South Asian Groups Research Articles

Is child weight status correctly reported to parents? Cross-sectional analysis of National Child Measurement Programme data using ethnic-specific BMI adjustments.

BackgroundBMI underestimates and overestimates body fat in children from South Asian and Black ethnic groups, respectively.MethodsWe used cross-sectional NCMP data (2015–17) for 38 270 children in three inner-London local authorities: City & Hackney, Newham and Tower Hamlets (41% South Asian, 18.8% Black): 20 439 4–5 year-olds (48.9% girls) and 17 831 10–11 year-olds (49.1% girls). We estimated the proportion of parents who would have received different information about their child’s weight status, and the area-level prevalence of obesity—defined as ≥98th centile—had ethnic-specific BMI adjustments been employed in the English National Child Measurement Programme (NCMP).ResultsHad ethnic-specific adjustment been employed, 19.7% (3112/15 830) of parents of children from South Asian backgrounds would have been informed that their child was in a heavier weight category, and 19.1% (1381/7217) of parents of children from Black backgrounds would have been informed that their child was in a lighter weight category. Ethnic-specific adjustment increased obesity prevalence from 7.9% (95% CI: 7.6, 8.3) to 9.1% (8.7, 9.5) amongst 4–5 year-olds and from 17.5% (16.9, 18.1) to 18.8% (18.2, 19.4) amongst 10–11 year-olds.ConclusionsEthnic-specific adjustment in the NCMP would ensure equitable categorization of weight status, provide correct information to parents and support local service provision for families.

A compilation of tri-allelic SNPs from 1000 Genomes and use of the most polymorphic loci for a large-scale human identification panel

In a directed search of 1000 Genomes Phase III variation data, 271,934 tri-allelic single nucleotide polymorphisms (SNPs) were identified amongst the genotypes of 2,504 individuals from 26 populations. The majority of tri-allelic SNPs have three nucleotide substitution-based alleles at the same position, while a much smaller proportion, which we did not compile, have a nucleotide insertion/deletion plus substitution alleles. SNPs with three alleles have higher discrimination power than binary loci but keep the same characteristic of optimum amplification of the fragmented DNA found in highly degraded forensic samples. Although most of the tri-allelic SNPs identified had one or two alleles at low frequencies, often single observations, we present a full compilation of the genome positions, rs-numbers and genotypes of all tri-allelic SNPs detected by the 1000 Genomes project from the more detailed analyses it applied to Phase III sequence data. A total of 8,705 tri-allelic SNPs had overall heterozygosities (averaged across all 1000 Genomes populations) higher than the binary SNP maximum value of 0.5. Of these, 1,637 displayed the highest average heterozygosity values of 0.6-0.666. The most informative tri-allelic SNPs we identified were used to construct a large-scale human identification panel for massively parallel sequencing, designed for the identification of missing persons. The large-scale MPS identification panel comprised: 1,241 autosomal tri-allelic SNPs and 29 X tri-allelic SNPs (plus 46 microhaplotypes adapted for genotyping from reduced length sequences). Allele frequency estimates are detailed for African, European, South Asian and East Asian population groups plus the Peruvian population sampled by 1000 Genomes for the 1,270 tri-allelic SNPs of the final MPS panel. We describe the selection criteria, kinship simulation experiments and genomic analyses used to select the tri-allelic SNP components of the panel. Approximately 5 % of the tri-allelic SNPs selected for the large-scale MPS identification panel gave three-genotype patterns in single individual samples or discordant genotypes for genomic control DNAs. A likely explanation for some of these unreliably genotyped loci is that they map to multiple sites in the genome - highlighting the need for caution and detailed scrutiny of multiple-allele variant data when designing future forensic SNP panels, as such patterns can arise from common structural variation in the genome, such as segmental duplications.

