Risk factors for coronary heart disease in two similar Indian population groups, one residing in India, and the other in Sydney, Australia

Qualitative Insights on the Importance of Sociocultural Contexts on Asian Indian Migrant Participation in Physical Activity and Sedentary Behavior

BACKGROUND

Influences on physical activity and sedentary behavior may differ for migrants moving from their country of origin to a new country. This study aimed to explore the range of contextual factors that influence physical activity and sedentary behavior among Indian migrants, making comparisons with India.

METHODS

Semistructured interviews were conducted with 21 Indian migrants (10 men and 11 women) aged between 18 and 65 years living in Melbourne, Australia. Data were analyzed thematically, coded inductively, and managed with NVivo.

RESULTS

Participants perceived a lack of social connection as a key barrier to physical activity participation. Group-based physical activity fostered social connections. Cultural associations were sites to engage in cultural physical activity and integrate with other Indians. Australia's physical contexts (eg, availability of facilities and built environment) facilitated physical activity behavior. Workplace environments (eg, the nature of the job) prompted sedentary behavior. Other contextual shifts with migration related to activities of daily living (eg, shifts in transport [walking] behavior in India to a greater reliance on cars in Australia) and migrant-friendly health communication (messaging from Australian health/allied health practitioners).

CONCLUSIONS

Sociocultural contexts remain key influences on migrant physical activity participation. Prioritizing integrated approaches and engaging insider codesign are important in tailoring and promoting migrant physical activity and limiting sedentary behavior.

A qualitative exploration of perspectives of physical activity and sedentary behaviour among Indian migrants in Melbourne, Australia: how are they defined and what can we learn?

Background

Although perceptions of what constitutes physical activity (PA) may vary between culturally diverse populations, very little research has explored the perceptions of PA among Indian migrants. This study aimed to identify how PA and sedentary behaviour (SB) are defined and describe how these definitions are shaped by cultural background and migration among a sample of Indian migrants living in Australia.

Methods

Using an exploratory qualitative approach, semi-structured interviews were conducted with twenty-one Indian migrants living in Melbourne (10 men and 11 women; age range: 18 to 65 years). Interviews were audio-recorded and transcribed verbatim. Data were coded and analysed inductively using thematic analyses.

Results

Data revealed two emerging themes: 1) Holistic perspectives related to PA, where although the majority of participants described PA as “any sort of movement”, or “physical exercise”, several of these descriptions had interwoven ideas related to the mind (mind-body connect), social, cultural, and to the outdoor environment; 2) Broader perspectives for SB, where descriptions of SB as “not having movement”, “doing nothing” or “being lazy”, were shaped with ideas of purpose and duration. Women spoke about how their perspectives of PA and SB may be shaped by native Indian experiences, particularly the gender roles, social caste, and regional subcultural norms which they perceived were important to consider among women who migrate to western settings.

Conclusions

Cultural background is important in shaping the perspectives of PA and SB among Indian migrants in Australia. Practitioners and researchers should consider the varying perspectives of PA to communicate and promote PA among migrant populations more effectively.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12099-4.

Cardiometabolic disease in South Asians: A global health concern in an expanding population

Cardiovascular disease (CVD) is one of the main causes of mortality and morbidity worldwide. As an emerging population, South Asians (SAs) bear a disproportionately high burden of CVD relative to underlying classical risk factors, partly attributable to a greater prevalence of insulin resistance and diabetes and distinct genetic and epigenetic influences. While the phenotypic distinctions between SAs and other ethnicities in CVD risk are becoming increasingly clear, the biology of these conditions remains an area of active investigation, with emerging studies involving metabolism, genetic variation and epigenetic modifiers (e.g., extracellular RNA). In this review, we describe the current literature on prevalence, prognosis and CVD risk in SAs, and provide a landscape of translational research in this field toward ameliorating CVD risk in SAs.

The impact of migration on body weight: a review

Immigrants may be more vulnerable to obesity as a result of the immigration process. The aim of this article is to summarize current knowledge about the impact of immigration on body mass index (BMI). A systematic review was performed in accordance with PRISMA guidelines through a database search of scientific articles (last updated in August 2014). Thirty-nine articles were included and assessed. Results varied according to ethnic background, country of origin and host country. A consistent positive association between BMI and time since immigration was found among Hispanic, European and African immigrants. Less than half of the studies observed a positive association among Asian immigrants. The quality of the majority of the studies assessed was poor, reflecting a need to improve methodology and concept definition. Immigration appears to have a deteriorative effect on BMI. Underlying causes may include changes in nutrition and physical activity, psychological and social factors, and genetic susceptibility and these aspects should be included as moderator variables in future studies.

