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Knox A, Sculthorpe N, Grace F. Caucasian and south Asian men show equivalent improvements in surrogate biomarkers of cardiovascular and metabolic health following 6-weeks of supervised resistance training. F1000Res 2019; 7:1334. [PMID: 30918627 PMCID: PMC6419981 DOI: 10.12688/f1000research.15376.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2019] [Indexed: 11/20/2022] Open
Abstract
Background: The South Asian population have greater cardiovascular risk than their age-matched Caucasian counterparts, characterized by unfavorable biomarkers. South Asians may also be partially resistant to the pleiotropic benefits of physical activity on cardiovascular health. There is a current absence of studies that compare markers of cardio-metabolic health between Caucasians and South Asians employing resistance exercise. This study set out to compare the response in biomarkers of cardio-metabolic health in Caucasians and South Asians in response to resistance exercise. Methods: Caucasian (n=15, 25.5 ± 4.8 yrs) and South Asian (n=13, 25.4 ± 7.0 yrs) males completed a 6-week progressive resistance exercise protocol. Fasting blood glucose, insulin, and their product insulin resistance (HOMA-IR), triglycerides (TRIGS), low density lipoprotein (LDL), high density lipoprotein (HDL), total cholesterol (TC), vascular endothelial growth factor (VEGF), asymmetric dimythylarginine (ADMA), L-arginine (L-ARG) and C-reactive protein (CRP) were established at baseline and following resistance exercise. Results: There were significant improvements in fasting glucose, TC, LDL, HDL and VEGF in both groups following resistance exercise ( p<0.05, for all). No change was observed in insulin, HOMA-IR, TRIGS, ADMA, L-ARG following resistance exercise ( p>0.05, in both groups). CRP increased in the South Asian group ( p<0.05) but not the Caucasian group ( p>0.05) Conclusions: The cardio-metabolic response to resistance exercise is comparable in young Caucasian and South Asian males though inflammatory response to exercise may be prolonged in South Asians.
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Affiliation(s)
- Allan Knox
- Exercise Science Department, California Lutheran University, Thousand Oaks, CA, 91360, USA
| | - Nicholas Sculthorpe
- Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, South Lanarkshire, ML3 0JB, UK
| | - Fergal Grace
- School of Health Science and Psychology, Federation University, Ballarat, Victoria, 3350, Australia
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Sarkar S, Ellahi B, Zotor F, Amuna P. Decreasing Physical Activity Levels across Religious Sikh Male South Asian Migrant Population in Kent, UK. JOURNAL OF HEALTH MANAGEMENT 2017. [DOI: 10.1177/0972063417727612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- S. Sarkar
- School of Science, University of Greenwich at Medway, Chatham, UK
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - B. Ellahi
- Faculty of Health and Social Care, University of Chester, Chester, UK
| | - F.B. Zotor
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
- These authors contributed equally to this work
| | - P. Amuna
- Faculty of Engineering and Science, University of Greenwich at Medway, Chatham, UK
- Research Section, Department of clinical Affairs, Primary Health care Corporation, Doha, Qatar
- These authors contributed equally to this work
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Curry WB, Dagkas S, Wilson M. Levels and patterns of physical activity and sedentary time among superdiverse adolescents in East London: a cross-sectional study. ETHNICITY & HEALTH 2017; 22:242-256. [PMID: 27809593 DOI: 10.1080/13557858.2016.1252833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Little is known about the physical activity (PA) and sedentary time (ST) habits of adolescents from superdiverse communities in the UK. The objectives of this study are to examine and report the patterns of PA/ST among adolescents in East London living in superdiverse communities, to identify opportunities/barriers to PA and inform policy/practice. DESIGN A total of 1260 young people (aged 11-13 years) from seven secondary schools in East London completed a questionnaire on PA/ST over the past seven days as part of the Newham's Every Child a Sports Person (NECaSP) intervention. Socio-demographic and anthropometric data were obtained. Significance tests were conducted to determine differences between socio-demographic and anthropometric predictors and PA/ST. Multinomial logit regression was used to explore the effects of ethnicity, sex, and body mass index (BMI) on PA levels. RESULTS Males were significantly more likely to engage in PA at least five times during school in the past week (U = 5.07, z = -11.76, p < .05). Obese participants were less likely to report engaging in PA five times in the past week (U = 4.11, z =-1.17, p < .05). Black Caribbean girls (U = 5.08, z = -1.92, p < .05) were significantly more likely to report engaging in no activity. Multinomial logit regression analyses revealed that girls with higher BMI were less likely to engage in PA at least four times after school in the last week than boys (b = .11, Wald X2(1) = 9.81, p < .01). Walking (36.4%), jogging/running (29.9%), and football (28%) were the most frequently reported activities. CONCLUSION Engaging girls in PA during and after school is important and making sports clubs and activities available and attractive to this target group may help increase engagement in PA and reduce ST. Findings support the need for more sex-specific and culturally responsive pedagogy in schools with curricula that respects diversity and individuality and has meaning and value amongst superdiverse young people. Finally, we need to extend current work presented and provide substantial evidence of the ways young people from minority ethnic groups process and act on the public health policy and the ways they understand and enact PA.
