Women Of South Asian Origin Research Articles

Vitamin B12 and Folate Markers Are Associated with Insulin Resistance During the Third Trimester of Pregnancy in South Asian Women, Living in the United Kingdom, with Gestational Diabetes and Normal Glucose Tolerance

BackgroundGestational diabetes mellitus (GDM) can adversely affect the health of the developing fetus. Women of South Asian origin are particularly at risk of developing GDM. Insulin resistance (IR) contributes to the etiology of GDM, and although studies have shown associations of vitamin B12 (B12) and folate status with GDM and IR, only a limited number of B12 and folate markers have been used. ObjectiveWe used a comprehensive panel of B12 and folate markers to examine their association with IR in pregnant women with diet-controlled GDM and normal glucose tolerance (NGT). MethodsIn this cross-sectional study, 59 British-Bangladeshi women (24 GDM and 35 NGT) with a mean age of 29 y, BMI (in kg/m2) 26.7 and gestational age 33 wk were recruited. Serum total B12, holotranscobalamin, folate, methylmalonic acid, plasma homocysteine, 5-methyltetrahydrofolate, and red cell folate (RCF) were measured along with other parameters. The independent sample t-test and chi-squared test were used to assess differences in markers between GDM and NGT women. Spearman's test was used to look for correlations. A simple multiple regression analysis was used to investigate if markers of B12 and folate status predicted IR, using the HOMA-IR and adjusting for age, GDM status, and BMI. ResultsThere were no differences in concentrations of B12 and folate markers between GDM and NGT women. In Spearman's analysis HOMA-IR correlated negatively with total serum B12 (P < 0.001) and holotranscobalamin (P < 0.05), and positively with BMI (P < 0.001), blood pressure (P < 0.05) and triglycerides (P < 0.05) in all women. MMA did not correlate with any of the B12 markers. In regression analysis, total B12 (β = −0.622, P = 0.004), RCF (β = 0.387, P = 0.018), and BMI (β = 0.024, P < 0.001) were the significant predictors of HOMA-IR variance. ConclusionsSignificant associations between markers of B12 and folate status with HOMA-IR were found during the third trimester in British-Bangladeshi women. B12 markers correlated poorly with each other.

Differential rates of group B streptococcus (GBS) colonisation in pregnant women in a racially diverse area of London, UK: a cross-sectional study.

To describe the epidemiology of maternal group B streptococcus (GBS) colonisation by racial group. Cross-sectional study. Antenatal clinics in London North West University Healthcare NHS Trust. Pregnant women. Group B streptococcus (GBS) colonisation status was recorded during a screening programme for the prevention of invasive early-onset GBS infection. Information regarding age, address, ethnicity, parity, mode of delivery, body mass index (BMI), and diabetes was routinely collected. Data were analysed by multivariable analysis. Association between GBS colonisation and putative risk factors. Overall, 29.1% (1836/6309) of the women were colonized with GBS. Multivariable analysis showed significantly higher colonisation among women of black African origin (39.5%; OR=1.57) compared with white British women (27.4%), and lowest colonisation in women of South Asian origin (23.3%; OR=0.8). Higher parity (≥2) was associated with higher colonisation (35.3%), with the odds of colonisation over 40% higher than for nulliparous women. Increasing BMI was associated with an incremental rise in colonisation from 23 to 35%. Colonisation was not associated with age, season or mode of testing. This study identified high maternal GBS colonisation rates in a racially and socially diverse population. The highest rates were seen in women of black African origin and also with higher parity and BMI. Further research is needed to understand the relationship between these factors and rectovaginal colonisation. Study of group B streptococcus colonisation in pregnant women in London shows highest rates in black African women and those with high BMI and parity.