Ethnic differences in the severity and clinical management of type 2 diabetes at time of diagnosis: A cohort study in the UK Clinical Practice Research Datalink

AimsTo characterize ethnic differences in the severity and clinical management of type 2 diabetes at initial diagnosis. MethodsAn observational cohort study of 179,886 people with incident type 2 diabetes between 2004 and 2017 in the Clinical Practice Research Datalink was undertaken; 63.4% of the cohort were of white ethnicity, 3.9% south Asian, and 1.6% black. Ethnic differences in clinical profile at diagnosis, consultation rates, and risk factor recording were derived from linear and logistic regression. Cox-proportional hazards regression was used to determine ethnic differences in time to initiation of therapeutic and non-therapeutic management following diagnosis. All analyses adjusted for age, sex, deprivation, and clustering by practice. ResultsIn the 12 months prior to diagnosis, non-white groups had fewer consultations compared to white groups, but risk factor recording was better than or equivalent to white groups for 9/10 risk factors for south Asian groups and 8/10 risk factors for black groups (p < 0.002). Blood pressure, BMI, cholesterol, eGFR, and CVD risk levels were more favourable in non-white groups, and prevalence of macrovascular disease was significantly lower (p < 0.003). Time to initiation of antidiabetic treatment and first risk assessment was faster in non-white groups relative to white groups, while time to risk factor measurement and diabetes review was slower. ConclusionsWe find limited evidence of systematic ethnic inequalities around the time of type 2 diabetes diagnosis. Ethnic disparities in downstream consequences may relate to genetic risk factors, or manifest later in the care pathway, potentially in relation to long-term risk factor control.

Intake of B vitamins in UK dwelling South Asian and White Caucasian women: Results from the D-FINES study

AbstractAdequate intakes of the B vitamins are essential for health; however there is a lack of data concerning B vitamin intakes in UK dwelling South Asian (SA) groups. We aimed to investigate whether UK SA women meet the LRNI for B vitamins, and whether their intake differs from same-age White Caucasian (WC) women. We used summer 2006 dietary intake data from the Food Standards Agency (FSA) funded D-FINES study (Vitamin D, Food Intake, Nutrition and Exposure to Sunlight in Southern England, project N05064). After removal of over- and under-reporters (energy: BMR ratio &lt; 1 or &gt; 1.6) there were n = 29 SA and n = 146 WC subjects. The two groups did not differ significantly in age and BMI. Overall mean (SD) for age was 50.6 (13.6) years and for BMI was 26.8 (4.8). In SA, 41% were Bangladeshi or Pakistani, 28% were Indian and 31% were of other ethnicity. Independent T-tests, using log transformed data, showed no statistically significant differences for any B vitamin (Bonferroni revised p value: &lt; 0.008). Results were as follows, giving median (IQR): Thiamine (mg) 1.5 (0.5) SA vs 1.4 (0.5) WC; (P = 0.8); Riboflavin (mg) 1.3 (0.5) SA vs. 1.5 (0.6) WC (P = 0.08); Niacin (mg) 30.7 (13.7) SA vs 33.3 (9.8) WC (P = 0.4); B6 (mg) 1.7 (0.5) SA vs 1.9 (0.7) WC (P = 0.2); B12 (micrograms) 2.8 (0.05) SA vs 3.6 (2.5) WC (P = 0.02); Folate (micrograms) 213 (93) SA vs 231 (82) WC (P = 0.8). In terms of percentages below the LRNI: Thiamine 0% SA and 0.7% (n = 1) WC; Riboflavin 0% SA and 1.4% (n = 2) WC; B12 10% (n = 3) SA and 0% WC. For Niacin, B6 and Folate no women in either group were below the LRNI. Overall, there were no ethnic differences in B vitamin intake by ethnicity. There was a trend for a slightly lower B12 intake in SA but this did not reach statistical significance after adjustment for multiple testing. It is of concern that 10% of SA did not meet the LRNI for B12. Of this 10%, the majority were not vegetarian or vegan. The sample size for SA was very small and further research is now required in a larger sample to confirm this finding. The D-FINES study was funded by the UK FSA (N05064). The views expressed are those of the authors alone.

Distinct patterns of socio-economic disparities in child-to-adolescent BMI trajectories across UK ethnic groups: A prospective longitudinal study.

