Nutrient Intake,Body Composition,Blood Cholesterol and Glucose Levels among Adult Asian Indians in the United States

Asian Indian (AI) immigrants have been suggested to be at increased risk for chronic disease. This study examined the metabolic risk factors for CVD among AI immigrants participating in a health fair in Southern Michigan, in the U.S. Participants included AI men (n = 44) and women (n = 57) who completed a demographic questionnaire, blood lipid (TC and HDL-C) and blood glucose (BG) test, resting BP check (SBP and DBP), body composition analysis and 24-h diet recall. For the entire group, the mean values were: BMI = 25.5, % body fat (BF) = 29.3; SBP = 129 mmHg; DBP = 76 mmHg; TC = 198 mg/dL; HDL-C = 48 mg/dL; BG = 111 mg/dL. Significant gender differences were observed: % BF (20% vs. 36%, P < 0.0001), lean body mass (122 vs. 48 lbs, P < 0.0001), HDL-C (42 vs. 52 mg/dL, P < 0.0025), TC/HDL-C (4.86 vs. 4.11, P < 0.03) and BG (122 vs. 105 mg/dL, P < 0.0001), for males and females, respectively. Dietary carbohydrate, protein and fat contributed 64, 14 and 25% of total energy intake. Among males, BMI was positively correlated with % BF (0.729, P < 0.01) and negatively correlated with HDL-C (−0.457, P < 0.05). Among females, BMI was positively correlated with % BF (0.801, P < 0.01), SBP (0.425, P < 0.05) and DBP (0.538, P < 0.01), and negatively correlated with % energy from saturated fat (−0.523, P < 0.01) and calcium intake (−0.445, P < 0.05). Despite having a dietary intake that meets the National Cholesterol Education Program, Adult Treatment Panel III recommendations, this group was at a higher risk for chronic disease, by virtue of increased BMI and % BF along with an altered metabolic profile (high BP and TC and low HDL-C).     

Health Care Practices of the Foreign Born Asian Indians in the United States. A Community Based Survey

Although successful utilization of medical and preventive care by members of the non-US born communities is an important public health concern, our knowledge regarding health practices of different ethnic subgroups is limited. In the present study, participants of the health fairs organized during South Asian cultural and religions events were asked anonymously to complete the South Asian Total Health Initiative (SATHI) health survey questionnaire to evaluate their health-related practices, self-health perception, and satisfaction with medical care. Among 1,250 surveyed, 1,016 foreign born Asian Indians adults that represented the fastest growing subgroups of the South Asian born nationals in the US were included in the analysis. We found that the majority reported healthy behavior (exercise activities and abstinence from alcohol or tobacco), high self-health perception, satisfaction with medical care, and compliance with annual routine medical examinations that was directly associated with the annual house income. Approximately 40% of women complied with breast and cervical cancer screenings and less than 20% of men complied with prostate cancer screening guidelines. Presence of chronic conditions (mostly cardiovascular pathology and/or diabetes) that were reported by approximately half of the participants negatively impacted their self-health perception. In conclusion, positive self-reported health perception and compliance with routine health examinations of the surveyed foreign born Asian Indians was reported along with an increased rate of chronic morbidity and underutilization of specific preventive services. Observed discrepancy between self-health perception and health status highlights the need to enhance utilization of preventive services among the non-US born Asian Indian community.     

Associations Between Discrimination and Cardiovascular Health Among Asian Indians in the United States

Asian Indians (AI) have a high risk of atherosclerotic cardiovascular disease. The study investigated associations between discrimination and (1) cardiovascular risk and (2) self-rated health among AI. Higher discrimination scores were hypothesized to relate to a higher cardiovascular risk score (CRS) and poorer self-rated health. Asian Indians (n = 757) recruited between 2010 and 2013 answered discrimination and self-reported health questions. The CRS (0-8 points) included body-mass index, systolic blood pressure, total cholesterol, and fasting blood glucose levels of AI. Multiple linear regression analyses were conducted to evaluate relationships between discrimination and the CRS and discrimination and self-rated health, adjusting for psychosocial and clinical factors. There were no significant relationships between discrimination and the CRS (p ≥ .05). Discrimination was related to poorer self-reported health, B = ?.41 (SE = .17), p = .02. Findings suggest perhaps there are important levels at which discrimination may harm health.     