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Affiliation(s)
- Whitney B Curry
- a Physical Activity and Health Research Group, Sport and Physical Activity Department , Edge Hill University , Ormskirk , UK
| | - Symeon Dagkas
- b School of Health, Sport and Bioscience , University of East London , London , UK
| | - Marcia Wilson
- b School of Health, Sport and Bioscience , University of East London , London , UK
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Abstract
Although South Asians express increased features (conventional) of insulin resistance syndrome, these do not fully explain the increased mortality both from ischaemic heart disease and ischaemic stroke in South Asians compared to Whites. Thrombotic risk factors for vascular disease, as a part of insulin resistance syndrome in South Asians, are being investigated and are an important moiety. The management of the epidemic of ischaemic vascular disease in South Asians is a major global endeavour.
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Affiliation(s)
- Kirti Kain
- Academic Unit of Molecular Vascular Medicine, G-Floor, Martin Wing, Leeds General Infirmary, Leeds, LS1 3EX, UK,
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5
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Abstract
South Asians have a higher prevalence of diabetes, coronary heart disease and cardiovascular death. Their predisposition to insulin resistance partly explains this excess risk. After immigration, the adoption of a western diet allied to increased sedentary behaviour leads to weight gain, hypertension and hyperlipidaemia, factors which in turn combine to amplify the chances of getting heart disease. Further contributory factors are increased sub-clinical inflammation, increased thrombogenic tendency and higher serum homocysteine levels. South Asians with diabetes might do as well as White people with respect to intensive glycaemic and blood pressure control. However, there is little evidence for measures to reduce cardiovascular risk as South Asians have not been included as a subgroup in most large trials. Future prospective studies, including studies on the prevention of diabetes and cardiovascular disease in this high-risk population, are therefore urgently required.
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Affiliation(s)
| | - Naveed Sattar
- Division of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Miles Fisher
- Department of Diabetes, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
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Scott WR, Zhang W, Loh M, Tan ST, Lehne B, Afzal U, Peralta J, Saxena R, Ralhan S, Wander GS, Bozaoglu K, Sanghera DK, Elliott P, Scott J, Chambers JC, Kooner JS. Investigation of Genetic Variation Underlying Central Obesity amongst South Asians. PLoS One 2016; 11:e0155478. [PMID: 27195708 PMCID: PMC4873263 DOI: 10.1371/journal.pone.0155478] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/29/2016] [Indexed: 12/19/2022] Open
Abstract
South Asians are 1/4 of the world's population and have increased susceptibility to central obesity and related cardiometabolic disease. Knowledge of genetic variants affecting risk of central obesity is largely based on genome-wide association studies of common SNPs in Europeans. To evaluate the contribution of DNA sequence variation to the higher levels of central obesity (defined as waist hip ratio adjusted for body mass index, WHR) among South Asians compared to Europeans we carried out: i) a genome-wide association analysis of >6M genetic variants in 10,318 South Asians with focused analysis of population-specific SNPs; ii) an exome-wide association analysis of ~250K SNPs in protein-coding regions in 2,637 South Asians; iii) a comparison of risk allele frequencies and effect sizes of 48 known WHR SNPs in 12,240 South Asians compared to Europeans. In genome-wide analyses, we found no novel associations between common genetic variants and WHR in South Asians at P<5x10-8; variants showing equivocal association with WHR (P<1x10-5) did not replicate at P<0.05 in an independent cohort of South Asians (N = 1,922) or in published, predominantly European meta-analysis data. In the targeted analyses of 122,391 population-specific SNPs we also found no associations with WHR in South Asians at P<0.05 after multiple testing correction. Exome-wide analyses showed no new associations between genetic variants and WHR in South Asians, either individually at P<1.5x10-6 or grouped by gene locus at P<2.5x10-6. At known WHR loci, risk allele frequencies were not higher in South Asians compared to Europeans (P = 0.77), while effect sizes were unexpectedly smaller in South Asians than Europeans (P<5.0x10-8). Our findings argue against an important contribution for population-specific or cosmopolitan genetic variants underlying the increased risk of central obesity in South Asians compared to Europeans.