SummaryBackgroundIn many high‐income countries, body mass index (BMI)/obesity levels are inversely associated with socio‐economic position (SEP). Little is known whether socio‐economic patterns in BMI trajectories throughout childhood differ by ethnicity, especially in the United Kingdom.ObjectivesTo investigate socio‐economic disparities in child‐to‐adolescent BMI trajectories and risks of overweight and obesity during adolescence across ethnic groups.MethodsMixed‐effects fractional polynomial and multinomial regression models were applied to estimate socio‐economic differences in BMI trajectories (3‐14 years) and risk of overweight/obesity at 14 years, respectively, in the UK Millennium Cohort Study (n = 15 996). Analysis was stratified by ethnicity.ResultPoverty was associated with higher BMI in children of White and South Asian origins, with a small difference at 3 years, which widened with age to 0.75 kg/m2 (95% CI, 0.59‐0.91) and 0.77 kg/m2 (0.26‐1.27) at 14 years for the White and South Asian groups, respectively. There was a reverse income‐BMI association in children of Black (African‐Caribbean) origin with the poverty group having a lower BMI (−0.37 kg/m2 [−0.71 to ‐0.04] at 5 years; −0.95 kg/m2 [−1.79 to −0.11] at 14 years). These patterns also presented with maternal education as a SEP indicator and for obesity at 14 years.ConclusionsSocio‐economic advantage may not be universally associated with lower BMI, which should be considered when planning obesity interventions. The positive SEP‐BMI association in children of Black origin requires replication and merits further investigation into underpinning mechanisms.

443PD - Genomic characteristics and predicted ancestry of NTRK1/2/3 and ROS1 fusion-positive tumours from >165,000 pan-solid tumours

BackgroundFusions involving ROS1 or NTRK1/2/3 are oncogenic drivers that occur in<1% of solid tumors. Small molecule inhibitors of NTRK (e.g. entrectinib and larotrectinib) and ROS1 (e.g. entrectinib and crizotinib) have shown clinically meaningful responses in NTRK fusion + solid tumors and in ROS1 fusion + NSCLC. We assessed the genomic landscape in these rare tumors to test for co-occurrence of clinically relevant biomarkers that may impact response to these inhibitors. MethodsComprehensive genomic profiling of>300 cancer-related genes, including tumor mutational burden (TMB) and predicted ancestry, was done at Foundation Medicine on 166,067 tumors from 75 solid tumor types, most from the US. Odds ratios for mutational co-occurrence were generated using Fisher’s exact test. ResultsAcross all solid tumors, NTRK and ROS1 fusions were statistically significantly mutually exclusive with driver alterations in KRAS, APC and PIK3CA. ROS1 fusions were also mutually exclusive with BRAF, PTEN and FBXW7. There was significant co-occurrence of NTRK fusions with alterations in 15 genes, including IGF1R, CDKN2B and CDK4. ROS1 fusions co-occurred with alterations in SMARCD1, CDKN2A/B and SETD2. No enrichment or exclusivity was seen with clinically actionable biomarkers such as EGFR, ERBB2, RET, ALK or MET. TMB was similar in NTRK and ROS1 fusion + vs – tumors. There was a higher NTRK prevalence in patients with primarily East Asian ancestry (0.46%, p=0.015) compared to South Asian (0.37%), American (0.34%), European (0.29%) or African (0.32%) ancestry, while there was a higher prevalence of ROS1 across all tumor types in East (0.74%, p<0.001) and South (0.78%, p=0.001) Asian ancestry groups compared to American (0.40%), European (0.31%) or African (0.31%) ancestry. ConclusionsAcross tumor types, NTRK and ROS1 fusions generally did not co-occur with clinically actionable alterations (e.g. EGFR, ERBB2) or alterations that are clear oncogenes (e.g. KRAS, BRAF). ROS1 and NTRK fusions occur at a slightly higher frequency in patients of primarily Asian ancestry compared to other ancestries. Future studies will evaluate these implications on response to NTRK and ROS1 inhibitors. Legal entity responsible for the studyF. Hoffmann-La Roche. FundingF. Hoffmann-La Roche. DisclosureT.R. Wilson: Shareholder / Stockholder / Stock options: Roche; Full / Part-time employment: Genentech. E.S. Sokol: Shareholder / Stockholder / Stock options: Roche; Full / Part-time employment: Foundation Medicine. S.E. Trabucco: Shareholder / Stockholder / Stock options: Roche; Full / Part-time employment: Foundation Medicine. J.Y. Newberg: Full / Part-time employment: Foundation Medicine. B. Simmons: Full / Part-time employment: Roche; Full / Part-time employment: Genentech. T. Riehl: Shareholder / Stockholder / Stock options, Full / Part-time employment: Roche; Full / Part-time employment: Genentech. S.L. Maund: Full / Part-time employment: Genentech.

