UK South Asian Research Articles

Recalibration of overweight–obesity prevalence from body-mass index in UK children of South Asian and black African origin: cross-sectional study based on National Child Measurement Programme data

BackgroundThe accurate assessment of overweight–obesity prevalence in UK children of South Asian and black African origin (in whom its consequences are especially adverse) is an important challenge. However, body-mass index (BMI), the marker of body fatness used in most national surveys, differs in its association to body fatness between ethnic groups, which biases ethnic comparisons of body fatness based on BMI. We recalibrated BMI values for ethnicity to assess overweight–obesity prevalence more accurately in UK South Asian and black African children in recent survey data from the National Child Measurement Programme (NCMP), an inclusive assessment programme in English primary schools. MethodsDeuterium dilution measurements of body fat and BMI were collated from four recent UK population-based studies (three in schools selected to provide balanced ethnic representation) in 873 children of South Asian, black African, and white European origin aged 9−11 years. Data were analysed with linear regression models to determine the age-adjusted and sex-adjusted BMI differences in South Asian and black African children compared with white Europeans at an equivalent level of body fatness (denoted by fat mass index [kg/m5], which is uncorrelated with height). These BMI adjustments were applied to NCMP 2012–13 survey data in 489 146 children aged 10–11 years to determine ethnic-specific overweight–obesity prevalences; standard NCMP overweight–obesity definitions were used. FindingsBMI adjustments for equivalent body fatness were +1·11 kg/m2 and +0·98 kg/m2 for South Asian boys and girls, respectively, and −1·20 kg/m2 and −1·66 kg/m2 for black African boys and girls, respectively; these adjustments were applied to NCMP data for South Asian and black African children. Overweight–obesity was recorded in 14 538 of 38 201 South Asian children (38·1%, 95% CI 37·6–38·5) and 9839 of 22 672 black African children (43·4%, 42·8–44·0) before BMI adjustment and in 18 145 of 38 201 (47·5%, 47·0–48·0) and 7065 of 22 672 (31·2%, 30·6–31·8), respectively, after adjustment; overweight–obesity was recorded in 92 002 of 292 467 white European children (31·5%, 95%CI 31·3–31·6). InterpretationUse of ethnic-specific BMI adjustments to obtain comparable assessments of body fatness substantially changed observed overweight–obesity prevalences in ethnic minority groups. Adjusted BMI particularly emphasised the substantial overweight–obesity burden in South Asian children, an important priority for prevention. FundingThis research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London and by grants from the British Heart Foundation (PG/11/42/28895), the Child Growth Foundation (GR 10/03), and the Wellcome Trust (WT094129MA).

The Dependence on Smokeless Tobacco in the South Asian Communities in East London.

Background & Objective:The purpose of the study was to understand the dependency on smokeless tobacco.Methods:The major aspect of the interview was to study the type of chewing tobacco used, frequency of purchase of chewing tobacco, change in attitude and behavior after the use of chewing tobacco. This study was done in 2005 in London. Of the 110 respondents interviewed 88 were used for the data analysis.Study Design:An exploratory study was conducted in East London, United Kingdom. The selected sample was interviewed through a questionnaire, based on the Severson Smokeless Tobacco Dependence Scale.Results:Cross tabulations report that in a sample of 88 South Asian UK resident men 46.6% used leaf (paan), 43.2% used processed form of chewing tobacco and 10.2% used gutka. Older age (67%) respondents were more likely than the younger age (30%) respondents to chew tobacco. The frequency of purchase of chewing tobacco is reported high (67.2%) in the older age group than the younger age group (50%).Conclusion:This current study used an amended form of the Severson Smokeless Tobacco Scale questionnaire to study the dependency on smokeless tobacco. The study could be developed in the selection of the sample, which would include both males and females to study the dependency on smokeless tobacco.