Socioeconomic Deprivation as Measured by the Index of Multiple Deprivation and Its Association with Low Sex Hormone Binding Globulin in Women

Objective:Sex hormone binding globulin (SHBG) is a marker of insulin resistance. Given established links between BMI and socioeconomic disadvantage, we investigated how SHBG varies by index of multiple deprivation (IMD).Research Design and Methods:Using laboratory data from a Midlands UK population of mixed ethnicity, we examined the relation between blood concentrations of SHBG and IMD in 1160 women aged between 17 and 71 years. Women with a serum SHBG >250 nmol/L were excluded.Results:Mean age was 28.7 (95% confidence interval (CI) 28.2–29.1) years. 48.2% of women were of Caucasian origin, 15.5% of Southern Asian ethnicity and 2.6% were of African or other origin (33.7% were of unknown origin).SHBG increased with age (Spearman’s ρ=0.195; p<0.001). A higher proportion of women of South Asian origin versus other ethnic groups had an SHBG <30 nmol/L (OR 1.93 (95% CI 1.37–2.71)).SHBG level was lower in individuals with greater socioeconomic disadvantage as measured by IMD (Spearman's ρ= -0.09; p=0.004 for SHBG versus IMD).In multivariate logistic regression, IMD women in the quartiles 2–5 (higher socioeconomic disadvantage) were more likely to have an SHBG <30 nmol/L (compatible with significant insulin resistance) versus quartile 1 (odds ratio (OR) 1.71 (95% confidence interval (CI) 1.17–2.53), adjusted for age (OR=0.97 (95% CI 0.95–0.98)) and ethnicity (for South Asian ethnicity OR=2.00 (95% CI 1.42–2.81) versus the rest).Conclusion:Lower SHBG levels in women are associated with a higher level of socioeconomic disadvantage. Given the known association between lower SHBG and higher plasma glucose, our findings suggest a link between socioeconomic disadvantage and future risk of type 2 diabetes.

Screening for inadequate dietary vitamin B-12 intake in South Asian women using a nutrient-specific, semi-quantitative food frequency questionnaire.

A high prevalence of vitamin B-12 (B-12) deficiency among young women of South Asian origin predisposes to significant health risks for these women and their future offspring. Vegetarian or low-meat based dietary practices contribute to B-12 deficiency. This study validated a nutrient-specific, semi-quantitative food frequency questionnaire (B12FFQ), developed to estimate dietary B-12 intake in South Asian women. The B12FFQ was developed, then tested in 60 apparently healthy South Asian women aged 18-50 years, living in Auckland, New Zealand. Participants recalled the frequency and quantity of vitamin B-12-containing foods consumed in the preceding three months. Pearson's correlations measured the associations between dietary B-12 intake and B-12 biomarkers (serum B-12 and holotranscobalamin [holoTC]). Likelihood of B12 insufficiency was calculated for vegetarian and non-vegetarian dietary practices. The B12FFQ was a valid measure of dietary B-12 intake - supported by moderate positive associations with serum B-12 (r=0.50, p<0.001, 95% CI [0.28, 0.67]) and holoTC (r=0.55, p<0.001, 95% CI [0.34, 0.71]). A dietary B-12 intake of less than 2.4 µg/day increased the likelihood of serum B-12 (X2 (1)=11.79, p=0.001) or holoTC (X2 (1)=6.33, p=0.012) insufficiency. A dietary B-12 intake of less than the recommended dietary allowance (2.4 µg/day), occurred in 61% (n=20/33) of participants with vegetarian and 22% (n=6/27) with non- vegetarian dietary practices. The B12FFQ provides a valid estimate of dietary B-12 intake. This easily administered food frequency questionnaire has the potential to identify low dietary B-12 intake as a contributor to B-12 depletion or deficiency.

The identification and treatment of women with hyperglycaemia in pregnancy: an analysis of individual participant data, systematic reviews, meta-analyses and an economic evaluation.

