UK South Asian Research Articles

Exploring the Religious Practice of Langar as a Route to Health Promotion in the Sikh Community in Northern England: A Qualitative Study.

Cardiovascular disease and type 2 diabetes are prevalent among UK South Asians. Langar is a Sikh religious food practice that could be important in dietary health promotion. This study explored perceptions of langar, its role in health, readiness and strategies for change and whether Gurdwaras (Sikh place of worship) are able to support change. Using an exploratory qualitative design, we conducted eight focus groups and one single interview with 28 Gurdwara attendees (12 males, 16 females), analysing transcripts using thematic analysis. Four themes were developed that described the meaning of langar, the understanding of health among Sikhs, the evolution of langar and implications for health and changing langar to protect health. It can be concluded that any change to langar needs to be gradual, respectful and widely supported. This research has scope to continue in light of the potential impact on health for the Sikh community.

Exploration of Dementia Help Seeking Behaviours Amongst UK South Asian Communities: A Systematic Review

In the UK, 25,000 people from ethnic minority background live with dementia. Although dementia associated risk factors are common amongst South Asians, they tend to present at services later and when in crisis. This review explores UK South Asian communities perception of dementia to understand factors impacting their decision to seek help. Search terms assisted by the PICO strategy were inputted into five databases and ten qualitative papers identified. Meta-ethnography methodological framework was implemented for analysis. Four overarching understandings were identified: unfamiliarity with dementia (related to carers initial interpretation of dementia symptoms as normal ageing), cultural expectations to provide care (influenced by communities believes), services not being able to meet cultural needs impacted carers from seeking help and protective factors (religion and community belonging appear to help carers manage their needs). Carers decisions to seek help from dementia services were often influenced by cultural norms and negative experiences of services. They, consequently, turned to alternative approaches to best suit meet their needs. Understanding South Asian’s carers dementia help seeking behaviour would help services adapt and cater appropriately for service users’ needs.

Left ventricular hypertrophy and mortality in ethnic minority groups in the UK: e-ECHOES study.

Hypertension is the key modifiable cardiovascular risk factor but is underdiagnosed, and its scale in South Asian and African-Caribbean communities is unknown. Left ventricular hypertrophy (LVH) is a measure of target organ damage in uncontrolled hypertension. The study assesses LVH prevalence in South Asian and African-Caribbean communities and its impact on mortality. This study is based on the large prospective UK community Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES, age ≥45 years). Left ventricular mass index (LVMI) was calculated using echocardiography to establish LVH. The predictive value of LVH all-cause and cardiovascular mortality was assessed using Cox regression. The study included 3200 South Asians (age 59 ± 10 years, 52% women, 45% had a history of hypertension, 5.8 ± 1.0-year follow-up). LVH was found in 1568 (49%), of whom 45% did not have hypertension diagnosis. On Cox regression, LVH was independently associated with all-cause mortality [hazard ratio 1.38, 95% confidence interval (95% CI) 1.01-1.88], cardiovascular mortality (hazard ratio 2.64, 95% CI 1.21-3.73). The projected overall hypertension prevalence was 82%, undiagnosed hypertension prevalence 37%. The study included 1858 African-Caribbeans (age 62 ± 12, 45% women, 45% had history of hypertension, 5.1 ± 0.9-year follow-up). LVH was found in 1186 (64%), of whom 32% did not have hypertension diagnosis. LVH was borderline associated with all-cause mortality (hazard ratio 1.57, 95% CI 1.01-2.44), but not cardiovascular mortality (hazard ratio 1.82, 95% CI 0.80-4.16). The projected overall hypertension prevalence was 78.5%, and undiagnosed hypertension prevalence was 20.8%. UK South Asians and African-Caribbeans have a high prevalence of hypertension, which is often underdiagnosed and poorly controlled.

Atrial fibrillation in UK South Asian hospitalized ischemic stroke patients: The BRAINS study.

