Advertisement

Impact of migration on coronary heart disease risk factors: Comparison of Gujaratis in Britain and their contemporaries in villages of origin in India

      Abstract

      The causes of the excess coronary heart disease (CHD) risk in South Asian migrants from the Indian subcontinent remain unclear. Comparisons of CHD risk factors amongst South Asian migrants living in Britain with those of the general UK population provide only a partial explanation. We compared Gujaratis in Britain with similar, non-migrant Gujaratis in India, to test the hypothesis that differences in CHD risk factors associated with migration would be more informative. Randomly sampled Gujaratis aged 25–79 years living in Sandwell (n = 242) were compared with age-, gender- and caste-matched contemporaries remaining in their villages of origin in Navsari, India (n = 295). Lifestyle indices, food intake and physical activity, were assessed with standardised questionnaires and energy expenditure and metabolic parameters measured.
      British Gujaratis had higher, mean body mass indices by 6 (4.5–7.4) kg/m2 mean (95% CI), and greater dietary energy intake, fat intake, blood pressure, fasting serum cholesterol, apolipoprotein B, triglycerides, non-esterified fatty acid (NEFA) and C-reative protein concentrations than Gujaratis in India. Dietary folate and serum folate and Vitamin B12 were lower and plasma homocysteine was higher in India. Smoking was less prevalent and high-density lipoprotein cholesterol tended to be higher in Britain. Diabetes prevalence was high in both populations and impaired fasting or 2 h post-glucose challenge plasma glucose was even more prevalent in Gujarat. In India, however, where insulin secretion and NEFA were lower diabetes and impaired glucose tolerance were less frequently accompanied by excess metabolic CVD risk factors.
      In conclusion, exposure to increased fat intake and obesity related to migration is likely to explain the disproportionate combination of established and emerging CHD risk factors prevalent in Gujaratis in Britain. Strategies to improve nutrition and to identify and treat cardiovascular risk factors such as dyslipidaemia and hypertension are urgently required.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Derry C.W.
        • Bourne D.E.
        • Sayed A.R.
        • et al.
        Variations in mortality of coloured, white and Asian population groups in the RSA, 1978–1982 Part VI. Ischaemic heart disease.
        South African Med J. 1987; 72: 698-700
        • Miller G.J.
        • Beckles GLA
        • Maude G.H.
        • et al.
        Ethnicity and other characteristics predictive of coronary heart disease in a developing community: the principal results of the St. James survey, Trinidad.
        Int J Epidemiol. 1989; 18: 808-817
        • Hughes K.
        • Lun K.C.
        • Yeo PP.B.
        Cardiovascular disease in Chinese, Malays, and Indians in Singapore. I. Differences in mortality.
        J Epidemiol Comm Health. 1990; 44: 24-28
        • Collins V.R.
        • Dowse G.K.
        • Cabealawa S.
        • Ram P.
        • Zimmet P.Z.
        High mortality from cardiovascular disease and analysis of risk factors in Indian and Melanesian Fijians.
        Int J Epidemiol. 1996; 25: 59-69
        • Tuomilehto J.
        • Li N.
        • Dowse G.
        • et al.
        P The prevalence of coronary heart disease in the multi-ethnic and high diabetes prevalence population of Mauritius.
        J Intern Med. 1993; 233: 187-194
        • Wild S.H.
        • Laws A.
        • Fortmann S.P.
        • Varady A.N.
        Byrne CD Mortality from coronary heart disease and stroke for six ethnic groups in California.
        Ann Epidemiol. 1995; 5: 432-439
        • Anand S.S.
        • Yusuf S.
        • Vuksan V.
        • 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).
        Lancet. 2000; 356: 279-284
        • Tunstall Pedoe H.
        • Clayton D.
        • Morris J.N.
        • Brigden W.
        • Mcdonald L.
        Coronary heart-attacks in East London.
        Lancet. 1975; 306: 833-838
        • Adelstein A.M.
        Current vital statistics: methods and interpretation.
        Brit Med J. 1978; 2: 983-987
        • Cruickshank J.K.
        • Beevers D.G.
        • Osbourne V.L.
        • Haynes R.A.
        • Corlett J.C.
        • Selby S.
        Heart attack, stroke, diabetes and hypertension in West Indians, Asians and whites in Birmingham, England.
        Brit Med J. 1980; 281: 1108
        • Balarajan R.
        Ethnicity and variations in mortality from coronary heart disease.
        Health Trends. 1996; 28: 45-51
        • Wild S.
        • McKeigue P.
        Cross sectional analysis of mortality by country of birth in England and Wales, 1970–92.
        Brit. Med. J. 1997; 314: 705-710
        • Harding S.
        Mortality of migrants from the Indian subcontinent to England and Wales: effect of duration of residence.
        Epidemiology. 2003; 14: 287-292
        • Collins V.R.
        • Dowse G.K.
        • Ram P.
        • Cabealawa S.
        • Zimmet P.Z.
        Non-insulin-dependent diabetes and 11-year mortality in Asian Indian and Melanesian Fijians.
        Diab Med. 1996; 13: 125-132
        • McKeigue P.M.
        • Ferrie J.E.
        • Pierpoint T.
        • Marmot M.G.
        Association of early-onset coronary heart disease in South Asian men with glucose intolerance and hyperinsulinaemia.
        Circulation. 1993; 87: 152-161
        • Chadha S.L.
        • Ramachandran K.
        • Shekhawat S.
        • et al.
        A three year follow-up study of coronary heart disease in Delhi.
        Bull W H Org. 1993; 71: 67-72
        • McKeigue P.M.
        • Shah B.
        • Marmot M.G.
        Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians.
        Lancet. 1991; 337: 382-386
        • Cruickshank J.K.
        • Cooper J.
        • Burnett M.
        • MacDuff J.
        • Drubra U.
        Ethnic differences in fasting plasma C-peptide and insulin in relation to glucose tolerance and blood pressure.
        Lancet. 1991; 338: 842-847
        • Chambers J.C.
        • Eda S.
        • Bassett P.
        • et al.
        C-reactive protein, insulin resistance, central obesity, and coronary heart disease risk factors in Indian Asians from the United Kingdom compared to European Whites.
        Circulation. 2001; 104: 145-150
        • Bhatnagar D.
        • Anand I.S.
        • Durrington P.N.
        • et al.
        Coronary risk factors in people from the Indian subcontinent living in West London and their siblings in India.
        Lancet. 1995; 345: 405-409
      1. Alberti KGMM, Zimmet PZ for the WHO consultation. Definition, diagnosis and classification of diabetes mellitus and its complications Part1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diab Med 1998;15:539–53.