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Affiliation(s)
- William R. Scott
- Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road, London, United Kingdom
- * E-mail:
| | - Weihua Zhang
- Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom
- Ealing Hospital NHS Trust, Southall, Middlesex, United Kingdom
| | - Marie Loh
- Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom
| | - Sian-Tsung Tan
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road, London, United Kingdom
- Ealing Hospital NHS Trust, Southall, Middlesex, United Kingdom
| | - Benjamin Lehne
- Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom
| | - Uzma Afzal
- Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom
| | - Juan Peralta
- Genomics Computer Centre, South Texas Diabetes and Obesity Institute, University of Texas at the Rio Grande Valley, Brownsville, Texas, United States of America
| | - Richa Saxena
- Broad Institute of Massachusetts Institute of Technology and Harvard, Massachusetts General Hospital, Cambridge, MA, United States of America
| | - Sarju Ralhan
- Hero DMC Heart Institute, Ludhiana, Punjab, India
| | | | - Kiymet Bozaoglu
- Genomics and Systems Biology, Baker IDI Heart and Diabetes Institute, Melbourne, VIC Australia
| | - Dharambir K. Sanghera
- Department of Pediatrics, Section of Genetics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
- Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - Paul Elliott
- Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom
- MRC-PHE Centre for Environment and Health, Imperial College London, Norfolk Place, London, United Kingdom
| | - James Scott
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road, London, United Kingdom
- Imperial College Healthcare NHS Trust, Du Cane Road, London, United Kingdom
| | - John C. Chambers
- Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom
- Ealing Hospital NHS Trust, Southall, Middlesex, United Kingdom
- MRC-PHE Centre for Environment and Health, Imperial College London, Norfolk Place, London, United Kingdom
| | - Jaspal S. Kooner
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road, London, United Kingdom
- Ealing Hospital NHS Trust, Southall, Middlesex, United Kingdom
- Imperial College Healthcare NHS Trust, Du Cane Road, London, United Kingdom
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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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Misra A, Misra R. Asian indians and insulin resistance syndrome: global perspective. Metab Syndr Relat Disord 2012; 1:277-83. [PMID: 18370652 DOI: 10.1089/1540419031361390] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Insulin resistance syndrome (IRS) is a crucial factor in causation of type 2 diabetes mellitus (T2DM) in Asian Indians. Approximately one-fifth of the migrant Asian Indians have evidence of metabolic syndrome. Furthermore, insulin resistance as estimated by homeostatic model assessment (HOMA-IR) was reported to be present in one-fifth of children and young adult Asian Indians with normal body mass index (BMI) and ~45-67% of those having high BMI. The cause(s) of such high prevalence of IRS in Asian Indians is not clear; however, inherent genetic predisposition, physical inactivity, excess regional body fat, and factors associated with migration may play an important role. It is important that lifestyle factor modification to prevent IRS and T2DM in Asian Indians should start in early childhood.