Using an interactive DVD about type 2 diabetes and insulin therapy in a UK South Asian community and in patient education and healthcare provider training

ObjectivesTo develop and pilot-test the feasibility and effectiveness of an interactive DVD about misconceptions within South Asian communities regarding insulin treatment in type 2 diabetes, for educating patients and community members and training healthcare providers. MethodsThe project setting was a South Asian (mainly Indian) community in Leicester, UK. Qualitative evidence from our previous studies was used to inform the content of the DVD script and accompanying resources. The intervention involved three components: facilitating DVD viewings for people with/without diabetes in community settings; training healthcare providers involved in managing South Asian patients with diabetes in primary care; and using the DVD and resources in primary care patient consultations. Evaluation involved a range of approaches including face-to-face interviews, telephone feedback and questionnaires. ResultsAnalysis of questionnaires and qualitative feedback from community participants showed some significant changes in attitudes and understanding about insulin and high acceptability of the DVD. Healthcare providers who attended the training found it informative and perceived the DVD and visual resources as potentially useful for facilitating acceptance of insulin. Primary care patient recruitment was challenging, but participants described the DVD as an acceptable and informative way of learning about insulin therapy. ConclusionThe DVD intervention was effective and feasible at community and healthcare provider levels. Practice implicationsAlthough based on a small sample, at patient level our findings suggested that the DVD worked at different levels helping some to accept the need for insulin and others to consolidate a decision to commence this treatment. Consideration needs to be given to patient engagement strategies for implementation in primary care consultations.

Risky cultures to risky genes: The racialised discursive construction of south Asian genetic diabetes risk

Type 2 diabetes within UK South Asian populations has increasingly become the focus of health science discourse. Growing rates across the globe have been a public health concern for a number of decades. Diabetes discourse has focused on lifestyle and a generalized idea of “cultural” factors as contributory factors. These have become part of what I identify as a South Asian diabetes “risk-package.” This risk formulation is extended to an additional genetic discourse which generates new causal explanations for this heightened “risk.” South Asian groups are already the subject of discursive, racialized risk constructions, which positions them as active owners of “risky culture.” The mobilization of genetic arguments repositions them as additionally passive owners of “risky genes.” I argue that the use of racial categories in genetic diabetes science, despite the relative uncertainty and ambiguity of scientific knowledge claims, is problematic and requires critical re-situating.

Tuberculosis in South Asian communities in the UK: a systematic review of the literature.

Rates of tuberculosis (TB) in UK South Asian communities are up to 17 times higher than in white British groups. Latent infection in new migrants provides only a partial explanation. We undertook a systematic review of the literature to establish existing knowledge about TB in South Asian communities. We undertook a search for literature relating to TB and its management in South Asian communities in the UK. Articles initially identified were screened for relevance. A narrative review of relevant articles was then conducted. We found 18 relevant articles. Associated risk factors for TB included poverty, deprivation, return visits to the Indian subcontinent, history of close contact with a case, gender, religion, possible dietary factors such as Vitamin D deficiency, duration of stay in the UK and country of birth. However, the evidence for these factors was often conflicting or weak, and suggests that commonly proposed hypotheses may not provide robust explanations for the higher rates of diagnosis. Migration patterns and the demographic profile of the South Asian communities are constantly changing. Further research into the determinants of TB infection in these communities in the UK is urgently needed to inform the commissioning of TB health services.

Perspectives on enhancing physical activity and diet for health promotion among at-risk urban UK South Asian communities: a qualitative study

ObjectivesTo explore perspectives on enhancing physical activity and diet among South Asians in urban deprived communities at high risk of chronic disease and to inform development of culturally appropriate health...

Exploring the social and interpersonal experiences of South Asian women with a diagnosis of Systemic Lupus Erythematosus

Systemic Lupus Erythematosus (SLE) negatively impacts life quality, disproportionately affecting women and UK ethnic minorities. The study aimed to explore how UK South Asian women with SLE make sense of their social and interpersonal experiences, within the context of their ethnicity and perceived cultural influences. A qualitative design was employed to collect data from a homogenous sample of six South Asian women with SLE. Semi-structured interviews elicited participants’ experiences of living with SLE and data were analysed using Interpretative Phenomenological Analysis. Master themes were (1) ‘SLE: Complexities and Ironies’, (2) ‘The Power of SLE’, (3) ‘A Sense of Personal Responsibility and Accountability’, (4) ‘Essential Relationships: Qualities and Consequences’ and (5) ‘Struggling in Public View’. Findings revealed that illness, function and emotion were experienced as interrelated, and psychosocial issues were a powerful feature in SLE illness processes. Body image concerns, difficulties maintaining roles and the perceived views of others, triggered embarrassment and withdrawal, negatively influencing social function and relationships. Interestingly, explicit references to ethnicity and culture were minimal, suggesting that for these women, the key features of experience tended to reflect those of other SLE groups. These findings call for an integrated, biopsychosocial and multidisciplinary approach to health care provision in this area.