        • Kjeldsen S.E.
        • Farsang C.
        • Sleigh P.
        • Mancia G.
        World Health Organization; International Society of Hypertension. 1999 WHO/ISH hypertension guidelines—highlights and esh update.
        J Hyperten. 2001; 19: 2285-2288
        • Richardson M.T.
        • Leon A.S.
        • Jacobs Jr., D.R.
        • Ainsworth B.E.
        • Serfass R.
        Ability of the Caltrac Accelerometer to assess daily physical activity levels.
        J Cardiopulm Rehab. 1995; 15: 107-113
        • Washburn R.A.
        • Laporte Re.
        Assessment of walking behaviour: effect of speed and monitor position on 2 objective physical activity monitors.
        Res Quart Ex Sport. 1988; 59: 83-85
        • Friedewald W.T.
        • Levy R.I.
        • Fredrickson D.S.
        Estimation of low density lipoprotein cholesterol in plasma without the use of the preparative centrifuge.
        Clin Chem. 1972; 18: 499-502
        • Laing I.
        • Olukoga A.O.
        • Gordon C.
        • Boulton A.J.M.
        Serum sex hormone binding globulin is related to hepatic and peripheral insulin sensitivity but not to beta cell function in men and women with type 2 diabetes.
        Diab Med. 1998; 15: 473-479
        • Mathews D.R.
        • Hosker J.P.
        • Rudenski A.S.
        • et al.
        Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man.
        Diabetelogia. 1985; 28: 412-419
        • Kannel W.B.
        • Brand N.
        • Skinner Jr., J.J.
        • Dawber T.R.
        • McNamara P.M.
        The relationship of obesity to blood pressure and development of hypertension: the Framingham Study.
        Ann Intern Med. 1967; 67: 48-59
        • Harris M.I.
        • Flegal K.M.
        • Cowie C.C.
        • et al.
        Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in US adults. The Third National Health and Nutrition Examination Survey, 1994.
        Diab Care. 1998; 21: 518-524
        • Perley M.
        • Kipnis D.M.
        Plasma insulin responses to glucose and tolbutamide of normal weight and obese diabetic and non-diabetic subjects.
        Diabetes. 1966; 15: 867-874
        • Thelle D.S.
        • Shaper A.G.
        • Whitehead T.P.
        • Bullock D.G.
        • Ashby D.
        • Patel I.
        Blood lipids in middle-aged British men.
        Br Heart J. 1983; 49: 205-213
        • Kato H.
        • Tillotson J.
        • Nichaman M.Z.
        • Rhoads G.G.
        • Hamilton H.B.
        Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California.
        Am J Epidemiol. 1973; 97: 372-385
        • Glueck C.J.
        • Taylor H.L.
        • Jacobs D.
        • Morrison J.A.
        • Beaglehole R.
        • Williams O.D.
        Plasma high-density lipoprotein cholesterol: association with measurements of body mass. The Lipid Research Clinics Program Prevalence Study.
        Circulation. 1980; 62: 62-69
        • Haffner S.M.
        • Stern M.P.
        • Hazuda H.P.
        • Mitchell B.D.
        • Patterson J.K.
        Cardiovascular risk factors in confirmed prediabetic individuals: does the clock for coronary disease start ticking before the onset of clinical diabetes.
        JAMA. 1990; 263: 2893-2898
        • Durrington P.N.
        Diabetic dyslipidaemia.
        Bailliere's Clin End Metab. 2000; 13: 265-278
        • Castelli W.P.
        • Garrison R.J.
        • Wilson P.W.
        • Abbot R.D.
        • Kalousdiou S.
        • Kammel W.B.
        Incidence of coronary heart disease and lipoprotein cholesterol levels. The Framingham Study.
        JAMA. 1986; 256: 2835-2838
        • Simons L.A.
        Interrelations of lipids and lipoproteins with coronary artery disease mortality in 19 countries.
        Am J Cardiol. 1986; 57: 5g-10g
        • Grundy S.M.
        Dietary therapy of hyperlipidaemia.
        Baillière's Clin Endocr Metab. 1987; 1: 667-698
        • Mensink R.P.
        • Katan M.B.