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Shenoy S, Dhawan N, Sandhu JS. Effect of Exercise Program and Calcium Supplements on Low Bone Mass among Young Indian Women- A Comparative Study. Asian J Sports Med 2012; 3:193-9. [PMID: 23012639 PMCID: PMC3445647 DOI: 10.5812/asjsm.34690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 03/21/2012] [Indexed: 11/16/2022] Open
Abstract
Purpose Low bone mass is a major health concern among young women nowadays due to sedentary lifestyle and lack of calcium rich food intake. Therefore there is an increase in the incidence of LBM among young university women so our main purpose of study was to compare effects of exercise program and calcium supplements on bone mass in young women. Methods This single blinded, cross sectional study included data collection in the form of SOS T-scores at distal radius for 104 young university women of mean age 22.3 years using Sunlight Omnisense Bone Sonometer 7000S. Of these, 62 women with low bone mass were included in a 3 month study but 60 subjects completed the study. They were randomly divided into 3 groups: exercise group (n=21), calcium supplementation group (n=21) and control group (n=20). All participants were evaluated pre and post protocol for T-score distal radius and midshaft tibia. Results After measuring SOS T-score of 104 subjects; we found that 60.57% had low bone mass and remaining 39.43% had normal bone mass. After 3 months, the exercise group showed significant improvement in distal radius SOS T-score (t=5.10, P<0.001), at midshaft tibia (t=3.71, P<0.001) followed by improvement in calcium group at distal radius (t=6.28, P<0.001), midshaft tibia (t=2.33, P<0.05) as compared to control group which showed a marginal increase. Conclusions Exercise group showed more improvement in T-scores than calcium and control group. Exercise is important modifiable factor to improve bone accretion at this age and reduce risk of developing osteoporosis related debilitating conditions later in life.
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Affiliation(s)
- Shweta Shenoy
- Faculty of Sports Medicine and Physiotherapy, Guru Nanak Dev University, Amritsar, Punjab
- Corresponding Author:Address: Faculty of Sports Medicine and Physiotherapy, Guru Nanak Dev University, Amritsar, Punjab. E-mail:
| | - Neha Dhawan
- Faculty of Sports Medicine and Physiotherapy, Guru Nanak Dev University, Amritsar, Punjab
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10
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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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Misra A, Khurana L. The Metabolic Syndrome in South Asians: Epidemiology, Determinants, and Prevention. Metab Syndr Relat Disord 2009; 7:497-514. [DOI: 10.1089/met.2009.0024] [Citation(s) in RCA: 228] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Anoop Misra
- Department of Diabetes and Metabolic Diseases, Fortis Hospital, Vasant Kunj, Delhi, India
- Center for Diabetes, Obesity, and Cholesterol Disorders (C-DOC), Diabetes Foundation (India), SDA, New Delhi, India
| | - Lokesh Khurana
- Center for Diabetes, Obesity, and Cholesterol Disorders (C-DOC), Diabetes Foundation (India), SDA, New Delhi, India
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Oliffe J, Grewal S, Bottorff J, Hislop T, Phillips M, Dhesi J, Kang H. Connecting masculinities and physical activity among senior South Asian Canadian immigrant men. CRITICAL PUBLIC HEALTH 2009. [DOI: 10.1080/09581590902951605] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Statin therapy in South Asians-facts and future. Am J Ther 2009; 17:e41-7. [PMID: 19262368 DOI: 10.1097/mjt.0b013e31817fd89a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
South Asians have higher overall burden of coronary heart disease. South Asian migrants suffer from more severe and fatal coronary heart disease at younger age despite similar risk factors compared with local population. Elevated blood cholesterol contributes to atherosclerosis and heart disease and is one of the primary modifiable risk factor for these conditions. Since the discovery of a fungal metabolite that inhibits 3-hydroxy-3methyl-glutaryl-coenzyme A reductase, statins have emerged rapidly as the global leader in medical therapeutics designed to lower low-density lipoprotein cholesterol and had reduced mortality and morbidity from coronary heart disease when used for primary or secondary prevention. Despite the considerable burden imposed by cardiovascular disease, South Asians remain inadequately targeted for risk-reduction strategies, including screening and treatment for dyslipidemia.
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Abstract
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.
