Migrant South Asian Populations Research Articles

Genetic variation and differentiation among a native British and five migrant South Asian populations of the East Midlands (UK) based on CODIS forensic STR loci

Background Short Tandem Repeats (STRs) are widely used in population and forensic genetic studies. Aim The objective of this study was to document the level and extent of genetic variation of the FBI Combined DNA Index System (CODIS) STR loci (D3S1358, vWA, FGA, D8S1179, D21S11, D18S51, D5S818, D13S317, D7S820, D16S539, TH01, TPOX and CSF1PO) in 6 populations (British, Indian (Punjabis and Gujaratis), Pakistani, Bangladeshi and Sri Lankan) of the East Midlands (UK). There is a lack of genetic research on the migrant South Asian populations. Subjects and methods DNA samples (N = 603) were analysed for 13 autosomal forensic STR loci along with the amelogenin locus following standard protocols. Data were analysed for genetic variation and a range of forensic indices. Results All loci were polymorphic in all populations with a variable degree of variation. Average observed heterozygosity was highest in Bangladeshi (0.803) and lowest in Punjabi (0.761). FGA locus had the highest power of discrimination (PD) in most populations. Conclusion FGA locus was most polymorphic and discriminatory among migrant populations demonstrating it as the marker with the highest potential in forensic analyses. These results could be useful for population and forensic genomic studies.

A comparison of cardiovascular risk scores in native and migrant South Asian populations.

BackgroundSouth Asians have increased cardiovascular risk burden but little data exists comparing cardiovascular (CV) risk models in migrant and native South Asians. Our retrospective cohort study in patients presenting with first acute myocardial infarction(MI) compares the predictive value of CV risk scores in native and UK migrant South Asians.MethodsRetrospective cohort study of 80 UK-based patients of South Asian origin admitted with first presentation MI, excluding patients with known coronary artery disease. A retrospective 10-year CV risk was calculated for each patient using four cardiovascular risk models: Framingham Risk Score(RiskFRS), World Health Organisation(RiskWHO), American College of Cardiology/American Heart Association(ACC/AHA) (RiskACC/AHA), and 3rdJoint British Societies'(RiskJBS). Our aim was to assess agreement between these risk scores and conduct comparative analysis with native South Asians.ResultsRiskJBS identified the largest proportion of migrant South Asians as ‘high risk’ with 65% of subjects having an estimated >20% 10-year CV risk. RiskWHO provided the lowest 10-year CV risk estimates for South Asian migrants, identifying 21.25% of the migrant cohort as >20% risk of major CV event. Comparative analysis with the native South Asian cohort demonstrated RiskJBS as the risk model most likely to identify patients as ‘high'(>20%) risk(55.9%; p = 0.224).ConclusionsThis study represents the first analysis of predictive cardiovascular risk scores comparing migrant and native South Asian populations. Significant variation between the CV risk scores were observed, leading to inaccuracies in patient cardiovascular risk estimation. Given the growing burden of cardiovascular disease in Asian countries and different population characteristics, we highlight the need for population specific CV disease risk models whilst providing stimulus for further large-scale prospective studies.

P612 Dietary practices and beliefs of British South Asians with inflammatory bowel disease: A prospective UK study