Intraocular pressure (IOP) after intravitreal dexamethasone implant (Ozurdex) amongst different geographic populations-GEODEX-IOP study.

To analyse the intraocular pressure rise after intravitreal dexamethasone implant (Ozurdex) amongst different geographic populations. The medical charts of 294 dexamethasone implants between February 2011 and 2017 were reviewed retrospectively. South Asian (India), White (Europe, US and Israel) Latino (Argentina and Brazil) patient data was included in the study. Ocular hypertension (OHT) was defined as intraocular pressure of >25 mmHg or an increase of at least 10 mmHg from baseline. The main indications for treatment were diabetic macular edema (ME) (65.6%), retinal vein occlusion (26.5%), uveitis (7.8%). Amongst 294 intravitreal implants, ocular hypertension (>25 mmHg) was recorded in 0, 8 and 9.5% in White, Latino, and South Asian groups, respectively. However, IOP > 20 mmHg was recorded in 14%, 28% and 27% in White, Latino, and South Asian groups, respectively. Incidence of very high IOP (>35 mmHg) was lower in all geographical groups. It was 3% in Latino followed by 2% in South Asian group. Latino and South Asian groups have higher IOP rise compared to White population. Most patients with elevated IOP fluctuate between 20-25 mmHg.

Performance of ancestry-informative SNP and microhaplotype markers

The use of microhaplotypes (MHs) for ancestry inference has added to an increasing number of ancestry-informative markers (AIMs) for forensic application that includes autosomal single nucleotide polymorphisms (SNPs) and insertions/deletions (indels). This study compares bi-allelic and tri-allelic SNPs as well as MH markers for their ability to differentiate African, European, South Asian, East Asian, and American population groups from the 1000 Genomes Phase 3 database. A range of well-established metrics were applied to rank each marker according to the population differentiation potential they measured. These comprised: absolute allele frequency differences (δ); Rosenberg’s informativeness for (ancestry) assignment (In); the fixation index (FST); and the effective number of alleles (Ae). A panel consisting of all three marker types resulted in the lowest mean divergence per population per individual (MDPI = 2.16%) when selected by In. However, when marker types were not mixed, MHs were the highest performing markers by most metrics (MDPI < 4%) for differentiation between the five continental populations.

Systematic review of diabetes management among black African immigrants, white and South Asian populations

Background This study aims to explore the differences in the management of di-abetes outcomes and prevalence among black Africans, white and South Asian populations living in western countries from published evidence. This review in-corporates findings from differences in diabetes management outcome among black Africans compared to white and South Asian populations. Methods A systematic search of major electronic databases with peer review pub-lications was conducted. PubMed, CIHNAL, Medline, Web of Science, Scopus, and Science direct databases were searched from 2007-2018. Relevant journals and ci-tations from references were searched for selection in the review. Data were ana-lysed to understand differences in diabetes outcomes among these populations. Results Fifteen articles met the inclusion criteria out of the sixty-six articles re-trieved and included in the review. Majority of the articles were cross-sectional quantitative studies (n=10) and qualitative studies (n=5). Diabetes prevalence and outcome measures such as haemoglobin A1c, blood pressure, cholesterol and body mass index were reported to be higher among black African than white popula-tions. The data showed disparity in diabetes management among black Africans as compared to white and South Asian groups. Conclusions The poorer health outcomes reported among black Africans as com-pared to white and South Asian populations suggest poor diabetes management. Further research is needed to understand why there is such disparity in the health outcome of black African populations living with diabetes in western countries. There is a need to have a consistent target outcome measure in studies. Further synthesis was not possible due to differences in outcome measures used by studies reviewed.