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Grace C, Begum R, Subhani S, Kopelman P, Greenhalgh T. Prevention of type 2 diabetes in British Bangladeshis: qualitative study of community, religious, and professional perspectives. BMJ 2008; 337:a1931. [PMID: 18984633 PMCID: PMC2659954 DOI: 10.1136/bmj.a1931] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2008] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To understand lay beliefs and attitudes, religious teachings, and professional perceptions in relation to diabetes prevention in the Bangladeshi community. DESIGN Qualitative study (focus groups and semistructured interviews). SETTING Tower Hamlets, a socioeconomically deprived London borough, United Kingdom. PARTICIPANTS Bangladeshi people without diabetes (phase 1), religious leaders and Islamic scholars (phase 2), and health professionals (phase 3). METHODS 17 focus groups were run using purposive sampling in three sequential phases. Thematic analysis was used iteratively to achieve progressive focusing and to develop theory. To explore tensions in preliminary data fictional vignettes were created, which were discussed by participants in subsequent phases. The PEN-3 multilevel theoretical framework was used to inform data analysis and synthesis. RESULTS Most lay participants accepted the concept of diabetes prevention and were more knowledgeable than expected. Practical and structural barriers to a healthy lifestyle were commonly reported. There was a strong desire to comply with cultural norms, particularly those relating to modesty. Religious leaders provided considerable support from Islamic teachings for messages about diabetes prevention. Some clinicians incorrectly perceived Bangladeshis to be poorly informed and fatalistic, although they also expressed concerns about their own limited cultural understanding. CONCLUSION Contrary to the views of health professionals and earlier research, poor knowledge was not the main barrier to healthy lifestyle choices. The norms and expectations of Islam offer many opportunities for supporting diabetes prevention. Interventions designed for the white population, however, need adaptation before they will be meaningful to many Bangladeshis. Religion may have an important part to play in supporting health promotion in this community. The potential for collaborative working between health educators and religious leaders should be explored further and the low cultural understanding of health professionals addressed.
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Affiliation(s)
- Clare Grace
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London E1 2AT.
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16
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Hall LML, Sattar N, Gill JMR. Risk of metabolic and vascular disease in South Asians: potential mechanisms for increased insulin resistance. ACTA ACUST UNITED AC 2008. [DOI: 10.2217/17460875.3.4.411] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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17
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Snape R, Binks P. Re-thinking sport: physical activity and healthy living in British South Asian Muslim communities. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/13606710701751377] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jaumdally JR, Varma C, Lip GYH. Statin therapy in South-Asian patients: clinical implications beyond lipid lowering? Expert Opin Pharmacother 2007; 8:1235-43. [PMID: 17563259 DOI: 10.1517/14656566.8.9.1235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Whether used as primary or secondary prevention, 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) can lead to a significant reduction in mortality and morbidity from cardiovascular disease. Given the benefit in halting atherosclerotic disease progression in patients with stable and acute coronary syndrome, the potential for use in South-Asians remains largely unreported. As this ethnic group has a high rate of coronary events at a younger age, with more extensive and diffuse atheroma, the authors review the impact of statins in relation to observed lipid profiles, as well as novel markers of vascular disease.
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Affiliation(s)
- J Rumi Jaumdally
- Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, B18 7QH, UK
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Barnett AH, Dixon AN, Bellary S, Hanif MW, O'hare JP, Raymond NT, Kumar S. Type 2 diabetes and cardiovascular risk in the UK south Asian community. Diabetologia 2006; 49:2234-46. [PMID: 16847701 DOI: 10.1007/s00125-006-0325-1] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 05/19/2006] [Indexed: 10/24/2022]
Abstract
A popular hypothesis for the greater prevalence of type 2 diabetes and cardiovascular disease in UK south Asians is that they have an increased susceptibility of developing insulin resistance in response to certain environmental factors, including obesity and adoption of a sedentary lifestyle. Insulin resistance is postulated as a central feature of the metabolic syndrome, culminating in type 2 diabetes, atherosclerotic vascular disease and CHD; a pathway potentially accelerated by migration/urbanisation. We describe and compare the prevalence of type 2 diabetes, cardiovascular disease and their associated risk factors in UK south Asian and white Caucasian populations to determine possible reasons for the increased preponderance of these diseases in south Asians, and highlight key evidence for optimal risk factor management. Finally, we describe a UK community-based programme that attempts to reduce the morbidity and mortality from type 2 diabetes and cardiovascular disease in south Asians through a new approach to management.