Gestational diabetes mellitus (GDM) is associated with a higher risk of important adverse outcomes. Practice varies and the best strategy for identifying and treating GDM is unclear. To estimate the clinical effectiveness and cost-effectiveness of strategies for identifying and treating women with GDM. We analysed individual participant data (IPD) from birth cohorts and conducted systematic reviews to estimate the association of maternal glucose levels with adverse perinatal outcomes; GDM prevalence; maternal characteristics/risk factors for GDM; and the effectiveness and costs of treatments. The cost-effectiveness of various strategies was estimated using a decision tree model, along with a value of information analysis to assess where future research might be worthwhile. Detailed systematic searches of MEDLINE® and MEDLINE In-Process & Other Non-Indexed Citations®, EMBASE, Cumulative Index to Nursing and Allied Health Literature Plus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment database, NHS Economic Evaluation Database, Maternity and Infant Care database and the Cochrane Methodology Register were undertaken from inception up to October 2014. We identified 58 studies examining maternal glucose levels and outcome associations. Analyses using IPD alone and the systematic review demonstrated continuous linear associations of fasting and post-load glucose levels with adverse perinatal outcomes, with no clear threshold below which there is no increased risk. Using IPD, we estimated glucose thresholds to identify infants at high risk of being born large for gestational age or with high adiposity; for South Asian (SA) women these thresholds were fasting and post-load glucose levels of 5.2 mmol/l and 7.2 mmol/l, respectively and for white British (WB) women they were 5.4 and 7.5 mmol/l, respectively. Prevalence using IPD and published data varied from 1.2% to 24.2% (depending on criteria and population) and was consistently two to three times higher in SA women than in WB women. Lowering thresholds to identify GDM, particularly in women of SA origin, identifies more women at risk, but increases costs. Maternal characteristics did not accurately identify women with GDM; there was limited evidence that in some populations risk factors may be useful for identifying low-risk women. Dietary modification additional to routine care reduced the risk of most adverse perinatal outcomes. Metformin (Glucophage,® Teva UK Ltd, Eastbourne, UK) and insulin were more effective than glibenclamide (Aurobindo Pharma - Milpharm Ltd, South Ruislip, Middlesex, UK). For all strategies to identify and treat GDM, the costs exceeded the health benefits. A policy of no screening/testing or treatment offered the maximum expected net monetary benefit (NMB) of £1184 at a cost-effectiveness threshold of £20,000 per quality-adjusted life-year (QALY). The NMB for the three best-performing strategies in each category (screen only, then treat; screen, test, then treat; and test all, then treat) ranged between -£1197 and -£1210. Further research to reduce uncertainty around potential longer-term benefits for the mothers and offspring, find ways of improving the accuracy of identifying women with GDM, and reduce costs of identification and treatment would be worthwhile. We did not have access to IPD from populations in the UK outside of England. Few observational studies reported longer-term associations, and treatment trials have generally reported only perinatal outcomes. Using the national standard cost-effectiveness threshold of £20,000 per QALY it is not cost-effective to routinely identify pregnant women for treatment of hyperglycaemia. Further research to provide evidence on longer-term outcomes, and more cost-effective ways to detect and treat GDM, would be valuable. This study is registered as PROSPERO CRD42013004608. The National Institute for Health Research Health Technology Assessment programme.

Challenges in collecting clinical samples for research from pregnant women of South Asian origin: evidence from a UK study.

ObjectiveTo recruit South Asian pregnant women, living in the UK, into a clinicoepidemiological study for the collection of lifestyle survey data and antenatal blood and to retain the women for the later collection of cord blood and meconium samples from their babies for biochemical analysis.DesignA longitudinal study recruiting pregnant women of South Asian and Caucasian origin living in the UK.SettingRecruitment of the participants, collection of clinical samples and survey data took place at the 2 sites within a single UK Northern Hospital Trust.ParticipantsPregnant women of South Asian origin (study group, n=98) and of Caucasian origin (comparison group, n=38) living in Leeds, UK.ResultsAmong the participants approached, 81% agreed to take part in the study while a ‘direct approach’ method was followed. The retention rate of the participants was a remarkable 93.4%. The main challenges in recruiting the ethnic minority participants were their cultural and religious conservativeness, language barrier, lack of interest and feeling of extra ‘stress’ in taking part in research. The chief investigator developed an innovative participant retention method, associated with the women's cultural and religious practices. The method proved useful in retaining the participants for about 5 months and in enabling successful collection of clinical samples from the same mother–baby pairs. The collection of clinical samples and lifestyle data exceeded the calculated sample size required to give the study sufficient power. The numbers of samples obtained were: maternal blood (n=171), cord blood (n=38), meconium (n=176), lifestyle questionnaire data (n=136) and postnatal records (n=136).ConclusionsRecruitment and retention of participants, according to the calculated sample size, ensured sufficient power and success for a clinicoepidemiological study. Results suggest that development of trust and confidence between the participant and the researcher is the key to the success of a clinical and epidemiological study involving ethnic minorities.

Coronary artery bypass grafting in South Asian patients: Impact of gender.

