Diet and Risk Factors for Coronary Heart Disease in Asians in Northwest London

McKeigue, Paul; Adelstein, A. M.; Shipley, MJ; Riemersma, R.A.; Marmot, Michael; Hunt, S.; Butler, Susan M.; Turner, Peter R.

doi:10.1016/s0140-6736(85)90684-1

Cited by 194 publications

(47 citation statements)

References 17 publications

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“…The difference in the ROC curve cut-point between South Asians and Europeans is especially large for HbA 1c (6.2 vs. 5.6%, Table 3), which is consistent with the large body of evidence that demonstrates that people of South Asian origin have a greater burden of glucose intolerance than Europeans (33,34). Given the differences in the sensitivity and specificity (and hence positive and negative predictive values) of the fasting glucose and HbA 1c to diagnose diabetes between ethnic groups, using likelihood ratios can help clinicians more reliably estimate the post-test probability of diabetes.…”

Section: Ethnic Variationssupporting

confidence: 80%

Diagnostic Strategies to Detect Glucose Intolerance in a Multiethnic Population

et al. 2003

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OBJECTIVE -Identifying individuals who have elevated glucose concentrations is important for clinicians so that preventive strategies can be invoked, and it is useful for researchers who study associations between elevated glucose and adverse health outcomes. These methods should be applicable worldwide across different ethnic groups. Therefore, the objective of our analysis was to determine whether using the fasting glucose and HbA 1c together could improve the classification of individuals with impaired glucose tolerance and diabetes in a multiethnic cohort randomly assembled in Canada.RESEARCH DESIGN AND METHODS -We determined the optimum diagnostic criteria to identify people with abnormal glucose tolerance using fasting plasma glucose, 2-h post-glucose load plasma glucose, and HbA 1c in 936 Canadians of South Asian, Chinese, and European descent.RESULTS -The sensitivity of the American Diabetes Association (ADA) criteria to diagnose diabetes compared with the World Health Organization definitions was poor at 48.3% (95% confidence interval [CI] 35.7-61.0). Using a receiver operator characteristic curve, the optimum combined cut-point using fasting glucose and HbA 1c to diagnose diabetes was a fasting glucose Ն5.7 mmol/l and an HbA 1c Ն5.9%. These cut-points were associated with a sensitivity and specificity of 71.7% (60.3-83.1) and 95.0% (93.5-96.4), respectively, a positive likelihood ratio (LR) of 14.3 (9.6 -19.0), and a negative LR of 0.3 (0.2-0.4). Significant ethnic variation in the sensitivity and specificity of this approach was observed: 47.4% (24.9 -69.8) and 97.6% (95.9 -99.4) among Europeans, 78.6% (57.1-100) and 95.9% (93.6 -98.2) among Chinese, and 85.2% (71.8 -98.6) and 91.3% (88.1-94.6) among South Asians, respectively. Participants with impaired glucose tolerance could not be identified reliably using the fasting glucose or HbA 1c alone or in combination.CONCLUSIONS -The sensitivity of the ADA criteria to diagnose diabetes is low, and there is substantial variation between ethnic groups. Fasting glucose and HbA 1c may be used together to improve the identification of individuals who have diabetes, allowing clinicians to streamline the use of the oral glucose tolerance test. Diabetes Care 26:290 -296, 2003I ndividuals with diabetes have an increased risk of developing significant end-organ damage, such as retinopathy, cataracts, nephropathy, neuropathy, and cardiovascular disease (CVD) (1,2). Tight glucose control has been demonstrated to attenuate many of these complications in patients with both type 1 and type 2 diabetes. Individuals with dysglycemia (i.e., elevated glucose levels below the diabetic cut-offs) also have an increased risk of diabetes, CVD, and death (3,4). Although there are no proven pharmacological therapies indicated for this group, some are being evaluated, and diet and lifestyle changes such as weight loss and exercise are effective (5,6). Nevertheless, identifying individuals who have dysglycemia (from normal glucose tolerance to frank diabetes) is important for clinic...