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Khan MS, Jafary FH, Jafar TH, Faruqui AM, Rasool SI, Hatcher J, Chaturvedi N. Knowledge of modifiable risk factors of heart disease among patients with acute myocardial infarction in Karachi, Pakistan: a cross sectional study. BMC Cardiovasc Disord 2006; 6:18. [PMID: 16643643 PMCID: PMC1464150 DOI: 10.1186/1471-2261-6-18] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Accepted: 04/27/2006] [Indexed: 01/06/2023] Open
Abstract
Background Knowledge is an important pre-requisite for implementing both primary as well as secondary preventive strategies for cardiovascular disease (CVD). There are no estimates of the level of knowledge of risk factor of heart disease in patients with CVD. We estimated the level of knowledge of modifiable risk factors and determined the factors associated with good level of knowledge among patients presenting with their first acute myocardial infarction (AMI) in a tertiary care hospital in Karachi, Pakistan. Methods A hospital based cross-sectional study was conducted at the National Institute of Cardiovascular Disease, a major tertiary care hospital in Karachi Pakistan. Patients admitted with their first AMI were eligible to participate. Standard questionnaire was used to interview 720 subjects. Knowledge of four modifiable risk factors of heart disease: fatty food consumption, smoking, obesity and exercise were assessed. The participants knowing three out of four risk factors were regarded as having a good level of knowledge. A multiple logistic regression model was constructed to identify the determinants of good level of knowledge. Results The mean age (SD) was 54 (11.66) years. A mere 42% of our study population had a good level of knowledge. In multiple logistic regression analysis, independent predictors of "good" level of knowledge were (odds ratio [95% confidence interval]) more than ten years of schooling were 2.5 [1.30, 4.80] (verses no schooling at all) and nuclear family system (verses extended family system) 2.54 [1.65, 3.89]. In addition, Sindhi ethnicity OR [3.03], higher level of exercise OR [2.76] and non user of tobacco OR [2.53] were also predictors of good level of knowledge. Conclusion Our findings highlight the lack of good level of knowledge of modifiable risk factors for heart disease among subjects admitted with AMI in Pakistan. There is urgent need for aggressive and targeted educational strategies in the Pakistani population.
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Affiliation(s)
- Muhammad S Khan
- Clinical Epidemiology Unit, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Fahim H Jafary
- Section of Cardiology, Departments of Medicine, Aga Khan University, Karachi, Pakistan
| | - Tazeen H Jafar
- Clinical Epidemiology Unit, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Azhar M Faruqui
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Syed I Rasool
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Juanita Hatcher
- Clinical Epidemiology Unit, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Nish Chaturvedi
- National Heart and Lung Institute, Imperial College London, UK
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Sinha S, Rathi M, Misra A, Kumar V, Kumar M, Jagannathan NR, Pandey RM, Dwivedi M, Luthra K. Subclinical inflammation and soleus muscle intramyocellular lipids in healthy Asian Indian males. Clin Endocrinol (Oxf) 2005; 63:350-5. [PMID: 16117825 DOI: 10.1111/j.1365-2265.2005.02353.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The relationship between C-reactive protein (CRP), a marker of subclinical inflammation, and intramyocellular lipid (IMCL) content, a novel correlate of insulin resistance, has not previously been investigated. METHOD AND DESIGN We estimated IMCL content in soleus muscle in 30 healthy Asian Indian males using proton magnetic resonance spectroscopy ((1)H MRS), and correlated it with body mass index (BMI), measures of abdominal obesity, percentage of body fat (%BF), serum lipoproteins, fasting and post-oral glucose load serum insulin levels and other surrogate markers of insulin resistance. RESULTS Soleus muscle IMCL content was significantly correlated with age (rho=0.64, P<0.001), BMI (rho=0.41, P<0.05), %BF (rho=.53, P<= 0.01), waist circumference (rho=0.45, P<0.05) and waist-to-hip circumference ratio (rho=0.58, P<0.01) but did not correlate significantly with insulin resistance measured by the homeostasis model assessment (HOMA-IR) or CRP levels. CRP levels did not correlate with the HOMA-IR value. CONCLUSIONS Soleus muscle IMCL content correlated significantly with measures of generalized and abdominal obesity but not with insulin sensitivity or CRP levels in healthy Asian Indian males. Studies are needed in other ethnic groups to corroborate these data.