BackgroundOutcomes following Coronary artery bypass grafting (GABG) vary between genders, with females having a higher postoperative mortality than males. Most of the studies are on Caucasian or mixed population and it is postulated that Asian population and in particular women have higher morbidity and mortality. In this study we have compared outcomes of elective CABG in men and women of South Asian origin in terms of morbidity and mortality.MethodsFrom January 2006 to December 2012, 1970 patients underwent isolated elective CABG at the Aga Khan University Hospital, Pakistan were selected. The prospectively collected data was analyzed retrospectively including univariate and multivariate analysis to find the association of morbidity and mortality.ResultsAmong the study patients 1664 (85%) were male and 306 (15%) female. Hypertension and diabetes were the most common comorbid conditions seen preoperatively in female patients. Atrial fibrillation and sepsis were the most common postop complications seen in females. In hospital mortality was 3.9% in female underwent CABG as against 0.6% in male. Multivariate analysis showed older age, renal failure, dyslipidemia and prolonged cross clamp time as predictors of postoperative morbidity. Multivariate analysis showed female gender, age and renal failure as predictors of in hospital mortality.ConclusionsFemale gender is an independent risk factor for postoperative mortality following CABG however, female gender is not found to be independent risk factor for morbidity. The trend of higher mortality in female patients was comparable to most studies done on Caucasian patients.

Breast cancer screening disparities among immigrant women by world region of origin: a population-based study in Ontario, Canada.

Rates of mammography screening for breast cancer are disproportionately low in certain subgroups including low‐income and immigrant women. The purpose of the study was to examine differences in rates of appropriate breast cancer screening (i.e., screening mammography every 2 years) among Ontario immigrant women by world region of origin and explore the association between appropriate breast cancer screening among these women groups and individual and structural factors. A cohort of 183,332 screening‐eligible immigrant women living in Ontario between 2010 and 2012 was created from linked databases and classified into eight world regions of origin. Appropriate screening rates were calculated for each region by age group and selected sociodemographic, immigration, and healthcare‐related characteristics. The association between appropriate screening across the eight regions of origin and selected sociodemographic, immigration, and health‐related characteristics was explored using multivariate Poisson regression. Screening varied by region of origin, with South Asian women (48.5%) having the lowest and Caribbean and Latin American women (63.7%) the highest cancer screening rates. Factors significantly associated with lower screening across the world regions of origin included living in the lowest income neighborhoods, having a refugee status, being a new immigrant, not having a regular physical examination, not being enrolled in a primary care patient enrollment model, having a male physician, and having an internationally trained physician. Multiple interventions entailing cross‐sector collaboration, promotion of patient enrollment models, community engagement, comprehensive and intensive outreach to women, and knowledge translation and transfer to physicians should be considered to address screening disparities among immigrant population. Consideration should be given to design and delivery of culturally appropriate and easily accessible cancer screening programs targeted at high‐ risk immigrant subgroups, such as women of South Asian origin, refugees, and new immigrants.

Maternal gestational diabetes is associated with genome-wide DNA methylation variation in placenta and cord blood of exposed offspring.

Exposure of a developing foetus to maternal gestational diabetes (GDM) has been shown to programme future risk of diabetes and obesity. Epigenetic variation in foetal tissue may have a mechanistic role in metabolic disease programming through interaction of the pregnancy environment with gene function. We aimed to identify genome-wide DNA methylation variation in cord blood and placenta from offspring born to mothers with and without GDM. Pregnant women of South Asian origin were studied and foetal tissues sampled at term delivery. The Illumina HumanMethylation450 BeadChip was used to assay genome-wide DNA methylation in placenta and cord blood from 27 GDM exposed and 21 unexposed offspring. We identified 1485 cord blood and 1708 placenta methylation variable positions (MVPs) achieving genome-wide significance (adjusted P-value <0.05) with methylation differences of >5%. MVPs were disproportionately located within first exons. A bioinformatic co-methylation algorithm was used to detect consistent directionality of methylation in 1000 bp window around each MVP was observed at 74% of placenta and 59% of cord blood MVPs. KEGG pathway analysis showed enrichment of pathways involved in endocytosis, MAPK signalling and extracellular triggers to intracellular metabolic processes. Replication studies should integrate genomics and transcriptomics with longitudinal sampling to elucidate stability, determine causality for translation into biomarker and prevention studies.

