Introduction:
Within the United Kingdom, people identifying as Asian/British Asian make up approximately 4.9% of the total population, according to data derived from the 2011 UK census survey. In figures, there are around 3,080,000 South Asians of Indian, Pakistani or Bangladeshi origin/ethnicity living in the U.K ((2011 Census- Office for National Statistics, 2013) The main focus of this review is to analyse and discuss food intake within the South Asian community and address consequences of certain dietary practices and choices, in relation to health and disease. The two main diseases that will be addressed in detail within this review include: Cardiovascular disease (CVD) and Type 2 Diabetes.
It is also important to mention that there are small variations in food intake within the South Asian community due to religion, country of origin and generational differences, but generally all three sub-groups (Indians, Pakistanis and Bangladeshis) have very similar food habits.
South Asian Diet in relation to disease:
South Asian diet is made up of large amounts of carbohydrates, specifically varieties of bread (naan, chapatti, paratha) and rice (biryani, ‘kitchri’ and boiled rice). Although a large bulk of South Asian diet is formed primarily of carbohydrates, other foods that are also consumed regularly include different forms of dairy (raita, yogurt, paneer) and meat dishes, as well as rich desserts (high in sugar and saturated fats) and fried snacks such as samosas and pakoras (high levels of salt and saturated fat) (Commonly Consumed South Asian Foods, 2014). Salt also tends to be used liberally in cooking. It is known that a high intake of dietary salt raises blood pressure and also increases the risk of cardiovascular diseases as well as having an effect on the kidneys. (Ekmekcioglu, Blasche and Dorner, 2013)
Cardiovascular Disease (CVD):
Cardiovascular disease (CVD) is a term that covers all diseases related to the heart and blood vessels. Within CVD, two main conditions influenced by diet and lifestyle factors include atherosclerosis (narrowing of the arteries) and coronary heart disease (CHD). CHD includes heart attack and angina, which generally occur as a result of atherosclerosis. People of Indian, Pakistani and Bangladeshi origins are recorded to have the highest rates of CHD mortality within the United Kingdom (SOUTH ASIANS AND HEART DISEASE, n.d.),
A large amount of food preparation in South Asian culture tends to involve frying with large quantities of oil and ‘ghee’. The consumption of these foods regularly, that contain high levels of saturated fats, alongside the methods of food preparation mentioned previously, can contribute to high levels of cholesterol in the body, specifically: ‘low-density lipoproteins’(LDL’s). A review on dairy products containing milkfat by the International Dairy Federation in Belgium, reported that amongst different dairy products, ghee was one containing some of the highest levels of cholesterol (Sserunjogi, Abrahamsen and Narvhus, 1998). Higher levels of LDL cholesterol are associated with an increased risk of developing cardiovascular disease, specifically atherosclerosis (Fat: the facts – Live Well – NHS Choices, n.d.) This is due to the accumulation of fatty deposits inside the walls of the arteries. Over a period of time, the build-up of fatty deposits can lead to the arteries becoming narrow (atherosclerosis), therefore restricting blood flow to the heart. A rich and constant supply of blood to the heart is needed to supply enough oxygen and keep it working efficiently. (Ramanathan and Skinner, 2005). Alongside fatty deposit build-up, there is also a high risk of the fatty-deposit-formed ‘plaques’, breaking or bursting, causing a blood clot. A blood clot can result in a heart attack if the supply of blood is blocked to that region, and it can also cause a stroke if supply of blood to the brain is blocked (High cholesterol, n.d.).
The ‘Health Survey England’ carried out in 2004 aimed to collect information regarding the health of the general population, with an objective to specifically target minority ethnic groups, which included South Asians. The survey showed that the prevalence of coronary heart disease was highest in both male and female Indians, and Pakistani males, amongst all the ethnic minority groups. Angina was recorded to have the highest prevalence in Pakistani males (nearly 31%) and in Indian females (approximately 15%). As well this, the occurrence of heart attack also had the highest prevalence in the Pakistani group (19% males and approximately 7% females) (Health Survey for England 2004: The Health of Minority Ethnic Groups– headline tables, 2004).
The cause of CVD development will have been influenced by different health, environmental and genetic factors, however, diet is an extremely important aspect to focus on, to contribute to lowering the prevalence of CVD in both males and females of South Asian origin. Different diet-related methods to tackle the high rates of CVD include: increasing awareness of diet-related heart health, and encouraging communities to make ‘heart-healthy’ swaps, such as avoiding or replacing food that is unhealthy and high in saturated fats. In a factfile published by the British Heart Foundation, it is made clear that CHD prevention strategies should focus on the risk factors of coronary heart disease that have already been established. Furthermore, awareness of cultural needs and language barriers within the South Asian community should also be considered. Risk factors that have already been established include the effect of diet, environment and genetics on the development of CHD. Diet and food intake is a risk factor that can be addressed and focussed on, to help lower existing rates of prevalence (SOUTH ASIANS AND HEART DISEASE, n.d.).