225-LB: Demographic and Clinical Comparisons of South Asians with Type 2 Diabetes vs. Caucasians and African Americans in an Urban Clinical Setting

Background: The incidence of type 2 diabetes (T2D) is rising worldwide. South Asians are at higher risk, nearly 2-4 times greater than white Europeans, and tend to develop T2D at an earlier age and lower BMI. Prior studies have shown a potential advantage of incretin-based therapies in South Asians. The purpose of this study is to compare baseline characteristics of South Asians with T2D with those of other ethnic groups and to determine whether South Asians have a better glycemic response to incretin-based therapies in an urban United States diabetes center. Methods: Retrospective chart review of patients with T2D at the University of Maryland Center for Diabetes and Endocrinology from 2010-16 was performed. Adult patients (ages 18-85) with T2DM were included. A total of 43 South Asians (India, Bangladesh, Pakistan, Sri Lanka) and 182 non-South Asians (further subclassified into black or Non-Hispanic white) were enrolled. Data on age of T2DM diagnosis, family history, BMI, diabetic medications, exercise, blood pressure, and presence of micro- or macrovascular complications were collected. Baseline characteristics were compared and tested for statistical significance by Chi-square test and student t-tests. Results: South Asians were diagnosed with T2D at a lower BMI (29 vs. 34; p&amp;lt;0.0001) compared to their non-south Asian counterparts. In the South Asian group, there was a trend towards lower age at diagnosis, higher incidence of CAD and nephropathy compared to non- South Asians. No differences in hemoglobin A1c between South Asians vs. non-South Asians were noted at 3-month follow-up after initiation of incretin-based therapy. Conclusion: South Asians are more likely to have T2D at a lower BMI than black or Non-Hispanic white patients in an urban United States setting. No significant difference in T2DM complications was noted among ethnic groups, and incretin-based therapies did not have a significant effect on in South Asians vs. non-South Asians. Disclosure A. Ahmed: None. W. Rahman: None. K.M. Munir: None.

Systematic review of diabetes management among black African immigrants, white and South Asian populations

# Background This study aims to explore the differences in the management of diabetes outcomes and prevalence among black Africans, white and South Asian populations living in western countries from published evidence. This review incorporates findings from differences in diabetes management outcome among black Africans compared to white and South Asian populations. # Methods A systematic search of major electronic databases with peer review publications was conducted. PubMed, CIHNAL, Medline, Web of Science, Scopus, and Science direct databases were searched from 2007-2018. Relevant journals and citations from references were searched for selection in the review. Data were analysed to understand differences in diabetes outcomes among these populations. # Results Fifteen articles met the inclusion criteria out of the sixty-six articles retrieved and included in the review. Majority of the articles were cross-sectional quantitative studies (n=10) and qualitative studies (n=5). Diabetes prevalence and outcome measures such as haemoglobin A1c, blood pressure, cholesterol and body mass index were reported to be higher among black African than white populations. The data showed disparity in diabetes management among black Africans as compared to white and South Asian groups. # Conclusions The poorer health outcomes reported among black Africans as compared to white and South Asian populations suggest poor diabetes management. Further research is needed to understand why there is such disparity in the health outcome of black African populations living with diabetes in western countries. There is a need to have a consistent target outcome measure in studies. Further synthesis was not possible due to differences in outcome measures used by studies reviewed.

Caucasian and south Asian men show equivalent improvements in surrogate biomarkers of cardiovascular and metabolic health following 6-weeks of supervised resistance training

Background: The South Asian population have greater cardiovascular risk than their age-matched Caucasian counterparts, characterized by unfavorable biomarkers. South Asians may also be partially resistant to the pleiotropic benefits of physical activity on cardiovascular health. There is a current absence of studies that compare markers of cardio-metabolic health between Caucasians and South Asians employing resistance exercise. This study set out to compare the response in biomarkers of cardio-metabolic health in Caucasians and South Asians in response to resistance exercise.Methods: Caucasian (n=15, 25.5 ± 4.8 yrs) and South Asian (n=13, 25.4 ± 7.0 yrs) males completed a 6-week progressive resistance exercise protocol. Fasting blood glucose, insulin, and their product insulin resistance (HOMA-IR), triglycerides (TRIGS), low density lipoprotein (LDL), high density lipoprotein (HDL), total cholesterol (TC), vascular endothelial growth factor (VEGF), asymmetric dimythylarginine (ADMA), L-arginine (L-ARG) and C-reactive protein (CRP) were established at baseline and following resistance exercise.Results: There were significant improvements in fasting glucose, TC, LDL, HDL and VEGF in both groups following resistance exercise (p&lt;0.05, for all). No change was observed in insulin, HOMA-IR, TRIGS, ADMA, L-ARG following resistance exercise (p&gt;0.05, in both groups). CRP increased in the South Asian group (p&lt;0.05) but not the Caucasian group (p&gt;0.05)Conclusions: The cardio-metabolic response to resistance exercise is comparable in young Caucasian and South Asian males though inflammatory response to exercise may be prolonged in South Asians.

