The Quality of Health in South Asians Compared to Europeans

CFS 312 Families, Individuals, and Environments

Jessika Berryessa
December 8, 2014

Abstract

In this research paper, the health quality of South Asians is being compared to that of Europeans
based in the United Kingdom (UK). The levels of physical activity, diet, genetics and
sociocultural factors help determine the health status of South Asian and European populations in
the UK. The risk factors associated with type 2 diabetes, cardiovascular disease and obesity vary
among these populations with more South Asians being at greater risk for these diseases than
Europeans. Compared to Europeans, South Asians tend to eat more fats, exercise less, are more
prone to insulin resistance and naturally hold more fat. Also, their cultural and religious beliefs
may be preventing them from increasing their physical activity levels and improving their eating
habits.
South Asians suffer up to a 50% higher CHD[coronary heart disease] mortality rate
compared to indigenous white Europeans in the UK (Gholap, Davies, Patel, Sattar & Khunti,
2011, p. 2). Not only are more South Asians dying from CHD than Europeans in the United
Kingdom, but South Asians tend to live an unhealthy lifestyle resulting in increase risks for other
diseases. People from Europe and South Asia are not only accustomed to different lifestyles, but
South Asians genetics are more prone to certain diseases than the genetics of Europeans.
Furthermore, South Asians are more prone to certain diseases due to genetic factors. A plethora
of research has been done comparing risk factors of disease in South Asian and European
populations in the United Kingdom. The dietary habits, physical activity, biological traits and
sociocultural factors vary among White European and South Asian cultures in the United
Kingdom, leading to differences in their quality of health. South Asians have a higher risk of
chronic diseases such as, diabetes, obesity and cardiovascular disease than Europeans.
Deciphering the reasons for the higher risk of cardiovascular disease, diabetes type 2 and obesity

in South Asian compared with European populations can be determined by analyzing physical
activity level, diet, genetics and cultural and religious beliefs.
List of Risk Factors of Cardiovascular Disease, Diabetes type 2 and Obesity
According to the World Health Organization (WHO; 2014a), an unhealthy diet and lack
of physical activity increase the risk of CVD[cardiovascular disease]. Bad eating habits and not
exercising can lead to obesity and increases in blood pressure, blood glucose and blood lipids.
Also, genetics is a determinant of CVD. Furthermore, CDC (2014b) contended, high levels of
HDL, or good cholesterol, reduce the risk of heart disease and stroke (para. 3). CDC (2014a)
states risk factors for type 2 diabetes include obesity, family history of diabetesimpaired
glucose tolerance, physical inactivity (para. 1). WHO (2014b) stated an increased intake of
energy-dense foods that are high in fat; and an increase in physical inactivity are causes of
obesity (para. 11). Fried food and foods containing butter and oils are high in fat and calories.
WHO (2014b) maintains a BMI is used as a measure of overweight and obesity and those who
have a BMI of 30 or more are considered to be obese. An increased BMI raises the risk for
cardiovascular disease and diabetes. In a study conducted by Balkau et al. (2007) the authors
concluded among men and women who consulted primary care physicians, BMI and
particularly WC[waist circumference] were both strongly linked to CVD and especially to
diabetes mellitus (para. 3). Also, according to WHO (2013), people who are at risk for diseases
such as cardiovascular diseases and diabetes are those who eat non-nutritious diets, do not
exercise and are exposed to tobacco smoke. These risks associated with cardiovascular disease,
obesity and diabetes are more common in South Asians than in Europeans.
Physical Activity Levels Contributing to Disease in South Asians and Europeans