        Effect of monounsaturated fatty acids versus complex carbohydrates on high density lipoproteins in healthy men and women.
        Lancet. 1987; i: 122-125
        • Thorogood M.
        Vegetarianism, coronary disease risk factors and coronary heart disease.
        Curr Opin Lipidol. 1994; 5: 17-21
        • Danesh J.
        • Collins R.
        • Peto R.
        Lipoprotein (a) and coronary heart disease: meta-analysis of prospective studies.
        Circulation. 2000; 102: 1082-1085
        • Durrington P.N.
        Lipoprotein (a).
        Baillierés Clin End Metab. 1995; 9: 773-795
        • Danesh J.
        • Wheeler J.G.
        • Hirschfield G.M.
        • et al.
        C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease.
        N Engl J Med. 2004; 350: 1387-1397
        • Fredrikson G.N.
        • Hedblad B.
        • Nilsson J.A.
        • Alm R.
        • Berglund G.
        • Nilsson J.
        Association between diet, lifestyle, metabolic cardiovascular risk factors and plasma C-reactive protein levels.
        Metabolism. 2004; 53: 1436-1442
        • Chambers J.C.
        • Ueland P.M.
        • Obeid O.A.
        • Wrigley J.
        • Refsum H.
        • Kooner J.S.
        Improved vascular endothelial function after oral B Vitamins: an effect mediated through reduced concentrations of free plasma homocysteine.
        Circulation. 2000; 102: 2479-2483
        • McKillop D.J.
        • Pentieva K.
        • Daly D.
        • et al.
        The effect of different cooking methods on folate retention in various foods that are amongst the major contributors to folate intake in the UK diet.
        Br J Nutr. 2002; 88: 681-688
        • Chambers J.C.
        • Obeid O.A.
        • Refsum H.
        • et al.
        Plasma homocysteine concentrations and risk of coronary heart disease in UK Indian Asian and European men.
        Lancet. 2000; 355: 523-527
        • Reddy K.S.
        The burden of disease among the global poor.
        Lancet. 1999; 23: 1477
        • Robertson T.L.
        • Kato H.
        • Gordon T.
        • et al.
        Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California.
        Am J Cardiol. 1977; 39: 239-243
        • Marmot M.
        General approaches to migrant studies: the relation between disease, social class and ethnic origin.
        in: Cruickshank J.K. Beevers D.G. Ethnic Factors in Health and Disease. Butterworth Heinemann, London1989: 12-17 ([Chapter 3])
        • Mbanya J.C.
        • Cruickshank J.K.
        • Forrester T.
        • et al.
        Standardized comparison of glucose intolerance in west African-origin populations of rural and urban Cameroon, Jamaica, and Caribbean migrants to Britain.
        Diab Care. 1999; 22: 434-440
        • Cruickshank J.K.
        • Mbanya J.C.
        • Wilks R.
        • Balkau B.
        • McFarlane-Anderson N.
        • Forrester T.
        Sick genes, sick individuals or sick populations with chronic disease? The emergence of diabetes and high blood pressure in African-origin populations.
        Int J Epidemiol. 2001; 30: 111-117
        • Rose G.
        The Strategy of Preventive Medicine.
        Oxford University Press, Oxford1993
      2. McGarry, J.D. Banting lecture 2001 dysregulation of fatty acid metabolism in the etiology of type 2 diabetes. Diabetes 2002;51:7–18.

        • Shuldiner A.R.
        • McLenithan J.C.
        Genes and pathophysiology of type 2 diabetes: more than just the Randle cycle all over again.
        J Clin Invest. 2004; 114: 1414-1417
        • Frayne K.N.
        • Williams C.M.
        • Arner P.
        Are increased plasma non-esterified fatty acid concentrations a risk marker for coronary heart disease and other chronic diseases?.
        Clin Sci. 1996; 90: 243-253
        • Malmström R.
        • Packard C.J.
        • Caslake M.
        • et al.
        Defective regulation of triglyceride metabolism by insulin in the liver in non-insulin-dependent diabetes mellitus.
        Diabetologia. 1997; 40: 454-462