Caucasian and south Asian men show equivalent improvements in surrogate biomarkers of cardiovascular and metabolic health following 6-weeks of supervised resistance training

Background: The South Asian population have greater cardiovascular risk than their age-matched Caucasian counterparts, characterized by unfavorable biomarkers. South Asians may also be partially resistant to the pleiotropic benefits of physical activity on cardiovascular health. There is a current absence of studies that compare markers of cardio-metabolic health between Caucasians and South Asians employing resistance exercise. This study set out to compare the response in biomarkers of cardio-metabolic health in Caucasians and South Asians in response to resistance exercise. Methods: Caucasian (n=15, 25.5 ± 4.8 yrs) and South Asian (n=13, 25.4 ± 7.0 yrs) males completed a 6-week progressive resistance exercise protocol. Fasting blood glucose, insulin, and their product insulin resistance (HOMA-IR), triglycerides (TRIGS), low density lipoprotein (LDL), high density lipoprotein (HDL), total cholesterol (TC), vascular endothelial growth factor (VEGF), asymmetric dimythylarginine (ADMA), L-arginine (L-ARG) and C-reactive protein (CRP) were established at baseline and following resistance exercise. Results: There were significant improvements in fasting glucose, TC, LDL, HDL and VEGF in both groups following resistance exercise ( p<0.05, for all). No change was observed in insulin, HOMA-IR, TRIGS, ADMA, L-ARG following resistance exercise ( p>0.05, in both groups). CRP increased in the South Asian group ( p<0.05) but not the Caucasian group ( p>0.05) Conclusions: The cardio-metabolic response to resistance exercise is comparable in young Caucasian and South Asian males though inflammatory response to exercise may be prolonged in South Asians.

The frequency of fingerprint patterns separated by ethnicity and sex in a general population from Sydney, Australia

ABSTRACTA total of 514 individuals from the Sydney area volunteered their fingerprint scans for analysis. The prints were classified using the eight main patterns of the National Crime Information Centre system. Additional information from the volunteers, including sex and ancestry, was documented. Using this information, the frequencies of each pattern for each biogeographical ancestry (BGA) group and sex were calculated. Trends showed that males and females have a difference in the frequency of plain arches; none of the other patterns showed clear differentiation. BGA trends showed that European and Middle Eastern groups had more similar frequencies for the less common patterns (plain arch, tented arch, radial loop, central pocket loop whorl and double loop whorl). Whereas for the common patterns of ulnar loop and plain whorl, European and South Asian groups were more similar in frequency.

Cerebral Blood Flow and Cognitive Functioning in a Community-Based, Multi-Ethnic Cohort: The SABRE Study.

Introduction: Lower cerebral blood flow (CBF) is associated with cardiovascular disease and vascular risk factors, and is increasingly acknowledged as an important contributor to cognitive decline and dementia. In this cross-sectional study, we examined the association between CBF and cognitive functioning in a community-based, multi-ethnic cohort.Methods: From the SABRE (Southall and Brent Revisited) study, we included 214 European, 151 South Asian and 87 African Caribbean participants (71 ± 5 years; 39%F). We used 3T pseudo-continuous arterial spin labeling to estimate whole-brain, hematocrit corrected CBF. We measured global cognition and three cognitive domains (memory, executive functioning/attention and language) with a neuropsychological test battery. Associations were investigated using linear regression analyses, adjusted for demographic variables, vascular risk factors and MRI measures.Results: Across groups, we found an association between higher CBF and better performance on executive functioning/attention (standardized ß [stß] = 0.11, p < 0.05). Stratification for ethnicity showed associations between higher CBF and better performance on memory and executive functioning/attention in the white European group (stß = 0.14; p < 0.05 and stß = 0.18; p < 0.01 respectively), associations were weaker in the South Asian and African Caribbean groups.Conclusions: In a multi-ethnic community-based cohort we showed modest associations between CBF and cognitive functioning. In particular, we found an association between higher CBF and better performance on executive functioning/attention and memory in the white European group. The observations are consistent with the proposed role of cerebral hemodynamics in cognitive decline.