Perspectives of UK Pakistani women on their behaviour change to prevent type 2 diabetes: qualitative study using the theory domain framework

BackgroundType 2 diabetes (T2D) is a debilitating disease, highly prevalent in UK South Asians, and preventable by lifestyle intervention. The ‘New life, New you’ (NLNY) physical activity (PA) and dietary...

External validation of two diabetes risk scores in a young UK South Asian population

AimsTo externally validate the Leicester Practice Risk Score (LPRS) and the Leicester Risk Assessment score (LRAS) in a young South Asian population. MethodsSouth Asian participants aged 25–39 years inclusive from a population based screening study were included. The risk scores were calculated and compared to the diagnosis of type 2 diabetes mellitus (T2DM) or T2DM and Impaired Glucose Regulation (IGR, including IFG and IGT) using either an oral glucose tolerance test (OGTT) or a HbA1c (≤48mmol/mol/6.5% and ≤42mmol/mol/6.0% respectively). Measures of discrimination and calibration were calculated. ResultsOf the 331 participants 8 (2.4%) had undiagnosed T2DM and 30 (9.1%) had IGR using an OGTT, 11 (3.4%) and 39 (12.1%) were found using HbA1c. Using the LPRS to detect T2DM on an OGTT gives an area under the ROC curve of 0.91 (95% CI 0.86, 0.97), including those with IGR gives an ROC of 0.72 (0.62–0.81), these values are 0.93 (0.88, 0.98) and 0.68 (0.60, 0.77) when using an HbA1c to define outcome. Acceptable levels of calibration were seen. Similar results are found for the LRAS. ConclusionsThese scores can be used to identify those with undiagnosed T2DM and/or IGR in a young South Asian population. This is the first study to externally validate scores developed for prevalent undiagnosed disease in this age group using both OGTT and HbA1c.

Vitamin D status and body composition in UK Caucasian and South Asian postmenopausal women: results from the DFINES II study

Vitamin D status and body composition in UK Caucasian and South Asian postmenopausal women: results from the DFINES II study

Seroprevalence of Cytomegalovirus, Epstein Barr Virus and Varicella Zoster Virus among Pregnant Women in Bradford: A Cohort Study

ObjectiveTo estimate the seroprevalence of cytomegalovirus (CMV), Epstein Barr virus (EBV) and varicella zoster virus (VZV) among pregnant women in Bradford by ethnic group and country of birth.MethodsA stratified random sample of 949 pregnant women enrolled in the Born in Bradford birth cohort was selected to ensure sufficient numbers of White UK born women, Asian UK born women and Asian women born in Asia. Serum samples taken at 24-28 weeks’ gestation were tested for CMV IgG, EBV IgG and VZV IgG. Each woman completed a questionnaire which included socio-demographic information.ResultsCMV seroprevalence was 49% among the White British women, 89% among South Asian UK born women and 98% among South Asian women born in South Asia. These differences remained after adjusting for socio-demographic factors. In contrast, VZV seroprevalence was 95% among women born in the UK but significantly lower at 90% among South Asian women born in Asia. EBV seroprevalence was 94% overall and did not vary by ethnic group/country of birth. ConclusionsAlthough about half of White British women are at risk of primary CMV infection in pregnancy and the associated increased risk of congenital infection, most congenital CMV infections are likely to be in children born to South Asian women with non-primary infection during pregnancy. South Asian women born in South Asia are at risk of VZV infection during pregnancy which could produce congenital varicella syndrome or perinatal chickenpox. Differences in CMV and VZV seroprevalence by ethnic group and country of birth must be taken into account when universal immunisation against these viruses is contemplated.