The Relationship between Macronutrient Distribution and Type 2 Diabetes in Asian Indians

Asian Indians (AIs) are at increased risk for type 2 diabetes mellitus than other ethnic groups. AIs also have lower body mass index (BMI) values than other populations, so can benefit from strategies other than weight reduction. Macronutrient distributions are associated with improved glycemic control; however, no specific distribution is generally recommended. This study looks at whether a macronutrient distribution of 50:30:20 (percent of total calories from carbohydrates, fats, and protein) is related to diabetes status in AIs. Diet and Hemoglobin A1c (HbA1c) were assessed from convenience sample of AI adults in Maryland. A ratio of actual to needed calories using the 50:30:20 macronutrient distribution was then tested against diabetes status to identify associations. All groups except non-diabetic females, were in negative energy balance. The non-diabetic group consumed larger actual to needed ratios of protein than pre-diabetics and diabetics. However, all groups consumed protein at the lower end of the Acceptable Macronutrient Distribution Range (AMDR), and the quality of all macronutrients consumed was low. Therefore, weight loss may not be the recommendation for diabetes management for AIs. Increasing protein and insoluble fiber consumption, could play a critical role.     

Parenting Attitudes of Asian Indian Mothers Living in the United States and in India

This study compared the parenting attitudes of Asian Indian mothers living in the United States with those living in India. Fifty seven mothers participated in the study (Living in the United States=23, Living in India=34). The parenting attitudes of the mothers were measured using the Adolescent-Adult Parenting Inventory (AAPI, Bavolek, 1984). The AAPI has four subscales: (a) Reversing Parent-Child Family Roles, (b) Lack of Empathic Awareness of Children's Needs, (c) Inappropriate Developmental Expectations of Children, and (d) Strong Parental Beliefs in the Use of Corporal Punishment. A one-way (2: country of domicile) ANOVA showed significant differences in the mothers' attitudes about inappropriate expectations for their children {F(1,55)=10.24, p h 0.002}, the use of corporal punishment {F(1,55)=6.423, p h 0.007}, and role reversal {F(1,55)=4.63, p h 0.03}. Post hoc analysis indicated that the Asian Indian mothers living in the United States had lower inappropriate expectations and tended not to reverse roles with their children. The results also showed that the Asian Indian mothers living in India favored the use of corporal punishment more than their counterparts in the U.S.     

Dietary Patterns in Asian Indians in the United States: An Analysis of the Metabolic Syndrome and Atherosclerosis in South Asians Living in America Study

Dietary patterns contribute to cardiovascular disease (CVD) risk. Asian Indians have earlier onset, more severe, and more prevalent CVD than many other racial/ethnic groups. We aimed to characterize dietary patterns in Asian Indians living in the United States and examine associations with cardiometabolic risk factors. One hundred fifty Asian Indians, aged 45 to 84 years, without known CVD, living in the San Francisco Bay, CA, area between August 2006 and October 2007 were enrolled into the Metabolic syndrome and Atherosclerosis in South Asians Living in America study. A food frequency questionnaire validated in Asian Indians, fasting blood samples, and computed tomography scans were obtained for all participants. Principal component analysis with varimax rotation was used to determine prevalent dietary patterns. Linear regression analyses were performed for associations between dietary patterns and metabolic factors, adjusting initially for age and sex, then additionally for BMI, income, education, metabolic equivalent of task-minutes of exercise, alcohol consumption, and smoking. Two distinct dietary patterns were identified that we termed “Western,” and “Vegetarian.” Compared with the Western diet, the Vegetarian diet was associated with lower homeostasis model of assessment-insulin resistance (−1.12 mmol/L×mU/L; P=0.05) and lower high-density lipoprotein cholesterol (−4.77 mg/dL; P=0.09). Given that the Western and Vegetarian dietary patterns were each associated with adverse metabolic changes, healthful diet choices may help Asian Indians improve risk factors for CVD.     

Drug abuse risks for acculturating immigrant adolescents: case study of Asian Indians in the United States

Immigrant parents and their U.S.-born children may experience stressful family conflicts over the disparate sociocultural norms of the United States and their country of origin. Such stresses may heighten adolescents' vulnerability to drug abuse. This article documents the extent of drug use in a sample of 200 U.S.-born Asian Indian adolescents. According to the study participants' self-reports on lifetime use, 28 percent had used alcohol on at least one occasion, 16.5 percent had used cigarettes, and 2.5 percent had used marijuana. Adolescents who placed importance on their parents' drug abuse prevention messages tended not to use drugs. The implications of the study's findings for drug abuse assessment, treatment, and prevention are discussed.     

Tuberculosis among American Indians of the contiguous United States

Paleopathologic findings provide strong evidence for the existence of tuberculosis in Andean populations of pre-Columbian America. Indirect evidence is available also to suggest its possible endemicity among some American Indian tribes who lived within the present-day contiguous United States before the arrival of Europeans. The available data suggest that tuberculosis became a major health problem in some tribes with increased population density and cultural changes after increased contact with European civilization, paralleling the deterioration in living conditions after relocation of the tribes to reservations. By 1900, tuberculosis had become one of the most serious health problems among North American Indians. Tuberculosis control was hampered by the lack of a specific treatment, and only the advent of specific chemotherapy in an ambulatory setting brought a breakthrough. Mortality, morbidity, and risk of infection have all sharply decreased over the past three decades. However, tuberculosis incidence rates among American Indians remain well above rates in the white population. An intensified effort to identify those with tuberculosis and those at risk of tuberculosis as well as to develop compliance-enhancing strategies with treatment regimens will be necessary to eliminate tuberculosis from Indian reservations.     