Caucasian and south Asian men show equivalent improvements in surrogate biomarkers of cardiovascular and metabolic health following 6-weeks of supervised resistance training.

Background: The South Asian population have greater cardiovascular risk than their age-matched Caucasian counterparts, characterized by unfavorable biomarkers. South Asians may also be partially resistant to the pleiotropic benefits of physical activity on cardiovascular health. There is a current absence of studies that compare markers of cardio-metabolic health between Caucasians and South Asians employing resistance exercise. This study set out to compare the response in biomarkers of cardio-metabolic health in Caucasians and South Asians in response to resistance exercise. Methods: Caucasian (n=15, 25.5 ± 4.8 yrs) and South Asian (n=13, 25.4 ± 7.0 yrs) males completed a 6-week progressive resistance exercise protocol. Fasting blood glucose, insulin, and their product insulin resistance (HOMA-IR), triglycerides (TRIGS), low density lipoprotein (LDL), high density lipoprotein (HDL), total cholesterol (TC), vascular endothelial growth factor (VEGF), asymmetric dimythylarginine (ADMA), L-arginine (L-ARG) and C-reactive protein (CRP) were established at baseline and following resistance exercise. Results: There were significant improvements in fasting glucose, TC, LDL, HDL and VEGF in both groups following resistance exercise ( p<0.05, for all). No change was observed in insulin, HOMA-IR, TRIGS, ADMA, L-ARG following resistance exercise ( p>0.05, in both groups). CRP increased in the South Asian group ( p<0.05) but not the Caucasian group ( p>0.05) Conclusions: The cardio-metabolic response to resistance exercise is comparable in young Caucasian and South Asian males though inflammatory response to exercise may be prolonged in South Asians.

Polyunsaturated fatty acids, inflammation, and metabolic syndrome in South Asian Americans in Maryland.

Metabolic syndrome (MetS) is characterized by the accumulation of cardiovascular risk factors among men and women worldwide. The use of very long‐chain polyunsaturated fatty acids (VLC PUFA) could potentially benefit individuals with MetS. The goal was to better understand the relationship between MetS and VLC PUFA in South Asian (SA) Americans who experience an elevated risk for heart disease. We analyzed a cross section of South Asian (SA) using the automated self‐administered 24‐hr recall (ASA24) and clinic data in a low‐income SA in Maryland. We found no correlation between MetS indicators (high‐density lipoprotein (HDL) cholesterol, triglycerides, fasting blood glucose, diastolic blood pressure, and waist circumference (WC)) and dietary n‐3 PUFA (eicosapentaenoic, docosapentaenoic acids). However, dietary n‐6 VLC PUFA (arachidonic acid [AA]) was associated with cholesterol and fasting blood glucose levels. SA with MetS did not have a significantly low level of dietary VLC PUFA intake, and there were no SA group differences in the intake of VLC PUFA but there were significant gender differences. Dietary practices in SA may contribute to increased proinflammatory markers and play a role in elevated MetS components.

The influence of South Asian ethnicity on the incremental shuttle walk test in UK adults.

The objective of this study was to compare incremental shuttle walking test (ISWT) performance between South Asian and Caucasian British adults, identify predictors of ISWT distance and produce ethnicity-specific reference equations. Data from a mixed gender sample aged 40–75 years from Leicestershire, United Kingdom, were selected for analyses. Analysis of covariance determined differences in ISWT performance between South Asian and Caucasian British ethnic groups. Linear regressions identified predictors of ISWT distance, which determined the reference equations. In total, 144 participants took part in the study (79 South Asian (54 ± 8 years, 71% female) and 65 Caucasian British (58 ± 9 years, 74% female)). Distance walked for the ISWT was shorter for South Asian individuals compared with Caucasian British (451 ± 143 vs. 575 ± 180 m, p < 0.001). The ethnicity-specific reference equations for ISWT distance explained 33–50% of the variance (standard error of the estimate (SEE): 107–119 m) for South Asians and explained 14–58% of the variance (SEE: 121–169 m) for Caucasian British. Ethnicity univariately explained 12.9% of the variance in ISWT distance and was significantly associated with ISWT distance after controlling for age, gender, height, weight, dyspnoea and lung function (B = −70.37; 1 = Caucasian British, 2 = South Asian), uniquely explaining 3.7% of the variance. Predicted values for ISWT performance were lower in South Asian people than in Caucasian British. Ethnicity-specific reference equations should account for this.