Risk factors for coronary heart disease among Asian Indians living in Australia

The aim of this study was to assess the coronary heart disease risk factors in the Asian Indian community living in a large city in Australia. A cross-sectional survey was conducted at the Australia India Friendship Fair in 2010. All people of Asian Indian descent who attended the Fair and visited the health promotion stall were eligible to participate in the study if they self-identified as of Asian Indian origin, were aged between 18 and 80 years, and were able to speak English. Blood pressure, blood glucose, waist circumference, height, and weight were measured by a health professional. Smoking, cholesterol levels, and physical activity status were obtained through self-reports. Data were analyzed for 169 participants. More than a third of the participants under the age of 65 years had high blood pressure. Prevalence of diabetes (16%) and obesity (61%) was significantly higher compared with the national average. Ten women identified themselves as smokers. Physical activity patterns were similar to that of the wider Australian population. The study has provided a platform for raising awareness among nurses and promoting advocacy on the cardiovascular risk among Asian Indians. Strategies involving Asian Indian nurses and other Asian Indian health professionals as well as support from the private and public sectors can assist in the reduction of the coronary heart disease risk factors among this extremely susceptible population.

Assessment of cardiovascular disease risk in South asian populations

Although South Asian populations have high cardiovascular disease (CVD) burden in the world, their patterns of individual CVD risk factors have not been fully studied. None of the available algorithms/scores to assess CVD risk have originated from these populations. To explore the relevance of CVD risk scores for these populations, literature search and qualitative synthesis of available evidence were performed. South Asians usually have higher levels of both “classical” and nontraditional CVD risk factors and experience these at a younger age. There are marked variations in risk profiles between South Asian populations. More than 100 risk algorithms are currently available, with varying risk factors. However, no available algorithm has included all important risk factors that underlie CVD in these populations. The future challenge is either to appropriately calibrate current risk algorithms or ideally to develop new risk algorithms that include variables that provide an accurate estimate of CVD risk.

Differences in Selected Lifestyle Risk Factors for Cardiovascular Disease Between Sri Lankans in Oslo, Norway, and in Kandy, Sri Lanka

Sri Lankans in Oslo have previously been shown to have lower risk of cardiovascular disease compared with those in Kandy, Sri Lanka. Here we present lifestyle risk factors for cardiovascular diseases: frequency and type of fat consumed, frequency of fruit and vegetable intake, alcohol consumption, and leisure time physical activity between 1145 Sri Lankans living in Oslo and 678 Tamils and Sinhalese Sri Lankans living in Kandy as possible explanatory factors for the differences observed. Those in Oslo were consuming healthier fats and reported higher levels of physical activity but frequency of vegetable and fruit consumption was lower. Alcohol consumption among women was negligible. Type of fats consumed might be protective for Oslo group compared with predominantly saturated fat diet in Kandy. Higher leisure time physical activity may also be protective for the Oslo group. Higher frequency of consumption of vegetables and fruits may be beneficial in Kandy.

Physical activity among South Asian women: a systematic, mixed-methods review

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.

Menopause versus aging: The predictor of obesity and metabolic aberrations among menopausal women of Karnataka, South India

Context:

Increased incidences of cardiovascular disorder and metabolic syndrome particularly after menopause have raised curiosity for the underlying factors. However, it is still a debate whether age or menopausal transition is a greater contributor.

Aims:

To elucidate the inter-relationships of age, menopause, and associated obesity and to assess their independent effects on aggravation of cardio metabolic risk factors in postmenopausal women.

Settings and Design:

Four hundred two women aged between 30 and 75 years were recruited in a cross-sectional study from Southern India. Three hundred sixteen participants exempting exclusion criteria, comprising of 169 premenopausal and 147 postmenopausal women were finally included.

Materials and Methods:

Anthropometric measurements such as weight, height, waist circumference (WC), hip circumference (HC), fat percentage, basal metabolic rate (BMR), and blood pressure were taken. Fasting plasma glucose, postprandial glucose, glycated hemoglobin (HbA1c), lipid profile, and C-reactive protein (CRP) were also measured.

Statistical Analysis Used:

Independent t-test, Analysis of covariates (ANCOVA), Pearson's correlation coefficients and multiple stepwise linear regression model analysis were done.