South Asian diaspora comprise one of the largest ethnic minority groups in the world yet data about atrial fibrillation (AF) in this demographic is understudied. Our aim is to identify differences in AF prevalence and treatment between South Asians and white British stroke patients. The UK arm of a prospective ongoing large international repository on stroke was analysed. Ethnic differences in AF prevalence and management in those with ischemic stroke were analysed. Of the 3515 individuals recruited with ischemic stroke, 1482 (men: 972, women: 510) were South Asian and 2033 (men:1141, women:892) of white British ethnicity. AF was present in 462 white British and 193 South Asians stroke patients, with South Asians displaying a lower prevalence of AF (South Asians: 13.0% vs white British 22.7%, P<0.001). Despite adjustment for traditional AF risk factors, South Asians had a significantly lower OR of AF compared to white British stroke patients (OR: 0.40, 95%CI: 0.33:0.49, P<0.001). Among confirmed AF cases, 31.8% of South Asians and 41.4% of white British were untreated at admission (P = 0.02). Antiplatelet treatment was significantly higher among South Asians at both admission (South Asian: 47.4% vs. white British: 29.9%, P<0.001) and discharge (South Asian: 49.5% vs. white British: 34.7%, P = 0.001), although anticoagulation treatment was similar across both ethnic groups at admission (South Asian: 28.5% vs white British: 28.1%, P = 0.93), and discharge (South Asian: 45.1% vs white British: 43.1%, P = 0.64). Stroke patients of South Asian descent are at significantly lower risk of AF but more likely to be on antiplatelet treatment compared to their white British counterparts.

Differential Associations of Cystatin C Versus Creatinine-Based Kidney Function With Risks of Cardiovascular Event and Mortality Among South Asian Individuals in the UK Biobank.

Background South Asian individuals have increased cardiovascular disease and mortality risks. Reliance on creatinine- rather than cystatin C-based estimated glomerular filtration rate (eGFRcys) may underestimate the cardiovascular disease risk associated with chronic kidney disease. Methods and Results Among 7738 South Asian UK BioBank participants without prevalent heart failure (HF) or atherosclerotic cardiovascular disease, we investigated associations of 4 eGFRcys and creatinine-based estimated glomerular filtration rate categories (<45, 45-59, 60-89, and ≥90 mL/min per 1.73 m2) with risks of all-cause mortality, incident HF, and incident atherosclerotic cardiovascular disease. The mean age was 53±8 years; 4085 (53%) were women. Compared with creatinine, cystatin C identified triple the number of participants with estimated glomerular filtration <45 (n=35 versus n=113) and 6 times the number with estimated glomerular filtration 45 to 59 (n=80 versus n=481). After multivariable adjustment, the eGFRcys 45 to 59 category was associated with higher risks of mortality (hazard ratio [HR], 2.38 [95% CI, 1.55-3.65]) and incident HF (sub-HR [sHR], 1.87 [95% CI, 1.09-3.22]) versus the eGFRcys ≥90 category; the creatinine-based estimated glomerular filtration rate 45 to 59 category had no significant associations with outcomes. Of the 7623 participants with creatinine-based estimated glomerular filtration rate ≥60, 498 (6.5%) were reclassified into eGFRcys <60 categories. Participants who were reclassified as having eGFRcys <45 had higher risks of mortality (HR, 4.88 [95% CI, 2.56-9.31]), incident HF (sHR, 4.96 [95% CI, 2.21-11.16]), and incident atherosclerotic cardiovascular disease (sHR, 2.29 [95% CI, 1.14-4.61]) versus those with eGFRcys ≥90; those reclassified as having eGFRcys 45 to 59 had double the mortality risk (HR, 2.25 [95% CI, 1.45-3.51]). Conclusions Among South Asian individuals, cystatin C identified a high-risk chronic kidney disease population that was not detected by creatinine and enhanced estimated glomerular filtration rate-based risk stratification for mortality, incident HF, and incident atherosclerotic cardiovascular disease.