Assessment of health care, hospital admissions, and mortality by ethnicity: population-based cohort study of health-system performance in Scotland

SummaryBackgroundEthnic minorities often experience barriers to health care. We studied six established quality indicators of health-system performance across ethnic groups in Scotland.MethodsIn this population-based cohort study, we linked ethnicity from Scotland's Census 2001 (April 29, 2001) to hospital admissions and mortality records, with follow-up until April 30, 2013. Indicators of health-system performance included amenable deaths (ie, deaths avertable by effective treatment), preventable deaths (ie, deaths avertable by public health policy), avoidable deaths (combined amenable and preventable deaths), avoidable hospital admissions, unplanned readmissions, and length of stay. We calculated rate ratios and odds ratios (with 95% CIs) using Poisson and logistic regression, which we multiplied by 100, adjusting first for age-related covariates and then for socioeconomic-related and birthplace-related covariates. The white Scottish population was the reference (rate ratio [RR] 100).FindingsThe results are based on 4·61 million people. During the 50·5 million person-years of study, 1·17 million avoidable hospital admissions, 587 740 unplanned readmissions, and 166 245 avoidable deaths occurred. South Asian groups had higher avoidable hospital admissions than the white Scottish group, with the highest reported RRs in Pakistani groups (RR 140·6 [95% CI 131·9–150·0] in men; RR 141·0 [129·0–154·1] in women). There was little variation between ethnic groups in length of stay or unplanned readmission. Preventable and amenable mortality were higher in the white Scottish group than several ethnic minorities including other white British, other white, Indian, and Chinese groups. Such differences were partly diminished by adjustment for socioeconomic status, whereas adjustment for country of birth had little additional effect.InterpretationThese data suggest concerns about the access to and quality of primary care to prevent avoidable hospital admissions, especially for south Asians. Relatively high preventable and amenable deaths in white Scottish people, compared with several ethnic minority populations, were unexpected. Future studies should both corroborate and examine explanations for these patterns. Studies using several indicators simultaneously are also required internationally.FundingChief Scientist's Office, Medical Research Council, NHS Research Scotland, Farr Institute.

The contribution of gestational age, area deprivation and mother's country of birth to ethnic variations in infant mortality in England and Wales: A national cohort study using routinely collected data.

ObjectivesWe aimed to describe ethnic variations in infant mortality and explore the contribution of area deprivation, mother’s country of birth, and prematurity to these variations.MethodsWe analyzed routine birth and death data on singleton live births (gestational age≥22 weeks) in England and Wales, 2006–2012. Infant mortality by ethnic group was analyzed using logistic regression with adjustment for sociodemographic characteristics and gestational age.ResultsIn the 4,634,932 births analyzed, crude infant mortality rates were higher in Pakistani, Black Caribbean, Black African, and Bangladeshi infants (6.92, 6.00, 5.17 and 4.40 per 1,000 live births, respectively vs. 2.87 in White British infants). Adjustment for maternal sociodemographic characteristics changed the results little. Further adjustment for gestational age strongly attenuated the risk in Black Caribbean (OR 1.02, 95% CI 0.89–1.17) and Black African infants (1.17, 1.06–1.29) but not in Pakistani (2.32, 2.15–2.50), Bangladeshi (1.47, 1.28–1.69), and Indian infants (1.24, 1.11–1.38). Ethnic variations in infant mortality differed significantly between term and preterm infants. At term, South Asian groups had higher risks which cannot be explained by sociodemographic characteristics. In preterm infants, adjustment for degree of prematurity (<28, 28–31, 32–33, 34–36 weeks) fully explained increased risks in Black but not Pakistani and Bangladeshi infants. Sensitivity analyses with further adjustment for small for gestational age, or excluding deaths due to congenital anomalies did not fully explain the excess risk in South Asian groups.ConclusionsHigher infant mortality in South Asian and Black infants does not appear to be explained by sociodemographic characteristics. Higher proportions of very premature infants appear to explain increased risks in Black infants but not in South Asian groups. Strategies targeting the prevention and management of preterm birth in Black groups and suboptimal birthweight and modifiable risk factors for congenital anomalies in South Asian groups might help reduce ethnic inequalities in infant mortality.