Results:

A significant increase in physical and metabolic factors was observed in postmenopausal women compared to premenopausal women except WC and HbA1c. Contrastingly, high-density lipoprotein cholesterol (HDL) levels and BMR were significantly decreased. After adjusting for BMI and age, the significant differences in the variables through the menopausal transition persisted, including an increase in WC. Significant correlation was observed between age and measures of general obesity such as BMI (P < 0.05) and fat percentage (P < 0.001) but not with central obesity indices. Menopausal status and WC exerted an independent effect on most of the metabolic risk factors (P < 0.001 or P < 0.01). Fat percentage was the predicting variable for CRP, HbA1c, diastolic blood pressure (P < 0.001), and HDL (P < 0.01). But Age showed independent effect only on HbA1c.

Conclusions:

Menopausal transition brings about anomalies in total body composition characterized by an increased body fat mass and central adiposity. This creates a compatible atmosphere for abnormal metabolism and aggravated cardio metabolic risk factors. Thus, menopausal status and associated obesity is the major predictor of metabolic aberrations over age in menopausal women.

Frequency distribution of the single-nucleotide -108C/T polymorphism at the promoter region of the PON1 gene in Asian Indians and its relationship with coronary artery disease

A single-nucleotide promoter region polymorphism (-108C/T) of the paraoxonase (PON1) gene had been suggested to influence an individual's susceptibility to coronary artery disease (CAD). No data is available on this polymorphism from India. One hundred seventy-eight healthy individuals and 204 angiographically proven CAD patients were recruited to get baseline data on the frequency distribution of the -108C/T polymorphism in normal people of Asian Indian ethnicity and its relation with the risk of CAD. Polymerase chain reaction followed by restriction fragment length analysis was used as the method for genotyping. Blood samples were used for DNA isolation. In the normal subjects, the genotypes were distributed as CT (43.26%) > CC (30.34%), >TT (26.4%). The allele frequency of the C allele was 0.52, and that of the T allele was 0.48. The patients showed a similar pattern, but the TT genotype was about two times more frequent in the controls than in patients. Odds ratios for developing CAD for individuals with CT, TT, and CT + TT genotypes were 0.89 (0.50-1.59), 0.56 (0.27-1.08), and 0.76 (0.44-1.29), respectively (at 95% confidence interval), when compared to CC homozygous people (age- and sex-adjusted, p = 0.114, all genotypes compared). This suggested a trend for the T allele as protective against CAD. This first report on the frequency distribution of the -108C/T polymorphism in people of Asian Indian ethnicity suggests that the normal distribution is similar to that observed for the Chinese, Japanese, and Latino people, but the disease association is unique. The TT genotype and the T allele which are widely found associated with the risk of CAD showed a protective trend in this study.

High Levels of Cardiovascular Risk Factors among Pakistanis in Norway Compared to Pakistanis in Pakistan

Objectives. Previous studies have shown that the Norwegian-Pakistanis had considerably higher prevalence for diabetes and obesity compared to Norwegians. We studied the additional risk of obesity, dyslipidemia, and hypertension among Pakistanis in Norway compared to Pakistanis living in Pakistan. Method. 770 Norwegian-Pakistani adults (53.9% men and 46.1% women) born in Pakistan from two surveys conducted in Norway between 2000 and 2002 were compared with a sample of 1230 individuals (29.1% men and 70.9% women) that participated in a survey in Pakistan in 2006. Results. Both populations had similar height, but Norwegian-Pakistanis had considerably higher mean weight. Of the Norwegian-Pakistanis, 56% of the males and 40% of the females had a BMI above 25 kg/m(2), as opposed to 30% and 56% in Pakistan, for males and females, respectively. Norwegian-Pakistanis had higher total cholesterol. Conclusion. Obesity and an unfavourable lipid profile were widely prevalent in both populations; the highest level was recorded amongst those living in Norway. The increased risk for obesity and dyslipidemia may be ascribed to change of lifestyle after migration.

Clustering of cardiometabolic risk factors in Asian Indian women: Santiniketan women study

OBJECTIVE

The aim of the present cross-sectional study was to investigate the clustering of cardiometabolic risk factors in premenopausal and postmenopausal Asian Indian women.

METHODS

A total of 214 healthy women (25-65 y) from the Bolpur-Santiniketan area, West Bengal, India, took part in the study. The women were categorized into two groups, namely, premenopausal (n = 161) and postmenopausal (n = 53). Anthropometric measures, namely, minimum waist circumference (WC) and the sum of four (biceps + triceps + subscapular + suprailiac) skinfolds (SF4), were measured accordingly. Intra-abdominal visceral fat (IVF) was also measured. Left arm systolic (SBP) and diastolic (DBP) blood pressure was taken in participants. Metabolic profiles, namely, total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), fasting plasma glucose (FPG), insulin, testosterone, and estrogen, were measured accordingly.