Case-based learning: insulin intensification in a Hindu patient with type 2 diabetes mellitus

Background In the UK, the prevalence of diabetes in the South Asian population is up to six times higher than white people​[1,2]​. UK South Asian people with diabetes also have an increased risk of complications, such as coronary heart disease, diabetic retinopathy, and end-stage renal disease​[3]​. The UK South Asian population is not homogenous — different lifestyles have emerged […]

Type 2 diabetes risks and determinants in second-generation migrants and mixed ethnicity people of South Asian and African Caribbean descent in the UK

Aims/hypothesisExcess risks of type 2 diabetes in UK South Asians (SA) and African Caribbeans (AC) compared with Europeans remain unexplained. We studied risks and determinants of type 2 diabetes in first- and second-generation (born in the UK) migrants, and in those of mixed ethnicity.MethodsData from the UK Biobank, a population-based cohort of ~500,000 participants aged 40–69 at recruitment, were used. Type 2 diabetes was assigned using self-report and HbA1c. Ethnicity was both self-reported and genetically assigned using admixture level scores. European, mixed European/South Asian (MixESA), mixed European/African Caribbean (MixEAC), SA and AC groups were analysed, matched for age and sex to enable comparison. In the frames of this cross-sectional study, we compared type 2 diabetes in second- vs first-generation migrants, and mixed ethnicity vs non-mixed groups. Risks and explanations were analysed using logistic regression and mediation analysis, respectively.ResultsType 2 diabetes prevalence was markedly elevated in SA (599/3317 = 18%) and AC (534/4180 = 13%) compared with Europeans (140/3324 = 4%). Prevalence was lower in second- vs first-generation SA (124/1115 = 11% vs 155/1115 = 14%) and AC (163/2200 = 7% vs 227/2200 = 10%). Favourable adiposity (i.e. lower waist/hip ratio or BMI) contributed to lower risk in second-generation migrants. Type 2 diabetes in mixed populations (MixESA: 52/831 = 6%, MixEAC: 70/1045 = 7%) was lower than in comparator ethnic groups (SA: 18%, AC: 13%) and higher than in Europeans (4%). Greater socioeconomic deprivation accounted for 17% and 42% of the excess type 2 diabetes risk in MixESA and MixEAC compared with Europeans, respectively. Replacing self-reported with genetically assigned ethnicity corroborated the mixed ethnicity analysis.Conclusions/interpretationType 2 diabetes risks in second-generation SA and AC migrants are a fifth lower than in first-generation migrants. Mixed ethnicity risks were markedly lower than SA and AC groups, though remaining higher than in Europeans. Distribution of environmental risk factors, largely obesity and socioeconomic status, appears to play a key role in accounting for ethnic differences in type 2 diabetes risk.Graphical abstract

'Wise up to cancer': Adapting a community based health intervention to increase UK South Asian women's uptake of cancer screening.

UK South Asian women are less likely to engage with cancer screening than the general population and present later with more advanced disease. Tailored interventions are needed to address barriers to these women accessing screening services. 'Wise up to cancer' is a community-based health intervention designed to increase cancer screening uptake. It has been implemented within the general population and a study was undertaken to implement it within a South Asian female community. This paper explores one workstream of the wider 'Wise up to Cancer' study which involved working out how best to adapt the baseline questionnaire (the first part of the intervention) for South Asian women in an inner-city location in Northern England. The aim of this workstream was to evaluate what worked well when implementing the adapted 'Wise up to Cancer' with South Asian women. In 2018, we conducted qualitative semi-structured interviews and focus group with 14 key stakeholders; women who had received the intervention, health champions and community workers to explore their perspectives on how the adapted intervention worked within a South Asian female community. The interviews were audio recorded or (notes taken), data were transcribed verbatim and the dataset was thematically analysed. We found that training peers as community health champions to deliver the intervention to address language and cultural barriers increased participant engagement, was beneficial for the peers and supported participants who revealed difficult social issues they may not have otherwise discussed. Accessing women in established community groups, following planned activities such as English language classes worked but flexibility was needed to meet individual women's needs. Further research is needed to explore the impact of adapting 'Wise up to Cancer' for this community in terms of engaging with cancer screening.