Abstract Background The increasing incidence of inflammatory bowel disease (IBD) in newly industrialised countries and immigrant populations appears to outpace that which genetic influences alone could instigate. Environmental factors, in particular, the western diet, are therefore implicated in its aetiopathogenesis. Limited data exist on the dietary practices of the migrant South Asian population with IBD. We aim to describe the dietary practices of British South Asian IBD patients and information resources utilised to guide these beliefs. Methods A prospective, cross-sectional, questionnaire-based study is being conducted across hospitals in the UK. Two-hundred South Asian patients with IBD are being recruited to complete a questionnaire regarding demographics and dietary practices. Results Data from 118 patients are available to date. Mean patient age is 43 years (51% female). Sixty-five per cent have ulcerative colitis (UC) and 33% Crohn’s disease (CD). Fifty-one per cent are of Indian ethnicity, 37% Pakistani and 10% Bangladeshi. Forty-nine per cent of patients were born in the UK to parents who were born outside of the UK and 51% of patients were born outside the UK. Mean disease duration is 10.5 years. Forty-six per cent considered diet to be an initiating factor in their IBD, based on their own experience (85%) as well as information from internet resources (31%) and other patients with IBD (19%). Fifty-nine per cent of patients felt that diet had triggered a relapse of their disease. Most commonly reported foods were spicy (69%) and fatty foods (47%), milk products (44%) and red meat (37%). Eighty-six per cent of patients avoided certain foods in an attempt to prevent an IBD ‘flare’. Most frequently avoided foods were spicy foods (76%), fatty foods (69%), red meat (60%), coffee (55%), carbonated drinks (54%) and milk products (53%). One in four patients had tried a specific exclusionary diet, with 13% having tried a gluten-free diet in the absence of coeliac disease, to manage their symptoms. Just over a half of patients reported being able to find specific dietary advice for IBD, most commonly via the internet. Over half of patients avoided eating the same meal as their family or eating out to prevent relapse of their IBD. 1 in 3 consumed certain foodstuffs or nutritional supplements to prevent a relapse of IBD, most commonly turmeric in 25% of these patients. Conclusion Dietary restriction may be highly prevalent amongst the British South Asian IBD community with a high proportion reporting diet as an initiating factor and trigger for disease flares. Studies on immigrant populations may hold valuable clues regarding the influence of migration, environmental influences and drift from traditional cultural practices on IBD aetiopathogenesis and related symptoms. A larger dataset will be presented at conference proceedings.

779 Dietary Practices and Beliefs of British South Asian Patients With Inflammatory Bowel Disease: A Prospective Study From the United Kingdom

INTRODUCTION: The increasing incidence of inflammatory bowel disease (IBD) in developing countries and immigrant populations appears to outpace that which genetic influences alone could instigate and implicates “westernisation” and diet in the aetiopathogenesis of IBD. 1 Limited data exist on the dietary practices of the migrant South Asian population with IBD. We aim to describe the dietary practices of British South Asian patients with IBD and the information resources which guide these beliefs. METHODS: A prospective, cross-sectional, questionnaire-based study is being conducted in the UK. Two-hundred South Asian patients with IBD will complete a questionnaire regarding demographics and dietary practices. Here we provide an interim analysis of the data collected from the first 27 patients. RESULTS: Mean patient age was 36.1 years (59% male). 56% had UC and 44% Crohn's. 62% identified themselves as Pakistani, 19% as Indian and 19% as Bangladeshi. 74% of patients were born in the UK to parents born outside of the UK, the remaining 26% were born outside of the UK. Mean disease duration was 10.2 years. 48% considered diet to be an initiating factor in their IBD, based on their own experience (100%) and internet resources (31%). 63% of patients felt that diet had triggered a relapse of their disease, the most commonly reported foods being spicy (65%), fatty foods (53%), milk products (35%) and red meat (35%). 81% of patients avoided certain foods in an attempt to prevent an IBD “flare.” Most frequently avoided foods were spicy foods (91%), fatty foods (86%), coffee and carbonated drinks (55%) and red meat (50%). Just over a third of patients reported being able to find specific dietary advice for IBD, most commonly on the internet. Around half of patients avoided eating the same meal as their family or eating out to prevent relapse of their IBD. CONCLUSION: Dietary restriction may be highly prevalent amongst the British South Asian community with IBD with a high proportion reporting diet as an initiating factor and trigger for IBD. Studies on immigrant populations may hold valuable clues for IBD pathogenesis or related symptoms. A larger dataset will be presented at conference proceedings.

Culturally Tailored Self-Management Interventions for South Asians With Type 2 Diabetes: A Systematic Review.

