Prevalence of diabetes, metabolic syndrome, and cardiovascular risk factors in US Asian Indians: results from a national study
Introduction
Migrant Asian Indians are reported to have high rates of diabetes (DM), metabolic syndrome (MetS), cardiovascular disease (CVD), and related complications in the US, Canada, and UK (Anand et al., 2000, Chandie Shaw et al., 2002, Enas et al., 1996, Hughes et al., 1997, McKeigue et al., 1993, McKeigue et al., 1992, Mohanty et al., 2005, Omar et al., 1985, Ramaiya et al., 1995, Samanta et al., 1991). Insulin resistance is highly prevalent in Asian Indian migrants, despite low rates of obesity (McKeigue, 1996, McKeigue et al., 1992, Whincup et al., 2002). In the United States, Asian Indians have the highest ethnic-specific prevalence of CVD, with age-specific mortality two to three times higher than Caucasians (Enas & Senthilkumar, 2001, Enas et al., 1996, Wild et al., 1995). Traditional risk factors such as hypertension, obesity, and hypercholesterolemia do not account completely for these high rates. Prevalence of DM and related conditions among US Asian Indians was assessed by Venkataraman et al. (2004) using a faith-based sample in Atlanta, GA. The overall prevalence of DM was 18.3% (22.5% in men and 13.6% in women). Mohanty et al. (2005) compared 555 Asian Indians to 87,846 non-Hispanic whites in the NHIS dataset from 1997 to 2000 and reported that the former had significantly higher odds of having diabetes. However, they also reported lower CHD and hypertension rates, in contrast to prior studies that showed much higher age-standardized CVD rates and related mortality in this ethnic group. Data from national surveys are limited due to small sample sizes or aggregation of ethnic data into a heterogeneous group of “Asian Americans” or “Asian and Pacific Islanders.” Population-based national studies on prevalence and risk factors for DM and CVD among US Asian Indians are currently lacking.
Asian Indians, the third largest and fastest growing US Asian subgroup, are heterogeneous, with numerous languages, religions, racial types, social habits, cultural practices, and diets. Despite a perception that they have high socio-economic status and good access to health care (Gupta, 2000), US Asian Indians have marked variations in educational attainment, income, and wealth, and a significant number lack education and job skills (Rangaswamy, 1995). Recent immigrant cohorts comprise both highly educated professionals and individuals who lack education and job skills. The latter are mostly family members of earlier immigrants (Rangaswamy, 1995). This heterogeneity makes it imperative to use large, randomized samples to determine disease prevalence and risk factors. Previous studies of Asian Indian health have employed hospital-based or convenience samples (Abate et al., 1995, 1996, 2004; Banerji et al., 1999; Enas et al., 1996; Raji, Seely et al., 2001; Raji, Williams et al., 2001; Venkataraman et al., 2004). The Diabetes among Indian Americans (DIA) study is the first to develop and utilize a large, randomly selected, nationwide cohort of US Asian Indians to determine the prevalence of DM, MetS, and CVD risk factors.
Section snippets
Subjects
Asian Indian adults were randomly selected at seven US urban sites—Houston, TX; Phoenix, AZ; Washington, DC; Boston, MA; San Diego, CA; Edison, NJ; and Parsippany, NJ. There is no directory/sampling frame available for Asian Indians in the US; hence directories were created at each site through compilations of several sources: (1) city-wide telephone directories with a search for the 100 most common Asian Indian last names, (2) directories of ethnic associations (e.g., Gujarati Association,
Demographic, dietary, and socioeconomic characteristics
The mean age of the subjects was 45.7±12.8 years (mean±S.D.) with a range of 19–91 years. The majority were male (61%), married (91%), employed (58%), and with some form of health insurance (85%). The modal income was $50,000 to $100,000; 12% reported income below $25,000.00. Mean length of residence in the US was 18.5±11.04 years, and 1.6% were born in the US. Fifty-seven percent reported a family history of diabetes and 6.6% were current smokers (predominantly male).
The majority of the
Discussion
These results from the first randomly selected, population-based study of Asian Indians in the US indicate a very high prevalence of diabetes, prediabetes, and MetS. The prevalence of DM for adults aged ≥20 years (17.4%) exceeds that of non-Hispanic whites (NHW) (7.8%), non-Hispanic blacks (13%), Hispanic Latinos (10.2%), and Native Americans/Alaskan natives (15.1%) as reported by the American Diabetes Association and Centers for Disease Control in 2001 (Fig. 1A). The gender disparity in DM
References (36)
- et al.
Prevalence of Type 2 diabetes and central adiposity in La Reunion Island, the REDIA Study
Diabetes Research and Clinical Practice
(2005) - et al.
Personal cancer prevention and screening practices among Asian Indian physicians in the United States
Cancer Detection and Prevention
(2004) - et al.
A comparison of the clinical features and vascular complications of diabetes between migrant Asians and Caucasians in Leicester, U.K
Diabetes Research and Clinical Practice
(1991) - et al.
Prevalence of diabetes mellitus and related conditions in Asian Indians living in the United States
American Journal of Cardiology
(2004) - et al.
Mortality from coronary heart disease and stroke for six ethnic groups in California, 1985 to 1990
Annals of Epidemiology
(1995) - et al.
Relationship of diet, abdominal obesity, and physical activity to plasma lipoprotein levels in Asian Indian physicians residing in the United States
Journal of American Dietetic Association
(1996) - et al.
Physico-chemical properties of low density lipoproteins in normolipidemic Asian Indian men
Hormone and Metabolic Research
(1995) - et al.
Differences in risk factors, atherosclerosis and cardiovascular disease between ethnic groups in Canada: The Study of Health Assessment and Risk in Ethnic groups (SHARE)
Indian Heart Journal
(2000) - et al.
Body composition, visceral fat, leptin, and insulin resistance in Asian Indian men
Journal of Clinical Endocrinology and Metabolism
(1999) - et al.
Statistical methods in medical research
(1994)
Increased end-stage diabetic nephropathy in Indo-Asian immigrants living in the Netherlands
Diabetologia
The prevention of type 2 diabetes: what is the evidence?
Minerva Endocrinologica
The American Diabetes Association, European Association for the Study of Diabetes, International Federation of Clinical Chemistry and Laboratory Medicine, and the International Diabetes Federation
Diabetes Care
Coronary heart disease and its risk factors in first-generation immigrant Asian Indians to the United States of America
Indian Heart Journal
Coronary artery disease in Asian Indians: an update and review
Internet Journal of Cardiology
Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey
JAMA
Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition
Circulation
Predictors of health among Indians in United States
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