National Lipid Association
National Lipid Association
May 23, 2019
3 min read

Acculturation to Western lifestyle among ASCVD factors in South Asians

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MIAMI — The adoption of culturally relevant dietary recommendations and lifestyle changes can play a role in the reduction of atherosclerotic CVD in South Asian adults, Geeta Sikand, MA, RDN, FAND, CDE, CLS, FNLA, said during a presentation at the National Lipid Association Scientific Sessions.

“My own father passed away at age 55 of a massive heart attack in 1976. He was a vegetarian, he was a teetotaler, nonsmoker, normal weight and walked 5 miles a day, but he did have hypertension, and he was treated for it,” Sikand, associate clinical professor of medicine in cardiology and the director of nutrition in the preventive cardiology program at the University of California, Irvine, said during the presentation. “In those days, we didn’t check lipids. It’s very important for South Asians to be treated in a timely manner and diagnosed in a timely manner.”

Objectives of the study included cataloging the effect of food acculturation on South Asian dietary patterns and associated ASCVD risk factors, explaining the effect of diet and lifestyle modification on atherosclerotic risk factors in South Asians and establish diet and lifestyle goals and resources to enable practitioners to culturally adjust American Heart Association/American College of Cardiology-recommended dietary patterns for that population.

Risk factors for South Asians with ASCVD included a relatively lower BMI but more central abdominal obesity, a higher rate of diabetes and an increased risk for early heart disease, Sikand said. There were sparse population-based data in the United States and no longitudinal studies worldwide.

Sikand noted in the presentation that based on a 2010 AHA science advisory on CVD in South Asians, migration and acculturation to Western lifestyle was associated with CVD development.

Among some of the CVD risk factors noted by Sikand were:

  • lack of adherence to a diet rich in vegetables and fruits;
  • dietary patterns consisting of saturated and hydrogenated fats and refined carbohydrates; and
  • increased consumption of animal protein, fried snacks, sweets and high-fat diary leading to increased insulin resistance and lower HDL.

Incident CVD in South Asians was affected by migration as a result of sedentary lifestyle, smoking, excessive alcohol use and a diet lacking fruit and vegetable intake, which led to a two- to threefold higher risk in non-adherers, Sikand said.

An examination of the MASALA study showed major lifestyle contributors to ASCVD included 75% of South Asians were overweight and had a 23% prevalence of diabetes. The prevalence was almost twice the percentage of age- and adiposity-matched Chinese Americans (13%) and close to four times the rate of non-Hispanic white adults (6%).


Dietary patterns among South Asians were categorized between nonvegetarians and lacto-vegetarians to determine ASCVD risk with both groups displaying high dyslipidemia incidence.

Nonvegetarians had a higher obesity risk and consumed excessive animal products, whereas lacto-vegetarians had increased ASCVD risk and were overweight and consumed excessive calories that included refined carbohydrates and saturated fats.

Changes in dietary patterns recommended included higher consumption in fruits and vegetables and low glycemic load carbohydrates such as barley, whole oats and whole wheat.

Lifestyle and dietary changes

The effect of diet of exercise intervention in South Asians with prediabetes and diabetes showed improved BMI based on data from trials including the South Asian Heart Lifestyle Intervention (SAHELI) study.

In recommendations for creating culturally tailored dietary patterns for South Asians, Sikand suggested limiting food high in saturated fats and dietary cholesterol, a greater emphasis in consumption of plant-based foods and the minimization of trans fat, sodium processed meats and sweetened beverages.

For physical activity, 150 minutes of moderate-intensity or 75 minutes of high-intensity exercise weekly were recommended.

The Dietary Approaches to Stop Hypertension (DASH) diet and healthy variations of Mediterranean and vegetarian dietary patterns were also among the guidelines endorsed for South Asian populations to reduce ASCVD risk, Sikand said.

The need for culturally relevant diet counseling is also essential in reducing ASCVD risk in South Asians.

Utilizing multiple personalized sessions with a dietitian led to improved LDL, triglycerides, BMI and HbA1c in 5,700 participants in 13 countries, Sikand said. Culturally tailored cardioprotective diet pattern and physical activity interventions in South Asians led to improved weight, insulin sensitivity and physical activity.

“There’s a high recidivism in subjects who are placed on an eating plan different from their usual dietary patterns,” Sikand said. “That’s why it’s so important to have culturally relevant diet counseling for South Asians.” – by Earl Holland Jr.


Sikand G. Impact of diet and lifestyle modification and physical activity as primary prevention. Presented at: National Lipid Association Scientific Sessions; May 16-19, 2019; Miami.

Disclosure: Sikand reports no relevant financial disclosures.