Diabetes mellitus is one of the most common chronic diseases worldwide and a leading cause of morbidity and mortality. A high prevalence of type 2 diabetes mellitus has been noted among the South Asian population, in general, and migrant South Asians. Self-management is considered a proponent to the management of diabetes. Although empirical evidence supports such interventions, little is known regarding the cultural congruency of such interventions for diverse cultural and ethnic groups, particularly South Asians. Our purpose was to determine the effectiveness of diabetes self-management education (DSME) and diabetes self-management support (DSMS), interventions on migrant South Asian's glycated hemoglobin (A1C) levels and whether DSME and DSMS interventions are culturally tailored to the migrant South Asian population. In this study, a systematic review, with narrative synthesis, was conducted. Data were extracted on the study, participant, and intervention characteristics and the cultural congruity using Leininger's sunrise model. Four studies meeting the inclusion criteria were included. Overall, most (75%) of the DSME and DSMS interventions were not effective in reducing A1C levels. Specific to cultural congruity of the interventions, all studies delivered the intervention based on the participant's preferred language and incorporated culturally sensitive dietary information primarily by persons of the same cultural and ethnic background. However, little information was presented on the provision and integration of culturally congruent care. Findings highlight the importance of rethinking the way in which South Asians are labelled as a homogenous group and accounting for such differences when adapting and designing culturally tailored DSME and or DSMS interventions in clinical practice.

Su1326 IBD in Migrant South Asian Populations: A Systematic Review of Epidemiology and Disease Phenotype

Su1326 IBD in Migrant South Asian Populations: A Systematic Review of Epidemiology and Disease Phenotype

Environmental Changes and the Onset of Inflammatory Bowel Disease (IBD) in the Migrant South Asian Population

Purpose: The increase in the incidence of IBD in South Asian patients over the past 2 decades has been attributed to both genetic and environmental factors. A comprehensive evaluation of hygiene and dietary changes among the Indian diaspora to the U.S. has never been conducted. Methods: In this pilot study, we administered a questionnaire to first generation Indian immigrants with IBD in Northern California. The questions were extensive and involved changes in diet, stress, hygiene and lifestyle after immigration from India to the U.S.A. Results: Twenty patients are enrolled to date. 12 ulcerative colitis (UC) patients and 8 Crohn's disease (CD) patients were surveyed. Average number of years since migrating to the United States was 22.5 years (11-50 years). Average number of years from time of migration to time of diagnosis was 11.9 years (3-40 years) Average age at diagnosis was 35 years (17-68 years). Significant dietary changes were noted upon immigration. These include increase in animal protein and fat intake, the consumption of pasteurized milk, adoption of a more western diet instead of traditional Indian diet, decreased consumption of freshly prepared foods, consistent daily use of the microwave and the consumption of pre-prepared or packaged foods (Table 1). 25% of UC and 12.5% of CD patients had ever smoked. 50% UC and 62.5% of the CD patients consumed any alcohol. Environmental changes include access to running hot water, switch to the use of toilet paper instead of water, appropriate hand washing techniques and use of hand sanitizer (Table 2). Life style changes included increased perceived stress which was seen in 83.3% UC and 87.5% CD patients. 95% of all patients surveyed came from a lower socioeconomic status prior to migrating to the U.S. with annual household incomes below $20,000. However, upon migration 85% had average annual household incomes above $80,000. 58.3% UC and 75 % of CD patients had no refrigerator while growing up in India. Improved oral hygiene was observed in 50% of UC and 87.5% CD patients. 41.6 %UC patients and 50% CD patients had a family history of IBD. However, in all affected family members, the symptoms and diagnosis of IBD occurred only after migration to the U.S. Conclusion: South Asian immigrants with IBD note a significant change in diet, hygiene and lifestyle after arrival in the US. Further studies will be done to compare these patients to non-IBD migrant controls and to determine microbiome variations with immigration and disease onset.

Barriers to Lifestyle Behavioral Change in Migrant South Asian Populations

The purpose of this literature review is to describe and assess the cultural barriers to behavior change in migrant South Asians, given the high morbidity and mortality associated with cardiovascular disease in this population. We reviewed studies that explored the relationship between South Asian culture in the Diaspora and lifestyle behaviors. Our review produced 91 studies, of which 25 discussed the relationship between various aspects of South Asians' belief system and their approach to modifying lifestyle habits. We identify 6 specific categories of beliefs which play the largest role in the difficulties South Asians describe with behavior change: gender roles, body image, physical activity misconceptions, cultural priorities, cultural identity, and explanatory model of disease. Future research and interventions should account for these cultural factors to successfully improve dietary habits and physical activity levels in migrant South Asian populations.