Portraits of UK Black and South Asian headteachers five years on: Leadership retention in the age of academization

This article analyzes the career trajectories of eight Black and South Asian headteachers who were part of a larger study of three generations of Black, Asian, and Minority Ethnic (BAME) headteachers (28) interviewed in 2015 (Johnson, 2017). Using a longitudinal life history approach and portraiture, it seeks to answer the question, “How do Black and South Asian headteachers narrate their career progression and leadership values over time?” In particular, I explore the growth of academization and the formation of Multi-Academy Trusts (MATs) on the work lives of Black and South Asian headteachers and the role of autonomy, value alignment, and professional support on their leadership retention.

Validation of a Genome-Wide Polygenic Score for Coronary Artery Disease in South Asians

BackgroundGenome-wide polygenic scores (GPS) integrate information from many common DNA variants into a single number. Because rates of coronary artery disease (CAD) are substantially higher among South Asians, a GPS to identify high-risk individuals may be particularly useful in this population. ObjectivesThis analysis used summary statistics from a prior genome-wide association study to derive a new GPSCAD for South Asians. MethodsThis GPSCAD was validated in 7,244 South Asian UK Biobank participants and tested in 491 individuals from a case-control study in Bangladesh. Next, a static ancestry and GPSCAD reference distribution was built using whole-genome sequencing from 1,522 Indian individuals, and a framework was tested for projecting individuals onto this static ancestry and GPSCAD reference distribution using 1,800 CAD cases and 1,163 control subjects newly recruited in India. ResultsThe GPSCAD, containing 6,630,150 common DNA variants, had an odds ratio (OR) per SD of 1.58 in South Asian UK Biobank participants and 1.60 in the Bangladeshi study (p < 0.001 for each). Next, individuals of the Indian case-control study were projected onto static reference distributions, observing an OR/SD of 1.66 (p < 0.001). Compared with the middle quintile, risk for CAD was most pronounced for those in the top 5% of the GPSCAD distribution—ORs of 4.16, 2.46, and 3.22 in the South Asian UK Biobank, Bangladeshi, and Indian studies, respectively (p < 0.05 for each). ConclusionsThe new GPSCAD has been developed and tested using 3 distinct South Asian studies, and provides a generalizable framework for ancestry-specific GPS assessment.

Very high prevalence of 25-hydroxyvitamin D deficiency in 6433 UK South Asian adults: analysis of the UK Biobank Cohort.

Little research has assessed serum 25-hydroxyvitamin D (25(OH)D) concentration and its predictors in Western-dwelling South Asians in a relatively large sample size. This observational, cross-sectional analysis assessed baseline prevalence of 25(OH)D deficiency in UK-dwelling South Asians (aged 40-69 years, 2006-2010) from the UK Biobank Cohort. Serum 25(OH)D measurements were undertaken using the DiaSorin Liaison XL assay. Of 6433 South Asians with a 25(OH)D measurement, using commonly used cut-off thresholds, 55 % (n 3538) had 25(OH)D < 25 nmol/l (severe deficiency) and 92 % (n 5918) had 25(OH)D < 50 nmol/l (insufficiency). Of the participants with a measurement, 20 % (n 1287) had 25(OH)D concentration <15 nmol/l (very severe deficiency). When 824 participants with undetectable (<10 nmol/l) 25(OH)D measurements were included (total n 7257), 29 % (n 2105) had 25(OH)D < 15 nmol/l, 60 % (n 4354) had 25(OH)D < 25 nmol/l and 93 % (n 6749) had 25(OH)D < 50 nmol/l. Logistic regression predictors of 25(OH)D < 25 nmol/l included the following characteristics: being male; Pakistani; higher BMI; 40-59 years old; never consuming oily fish; summer sun exposure <5 h/d, not using a vitamin D-containing supplement, measurement in winter or spring and vegetarianism. In terms of region, median 25(OH)D concentration was 19-20 nmol/l in Scotland, Northern England, the Midlands and Wales. Across Southern England and London, it was slightly higher at 24-25 nmol/l. Our analyses suggest the need for increased awareness of vitamin D deficiency in South Asians as well as urgent public health interventions to prevent and treat vitamin D deficiency in this group.

The Need for Culturally Competent Care Within Gastroenterology Services: Evidence from Research with Adults of South Asian Origin Living with Inflammatory Bowel Disease.

