Abstract
South Asians (i.e., people who originate from India, Pakistan, Sri Lanka, Nepal, and Bangladesh) have higher cardiovascular disease rates than other populations, and these differences persist in their offspring. Nutrition is a critical lifestyle-related factor that influences fetal development, and infant and child health in early life. In high-income countries such as Canada, nutrition-related health risks arise primarily from overnutrition, most strikingly for obesity and associated non-communicable diseases. Evidence for developmental programming during fetal life underscores the critical influence of maternal diet on fetal growth and development, backed by several birth cohort studies including the Pune Maternal Nutrition Study, the South Asian Birth Cohort Study, and the Born in Bradford Study. Gestational diabetes mellitus is a strong risk factor for type 2 diabetes, future atherosclerosis and cardiovascular disease in the mother and increases the risk of type 2 diabetes in her offspring. Non-pharmacological trials to prevent gestational diabetes are few, often not randomized, and are heterogeneous with respect to design, and outcomes have not converged upon a single optimal prevention strategy. The aim of this review is to provide an understanding of the current knowledge around perinatal nutrition and gestational diabetes among the high-risk South Asian population as well as summarize our research activities investigating the role of culturally-tailored nutrition advice to South Asian women living in high-income settings such as Canada. In this paper, we describe these qualitative and quantitative studies, both completed and underway. We conclude with a description of the design of a randomized trial of a culturally tailored personalized nutrition intervention to reduce gestational glycaemia in South Asian women living in Canada and its implications.
Highlights
As of 2016 in Canada, >1.9 million people (5.4% of the population) were of SouthAsian (SA) ancestry—i.e., people who originate from India, Pakistan, Sri Lanka, Nepal, and Bangladesh—comprising the largest visible minority group in Canada (25.6%) [1]
Evidence collected over the last 20 years suggests that cardiovascular disease (CVD) rates in SAs are higher than other ethnic groups living in Canada [3,4,5,6], and, among SAs, CVD is more severe, presents at younger ages, and in some contexts, this is due to differential access to diagnostic and treatment services compared to non-SAs [7,8,9]
The aim of this review is to provide an understanding of the current knowledge around perinatal nutrition and gestational diabetes among the high-risk South Asian population as well as summarize work investigating the role of culturally tailored nutrition advice to South Asian women living in high-income settings like Canada
Summary
Asian (SA) ancestry—i.e., people who originate from India, Pakistan, Sri Lanka, Nepal, and Bangladesh—comprising the largest visible minority group in Canada (25.6%) [1] This number is projected to reach approximately 4.1 million by 2036, of which nearly 1 million will be women of child-bearing age [2]. Evidence collected over the last 20 years suggests that cardiovascular disease (CVD) rates in SAs are higher than other ethnic groups living in Canada [3,4,5,6], and, among SAs, CVD is more severe, presents at younger ages, and in some contexts, this is due to differential access to diagnostic and treatment services compared to non-SAs [7,8,9] The etiology of this elevated risk for CVD in SAs is not fully understood but early life fetal and childhood exposures have been proposed as major determinants.
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