RESULTS

The four factors identified in premenopausal women were factor 1: WC, SF4, IVF, TC, and TG; factor 2: HDL, SBP, DBP, and insulin; factor 3: TC, TG, LDL, and testosterone; and factor 4: FPG, testosterone, and estrogen. These four factors cumulatively explained 72.97% of the total phenotypic variation. In postmenopausal women, the four factors identified were factor 1: TC, TG, HDL, LDL, and DBP; factor 2: FPG, SBP, and DBP; factor 3: WC, SF4, and IVF; and factor 4: FPG, insulin, testosterone, and estrogen. These four factors together explained 90.71% of the total phenotypic variation in cardiometabolic risk factors.

CONCLUSIONS

No common underlying physiological variables in premenopausal and postmenopausal women indicate that a single risk axis for clustering of cardiometabolic phenotypes is highly unlikely.

Lifestyle of Asian Indians with coronary heart disease: the Australian context

This paper aims to report lifestyle factors of Asian Indians in Australia in relation to coronary heart disease. This issue has not been previously explored in the Australian context. This study also seeks to identify factors that could inform health education and rehabilitation programs for migrant Asian Indians in Australia. The qualitative descriptive approach of constructivism was used for this study. Semi-structured, in-depth conversations were conducted with eight patients and five family members. Participants were at risk for coronary heart disease either due to unhealthy diet and/or lack of physical exercise and irregular health checks. Although lifestyle modifications were implemented by participants after the cardiac event; these changes were implemented inconsistently and without continuity. Knowledge of the beneficial effects of a healthy diet did not deter the participants from continuing to follow unhealthy dietary habits. The introduction of any exercise or physical activity by participants in this study lacked consistency. A positive aspect revealed from this study was the influence of culture and religious faith, which helped patients and family members to cope with the illness trajectory. The results of this study suggest that health education and rehabilitation programs need to be designed specifically for this high-risk group would be beneficial when initiated early in life and need to be targeted to the individual.

Comparison of anthropometric, metabolic and dietary fatty acids profiles in lean and obese dyslipidaemic Asian Indian male subjects

OBJECTIVES

To compare obesity measures, metabolic profiles and dietary fatty acids in lean and obese dyslipideamic Asian Indian male subjects.

DESIGN

Cross-sectional.

SETTINGS

Asian Indians living in the eastern part of India.

SUBJECTS

One hundred and thirty (Group I: lean control, n=50; Group II: lean dyslipidaemic, n=40 and Group III: obese dyslipidaemic, n=40) Asian Indian male subjects (> or =30 years) living in the eastern part of India.

METHODS

Anthropometric measures namely height, weight, circumferences of waist (WC) and hip, lipids (total cholesterol (TC) and triglycerides (TG)), lipoproteins (high- (HDL) and low-density lipoproteins (LDL)), fasting plasma glucose (FPG) and dietary fatty acids were obtained from each participant. Obesity measures, that is, body mass index (BMI), waist-hip ratio (WHR) and conicity index (CI) were subsequently calculated from anthropometric measures. Obesity was defined as individuals having BMI> or =25 kg/m(2). SUBJECTS with one or more of the following conditions were considered as dyslipidaemic: TG> or =2.3 mmol/l, TC> or =6.2 mmol/l, or TC/HDL> or =4.4 mmol/l. Daily intake of nutrients as well as saturated (SFA), monounsaturated (MUFA) and polyunsaturated fatty acids (PUFA) were estimated by adding together all the foodstuffs consumed on weekly and monthly manner. Conversion of foodstuffs into nutrients was performed according to standard nutritive values of Indian foodstuffs.

RESULTS

Analysis of variance with Scheffe's post hoc test revealed that Group I had significantly lower mean compared to both Group II and Group III for age, WC, WHR, CI, TC, TG, LDL, FPG, total carbohydrates intake and intake of trans fatty acids. On the other hand, Group I had significantly lower mean than Group III only for BMI as well as intake of total proteins, total fats, total energy and erucic acids. Although, Group I had significantly greater mean compared to both Group II and Group III for HDL, UFA/SFA, MUFA/SFA and PUFA/SFA. Pearson's partial correlations (controlling for age and total energy) revealed that central obesity measures (WC, WHR and CI) had significant association with dietary fatty acids and their ratios. Furthermore, partial correlations (controlling for age) also showed that the ratios of unsaturated to SFA had significant negative association with lipids, lipoproteins (except HDL) and plasma glucose. Discriminant function analysis revealed that overall 78% of all entries were positively (correctly) classified in three groups using fatty acids and their ratios.

CONCLUSION

It seems rational to argue that while dealing with dyslipidaemic Asian Indians, clinicians should consider obesity measures, metabolic profiles and dietary fatty acids simultaneously to better comprehend the condition (s).