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Section: Ethnic Variationssupporting

confidence: 80%

Diagnostic Strategies to Detect Glucose Intolerance in a Multiethnic Population

et al. 2003

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“…13,62,63 These studies indicate the possibility of an Indian paradox, and that the concept of normal saturated fat intake and normal cholesterol level may have little meaning among Indians. On a population basis, the risk of CAD rises progressively with increases in saturated fat intake >5% kcal/day and in serum cholesterol level >150 mg/dl (3.89 mmol/L).…”

Section: Indian Scenario Of Cardiovascular Diseasesmentioning

confidence: 99%

Cardiovascular disease risk factors in Asian Indian population: A systematic review

Nag

Ghosh

2014

Journal of Cardiovascular Disease Research

117

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a b s t r a c tBackground: Cardiovascular diseases (CVDs) are the number one cause of death globally and are the leading cause of death in India also. Several surveys conducted across the country over the past few decades have shown a rising prevalence of major risk factors for CVD in Asian Indian population. The problem of increasing risk factors for CVD in India is because of lack of surveillance system and lack of proper diagnosis. This study will help to point out the need of research so that some advanced diagnosis system may be developed for proper diagnosis of CVDs and to reduce the growing burden of CVDs in the country. Methods: We did a literature search for the period from 1968 to 2012 using PUBMED search to identify all relevant studies of cardiovascular diseases. Besides PUBMED searching, manual searching has also been done. This article provides a review of current understanding of the epidemiology of cardiovascular disease, particularly, coronary heart disease (CHD), stroke and related risk factors in Asian Indian population. Results: Hypertension and diabetes are highly prevalent among Asian Indian population, which may explain their high rate of stroke and heart attack in India. The increasing rate of CVD may be explained by the high rates of other risk factors including adverse lipid profile. The etiology of cardiovascular diseases (CVD) is multifactorial and no single factor is an absolute cause. Conclusion: The cardiovascular diseases and its risk factors are increasing with a rapid pace in Asian Indian population. Though the prevalence of CVD risk factors is found higher in urban population, yet it is increasing at an alarming rate in rural population also, which is a serious threatening to the nation. Since majority of the Indians live in rural area, CVD may lead to epidemic proportions. We need health promotion programs and reorientation of primary health care to improve CVD detection in earlier stage and its management.

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“…An important question is whether this low LC n-3 PUFA status in South Asians is a result of a lower dietary intake or metabolic incapacity to incorporate, utilise and/or synthesise LC n-3 PUFA. In accord with the 'n-3 index' studies differences have been reported in dietary intake of PUFA between South Asians and Caucasians, mainly as increased n-6 PUFA from vegetable oils (McKeigue et al 1985;Miller et al 1988;Lovegrove et al 2004) in combination with a lower intake of the cardioprotective LC n-3 PUFA in South Asians (Sevak et al 1994;Lovegrove et al 2004). The lower dietary intake of LC n-3 PUFA alone, or in combination with the high n-6 PUFA intake, could be a viable explanation for the low LC n-3 PUFA status reported in Indian Asian groups, which could be easily addressed.…”

Section: Dietary Pufa and Cvd Riskmentioning

confidence: 80%

CVD risk in South Asians: the importance of defining adiposity and influence of dietary polyunsaturated fat

Lovegrove

2007

Proc. Nutr. Soc.

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The prevalence of the metabolic syndrome (MetS), CVD and type 2 diabetes (T2D) is known to be higher in populations from the Indian subcontinent compared with the general UK population. While identification of this increased risk is crucial to allow for effective treatment, there is controversy over the applicability of diagnostic criteria, and particularly measures of adiposity in ethnic minorities. Diagnostic cut-offs for BMI and waist circumference have been largely derived from predominantly white Caucasian populations and, therefore, have been inappropriate and not transferable to Asian groups. Many Asian populations, particularly South Asians, have a higher total and central adiposity for a similar body weight compared with matched Caucasians and greater CVD risk associated with a lower BMI. Although the causes of CVD and T2D are multi-factorial, diet is thought to make a substantial contribution to the development of these diseases. Low dietary intakes and tissue levels of long-chain (LC) n-3 PUFA in South Asian populations have been linked to high-risk abnormalities in the MetS. Conversely, increasing the dietary intake of LC n-3 PUFA in South Asians has proved an effective strategy for correcting such abnormalities as dyslipidaemia in the MetS. Appropriate diagnostic criteria that include a modified definition of adiposity must be in place to facilitate the early detection and thus targeted treatment of increased risk in ethnic minorities.

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Diet and Risk Factors for Coronary Heart Disease in Asians in Northwest London

Cited by 194 publications

References 17 publications

Diagnostic Strategies to Detect Glucose Intolerance in a Multiethnic Population

Diagnostic Strategies to Detect Glucose Intolerance in a Multiethnic Population

Cardiovascular disease risk factors in Asian Indian population: A systematic review

CVD risk in South Asians: the importance of defining adiposity and influence of dietary polyunsaturated fat

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