Assessing Physical Activity in Muslim Women of South Asian Origin

We assessed the quality of data on physical activity obtained by recall from Muslim women of South Asian origin, and the feasibility of using accelerometer-based physical activity monitors to provide more objective measures of physical activity in this group. In this largely qualitative study, 22 British Pakistani women were asked to wear accelerometers (the GT1M Actigraph and/or the Sensewear Armband) for 4 days, provided 2 24-hour recalls of activities, and were interviewed about their experiences with the monitors. Women reported spending most of their time in housework and childcare, activities which generated the majority of recorded bouts of moderate to vigorous physical activity. However, women had difficulty in recalling the timing, and assessing the intensity, of these usually unstructured activities. A significant minority of accelerometer datasets were incomplete and some women reported either forgetting to wear the accelerometer or finding it intrusive. Questionnaires are unlikely to provide an accurate assessment of physical activity in this group of women. This suggests that accelerometer data will be preferable. However, collecting sufficient data for large-scale studies using activity monitors in this population will be challenging.

The prevalence of urinary incontinence in pregnancy among a multi‐ethnic population resident in Norway

To investigate prevalence of urinary incontinence (UI) in a multi-ethnic population of pregnant women, and to analyse for possible associations of the known risk factors for UI in such a population. Population-based cross-sectional study. All pregnant women in three administrative city districts attending the Child Health Clinics. Out of 823 women identified in the [corrected] first trimester, 772 (94%) [corrected] agreed to participate in the study at 28 weeks of gestation. Inclusion criteria were: healthy women at 20 weeks of gestation or less and able to communicate in Norwegian, Arabic, English, Sorani, Somali, Tamil, Turkish, Urdu or Vietnamese. Differences between ethnic groups were tested by simple descriptive statistics. Associations were estimated by logistic regression analysis and presented as crude (cOR) and adjusted (aOR) odds ratios. Prevalence of UI as ascertained using the International Consultation on Incontinence Questionnaire-urinary incontinence-short form. Prevalence rates of UI at 28 weeks of gestation were 26% for women of African origin, 36% for women of Middle Eastern origin, 40% for women of East Asian origin, 43% for women of South Asian origin and 45% for women of European/North American origin. The difference was significant between women of African and European/North American origins (P = 0.011) and between women of African and South Asian origins (P = 0.035). Age (aOR 1.05; 95% CI 1.01-1.09) and parity (aOR 2.34; 95% CI 1.66-3.28) were positively associated with the prevalence of UI in pregnancy. Women of African origin had significantly reduced odds for UI (aOR 0.42; 95% CI 0.20-0.87). East Asian and African women reported the highest perceived impact of UI in pregnancy. A high prevalence of UI was found in a multi-ethnic pregnant population.

South Asian Women in the U.S. and their Experience of Domestic Violence

This study examined the extent of domestic violence and sociocultural factors (isolation, social support, acculturation, and patriarchy) associated with domestic violence among a community sample of 215 women of South Asian origin in the U.S. The sample is the largest to date in a study of domestic violence among South Asian women. Both paper and Web surveys were used. Of the sample, 38 % experienced some form of abuse in the past year. Isolation from spouse/partner and perceived social support predicted abuse. This information is vital in developing effective and culturally appropriate intervention methods for South Asian women victims of domestic violence.

Striking similarities: representing South Asian women's industrial action in Britain

The focus of this article is two significant episodes in British labour politics. The first is the Grunwick strike between 1976 and 1978; the second a dispute at Gate Gourmet that began in 2005. In both disputes, women of South Asian origin were the key actors and their legacy has been constructed through striking imagery as one in which against the odds exotic or passive Others became unexpected heroines of industrial struggle. These representations retained their power, despite significant social, economic and political changes in ‘post-Fordist’ Britain, including in the political rights of strikers, and in the participation and position of both women and minority workers in the labour force. Drawing on interviews with South Asian women involved in each dispute, this article challenges these representations and their significance in accounts of the action, documenting the complex, multiple motives of South Asian women involved in labour politics in the UK.

