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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:

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.

How can religion be related to your body weight?

There is growing interest in understanding the connection between religion and health. One way that religion may influence health is through health behaviors; for example, religious beliefs may influence what someone eats. We wanted to see whether religious affiliation was linked to body weight using the MASALA Study data. MASALA includes 67% Hindus, 8% Sikhs, 7% Muslims, 6% Jains, 3% Christians, 2% other, and 6% individuals who do not have any religious affiliation.

We found that South Asians with Hindu, Sikh or Muslim religious affiliation had a higher body weight compared to those who had no religious affiliation. When we dug deeper to understand why this link exists, we found that dietary patterns, exercise, smoking and traditional cultural beliefs explained some of the link between religion and weight, but not all of it. Programs to help South Asians lose weight and prevent chronic disease like diabetes and heart disease may be more successful if they are conducted in partnership with religious organizations and if they are tailored to cultural and religious beliefs. 

What does anxiety have to do with heart disease?

MASALA has found that psychological symptoms are linked to cardiovascular disease risk.

Among men, those who had higher levels of anxiety and depression had thicker walls of their carotid arteries. In women, higher stress level was linked to thicker carotid walls. Thicker carotid arteries can lead to higher risk of stroke. 

Discrimination, the perception of unfair treatment or harassment as based on one’s race, may also influence the mental health and well-being of MASALA participants. Those who reported experiencing discrimination had higher levels of depressive symptoms, anger, and anxiety.  

Some things that were found to help this anxiety was by actively coping and talking about experiences with others.