence interval [CI] = 1.9, 5.8) and women (OR = 4.2; 95% CI = 2.3, 7.7) from the Indian subcontinent were more likely than were European migrants to have diabetes without corresponding increased risk of being overweight. Men and women from Mexico, Central America, or the Caribbean were more likely to be overweight (men: OR = 1.5; 95% CI = 1.3, 1.7; women: OR = 2.0; 95% CI = 1.7, 2.2) and to have diabetes (men: OR = 2.0; 95% CI = 1.4, 2.9; women: OR = 2.0; 95% CI = 1.4, 2.8) than were European migrants. CONCLUSIONS Considerable heterogeneity in both prevalence of overweight and diabetes by region of birth highlights the importance of making this distinction among US immigrants to better identify subgroups with higher risks of these conditions.
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Prevalence of diabetes, metabolic syndrome, and cardiovascular risk factors in US Asian Indians: results from a national study. J Diabetes Complications 2009; 24:145-53. [PMID: 19303333 DOI: 10.1016/j.jdiacomp.2009.01.003] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Revised: 11/23/2008] [Accepted: 01/06/2009] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although studies of immigrant Asian Indians in other countries show high rates of diabetes (DM), metabolic syndrome (MetS), and cardiovascular disease (CVD), no randomized, population-based studies of this rapidly growing ethnic group exist in the US. METHODS The sample comprised 1038 randomly selected Asian Indian immigrants, aged 18 years and older at seven US sites. Prevalence of diabetes and MetS (age-adjusted and sex-adjusted means) was estimated and ANOVA was used to calculate gender and group differences (normoglycemia/impaired fasting glucose/diabetes) for CVD risk factors. RESULTS The mean age was 48.2 years. The majority of respondents were male, married, educated, and with some form of health insurance. Prevalence of diabetes was 17.4%, and 33% of the respondents had prediabetes. Cardiovascular risk factors, especially high levels of triglycerides, total cholesterol, LDL cholesterol, homocysteine, and C-reactive protein, and low levels of HDL cholesterol, were also prevalent; elevated lipoprotein(a) was not observed. The age-adjusted prevalence of MetS was 26.9% by the original NCEP/ATP III criteria, 32.7% by the modified NCEP/ATP III criteria, and 38.2% by the IDF criteria. The MetS rates for women, but not for men, increased with age using all three criteria. There was a progressive worsening of all metabolic parameters as individuals progressed from normal to IFG to diabetes. CONCLUSION The prevalence rates of diabetes and MetS among US Asian Indians are higher than reported in earlier, nonrandomized, smaller surveys. These data provide a firm basis for future mechanistic and interventional studies.
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