Development of a childhood obesity prevention programme with a focus on UK South Asian communities

ObjectiveWe report the development of a childhood obesity prevention intervention for UK South Asian primary school-aged children, guided by the UK Medical Research Council (MRC) framework for complex intervention development and evaluation. MethodsWe combined information gained from a literature review, stakeholder focus groups, an expert group, review of local resources and mapping to the Analysis Grid for Environments Linked to Obesity (ANGELO framework) in an intervention development process. The study took place in 2007 in Birmingham, UK. ResultsContextual information from the stakeholder focus groups was essential for informing intervention development. The expert group defined guiding principles for the intervention. Informing intervention design by assessing existing local resources addressed intervention sustainability. The use of the ANGELO framework ensured a comprehensive environmental approach to intervention development. The intervention consisted of two broad processes; increasing children's physical activity levels through school, and increasing skills of families through activity-based learning. The developed intervention is being evaluated in a major study. ConclusionsThe intervention development process has resulted in a tailored intervention programme to prevent childhood obesity in UK South Asian communities, but also intervention processes that could be applied to other communities and tailored to local context.

Perceived barriers to initiating and maintaining physical activity among South Asian and White British adults in their 60s living in the United Kingdom: a qualitative study

ObjectiveTo explore the barriers to initiating and maintaining regular physical activity (PA) among UK Indian, Pakistani and White British adults in their 60s.DesignAn exploratory qualitative approach was utilised using 15 focus groups and 40 in-depth interviews. Purposive sampling was used to recruit participants with different experiences of participation or non-participation in PA.ResultsMisunderstandings about the value of exercise in later life, particularly for those with ongoing healthcare problems, were identified in UK South Asian and White British older adults' accounts of their experience of the barriers to initiating and maintaining regular PA. Both groups and genders said that PA could exacerbate pre-existing health problems and result in physical harm. Although most beliefs were similar to those of the White British, ethnic-specific factors, such as language barriers, religious beliefs and cultural practices could act as additional barriers to undertaking and maintaining PA among UK South Asian older adults.Conclusions and implicationsUnderstanding the multiple levels of influence on older adults' PA behaviour can provide the basis for developing comprehensive approaches to health promotion initiatives aimed at increasing PA levels. Healthcare providers need to understand the characteristics and specific barriers faced by these groups of older adults; work with older people from these groups to develop culturally appropriate PA programmes and address the misunderstandings and misconceptions about the value of exercise in later-life, particularly in those with ongoing health problems.

Ankle pressures in UK South Asians with diabetes mellitus: a case control study

ObjectivesTo study ethnic differences in ankle pressures in South Asians versus Europeans and in those with and without diabetes mellitus (DM).DesignCase control.SettingPrimary care.Participants391(DM=154) South Asian and 252(DM=72) European adults.InterventionNone.Main outcome...

Heath Beliefs of UK South Asians Related to Lifestyle Diseases: A Review of Qualitative Literature

Objective. To review available qualitative evidence in the literature for health beliefs and perceptions specific to UK South Asian adults. Exploring available insight into the social and cultural constructs underlying perceptions related to health behaviours and lifestyle-related disease. Methods. A search of central databases and ethnic minority research groups was augmented by hand-searching of reference lists. For included studies, quality was assessed using a predetermined checklist followed by metaethnography to synthesise the findings, using both reciprocal translation and line-of-argument synthesis to look at factors impacting uptake of health behaviours. Results. A total of 10 papers varying in design and of good quality were included in the review. Cultural and social norms strongly influenced physical activity incidence and motivation as well as the ability to engage in healthy eating practices. Conclusions. These qualitative studies provide insight into approaches to health among UK South Asians in view of their social and cultural norms. Acknowledgement of their approach to lifestyle behaviours may assist acceptability of interventions and delivery of lifestyle advice by health professionals.

Design and baseline characteristics of the PODOSA (Prevention of Diabetes & Obesity in South Asians) trial: a cluster, randomised lifestyle intervention in Indian and Pakistani adults with impaired glycaemia at high risk of developing type 2 diabetes

ObjectivesTo describe the design and baseline population characteristics of an adapted lifestyle intervention trial aimed at reducing weight and increasing physical activity in people of Indian and Pakistani origin at...

