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Healthy dietary changes in South Asian adults may reduce CVD risk

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Wahida Karmally



MIAMI — The preparation of foods common in South Asian cuisines can increase the risk for CVD, but early action and substituting for healthier preparations may impact the risk, according to a presentation at the National Lipid Association Scientific Sessions.

According to the 2013 American Community Survey, there are an estimated 4.3 million South Asian individuals in the United States, with 3.5 million that were counted in the 2010 census. They typically come from India, Bangladesh, Bhutan, Pakistan, Nepal, Sri Lanka and the Maldives, with Indians comprising of 80% of the total South Asian population, Wahida Karmally, DrPH, RDN, CDE, CLS, FNLA, special research scientist at Columbia University, said during the presentation.

Changes in dietary patterns

After South Asian individuals move to the United States, changes in dietary patterns can impact CVD risk factors such as type 2 diabetes and obesity, which may be detrimental to this patient population because CHD is the most common in South Asian migrants, according to the presentation.

“In addition, the documented linguistic, social and economic barriers faced by these populations may result in risk factors for CVD,” Karmally said during the presentation.

Although illness is often seen as something to accept and endure rather than cure, most South Asian people respect their health care provider’s authority.

“Most will not ask a lot of questions, as this is viewed as impolite,” Karmally said during the presentation. “They would rather ignore suggestions if they do not agree, which may result in missed appointments or excuses for not following the plan of care. Offering a variety of treatment choices can make the health care provider seem incompetent, as it is expected that the health care provider be confident.”

Some barriers that South Asian individuals have for healthy lifestyle changes include the fear of racial harassment or abuse when exercising, prioritizing work over physical activity, cultural barriers regarding eating traditional food and different perceptions of a healthy body weight, according to the presentation. South Asian women have additional barriers including fear for personal safety, expectations to stay at home, concerns about the acceptability of wearing Western exercise clothing and the lack of same-gender venues.

Acculturation, which is based on a sense of belonging and social contacts, may play a role in the development of CVD in South Asian individuals, as there is variability among Asian subgroups, according to the presentation.

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Dietary habits of South Asian populations include staples such as legumes, rice and other grains. Many South Asian people are vegetarians, which can include a diet low in protein, high in carbohydrates and may lead to several nutrient deficiencies. Muslim individuals do not eat pork, whereas Hindu individuals do not eat beef even if they eat other meats. Products with gelatin are avoided because the processed collagen is derived from pigs or cows.

Fasting is common in South Asian people, especially in those who observe Ramadan, which involves fasting from dawn to dusk for 30 consecutive days. South Asian adults commonly chew betel leaves, often with flavored tobacco.

Recipes for South Asian foods include a variety of spices and are fried in generous amounts of oils/fats. Turmeric is a key ingredient in Indian curry that has antioxidative and anti-inflammatory properties and considered to be a protective factor for the aging brain and to prevent dementia, according to the presentation.

Data on the dietary patterns of South Asian individuals in the United States are limited, as they are mainly published from Australia and the United Kingdom and included people from Pakistan, India, Sri Lanka and Bangladesh.

Common foods in South Asian immigrants

In one study published in the Journal of the Academy of Nutrition and Dietetics in 2002, South Asian people were more likely to eat fast foods, Western desserts, snacks and traditional festival foods. This population ate more dairy, potatoes, meat, oil and fish and less lentils, beans, vegetables and fruits, which is a shift that occurred after migration. The Western dietary pattern has been shown to increase the risk for metabolic syndrome.

According to the MASALA study published in the Journal of the Academy of Nutrition and Dietetics in 2014, Asian Indian people who lived in the United States for longer than an average of 20 years were more likely to eat a predominately Western diet. These individuals who had Western and vegetarian dietary patterns had adverse metabolic changes.

“South Asian dietary patterns are high in saturated and partially hydrogenated fats from ghee, coconut products, palm oil, partially hydrogenated vegetable oils and refined carbohydrates,” Karmally said during the presentation. “Lack of adherence to healthy behaviors was associated with a two- to threefold increased risk of incident CVD in South Asians.”

More work needs to be done in South Asian populations to align more with the 2019 American College of Cardiology/American Heart Association guidelines on primary prevention of CVD, according to the presentation.

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“If you look at the typical eating patterns currently followed by most individuals in this country, [they] do not align with recommendations from the dietary guidelines,” Karmally said during the presentation. “Among the immigrants, the first 5 years since migration may be a window of opportunity to provide targeted interventions to ensure maintenance of healthy dietary habits.”

Strategies to promote a healthy lifestyle in South Asian people include efforts to encourage a dietary pattern with legumes, whole grains, fruits, vegetables, nonfat/low-fat dairy and unsaturated oils and fats and a reduction in the consumption of convenience foods and sugar-sweetened beverages, according to the presentation. Health care providers should also focus on maintaining healthful dietary behaviors by engaging the South Asian community.

“Patients should enjoy food,” Karmally said during the presentation. “Only then a good healthy eating pattern can be sustainable. South Asians eat whole grains like millet, whole wheat, vegetables, legumes. It’s just how they are prepared can be problematic. Recipe makeovers with unsaturated oils/fats, also using nut butters can give a very creamy consistency to the food.” – by Darlene Dobkowski

Reference:

Karmally W. Session VIII: Heart Healthy Eating and Cultural Differences. Presented at: National Lipid Association Scientific Sessions; May 16-19, 2019; Miami.

Disclosure: Karmally reports she has financial relationships with Sesame Workshop and the United Soybean Board.