Asian Indians Up Diabetes Risk by Adopting Poor Lifestyle

Marlene Busko

July 13, 2018

ORLANDO — An observational study of 1000 adult Asian Indians who had been living in the United States for about 20 years found that adopting American habits was bad for their cardiometabolic health: those with an unhealthy diet had poor HbA1c levels and those who were inactive had poor HDL-C levels.

Nitha Mathew Joseph, PhD, RN, assistant professor at the Cizik School of Nursing at the University of Texas Health Science Center at Houston presented the findings during an oral session and press briefing at the American Diabetes Association (ADA) 2018 Scientific Sessions.

"Clinicians need to be aware that Asian Indian Americans are at especially high risk for type 2 diabetes and they should screen such patients for prediabetes, insulin resistance, and diabetes," lead author Mathew Joseph told Medscape Medical News." They then need to ensure that they receive appropriate diet and exercise information," she added.

The study also suggests that "providing or implementing culturally friendly dietary education and physical activity intervention programs in the clinic itself or [in the Asian] Indian community may promote positive lifestyle changes and prevent diabetes and heart disease."

Invited to comment, Rucha J. Mehta, MD, an endocrinologist in Bhat, Ahmedabad, India told Medscape Medical News in an email that "indeed a sedentary lifestyle as well as adoption of unhealthy dietary patterns seems to be the reason for the increasing prevalence of diabetes in India and the same is likely true of [Asian] Indians residing in the United States."

The work suggests that, "in this ethnic group that is already at high risk [of type 2 diabetes] due to a genetic predisposition, environmental factors would [also] play a significant role," and the people who adopt an unhealthy lifestyle in their new home would be at greater risk, she said.

"I strongly believe that physicians caring for Asian Indians with diabetes need to spend a good amount of time analyzing the dietary patterns of this group," she stressed, "as it is a very carbohydrate-rich diet. This will enable more successful management of their patients with diabetes and help prevent progression to dysglycemia in the prediabetic group."

"Asian Indians have one of the highest incidence rates of diabetes," she stressed, "with rapid conversion from normoglycemia to dysglycemia. Public health interventions are needed to target modifiable risk factors to slow down the diabetes epidemic in this population."

Fast Growing Group, High Diabetes Prevalence

Asian Indians are the second largest and fastest growing group of Asian Americans, following Chinese, Mathew Joseph reported, and they have higher rates of diabetes, metabolic syndrome, and cardiovascular disease (CVD) than other groups.

Previous research has shown that "Asian Indians are coming to the United States and eating fast foods, fatty foods, sugar-sweetened beverages, and added sweeteners, and so on, and [are] driving everywhere (as opposed to walking)," she added, "and this is putting them at higher risk of developing type 2 diabetes and CVD."

Mathew Joseph and colleagues aimed to investigate the relationship between physical activity, diet, acculturation, and risk factors for diabetes and CVD among 1038 Asian Indian immigrants who had participated in a national study of diabetes in Indian Americans (J Diabetes Complications. 2010;24:145-153).

Participants, who were enrolled at seven sites, were an average age of 48.5 years old and had been living in the United States for 18.5 years.

Researchers used the English proficiency scores from the Acculturation Scale for Southeast Asians to estimate acculturation.

The study assessed diet and physical activity based on the participants' replies to the Health Promoting Lifestyle Profile II questionnaire.

HbA1c, fasting blood glucose, body mass index, blood pressure, HDL-C, LDL-C, total cholesterol, and triglycerides were also measured.

Of these variables, dietary behavior significantly mediated the relationship between acculturation and HbA1c (P = .047), and physical activity mediated the relationship between acculturation and HDL-C (P = .011).

"Culturally specific dietary education and physical activity interventions for this high-risk ethnic group may have the potential to reduce cardiometabolic risks," the researchers reiterate. "The results provide a firm basis for developing educational programs."

Mathew-Joseph and Mehta have reported no relevant financial relationships.

American Diabetes Association 2018 Scientific Sessions. June 22, 2018; Orlando, Florida. Abstract 247-OR.

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