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Affiliation(s)
- Sanjeev Sinha
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
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Abstract
CONTEXT Studies, mostly from outside the United States, have found high prevalence of diabetes, coronary heart disease (CHD), and hypertension among Asian Indians, despite low rates of associated risk factors. OBJECTIVE To analyze the prevalence of obesity, diabetes, CHD, hypertension, and other associated risk factors among Asian Indians in the United States compared to non-Hispanic whites. DESIGN, SETTING, AND SUBJECTS Cross-sectional study using data from the National Health Interview Survey (NHIS) for 1997, 1998, 1999, and 2000. We analyzed 87,846 non-Hispanic whites and 555 Asian Indians. MAIN OUTCOME MEASURES Whether a subject reported having diabetes, CHD, or hypertension. RESULTS Asian Indians had lower average body mass indices (BMIs) than non-Hispanic whites and lower rates of tobacco use, but were less physically active. In multivariate analysis controlling for age and BMI, Asian Indians had significantly higher odds of borderline or overt diabetes (adjusted OR [AOR], 2.70; 95% confidence interval [CI], 1.72 to 4.23). Multivariate analysis also showed that Asian Indians had nonsignificantly lower odds ratios for CHD (AOR, 0.58; 95% CI, 0.25 to 1.35) and significantly lower odds of reporting hypertension (AOR, 0.58; 95% CI, 0.42 to 0.82) compared to non-Hispanic whites. CONCLUSION Asian Indians in the United States have higher odds of being diabetic despite lower rates of obesity. Unlike studies on Asian Indians in India and the United Kingdom, we found no evidence of an elevated risk of CHD or hypertension. We need more reliable national data on Asian Indians to understand their particular health behaviors and cardiovascular risks. Research and preventive efforts should focus on reducing diabetes among Asian Indians.
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Abstract
The study of disease patterns in ethnic minority groups offers insights into the causation of disease. Ethnic minorities have wide variations in health conditions and behaviors, and stereotyping can lead to spurious assumptions in caring for patients. This article presents basic information relating to major illnesses such as cardiovascular disease, diabetes, and cancer and common health disorders observed among ethnic groups primarily in the United Kingdom and United States.
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Misra A, Vikram NK. Insulin resistance syndrome (metabolic syndrome) and obesity in Asian Indians: evidence and implications. Nutrition 2004; 20:482-91. [PMID: 15105039 DOI: 10.1016/j.nut.2004.01.020] [Citation(s) in RCA: 215] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This review describes prevalence, determinants, and possible pathophysiologic mechanisms and suggests management and research directions for insulin resistance syndrome (metabolic syndrome) in Asian Indians. METHOD We reviewed the topic using the terms Asian Indians, Asians, South Asians, and Indians coupled with the terms insulin resistance, hyperinsulinemia, metabolic syndrome, and obesity from the databases Pubmed (National Library of Medicine, Bethesda, MD, USA) and Current Contents (Institute for Scientific Information, Thomson Scientific, Philadelphia, PA, USA) and from non-indexed publications of the medical research and governmental institutions in India. RESULTS Asian Indians have a high prevalence of insulin resistance syndrome that may underlie their greater than normal tendency to develop diabetes mellitus and early atherosclerosis. Important reasons could be their excess body fat and adverse body fat patterning including abdominal adiposity even when the body mass index is within the currently defined normal limits. Some of these features have been reported at birth and childhood. Whether Asian Indians also have tendency to develop insulin resistance de novo, independent of total or regional adiposity, needs further investigation. Underlying genetic tendency or early-life adverse events may contribute to such a phenotype, but lifestyle factors alone or modulated by inherited factors appear to play an important role because obesity and dyslipidemia become worse with urbanization and migration. Systemic stress may contribute to insulin resistance syndrome in the intra-country and inter-country migrant Asian Indians. CONCLUSIONS High prevalences of excess body fat, adverse body fat patterning, hypertriglyceridemia, and insulin resistance beginning at a young age have been consistently recorded in Asian Indians irrespective of their geographic locations. These data suggest that primary prevention strategies should be initiated early in this ethnic group.