A multi-centre qualitative study exploring the experiences of UK South Asian and White Diabetic Patients referred for renal care

BackgroundAn exploration of renal complications of diabetes from the patient perspective is important for developing quality care through the diabetic renal disease care pathway.MethodsNewly referred South Asian and White diabetic renal patients over 16 years were recruited from nephrology outpatient clinics in three UK centres - Luton, West London and Leicester – and their experiences of the diabetes and renal care recorded.A semi-structured qualitative interview was conducted with 48 patients. Interview transcripts were analysed thematically and comparisons made between the White and South Asian groups.Results23 South Asian patients and 25 White patients were interviewed. Patient experience of diabetes ranged from a few months to 35 years with a mean time since diagnosis of 12.1 years and 17.1 years for the South Asian and White patients respectively. Confusion emerged as a response to referral shared by both groups. This sense of confusion was associated with reported lack of information at the time of referral, but also before referral. Language barriers exacerbated confusion for South Asian patients.ConclusionsThe diabetic renal patients who have been referred for specialist renal care and found the referral process confusing have poor of awareness of kidney complications of diabetes. Healthcare providers should be more aware of the ongoing information needs of long term diabetics as well as the context of any information exchange including language barriers.

Ethnic and socioeconomic influences on childhood blood pressure

Compared to UK white European adults, UK black African-Caribbean adults have higher mean SBP and DBP; UK South Asian adults have higher mean DBP but lower SBP. Information on blood pressure (BP) in UK children from different ethnic groups is limited. The aim of this study was to compare BP levels in UK children of black African-Caribbean, South Asian and white European origin. BP and body build were measured in 5666 children in a cross-sectional study of UK primary school children of South Asian, black African-Caribbean and white European origin aged 9-10 years. Ethnic and socioeconomic differences in BP were obtained from multilevel linear regression models. After adjustment for height and adiposity, black African-Caribbean children had lower mean SBP than white Europeans [difference 1.62 mmHg, 95% confidence interval (CI) 0.86-2.38 mmHg], whereas mean DBP was similar (difference 0.58 mmHg, 95% CI -0.12 to 1.28 mmHg). The lower SBP was particularly marked in black African rather than Caribbean children (P = 0.002). South Asian children had lower mean SBP (difference 1.10 mmHg, 95% CI 0.34-1.86 mmHg) than white Europeans and higher mean DBP (difference 1.07 mmHg, 95% CI 0.37-1.76 mmHg). The higher mean DBP was particularly marked among Indian and Bangladeshi, rather than Pakistani, children (P = 0.01). BP was unrelated to socioeconomic circumstances; ethnic differences in BP were not affected by socioeconomic adjustment. A BP pattern similar to that in adults is present in UK South Asian but not in UK black African-Caribbean children at 9-10 years.

OP29 Ethnic and Socioeconomic Influences on Childhood Blood Pressure: The Child Heart and Health Study in England (Chase)

BackgroundCompared to UK white European adults, UK black African-Caribbean adults have higher mean systolic (SBP) and diastolic (DBP) blood pressure; UK South Asian adults have higher mean DBP but lower...

Colorectal cancer incidence and trend in UK South Asians: a 20-year study

South Asians comprise 13.6% of the Wolverhampton population. We aimed to compare the incidence and trend of colorectal cancer in this subgroup with the non South Asian population over a 20-year period. Patients of South Asian origin diagnosed with colorectal cancer from 1989 to 2008 were identified from the hospital histopathology database and compared with those of non South Asian origin. 1991 and 2001 census data were used to standardize for differing age and sex distributions in the two study populations. The median unadjusted incidence of colorectal cancer from 1989 to 2008 was 6.17 per 100,000 per year in South Asians compared with 71.70 per 100,000 per year in non South Asians (77.79% white British). The age and sex adjusted odds ratio for colorectal cancer in South Asians was 0.2 (P < 0.001). There was an equal increased trend in the incidence in both the South Asians and non South Asians over the study period (0.8% per year). In patients < 50 years, the gender difference in the incidence of cancer was not significant, but as age increased this rose significantly (males > females). There was a markedly lower incidence of colorectal cancer in South Asians compared with non South Asians, maintained over 20 years. Colorectal cancer incidence increased by a small and similar amount over the period in both groups. There was a male preponderance of colorectal cancer in both populations over 50 years.