Translation of health programs for American Indians in the United States

American Indian and Alaska Native (AI/AN) cultures in the United States include a diverse group of indigenous cultures that have been affected by their contact with European Americans and have suffered adverse psychological, physical, and economic consequences. AI/AN adolescents have the highest prevalence of cigarette smoking of all U.S. ethnic groups. Culturally competent health promotion programs are needed to enhance their resiliency and help them avoid recreational, addictive use of commercial tobacco. The authors describe the diverse AI/AN populations and their unique health and social issues, including adolescent smoking. They present examples of smoking prevention programs tailored or adapted for AI/AN adolescents and make recommendations for implementation and evaluation of prototype programs. Recommendations include involving the community, respecting tribes' wishes for confidentiality, being aware of IRB issues, beginning with formative and qualitative research, using culturally appropriate measures, understanding the diversity of AI/AN cultures, and involving multiple generations of the family.     

Medical Pluralism of Chinese Women Living in the United States

This study provides national prevalence estimates for complementary and alternative (CAM) use, visits to doctors for health problems, and the effects of acculturation on health practices in Chinese women living in the United States. A national telephone survey of 3,172 women on their use of complementary and alternative medicine was conducted in 2001. This study focuses on a subsample of 804 Chinese-American women who were asked about health practices and service utilization. Interviews were conducted in Mandarin, Cantonese and English. Forty-one percent of Chinese-American women used some form of CAM in 2001. Socio-economic status, a common predictor of CAM use in other studies of the general population in the United States, did not predict use in this sample. Traditional Chinese medicine (TCM) is used across acculturation levels. As Chinese women adapt to American culture they tend to use a greater variety of healthcare practices and to adopt mainstream CAM practices, but they also continue to use TCM.     

Resurgence of a New "Clean Living" Movement in the United States

During the late 19th century, a "clean living" movement emerged in the U.S. dominated by efforts to control alcohol consumption, tobacco use, and females' reproductive health. The movement also advocated proper diet, exercise and physical fitness, pure water, and moderation in caffeine and red meat consumption. Remarkably similar concerns have emerged again in contemporary American society. The current "movement" lacks central organization. Rather, it reflects a loosely related coalition of single-issue advocacy groups. Yet, the focus seems remarkably similar to the 19th century movement--legislative limitation of individual choice regarding personal health behavior, particularly with substance use and females' reproductive health. This article reviews the 19th century movement, describes aspects of the contemporary movement, and offers implications and recommendations for school health professionals.     

Trichinosis in Southeast Asian refugees in the United States.

Between 1975 and 1984, the incidence of trichinosis in the United States (per million person years at risk) was 25 times greater for the Southeast Asian refugee population than for the general United States population. Cases in the southeast Asian refugees differed from those reported previously in the general population in geographic distribution and source of infected meat. Cambodians and Laotians accounted for over 90 per cent of the cases in the Southeast Asian refugees, but comprised less than 50 per cent of that total population.     

Korean Women Living in the United States as Student Wives

Korean students' wives who travel with their husbands to the United States while they pursue academic degrees often experience the extremes of assimilation into the host culture. The purpose of this study is to address the following questions: (a) What are the processes used by Korean women to adapt to life in the United States, and (b) what are the barriers they encounter, as wives of students and mothers of their children, in adapting to this new life? Fourteen Korean wives were interviewed. All interviews were completed in Korean and transcribed verbatim. The study reveals eight phases to the basic social process of adjusting to life in the United States: preconfronting, confronting, discovering, undergoing crisis, seeking, reorienting, reflecting, and reconfronting. These were observed to be dynamic and recurrent ongoing phases that are likely to repeat themselves. The study findings provide health care practitioners with a better understanding of Korean wives' adjustment to life in the United States and suggest the development of culturally appropriate interventions.     

