Acculturation Strategies and Symptoms of Depression

Culture refers to the symbolic and learned aspects of human groups or societies, including language, beliefs, attitudes, values, norms, and behaviors.  Immigrants who move to the United States (US) from other countries use different strategies to adapt to US culture, which is oftentimes quite different from the culture in which they grew up.  We found that some South Asian immigrants in the MASALA study prefer to combine aspects of US and South Asian cultures, while others show a strong preference for either US or South Asian culture.  We refer to these ways of adapting to life in the US as “acculturation strategies.”  While there is no right or wrong way to adapt to life in a new country, we wanted to know whether people who use different acculturation strategies have different levels of depressive symptoms.  Depression, which is characterized by feelings of sadness and hopelessness and problems with sleeping and eating, is a common mental health problem that is not always recognized or adequately treated by health care providers.  After accounting for some important factors that might cause people to use different acculturation strategies and to have different levels of depressive symptoms, we found that immigrants in the MASALA study who showed a strong preference for South Asian culture had more symptoms of depression than those who showed either a preference for combining South Asian and US cultures or a strong preference for US culture.  Future studies can help us understand why this is the case.  If you or someone you know may be struggling with depression, you should know that effective treatments, including medications and talk therapy, are available.  You can learn more about depression–and how to get help–on this website from the National Institutes of Health:  https://www.nimh.nih.gov/health/publications/depression/index.shtml.

Have you ever wondered what the healthiest weight for you should be?

The World Health Organization has proposed lower weight criteria for Asians than other individuals because Asians have more health problems at a lower body weight. The body mass index (BMI) proposed for Asians are shown in the table. However, many people even in the normal weight range can have health problems like diabetes, high blood pressure and heart disease.

We looked at the MASALA data and compared it to our sister study, the Multi-Ethnic Study of Atherosclerosis (MESA) which includes Whites, African Americans, Latinos and Chinese individuals. We found that many people in the normal BMI category still had abnormal risk factors, and this was highest for South Asians.  Almost 44% of South Asians, 38% of Latinos, 32% Chinese, 31% of African Americans, and 21% of Whites who are of normal weight have more than 2 metabolic risk factors.  This cannot be explained by differences in the age, sex, education, physical activity, dietary intake, smoking, alcohol use, and where the body fat is stored.  To have the same number of risk factors as a White person who has a BMI of 25, a South Asian person would have a BMI of 19.6!

Currently, physicians check for diabetes and other risk factors when someone is overweight (BMI of 23 for Asians). But our study results show that many people would be missed if we relied on body weight or BMI. Just being a South Asian should be reason enough to be screened for metabolic risk factors, because weight or BMI is not a helpful criterion.

For more information, please click on the links below:

New York Times: Healthy Weight? You May Still Be at Risk for Heart Disease

Newsweek: There's a Dangerous Racial Bias in the Body Mass Index

UCSF News: Race Ranks Higher than Pounds in Diabetes, Heart-Health Risks

NBC News Asians, Blacks, Hispanics Have More Heart Disease Risks at Normal Weight: Study

India West Normal-Weight S. Asians Have Higher Heart, Diabetes Risk

Type 2 diabetes after gestational diabetes mellitus in South Asian women in the United States

There are a multitude of risk factors for type 2 diabetes. In many women, a history of gestational diabetes mellitus (GDM) has been shown to be a major additional risk factor for type 2 diabetes. GDM is a particular kind of diabetes that is diagnosed in women during pregnancy, which requires treatment with a strict diet and sometimes with medications in late pregnancy. Without proper prenatal care, GDM may remain undiagnosed. Similarly, a history of GDM may not be discussed when screening a woman for type 2 diabetes risk factors many years after a pregnancy.

South Asians are at particularly high risk for both gestational diabetes and type 2 diabetes. In this study, we wanted to determine if South Asian women had a higher risk of type 2 diabetes if they previously had a pregnancy complicated by gestational diabetes.  We found that South Asian women with a history of GDM were three times more likely to have type 2 diabetes than women without a history of GDM.

Our findings underscore the need to support efforts to identify a history of GDM while screening for type 2 diabetes.

A MASALA Participant Shares Her Story

MASALA Northwestern University Team

MASALA Northwestern University Team

Gayatri, age 52, shares how being involved in the MASALA Study has influenced her life.

“My husband had a heart attack when he was 42, no previous history, he was not overweight, no prior indicators that this should happen to him. His doctor was also taken by surprise.

So when I heard about the study, I felt it was important and I wanted to support and contribute to it.”

Has your participation benefitted you? Please tell us how.

“Oh my goodness, tremendously. When I came in for my Exam 2 visit, my blood pressure was so high. My regular routine includes, exercising every day, walking the dog, walking between 3-5 miles. My body Mass Index (BMI) was fine. I eat a plant-based diet and I do not use a lot of sugar.