It is widely acknowledged that the incidence of inflammatory bowel disease [IBD] is rising within South Asian populations, yet research into the experiences of this group of patients is rare. In this study the lived experiences of UK South Asian adults with IBD, including support from gastroenterology services, was investigated. A sample of 33 patients representing the diversity of the UK South Asian population were recruited through five gastroenterology clinics in England. In-depth semi-structured interviews were conducted, audio-recorded, transcribed and analysed using the Framework approach. Although many experiences align with those of the general IBD population, participants believed that South Asian cultures and/or religions can lead to additional challenges. These are linked to: family and friends' understanding of IBD; self and family attributions regarding IBD; stigma surrounding ill health; the taboo of bowel symptoms; managing 'spicy food'; beliefs about food and ill health; roles within the family; living with extended family; the use of complementary and alternative therapies; and visits to family overseas. Religious faith helped many to cope with having IBD, but symptoms could hamper their ability to practise faith. Gastroenterology services were viewed positively, but unmet needs were identified, some of which were culturally specific. Gastroenterology services have an important role to play in helping patients to overcome the challenges they encounter in their everyday life, both by providing individual patients with culturally appropriate care and advice, and via interventions to increase awareness and understanding of IBD within wider South Asian communities.

Sharpening the global focus on ethnicity and race in the time of COVID-19

Sharpening the global focus on ethnicity and race in the time of COVID-19

British South Asian Patients' Perspectives on the Relevance and Acceptability of Mobile Health Text Messaging to Support Medication Adherence for Type 2 Diabetes: Qualitative Study.

BackgroundThe prevalence of type 2 diabetes (T2D) is greater in South Asian populations and health outcomes are poorer compared with other ethnic groups. British South Asians are up to six times more likely to have T2D than the general population, to develop the condition at a younger age, and to experience diabetes-related complications. Interventions to support people in managing their condition can potentially reduce debilitating complications. Evidence to support the use of digital devices in T2D management, including mobile phones, has shown positive impacts on glycemic control. There is increasing recognition that health interventions that are culturally adapted to the needs of specific groups are more likely to be relevant and acceptable, but evidence to support the effectiveness of adapted interventions is limited and inconclusive.ObjectiveThis formative study aimed to explore the perceptions and views of British South Asian patients with T2D on mobile health SMS text messaging to support medication adherence, aimed at the general UK population.MethodsEight exploratory focus groups were conducted in Leicester, the United Kingdom, between September 2017 and March 2018. A diverse sample of 67 adults took part.ResultsBritish South Asian people with T2D who use digital devices, including mobile phones, felt that short messages to support medication adherence would be acceptable and relevant, but they also wanted messages that would support other aspects of self-management too. Participants were particularly interested in content that met their information needs, including information about South Asian foods, commonly used herbs and spices, natural and herbal approaches used in the United Kingdom and in South Asia, and religious fasting. Short messages delivered in English were perceived to be acceptable, often because family members could translate for those unable to read or understand the messages. Suggestions to support patients unable to understand short messages in English included having them available in different formats, and disseminated in face-to-face groups for those who did not use digital devices.ConclusionsExploring the views of British South Asian patients about SMS text messaging aimed at the general UK population is important in maximizing the potential of such an intervention. For such a digital system to meet the needs of UK South Asian populations, it may also have to include culturally relevant messages sent to those who opt to receive them. It is equally important to consider how to disseminate message content to patients who do not use digital devices to help reduce health inequalities.

N18 Facilitating involvement of patients from ethnic minority groups in research: experiences of offering patients a choice of interviewer

