Diabetes and Indian Culture  

• Age, family history of diabetes, obesity, dyslipidemia, hypertension, and physical inactivity are all associated with the presence of diabetes in all populations.¹

• South Asians may have an increased genetic susceptibility to diabetes, which is further enhanced by environmental triggers such as physical inactivity, excessive caloric intake, glycemic load and obesity.

• Recent studies indicate that specific cultural factors may also increase diabetes risk.² Low consumption of fruits and vegetable results in low consumption of potassium and magnesium ─ which are also risk factors for diabetes.³

• Assimilation into a western lifestyle is generally associated with worsening health outcomes, ^4-7  while retention of traditional lifestyles and dietary patterns has been protective.⁷  Indians appear to be the exception.

• Kanaya et al ⁸ developed a 7-item scale to examine traditional Indian beliefs. The base question was “How much would you wish these Indian traditions would be practiced in America in the future?” These seven items included: Performing religious ceremonies; serving sweets at ceremonies; fasting on specific occasions; living in a joint family; having an arranged marriage; eating a staple diet of rice, chapattis, vegetables, and yogurt; using spices for health and healing. The items were scored on a Likert scale with scores from 7 to 18 representing strong traditional Indian beliefs, 19 to 24 moderate traditional beliefs, and 25 to 35 weak traditional beliefs.⁸

• An intriguing finding was that individuals with more moderate or strong traditional Indian beliefs were more likely to have prediabetes or diabetes than those with weaker traditional beliefs.

• Continuing the tradition of serving Indian sweets, having an arranged marriage, and fasting on specific occasions were items most associated with diabetes.⁹ Those with stronger traditional Indian beliefs were more likely to have a higher proportion of carbohydrate intake, which is consistent with the wish to maintain the Indian tradition of serving sweets. Many of the Indian sweets are made of refined flour with coconut, butter or ghee, deep-fried in oil and served with sugary syrup and therefore very high in saturated fats and trans fats.

• Fasting may promote the “thrifty gene” phenotype and, through compensatory feedback mechanisms through the central nervous system, promote the storage of energy into adipose tissue stores.^{10, 11}

• The tradition of arranged marriage may be linked to other traditional dietary or genetic factors that promote diabetes. This construct of traditional Indian beliefs needs further study because this may hold a key to potentially modifiable behaviors that can lower diabetes risk.⁹

• Besides, consanguinity especially marriage between first cousins is very common in many communities in South Asia.

Sources

1. Zhou X, Ji L, Luo Y, et al. Risk factors associated with the presence of diabetes in Chinese communities in Beijing. Diabetes Res Clin Pract. Dec 2009;86(3):233-238.

2. Radha V, Mohan V. Genetic predisposition to type 2 diabetes among Asian Indians. Indian J Med Res. Mar 2007;125(3):259-274.

3. Chatterjee R, Yeh HC, Shafi T, et al. Serum and dietary potassium and risk of incident type 2 diabetes mellitus: The Atherosclerosis Risk in Communities (ARIC) study. Arch Intern Med. Oct 25 2010;170(19):1745-1751.

4. Kandula N. R., Tirodkar MA, Lauderdale DS, Khurana NR, Makoul G, Baker DW. Knowledge gaps and misconceptions about coronary heart disease among U.S. South Asians. Am J Prev Med. Apr 2010;38(4):439-442.

5. Kandula N R, Diez-Roux AV, Chan C, et al. Association of acculturation levels and prevalence of diabetes in the multi-ethnic study of atherosclerosis (MESA). Diabetes Care. Aug 2008;31(8):1621-1628.

6. Gilbert PA, Khokhar S. Changing dietary habits of ethnic groups in Europe and implications for health. Nutr Rev. Apr 2008;66(4):203-215.

7. Perez-Escamilla  R, Putnik P. The role of acculturation in nutrition, lifestyle, and incidence of type 2 diabetes among Latinos. J Nutr. Apr 2007;137(4):860-870.

8. Kanaya AM, Wassel CL, Mathur D, et al. Prevalence and correlates of diabetes in South asian indians in the United States: findings from the metabolic syndrome and atherosclerosis in South asians living in america study and the multi-ethnic study of atherosclerosis. Metabolic syndrome and related disorders. Apr 2010;8(2):157-164.

9. Kanaya AM, Barrett-Connor E, Gildengorin G, Yaffe K. Change in cognitive function by glucose tolerance status in older adults: a 4-year prospective study of the Rancho Bernardo study cohort. Arch Intern Med. Jun 28 2004;164(12):1327-1333.

10. Neel JV. Diabetes mellitus:  a “thrifty genotype rendered detrimental by “progress”  1962. Am Hum Genet. 1962;14:353 – 362.

11. Schwartz MW. Central nervous system regulation of food intake. Obesity (Silver Spring, Md. Feb 2006;14 Suppl 1:1S-8S.