Vegetarianism, vitamin B12 status, and insulin resistance in a group of predominantly overweight/obese South Asian women

Objectives Asian Indians are an at-risk group for vitamin B12 deficiency (because of vegetarianism) and insulin resistance (IR). Vegetarianism and consequent vitamin B12 deficiency may be associated with IR. This study aimed to describe the vitamin B12 status of predominantly overweight/obese women of South Asian origin living in Auckland and to correlate serum vitamin B12 and vegetarian status with IR as part of the larger Surya Study looking at health and lifestyle in this population. Methods This was a cross-sectional study of 135 women at least 20 y of age who were not taking vitamin B supplements or medications that could affect vitamin B12 concentrations (serum vitamin B12 < 800 pmol/L). Data collection included serum vitamin B12, serum folate, measurements of IR (HOMA2-IR), and anthropometry. Vegetarian status was established for 124 subjects (90 non-vegetarians, 34 vegetarians). Results Mean serum vitamin B12 was 227 pmol/L (95% confidence interval 210–245), serum folate was 19.1 nmol/L (18.0–20.2), and HOMA2-IR was 1.24 (1.13–1.36). Non-vegetarians had higher serum vitamin B12 levels (257 pmol/L, 235–281) than vegetarians (181 pmol/L, 159–207), P < 0.001. Vitamin B12 deficiency (<150 pmol/L) in vegetarians was 24% versus 9% in non-vegetarians. Non-vegetarians had increased body mass index (25.9 kg/m 2, 25.0–26.9, versus 23.9 kg/m 2, 22.6–25.3), waist circumference (81 ± 10.1 versus 75.8 ± 9.88 cm), and HOMA2-IR levels (1.30, 1.17–1.46, versus 1.00, 0.83–1.22). No correlation was found between serum vitamin B12 and HOMA2-IR. A significant positive correlation between non-vegetarian status and IR disappeared after controlling for body mass index. Conclusions This study population has a low serum vitamin B12 status, especially if vegetarian. The high rates of observed obesity may have overshadowed any other contributing factor to IR.

65 Outcomes after cardiac surgery: are women of South Asian origin at increased risk?

<h3>Objectives</h3> The population served by our centre has a relatively high proportion of people originating from the Indian subcontinent (“South Asians”) compared to the national average (14.3% vs 4.6%). We observed that the mortality rate in South Asian women undergoing cardiac surgery in our unit appeared to be relatively high. We investigated this observation further to determine whether ethnic origin was an independent risk factor for postoperative death in females. <h3>Methods</h3> Data for all patients undergoing cardiac surgery were collected prospectively in a registry. Retrospective analysis was carried using SPSS on data for 4901 patients operated on in the 6-year period April 2004 to March 2010. Categorical data associated with mortality were analysed using χ² tests. Risk factors for in-hospital mortality were subjected to univariate analysis, and those found to be significant were tested for independence using multivariate logistic regression. <h3>Results</h3> During the study period, 1160 female patients underwent surgery with a mortality rate of 4.7%. Mortality in 113 South Asians was 8.9% vs 4.3% in non-Asians (p=0.03). Of 20 risk factors tested with univariate analysis, 16 were significantly associated with mortality. Logistic regression showed the following to be independent predictors of postoperative mortality: urgency of operation (OR 32.0; p&lt;0.001), older age (OR 24.2; p&lt;0.001), preoperative renal dysfunction (OR 15.8; p&lt;0.001), diabetes (OR 7.8; p=0.005), South Asian ethnicity (OR 7.3; p=0.007), extra-cardiac arteriopathy (OR 4.8; p=0.028), and an operation other than isolated CABG (OR 5.8; p=0.016). <h3>Conclusions</h3> In our population, South Asian ethnicity appears to be an independent risk factor for mortality in females undergoing cardiac surgery. Studies in larger populations are warranted.

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South Asians and coronary heart disease: always bad news?

Latest data from the 2001 UK Census noted that, although coronary mortality fell among all migrants, rate ratios for coronary mortality remain higher for men and women of south Asian origin.1 Ethnic inequalities in coronary heart disease (CHD) therefore continue to exist and justify the significant and commendable efforts of the UK's National Health Service (NHS) to address these inequalities. Ethnic disparities in CHD mortality continue to be reported from around the globe. Sheth et al reported on cardiovascular mortality among Canadians of European, south Asian, or Chinese origin from 1979 to 1993.2 In their analysis of 1.2 million deaths, rates of death from ischaemic heart disease were highest among Canadians of south Asian origin, whereas those of Chinese origin had a substantially lower rate. Before we discuss the causes of ethnic disparities in CHD, one must be cognisant of the fact that south Asians are a heterogeneous group and therefore important differences do exist between specific ethnic groups, not only in disease outcomes but also risk factor profiles too. These differences are too extensive to be addressed in this short summary but more detailed accounts are accessible elsewhere.3 It is well known that south Asians have substantially higher rates of diabetes, and this is often the risk factor most blamed for their higher CHD mortality.4 In a prospective cohort study conducted of 828 south Asian and 27 962 non south Asian patients in the UK with insulin-treated diabetes, the standardised mortality ratio for south Asians diagnosed with diabetes before 30 years of age was 3.9 (95% CI = 2.0 to 6.9) in men and 10.1 (95% CI = 5.6 to 16.6) in women; in corresponding non south Asian men and women, the figures were 2.7 (95% CI = 2.6 to …