There was no indication that my blood pressure should be that high. If it hadn’t been for the MASALA Study, I wouldn’t know about my high blood pressure.

I am one of the younger participants in the study and this happened to me at this age, so there are people in their 60s in the study, who would be prime candidates of what happened to me. Going to my visit helped me diagnose this issue.

The MASALA Study has helped me avoid a stroke or heart attack.”

MASALA featured in India Currents: Mitigating the Risk of Heart Disease

MASALA featured in India Currents: Mitigating the Risk of Heart Disease

By Prakash Narayan

Published on September 2, 2016

At the outset I should mention that I am a software engineer, far removed from the medical profession. Recently I was at a FinTech (Financial Technology) conference in San Jose, where the panelists were talking about the importance of KYC (Know Your Customer). They were lamenting on how hard it is to get reliable data about customers. Since this conference was packed with backtoback sessions, the only way for the audience to participate was on Twitter – using the hash tag NBSV16. My tweet, “For customer acquisition, I think the panelists are missing a key point: incentives – people are willing to provide data in exchange for them”, resonated well with others (judging from the number of “retweets” and “favorites” that it received).

It was one such incentive that led me to respond to a request from UCSF six years ago to participate in a study on factors leading to heart disease in South Asians. The incentive provided in the email (that called for volunteers to the study) was that they would conduct tests to determine CAC (Coronary Artery Calcium) levels. They went on to say even though monitoring CAC periodically could significantly reduce the risk to heart disease, this is not covered by insurance in normal “Well Care” checks.

I met Alka Kanaya, Professor of Medicine at UCSF, on a beautiful Saturday morning in May 2011 (a weekend was the only time I had available for a 34 hr. appointment). I remember being impressed with how thorough they were in their questionnaire—asking me questions ranging from my food habits, to exercise routine to social life. They even probed my participation in online social networks and my awareness of the physical activities among my friends.

Kanaya completed follow up tests in Nov. 2015—which allowed her to compare against the baseline. In May 2016, she went on a “road show” around the various cities in the Bay Area to present her findings at the conclusion of Phase 1 of her study.

I attended the presentation in the Milpitas library. The study (called MASALA – acronym for Mediators of Atherosclerosis in South Asians Living in America) was funded by the NIH and had a total of 906 participants from the Bay Area and Chicago. The motivation for conducting the study is that while heart disease is the leading cause of death worldwide, South Asians account for greater than half of the world’s cardiac patients. In fact, South Asian immigrants to the United States have higher death rates to heart disease than any other major ethnic group, and we don’t know why. One theory is the “Thrifty gene hypothesis” proposed by James V. Neel, a geneticist, in 1962. According to this, South Asian genes are programmed for famine. So when we switch over to Western-styled diet, the number of calories we consume increases—which, in turn, increases chances of heart ailments. Our ancestors had the perfect solution for maintaining a stable diet – fasts, whether it is for “Ekadashi”, Lent or Ramzan.

Most of us are aware that the major risk factors to heart disease are high cholesterol, high blood pressure, diabetes, smoking, physical inactivity, poor diet, obesity and stress. The father of modern medicine, Hippocrates, said in 400 BC, “Let food be thy medicine, and let medicine be thy food.” We are reminded often that our health is largely in our control. The choices that we make everyday can lead to vibrant health or to a never-ending struggle with diseases and conditions. While we purportedly know all of this, Kanaya’s study attempts to comprehensively understand why South Asians have increased propensity to heart disease and how it can be prevented.

It is not possible to do justice to all the findings from her study in this article. You are encouraged to visit their website http://www.masalastudy.org for more information.

There is sufficient data compiled on Caucasians, African Americans, Latinos and Chinese— with sample sizes in the thousands. This allows for portals that provide a risk assessment of Cardiovascular Disease for people of those ethnicities based on answers to a few simple questions. Dr. Kanaya’s study is a step in this direction for South Asians. Hopefully, at the conclusion of Phase 2 of her study (which has been approved by the NIH), we will have similar engines and risk models for South Asians as well.

One interesting preliminary finding from this study is to understand how social relationships and community involvement affect cardiovascular health. The average network size (defined as people, outside work, that you interact with multiple times a week) for South Asians is 6. Of this, 70% is kin. The conclusion of the study is in the chart. Certainly, exercising with another person is more effective than doing it alone.

The MASALA study has only scratched the surface in helping us understand how South Asians can prevent heart disease.

Read about MASALA on the UCSF News Center

Read about MASALA on the UCSF News Center

South Asians have an increased chance of developing cardiovascular disease and diabetes. More than 60 percent of cardiovascular disease patients around the world are of South Asian descent.