Defining obesity cut-off points for migrant South Asians.

BackgroundBody mass index (BMI) and waist circumference (WC) are used to define cardiovascular and type 2 diabetes risk. We aimed to derive appropriate BMI and WC obesity cut-off points in a migrant South Asian population.Methods4688 White Europeans and 1333 South Asians resident in the UK aged 40–75 years inclusive were screened for type 2 diabetes. Principal components analysis was used to derive a glycaemia, lipid, and a blood pressure factor. Regression models for each factor, adjusted for age and stratified by sex, were used to identify BMI and WC cut-off points in South Asians that correspond to those defined for White Europeans.FindingsFor South Asian males, derived BMI obesity cut-off points equivalent to 30.0 kg/m2 in White Europeans were 22.6 kg/m2 (95% Confidence Interval (95% CI) 20.7 kg/m2 to 24.5 kg/m2) for the glycaemia factor, 26.0 kg/m2 (95% CI 24.7 kg/m2 to 27.3 kg/m2) for the lipid factor, and 28.4 kg/m2 (95% CI 26.5 kg/m2 to 30.4 kg/m2) for the blood pressure factor. For WC, derived cut-off points for South Asian males equivalent to 102 cm in White Europeans were 83.8 cm (95% CI 79.3 cm to 88.2 cm) for the glycaemia factor, 91.4 cm (95% CI 86.9 cm to 95.8 cm) for the lipid factor, and 99.3 cm (95% CI 93.3 cm to 105.2 cm) for the blood pressure factor. Lower ethnicity cut-off points were seen for females for both BMI and WC.ConclusionsSubstantially lower obesity cut-off points are needed in South Asians to detect an equivalent level of dysglycemia and dyslipidemia as observed in White Europeans. South Asian ethnicity could be considered as a similar level of risk as obesity (in White Europeans) for the development of type 2 diabetes.

Colorectal cancer in South Asians in UK and the role of recessive mutations

Aims: 1. To examine the rate of incidence of colorectal cancer (CRC) in the South Asian (SA) population in UK. 2. To examine the hypothesis that recessive mutations contribute to susceptibility to CRC among SA, in view of consanguinity in the family. Methods: 1. SA cases from Bradford were identified from data on CRC from NYCRIS from 1997-2004 based on post code and incidence rate calculated using data from the 2001 census. 2. 59 cases of CRC were recruited from 5 hospitals in Yorkshire and 195 controls were recruited from the community. Blood / saliva samples were obtained together with family history. Genetic analysis was done to look for mutation R802X in PMS2, and Y165C and G382D in MYH genes. MREC approval was obtained for the study. Results: 1. Age standardized rate of incidence of CRC per 100,000 per annum in SA from Bradford was found to be 11.4, which is nearly twice the rate in South Asia, but 1/3 the rate for Caucasians. 2. All families of Pakistani origin had consanguineous marriages but none was found in Indians. 2 homozygous and 1 heterozygous cases for mutation R802X were found in PMS2. Single case of heterozygous variant leu786 met was found in exon 14 of PMS2. No mutation was found in MYH. Conclusion: The incidence of CRC has doubled in migrant SA population in UK compared with the rate in South Asia. Recessive mutations are likely to be a contributor to CRC in view of consanguineous marriages in this population.