Abstract Background Recruitment of inflammatory bowel disease (IBD) patients from an ethnic minority background to research is known to be very low. It has been suggested that interviewer characteristics may affect the willingness of individuals to take part in research, with some researchers advocating ethnicity and gender matching. A study on UK South Asian adults’ experiences of living with IBD provided an opportunity to explore these methodological issues further. Methods The study comprised qualitative interviews with adult patients with IBD identifying themselves as Indian/British Indian, Pakistani/British Pakistani, and Bangladeshi/British Bangladeshi. They were recruited from five clinics across England. Rather than presupposing what participants’ preferences might be, patients were offered a choice of interviewer in terms of the following characteristics: gender, shared experience (or not) of IBD, ethnicity and language (Bengali, Gujarati, Hindi, Mirpuri, Punjabi, Urdu). These interviewers were a particular type of ‘peer researcher’; distinctive in that they are a professional researchers and assumptions have not been made about the ‘peer’ characteristic which is most pertinent to study participants. Results Adopting this study design required strategic planning in terms of resources and research management. Recruitment to the study was good, with over 40% of those invited (n = 41) returning a response form indicating an interest in taking part. Some had no preference over who interviewed them (8 women, 6 men). Where a preference was expressed, gender was the most important factor. Almost all favoured a female rather than a male interviewer (12 vs. 1). The next most frequently requested option was for an interviewer with personal experience of IBD (n = 11). Very few prioritised the ethnicity of the interviewer. Of those that did, two also requested to be interviewed in a South Asian language. Involvement of ‘peer interviewers’ in the development of the interview guide led to the addition of research questions that would not otherwise have been included. In some interviews, shared experience (between interviewer and interviewee) increased the richness of data elicited which, on occasion, threatened ‘even-ess’ of emphasis across the dataset. Conclusion The study achieved an above average recruitment rate, the sampling frame was achieved, and rich data was generated. The research team intend to adopt a similar approach in future studies where it is anticipated recruitment to the study may be challenging and the topics for discussion are sensitive.

Vitamin D, muscle strength and physical function in UK South Asian older women

AbstractA positive association has been reported between vitamin D status, muscle strength and physical function in older Caucasian women. However, little is known about this relationship in UK South Asian older women. This cross-sectional study aimed to explore the association between vitamin D status, muscle strength and physical function in UK South Asian (Pakistani and Indian) older women.One hundred and twenty community-dwelling women were recruited via visiting community centres, mosques, Indian temples (Gurdwara) and by word of mouth (between January to May 2018). Inclusion criteria were: community-dwelling, South Asian women, age 60 years and above, able to communicate effectively and able to give written or verbal consent. A general interview (demographic, anthropometric, self-reported exhaustion, health history, supplementation use/duration/dose), handgrip strength (kg), short physical performance battery (single chair stand, repeated chair stands, balance, timed up-and-go test), and blood 25 hydroxyvitamin D (25(OH)D, nmol/l) concentration were performed. Dietary intake and self-reported physical activity was also assessed using multiple-pass 24-hour diet recall method and International Physical Activity Questionnaire (IPAQ) short form respectively.Overall, 47% of participants had insufficient blood 25(OH)D concentration (&lt; 50nmol/L) and 53% had sufficient blood 25(OH)D (≥ 50nmol/L) using the IOM classification. As expected 86% of current vitamin D supplement users had adequate vitamin D status and only 14% of women who reported current vitamin D supplement use had insufficient vitamin D status. Amongst supplement non-users 68% had insufficient vitamin D status and only 32% had adequate levels. An inverse correlation (Spearman's analysis) was found between vitamin D status and single chair stand test (sec) (r = -0.25, p = 0.006); repeated chair stand test (sec) (r = -0.29, p = 0.002) and timed up-and-go test (sec) (r = -0.20, p = 0.02). No correlation was observed between vitamin D status and handgrip strength (r = 0.09, p = 0.30).The prevalence of vitamin D insufficiency is high in post-menopausal South Asian women not taking vitamin D supplements. Significant association was observed between vitamin D status and some aspects of muscle strength and physical function. We are now conducting a randomized control trial to investigate whether vitamin D supplementation may restore muscle strength and function in this population.

