Relation of Ectopic Fat with Atherosclerotic Cardiovascular Disease Risk Score in South Asians Living in the United States (from the MASALA Study)

Photograph from Mayo Foundation for Medical Education and Research

Photograph from Mayo Foundation for Medical Education and Research

It is well known that obesity is a risk factor for heart disease. Increasingly we are learning that where that fat is stored also has implications for heart disease risk. The most obvious differences in fat storage location can be seen in the fat distributions of men compared to women, or between those who are apple shaped versus pear shaped. In MASALA, fat has been measured from around the heart (pericardial), in the liver (hepatic), in the muscle (intermuscular), in the body cavity (visceral), and under the skin (subcutaneous). The area under the skin is traditionally considered the primary location of fat storage in healthy normal weight individuals. Fat stored in other locations is generally considered to be an indication of obesity or excess fat. We looked at whether fat stored in these different areas had different associations with heart disease risk using the ASCVD risk score.

In MASALA, we found that more fat around the heart and in the body cavity had the strongest associations with heart disease risk, followed by fat in the muscle. The relationships we observed for heart disease risk with fat in the liver and under the skin were different, suggesting that fat stored in these areas may have a different function. These findings support prior research reporting that fat stored in different locations has different properties, functions, and contributions to heart disease risk. More work is needed to understand why fat gets stored in different locations and how we can use this knowledge to reduce heart disease risk.

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South Asians may cope with discrimination by consuming more sweets

In a recent analysis of MASALA data, we found that experiences of discrimination, or perceiving unfair treatment in social settings, was associated with poorer dietary intake. Specifically those who experienced the highest amount of discrimination had higher consumption of sweets, both South Asian sweets and American sweets. Experiences of discrimination were not related to fruit and vegetable consumption. 

One explanation for the findings is that experiences of discrimination are shown to be stressful for individuals and eating sweets may be one way South Asians cope with these experiences.  Advanced studies are needed to explore relationships between discrimination and health behaviors among South Asians. Ours is the first known study to demonstrate such links. 


Full article: Are Experiences of Discrimination Related to Poorer Dietary Intakes Among South Asians in the MASALA Study?



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:

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.