Not only do South Asians exercise less than Europeans, but also they do not exercise as
frequently in general. Yates et al. (2010) found that South Asians (SAs) may have a greater
resistance to losing weight through exercise than White Europeans (WEs). In general this study
reported that more White European women and men had a higher level of physical activity than
South Asian men and women. South Asian women and European men had a lower waist
circumference and women who were highly active than those who had a low activity level. A
lower BMI was only strongly associated in highly active White Europeans, but not highly active
South Asians. In other words, even with high levels of physical activity, South Asians are
resistant to weight loss. Physical activity also increased South Asian and White European mens
HDL cholesterol. Physical activity affected more White Europeans than South Asians. There are
several sociocultural factors contributing to this reason which are discussed in the next section.
Sociocultural Factors Contributing to Physical Activity Levels of South Asians Compared
to Europeans
As reported by Yates et al. (2010) physical activity is frowned upon in South Asian
culture, "language difficulties, lack of familiarity with the wider community, fear of racism and
crime and increased social deprivation (para. 25). Many South Asian people do not want to go
outside or to the gym to exercise because they are afraid of how people from other cultures will
perceive them. Darr, Astin and Atkin (2008) suggested a lack of exercise is a contributory factor
in the likelihood of the development of coronary heart disease in South Asians. They contend
South Asians do not participate in physical activity as often than Europeans because they do not
consider exercise important.
The Role of Genetics in Disease in South Asians compared to Europeans

Genetics play a large part in the risks of disease in South Asians in comparison to
Europeans. South Asians may be more prone to diabetes than Europeans. Bhopal (2012)
compared certain factors relating to diabetes type 2 in South Asians and Europeans from fetuses
to adults. He noted that South Asian babies are smaller, have high amounts of adipose tissue and
low muscle mass compared to European babies. One reason is the gestation period of South
Asians is shorter than Europeans and premature babies usually have more fat than European
babies. South Asian mothers of the fetus and the fetus itself have high insulin and glucose levels.
The fetus also has fewer B-cells than Europeans, which means South Asian fetuses require less
intake of calories. Low muscle mass in South Asians leads to a low capacity for oxidation and
fatty acid utilization, which are factors in insulin-resistance. He indicates that the muscles of
South Asians are insulin resistant. In adulthood a surplus of energy intake in South Asians is
stored in ectopic fat depots in the liver. Bhopal (2012) stated a fatty liver leads to insulin
resistance. Therefore, he explained, insulin resistance leads to glucose being transformed into fat
by the liver. Insulin resistance contributes to obesity by transforming glucose into stored fat.
South Asians require less energy intake because they have a high amount of adipose tissue,
which is less metabolically active than lean tissue (p. 37). The consumption of excess calories
in South Asians can be detrimental to their health. This suggests that, the more energy intake,
the more fat stored which in turn creates insulin resistance. Insulin resistance turns glucose into
fat, raising the risk for obesity in South Asians. South Asians have a higher risk of diabetes
because they are more prone to insulin resistance. Excess stores of fat found in the liver
contributes to metabolic syndrome leading to cardiovascular disease and diabetes.
Genetics: Metabolic Syndrome in South Asians

Misra and Khurana (2011) also found that urban Asian Indians who have non-alcoholic
fatty liver disease (NAFLD) had significantly higher fasting hyperinsulinemia, the metabolic
syndrome and glucose intolerance than those without NAFLD" (p. 3). Both metabolic syndrome
and glucose intolerance increase the risk for cardiovascular disease and diabetes. Meigs et al.
(2007) advocated there is an increased likelihood of developing CVD and diabetes if a person
has both insulin resistance and a metabolic syndrome. According to Meigs et al. (2007), people
with the cluster of risk factors including obesity, impaired fasting glucose (IFG), hypertension,
low HDL cholesterol, and elevated triglycerides are thought to have the metabolic syndrome,
reflecting underlying insulin resistance (p. 1). Metabolic syndrome increases the risk of
cardiovascular disease by low levels of HDL cholesterol, hypertension and trigylcerides. As said
by Misra and Khurana (2011) more South Asians have metabolic syndrome than Europeans.
They point out, South Asians having the metabolic syndrome showed higher diastolic blood
pressure, plasma triglycerides, fasting insulin and lower high-density lipoprotein-cholesterol
(HDL-C) levels compared with UK[United Kingdom] Whites (p. 5). In other words, South
Asians have a higher probability than Europeans to develop cardiovascular disease and diabetes
due to genetic factors.
The Sociocultural Influences of Diet of South Asians Compared to Europeans
Many researchers believe South Asians dietary habits are unhealthy. Bhopal (2012)
believes South Asian diets are directed toward food that is pleasing to their palate, such as foods
that are high in fat. He postulates the appreciation of pleasurable food is embedded in South
Asian culture. They do not consume food to benefit their health, but to satisfy their palate. He
continues to say in South Asian culture, being overweight is an indicator of good health and