A comparison of the effects of protein supplementation and resistance exercise on UK South Asian and white European middle-aged adults

A comparison of the effects of protein supplementation and resistance exercise on UK South Asian and white European middle-aged adults

Very high prevalence of vitamin D deficiency in South Asian adults (n 6433) in the UK Biobank: urgent action required

AbstractPublished studies have suggested a high prevalence of 25-hydroxyvitamin D (25OHD) deficiency in western dwelling South Asians, particularly in women. However, sample sizes have been relatively small with few men. Moreover, South Asians are vastly under-represented in national dietary surveys and further research into 25(OH)D status is needed. The UK Biobank is a cohort of 500,000 individuals; n 6433 are of South Asian ethnicity and have baseline serum 25(OH)D data (2006–2010, aged 40–69 years). Blood draws were spread across the year. Of note, the 25(OH)D measurements were produced using the DiaSorin Liaison XL assay which underestimates 25(OH)D by 4% at 25nmol/L, but overestimates 25(OH)D by 5–10% at ≥ 40nmol/\L(1). We used the commonly used cut-points of &lt; 25nmol/L (deficiency), &lt; 50nmol/L (insufficiency). In women (n 2927), median (IQR) was 24.3 (20.5) nmol/L with 50.4% &lt; 25nmol/L, and 88.6% &lt; 50nmol/L. In men (n 3506), median (IQR) was 21.7 (16.2) with 58.4% &lt; 25 nmol/L and 93.8% &lt; 50 nmol/L. Of concern, 17.8% of women and 21.1% of men had 25(OH)D &lt; 15nmol/L. A Mann Whitney test showed that gender differences were statistically significant (P &lt; 0.0001). In terms of ethnic sub-groups, in the Bangladeshi group (n 207), median (IQR) was 26.1 (14.3) nmol/L with 43.5% &lt; 25nmol/L and 91.3% &lt; 50nmol/L. In the Indian group (n 4792), median (IQR) was 23.8 (19.3) with 52.0% &lt; 25nmol/L and 90.4% &lt; 50nmol/L. Finally, in the Pakistani group (n 1434) median (IQR) was 19.3(14.5) with 65.7% &lt; 25nmol/L and 94.9% &lt; 50nmol/L. A Kruskal Wallis test showed that ethnic subgroup differences were statistically significant (P &lt; 0.0001). To the authors’ knowledge, this is the largest analysis to date of 25(OH)D status in European dwelling South Asians. Deficiency of 25(OH)D was almost universal, with 50% or more not even reaching 25nmol/L. Of great concern, 20% of participants had levels &lt; 15nmol/L which, although not a widely used cut-off point, still represents severe deficiency and likely osteomalacia. Moreover, these results are most probably an underestimation of this societal challenge as the UK Biobank is likely to contain participants that are healthier and more educated than the general population. In conclusion, our analyses suggest the need for urgent public health interventions to prevent and treat vitamin D deficiency in UK South Asians. This research was conducted using the UK Biobank Resource under application number 15168.

Ethnic differences in height growth trajectories and early life factors: findings from the UK Millennium Cohort Study

Height growth is an important biomarker for early life exposures that influence later disease risk. Previous studies show that ethnic minority children in the UK tend to be born lighter but experience more rapid infancy growth than White peers. However, whether subsequent child-to-adolescent growth differs by ethnic group is insufficiently understood. We used the data from 15,239 singletons in the UK Millennium Cohort Study and applied mixed-effects cubic growth models to examine ethnic differences in height trajectories between 3y and 14y. Models were subsequently adjusted for potential early life explanatory factors. Compared with White counterparts, South Asian children had lower birthweight and shorter parents on average, but were slightly taller at 3y by 0.5cm [95% CI: 0.2–0.9] and had comparable childhood and adolescent trajectories, except that girls had a slower growth in adolescence. Height of South Asians relative to White children increased after adjusting for birthweight (taller by 1.3cm at 3y). Black African/Caribbeans were taller than White children at all ages between 3y and 14y (at 3y boys: 2.2cm, 1.2–2.7; girls: 3.2cm, 2.6–3.8) with height differences widening in childhood and reducing in adolescence. Adjustment for potential explanatory factors did not alter these differences. Despite having lower birthweight, contemporary UK South Asian children had comparable child-to-adolescent growth as White children. Black African/​Caribbeans were considerably taller than other ethnic groups. Future research is needed in understanding the role of genetic and other environmental factors (such as diet) in these distinct growth patterns across ethnic groups and their health implications.

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.