Higher Intake of Dairy Is Associated with Lower Cardiometabolic Risks and Metabolic Syndrome in Asian Indians

There is conflicting evidence about the association between dairy products and cardiometabolic risk (CMR). We aimed to assess the association of total dairy intake with CMR factors and to investigate the association of unfermented and fermented dairy intake with CMR in Asian Indians who are known to have greater susceptibility to type 2 diabetes and cardiovascular diseases compared to white Europeans. The study comprised 1033 Asian Indian adults with normal glucose tolerance chosen from the Chennai Urban Rural Epidemiological Study (CURES). Dietary intake was assessed using a validated open-ended semi-quantitative food frequency questionnaire. Metabolic syndrome (MS) was diagnosed based on the new harmonising criteria using central obesity, dyslipidaemia [low high-density lipoprotein cholesterol (HDL) and increased serum triglycerides (TG)], hypertension and glucose intolerance. Increased consumption of dairy (≥5 cups per day of total, ≥4 cups per day of unfermented or ≥2 cups per day of fermented dairy) was associated with a lower risk of high fasting plasma glucose (FPG) [hazards ratio (HR), 95% confidence interval (CI): 0.68, 0.48–0.96 for total dairy; 0.57, 0.34–0.94 for unfermented dairy; and 0.64, 0.46–0.90 for fermented dairy; p < 0.05 for all] compared to a low dairy intake (≤1.4 cups per day of total dairy; ≤1 cup per day of unfermented dairy; and ≤0.1 cup per day of fermented dairy). A total dairy intake of ≥5 cups per day was also protective against high blood pressure (BP) (HR: 0.65, 95% CI: 0.43–0.99, p < 0.05), low HDL (HR: 0.63, 95% CI: 0.43–0.92, p < 0.05) and MS (HR: 0.71, 95% CI: 0.51–0.98, p < 0.05) compared to an intake of ≤1.4 cups per day. A high unfermented dairy intake (≥4 cups per day) was also associated with a lower risk of high body mass index (BMI) (HR: 0.52, 95% CI: 0.31–0.88, p < 0.05) compared to a low intake (≤1 cup per day), while a reduced risk of MS was observed with a fermented dairy intake of ≥2 cups per day (HR: 0.71, 95% CI: 0.51–0.98, p < 0.05) compared to an intake of ≤0.1 cup per day. In summary, increased consumption of dairy was associated with a lower risk of MS and components of CMR.     

"All of those things we don't eat": a culture-centered approach to dietary health meanings for Asian Indians living in the United States

This article applies a culture-centered approach to analyze the dietary health meanings for Asian Indians living in the United States. The data were collected as part of a health promotion program evaluation designed to help Asian Indians reduce their risk of chronic disease. Community members who used two aspects of the program participated in two focus groups to learn about their health care experiences and to engage them in dialogue about how culture impacts their overall health. Using constructionist grounded theory, we demonstrate that one aspect of culture, the discourses around routine dietary choice, is an important, but underrecognized, aspect of culture that influences community members' experiences with health care. We theorize community members' dietary health meanings operate discursively through a dialectic tension between homogeneity and heterogeneity, situated amid culture, structure, and agency. Participants enacted discursive homogeneity when they affirmed dietary health meanings around diet as an important means through which members of the community maintain a sense of continuity of their identity while differentiating them from others. Participants enacted discursive heterogeneity when they voiced dietary health meanings that differentiated community members from one another due to unique life-course trajectories and other membership affiliations. Through this dialectic, community members manage unique Asian Indian identities and create meanings of health and illness in and through their discourses around routine dietary choice. Through making these discursive health meanings audible, we foreground how community members' agency is discursively enacted and to make understandable how discourses of dietary practice influence the therapeutic alliance between primary care providers and members of a minority community.     

The Effect of a Low-Glycemic Diet vs a Standard Diet on Blood Glucose Levels and Macronutrient Intake in Children with Type 1 Diabetes

A low-glycemic index (GI) diet may lower postprandial hyperglycemia and decrease the risk for postabsorptive hypoglycemia in people with type 1 diabetes. However, insufficient evidence exists on the efficacy of a low-GI diet to support practice recommendations. The goal of this study was to examine the blood glucose response to and the macronutrient composition of low-GI meals vs usual meals consumed ad libitum at home in children with type 1 diabetes. A within-subject, crossover design was employed. Twenty-three participants were recruited between June and August 2006. Participants wore a continuous blood glucose monitoring system and completed diet diaries on 2 days. On 1 day, participants consumed their usual meal; on another day, participants consumed low-GI meals ad libidum. Order of the 2 days was counterbalanced. The mean GI was 34±6 for the low-GI day and 57±6 for the usual meal day (P<0.0001). During the low-GI day, mean daytime blood glucose values (125±28 mg/dL [6.9±1.5 nmol/L] vs 185±58 mg/dL [10.3±3.2 nmol/L], P<0.001), blood glucose area above 180 mg/dL (4,486±6,138 vs 26,707±25,038, P<0.006), and high blood glucose index (5.1±5.1 vs 13.6±7.6, P<0.001) were lower compared to the usual mean day. During the low-GI day, subjects consumed more fiber (24.5±12.3 g vs 14.5±6.1 g, P<0.007) and less fat (45.7±12.2 g vs 76.8±32.4 g, P<0.005); however, there were no differences in energy, carbohydrate, or protein intake. In this pilot study, a low-GI diet was associated with improved diet quality and a reduction in hyperglycemia.