P13 Association of prenatal and postnatal smoking and alcohol consumption on birth weight in the white British population in Bradford: preliminary findings from the born in Bradford study

BackgroundExposure to cigarette smoke and heavy alcohol consumption has been known to influence birth weight and risk of being small for gestational age. Despite this knowledge, very little exploration of...

Bone density, calcium intake and vitamin D status in South Asian women living in Auckland, New Zealand

AbstractAim: To investigate the bone health and associated risk factors of a group of South Asian women living in New Zealand. Studies on the Indian subcontinent suggest a high incidence of low bone mineral density in women with poor vitamin D status and low dietary calcium intake.Methods: Subjects were women of South Asian origin (n = 91) living in Auckland, New Zealand. Subjects were stratified by menopausal status. They completed a 4‐day food diary, and provided a fasting blood sample. Bone mineral density was measured in the lumbar spine and proximal femur using dual X‐ray densitometry.Results: Mean age of premenopausal (n = 71) and postmenopausal (n = 20) women was 39.8 ± 7.8 and 55.3 ± 5.4 years, respectively. Osteoporosis (T‐score ≤−2.5) was present in 32% of postmenopausal and 3% of premenopausal subjects, but only in the lumbar spine. Adequate 25(OH)D levels (&gt;50 nmol/L) were found in only 22% of premenopausal, and 26% of postmenopausal women. A body mass index in the overweight or obese category was found in 61% of premenopausal and 75% of postmenopausal women.Conclusion: The high incidence of osteoporosis in the postmenopausal group could be associated with the early age of oophorectomy or menopause together with low vitamin D status.

UK Food Standards Agency Workshop Report: an investigation of the relative contributions of diet and sunlight to vitamin D status

The UK Food Standards Agency (FSA) convened an international group of scientific experts to review three Agency-funded projects commissioned to provide evidence for the relative contributions of two sources, dietary vitamin D intake and skin exposure to UVB rays from sunlight, to vitamin D status. This review and other emerging evidence are intended to inform any future risk assessment undertaken by the Scientific Advisory Committee on Nutrition. Evidence was presented from randomised controlled trials to quantify the amount of vitamin D required to maintain a serum 25-hydroxy vitamin D (25OHD) concentration >25 nmol/l, a threshold that is regarded internationally as defining the risk of rickets and osteomalacia. Longitudinal evidence was also provided on summer sunlight exposure required to maintain 25OHD levels above this threshold in people living in the British Isles (latitude 51 degrees-57 degrees N). Data obtained from multi-level modelling of these longitudinal datasets showed that UVB exposure (i.e. season) was the major contributor to changes in 25OHD levels; this was a consistent finding in two Caucasian groups in the north and south of the UK, but was less apparent in the one group of British women of South Asian origin living in the south of the UK. The FSA-funded research suggested that the typical daily intake of vitamin D from food contributed less than UVB exposure to average year-round 25OHD levels in both Caucasian and Asian women. The low vitamin D status of Asian women has been acknowledged for some time, but the limited seasonal variation in Asian women is a novel finding. The Workshop also considered the dilemma of balancing the risks of vitamin D deficiency (from lack of skin exposure to sunlight in summer) and skin cancer (from excessive exposure to sunlight with concomitant sunburn and erythema). Cancer Research UK advises that individuals should stay below their personal sunburn threshold to minimise their skin cancer risk. The evidence suggests that vitamin D can be produced in summer at the latitude of the UK, with minimal risk of erythema and cell damage, by exposing the skin to sunlight for a short period at midday, when the intensity of UVB is at its daily peak. The implications of the new data were discussed in the context of dietary reference values for vitamin D for the general population aged 4-64 years. Future research suggestions included further analysis of the three FSA-funded studies as well as new research.