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Affiliation(s)
- Anoop Misra
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
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Wasir JS, Misra A. The Metabolic Syndrome in Asian Indians: Impact of Nutritional and Socio-economic Transition in India. Metab Syndr Relat Disord 2004; 2:14-23. [DOI: 10.1089/met.2004.2.14] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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The dietitians challenge: the implementation of nutritional advice for people with diabetes. J Hum Nutr Diet 2003; 16:421-52; quiz 453-6. [DOI: 10.1046/j.1365-277x.2003.00460.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Connor H, Annan F, Bunn E, Frost G, McGough N, Sarwar T, Thomas B. The implementation of nutritional advice for people with diabetes. Diabet Med 2003; 20:786-807. [PMID: 14510859 DOI: 10.1046/j.1464-5491.2003.01104.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
These consensus-based recommendations emphasize the practical implementation of nutritional advice for people with diabetes, and describe the provision of services required to provide the information. Important changes from previous recommendations include greater flexibility in the proportions of energy derived from carbohydrate and monounsaturated fat, further liberalization in the consumption of sucrose, more active promotion of foods with a low glycaemic index, and greater emphasis on the provision of nutritional advice in the context of wider lifestyle changes, particularly physical activity. Monounsaturated fats are now promoted as the main source of dietary fat because of their lower susceptibility to lipid peroxidation and consequent lower atherogenic potential. Consumption of sucrose for patients who are not overweight can be increased up to 10% of daily energy provided that this is eaten in the context of a healthy diet and distributed throughout the day [corrected]. Evidence is presented for the effectiveness of advice provided by trained dieticians. The increasing evidence for the importance of good metabolic control and the growing requirement for measures to prevent Type 2 diabetes in an increasingly obese population will require major expansion of dietetic services if the standards in National Service Frameworks are to be successfully implemented.
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Affiliation(s)
- H Connor
- County Hospital, Hereford HR1 2ER, UK.
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Abstract
The potential role of haemostatic risk markers is largely unexplored in South Asians, who have increased morbidity and mortality from cardiovascular disease and an increased prevalence of insulin resistance. To investigate differences in thrombotic risk markers between South Asian and White populations, 42 Asian and 50 White males and 96 Asian and 80 White females, clinically free from vascular disease, were recruited. Venous blood samples were taken for measures of haemostasis and determination of blood lipids. South Asian females showed lower fasting blood glucose than White females (4.6 vs. 4.8 mmol/l, P<0.008). In the South Asian population, total cholesterol was lower in females, with a similar trend in males (females 5.0 vs. 5.5 mmol/l, P<0.001; males 5.1 vs. WM 5.5 mmol/l, P=0.09), but no difference in triglyceride levels. South Asian subjects of both genders had markedly higher levels of fibrinogen (females 3.3 vs. 2.8 mg/dl, P<0.0005; males 3.0 vs. 2.5 mg/dl P<0.002) and PAI-1 activity (females 14.6 vs. 8.7 ng/ml, P<0.0005, males 21.3 vs. 12.2 ng/ml, ) P<0.0005). Factor VII:C was lower in both South Asian groups (females 110.9 vs. 122.4%, P<0.005; males 103.3 vs. 125%, P<0.0005). Factor XII was lower in South Asian females and there were no differences in Factor XII levels in male populations. These results suggest that elevated PAI-1 and fibrinogen in Asians of both genders may contribute to the increased vascular risk experienced in this population; however, the role of dyslipidaemia and Factor VII are not clear in these processes.
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Affiliation(s)
- K Kain
- Academic Unit of Molecular Vascular Medicine, G-Floor, Martin Wing, Leeds General Infirmary, LS1 3EX, Leeds, UK.
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