The ‘Leicestershire Nutrition and Dietetic services’ team have information online, tailored towards the South Asian community, regarding incorporating healthy food into the South Asian diet. The online webpage targeted at eating a ‘cardio-protective’ diet aims to provide information on healthy swaps and substitutions for day-to-day foods as well as advice on eating and maintaining the ‘5-a-day’ advice alongside reducing the consumption of saturated fats (Eating for a healthy heart South Asian Diet, 2012)
Type 2 Diabetes:
The second disease affected by diet and lifestyle that has a high prevalence in the South Asian community, is: Type 2 diabetes. Currently in the United Kingdom, there are approximately 3.9 million people living with diabetes, with type 2 diabetes making up 90% of cases. Not only does diabetes affect a vast number of people across the United Kingdom, it has a major financial impact on the NHS, with costs currently totalling £23.7 billion, a figure that is estimated to reach close to £40 billion by 2036 (Diabetes: Facts and stats, n.d.).
One of the focal points of ‘Health Survey England’, carried out in 2004 was concerning the health of individuals from minority ethnic groups. The prevalence of type 2 diabetes was assessed in both men and women, from different ethnic backgrounds, such as South Asian, Chinese Black African and Black Caribbean. Results showed that there was a higher prevalence of type 2 diabetes in Indian, Pakistani and Bangladeshi men, between the ages of 35-54 years old and 55 years+, in comparison to the general population. Furthermore, results of the survey also showed that Type 2 diabetes in women aged 35 years+ was more common in the Indian, Pakistani and Bangladeshi groups (Health Survey for England 2004: The Health of Minority Ethnic Groups– headline tables, 2004).
Furthermore, according to research presented at a professional conference by ‘Diabetes UK’, there are much higher rates of type 2 diabetes in young people of South Asian origin, also leading to an increased risk of the development of heart disease and associated conditions, in comparison to their white counterparts. The study that was carried out, also showed that there was an increased risk of cardiovascular conditions, hypertension and high levels of cholesterol in South Asians suffering from type 2 diabetes, between the ages of 20-60 years old (Young South Asian people at higher risk of diabetes and associated heart disease, 2014).
These results reflect the growing number of cases of type 2 diabetes found in people of South Asian origin. Evidence shows that lifestyle factors significantly contribute to type 2 diabetes. By analysing the results of the HSE, there is reason to suggest that a main contributing factor of type 2 diabetes in people of South Asian origin, is dietary habits and food intake.
The above research, alongside the results of the HSE survey, show that type 2 diabetes is a condition that doesn’t solely affect a specific age group or gender, within the South Asian community. This highlights the importance of educating all members of the community on type 2 diabetes and educating them on matters of prevention and management.
It is also important to consider whether the advice and information regarding diabetes, given to the South Asian community, is information which can be processed and understood in the correct way, by the people that the information is actually targeted towards. This would be dependent on multiple factors such as age, languages spoken and what culture the addressees associate with more. A document provided by the South Asian Health foundation, which addresses Type 2 Diabetes specifically within the UK South Asian population, stresses that an approach which is culturally appropriate, is paramount in delivering information effectively, as knowledge alone is not sufficient, if action is not taken. They also discuss that there is a variety of material that has been specifically produced for people from South Asia and education and advice that is being given should be moulded around any knowledge the individuals/groups may already possess. (Hanif et al., 2014)
An example of a source of information that is culturally appropriate, is the website named ‘Apnee Sehat’, translating to ‘Your health’. Their aim is to positively impact health outcomes in 500,000 South Asians suffering from diabetes, through education, consultancy and clinics. (Apnee Sehat: 2015)
Conclusion:
After analysing the literature and different pieces of research presented within this review, there is evidence of some studies that have been carried out to assess the relation between food intake and the prevalence of certain diseases in the South Asian community. However, there is scope to carry out more research. For example, although the Health Survey England (HSE) is carried out annually, the HSE that was specifically targeted towards ethnic minorities, carried out more than a decade ago (in 2004), could be repeated as it is dated. It is a useful source of information as results are given as statistics and percentages. If it is repeated now, it could provide more accurate information that reflects the current health status of South Asian individuals. Furthermore, a lot of studies based on South Asians have been carried out abroad rather than in the United Kingdom, which means that results and findings cannot be directly applied to individuals within the United Kingdom.
In summary, clear links and trends have been identified between food intake and the development of certain diseases in South Asians. However, an important point to address, that has been highlighted within this review, is that education and prevention is only effective if the delivery and source of information is culturally appropriate. This may be a reason why despite so much information being available to people, change has not been significant, which is clear to see by analysing the figures and statistics.
It is also important to understand that within South Asian culture, adopting a healthy lifestyle may not be as easy as it seems to be. This is because for a large number of South Asians, customs, tradition and habits may be things that have been passed down from generation to generation. For example: when cooking food, it is mainly based on estimations and techniques that have been passed down from previous generations, rather than a focus on what is healthy and how much of certain product/an ingredient (e.g. ghee, salt etc.) is being used in the cooking. This is why culturally appropriate methods will be particularly useful and effective, in bringing about change.