Epidemiology of diabetes among South Asians in the United States: lessons from the MASALA study

• Type of Material: Article
• Authors: Unjali Gujral, Emory University; Alka M. Kanaya, University of California San Francisco
• Language: English
• Date: 2020-11-20
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 New York Academy of Sciences.
• Final Published Version (URL): http://dx.doi.org/10.1111/nyas.14530
• Title of Journal or Parent Work: ANNALS OF THE NEW YORK ACADEMY OF SCIENCES
• Volume: 1495
• Issue: 1
• Start Page: 24
• End Page: 39
• Grant/Funding Information: U.P.G. was supported by supported in part by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Grant number P30-DK-111024. The MASALA study was supported by Grants R01HL093009 and R01HL120725 from the National Heart, Lung, and Blood Institute, the National Center for Research Resources, and the National Center for Advancing Translational Sciences, the National Institutes of Health (NIH); and through the UCSF-CTSI Grants UL1RR024131 and UL1TR001872. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or the NIH. The authors thank the other investigators, the staff, and the participants of the MASALA study for their valuable contributions.
• Keywords: type 2 diabetes; RACIAL/ETHNIC GROUPS; MASALA; BMI; insulin resistance; Science & Technology; INSULIN-RESISTANCE; BODY-MASS INDEX; URBAN-RURAL EPIDEMIOLOGY; Multidisciplinary Sciences; BMI CUT POINTS; METABOLIC SYNDROME; PHYSICAL-ACTIVITY; Science & Technology - Other Topics; South Asian; ORGANIC POLLUTANTS POPS; OBSTRUCTIVE SLEEP-APNEA; RISK-FACTORS; the United States; ethnicity

Abstract

South Asian individuals in the United States are at an increased risk of type 2 diabetes (T2DM); however, the mechanisms behind this are not well understood. The Mediators of Atherosclerosis in South Asians Living in America (MASALA) study is the only longitudinal cohort of South Asians in the United States and provides key insights as to the epidemiology of T2DM in South Asians. Evidence from the MASALA study suggests that South Asians experience a disproportionately high burden of prevalent and incident T2DM compared with members of other race/ethnic groups. Higher insulin resistance in South Asians, even with low body mass index (BMI), more impairment in insulin secretion, and greater deposition of ectopic fat likely play a role in T2DM etiology. Furthermore, South Asian migrants to the United States experience a range of factors related to acculturation, social networks, and religious beliefs, which may impact physical activity and dietary practices. Interventions to prevent T2DM in South Asians should include a focus on cultural factors related to health and should consider the complete mechanistic pathway and the relative contributions of insulin resistance, β cell dysfunction, and ectopic fat deposition on T2DM development in South Asians, particularly in those with lower BMI.