success. Being overweight is accepted in their culture and they have no motivation to lose
weight. Barret et al. (2006) believed South Asian diet is influenced by religion (p. 4). They go
on to say type 2 diabetes and coronary heart disease is related to poor gestational nutrition (p.
5). Combined with their cultural beliefs on preferences of food and South Asians requiring less
caloric intake due to naturally having more fat storage than Europeans, they are at greater risk for
diseases associated with these factors.
The Associations Between South Asian Diet and Disease
Darr, Astin and Atkin (2008) suggested a high fat diet is linked to coronary heart disease.
They mention that South Asian meals contain many fats such as sunflower oil and butter, which
is used frequently. They also tend to eat a lot of fried foods. Liess (2012) recommended to
decrease the consumption of foods that are fried and greasy in order to lower saturated fat intake.
Saturated fat increases LDL cholesterol and decreases HDL cholesterol, which can increase the
chances of heart attack or stroke. An increase of LDL cholesterol levels and a lower amount of
HDL cholesterol levels can be caused by eating food with high amounts of saturated fat, which
increases the risk for cardiovascular disease. Gholap et al. (2011) found the South Asian
vegetarian diet raised the levels of glucose and insulin because of high intake of carbohydrates.
They also addressed that diabetes type 2 is positively correlated with the levels of carbohydrate
and insulin levels in South Asians. Misra and Khurana (2011) agreed claiming South Asians
consume more carbohydrates than Europeans and is associated with higher fasting glucose,
triacylglycerols, higher HDL and post-glucose load insulin levels (p. 10). They also declare
South Asians consume more amounts of omega 6 fatty acids and complete fatty acids and less
omega 3 fatty acids than Europeans. Europeans eat more fruits and vegetables than South

Asians. According to Thompson, Manore and Vaughan (2011), some fatty acids are associated
with an increased risk of chronic diseases (p. 12). Moreover they maintain taking in soluble
fiber on a normal day basis can lower blood cholesterol and glucose levels, which can lower the
possibility of developing both cardiovascular disease and type 2 diabetes. Fruits, oats and beans
contain soluble fibers. Thompson, Manore and Vaughan (2011) continue to say omega 3 fatty
acids decrease the possibility of heart disease. Gholap et al. (2011) asserted diabetes type 2 is
positively correlated with the levels of carbohydrate and insulin levels in South Asians. Based
on the evidence found, the diet of South Asians either increase or do not help to prevent the risk
of diseases such as cardiovascular disease and type 2 diabetes.

Sociocultural Factors: Tobacco Use as an Association with the Risk of Disease

According to WHO (2014c), tobacco is the leading cause of death, illness and
impoverishment (para. 2). Barnett et al. (2006) contended smoking rates in Caucasian males
and South Asians are about equal. He continued to say religion affects smoking rates among the
South Asian population, indicating that Hindus smoke more tobacco than Sikhs. Although,
smoking is a risk factor of coronary heart disease, the use of smokeless tobacco has been
considered to afford an equivalent risk for MI [myocardial infraction] as smoked tobacco
(Gholapa et al., 2011, p. 4). Gholapa et al. also added that smokeless tobacco is common in the
Indian population. Meaning, the Indian population are at high risk for developing CHD.
In conclusion, South Asians have a higher risk for diabetes, cardiovascular disease and
obesity than Europeans. Lack of physical activity, genetics, poor diet and sociocultural
influences increase the possibility of disease in South Asians more than in Europeans.

Europeans exercise more and consume a healthier diet than South Asians. South Asians do not
exercise often nor eat a balanced diet. South Asians do not acquire all the essential nutrients in
their diets and they consume an excess amount of fats and calories. Many sociocultural factors
are preventing South Asians from eating a healthy diet and increasing physical activity such as,
religion, weather, overweight being seen as a positive attribute, favoring appetizing foods and
believing physical activity is not necessary. South Asian biological traits are associated with an
increase risk for disease more than Europeans. South Asians are more probable to have insulin
resistance, more stored fat and low muscle density compared to Europeans. The Indian
population are at a higher risk for coronary heart disease due to the common use of smokeless
tobacco. All of these factors contribute to diabetes, cardiovascular disease and obesity and
therefore Europeans have a greater quality of health than South Asians.

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