Proteinuria in South Asian children: prevalence and determinants

Proteinuria in children is a marker of kidney disease and atherosclerosis, both which are known predictors of cardiovascular mortality. Recent evidence suggests that migrant South Asian populations living in the West may be at higher risk of kidney disease than native Caucasians. However, the determinants of proteinuria in South Asian children have not been explored. Previously, we reported ethnic variation in the prevalence of proteinuria in the adult population of Pakistan. However, it is not known whether ethnic predisposition to proteinuria appears during childhood or whether it is acquired later in life as a result of prolonged exposure to undiagnosed diabetes and hypertension. Analyses were based on a subset of data for 4977 children aged 5 to less than 15 years collected as part of the broad National Health Survey of Pakistan, conducted between 1990 and 1994. Proteinuria was defined as a dipstick positive for protein on a random urine sample. Ethnicity was reported as "mother-tongue", which is specific for each of the five major ethnic subgroups of Pakistan: Muhajir, Punjabi, Sindhi, Pashtun, and Baluchi. The overall prevalence (95% CI) of proteinuria in the children was 3.3% (2.7-3.9%). It was 6.2% in Sindhis, 3.6% in Muhajirs, 2.8% in Punjabis, 2.8% in Baluchis, and 1.0% in Pashtuns (p<0.001). In multivariable analyses, proteinuria was associated with greater height (p=0.007), urban dwelling (p=0.03), lower socioeconomic status (p=0.02), and certain ethnicities (p=0.005). The ethnic variation in proteinuria in South Asian children mirrors variation among ethnic groups in adults. This suggests variations in susceptibility or early exposure to causes of chronic kidney disease, rather than long-term exposure to undiagnosed diabetes or hypertension. Further studies are needed to determine factors in early life that may differentially predispose certain ethnic groups to proteinuria.

Self-rated health in Pakistan: results of a national health survey

BackgroundSelf-rated health (SRH) is a robust predictor of mortality. In UK, migrants of South Asian descent, compared to native Caucasian populations, have substantially poorer SRH. Despite its validation among migrant South Asian populations and its popularity in developed countries as a useful public health tool, the SRH scale has not been used at a population level in countries in South Asia. We determined the prevalence of and risk factors for poor/fair SRH among individuals aged ≥15 years in Pakistan (n = 9442).MethodsThe National Health Survey of Pakistan was a cross-sectional population-based survey, conducted between 1990 and 1994, of 18 135 individuals aged 6 months and above; 9442 of them were aged ≥15 years. Our main outcome was SRH which was assessed using the question: "Would you say your health in general is excellent, very good, good, fair, or poor?" SRH was dichotomized into poor/fair, and good (excellent, very good, or good).ResultsOverall 65.1% respondents – 51.3 % men vs. 77.2 % women – rated their health as poor/fair. We found a significant interaction between sex and age (p < 0.0001). The interaction was due to the gender differences only in the ages 15–19 years, whereas poor/fair SRH at all older ages was more prevalent among women and increased at the same rate as it did among men. We also found province of dwelling, low or middle SES, literacy, rural dwelling and current tobacco use to be independently associated with poor/fair SRH.ConclusionThis is the first study reporting on poor/fair SRH at a population-level in a South Asian country. The prevalence of poor/fair health in Pakistan, especially amongst women, is one of the worst ever reported, warranting immediate attention. Further research is needed to explain why women in Pakistan have, at all ages, poorer SRH than men.

Cancer incidence in the south Asian population of England (1990-92).

Cancer incidence among English south Asians (residents in England with ethnic origins in India, Pakistan or Bangladesh) is described and compared with non-south Asian and Indian subcontinent rates. The setting for the study was areas covered by Thames, Trent, West Midlands and Yorkshire cancer registries. The study identified 356 555 cases of incident cancer (ICD9:140–208) registered between 1990 and 1992, including 3845 classified as English south Asian. The main outcome measures were age specific and directly standardized incidence rates for all cancer sites (ICD9:140–208). English south Asian incidence rates for all sites combined were significantly lower than non-south Asian rates but higher than Indian subcontinent rates. English south Asian rates were substantially higher than Indian subcontinent rates for a number of common sites including lung cancer in males, breast cancer in females and lymphoma in both sexes. English south Asian rates for childhood and early adult cancer (0–29 years) were similar or higher than non-south Asian rates. English south Asian rates were significantly higher than non-south Asian rates for Hodgkin's disease in males, cancer of the tongue, mouth, oesophagus, thyroid gland and myeloid leukaemia in females, and cancer of the hypopharynx, liver and gall bladder in both sexes. The results are consistent with a transition from the lower cancer risk of the country of ethnic origin to that of the country of residence. They suggest that detrimental changes in lifestyle and other exposures have occurred in the migrant south Asian population. © 1999 Cancer Research Campaign