Skip to main content Accessibility help
×
Home

South Asian diets and insulin resistance

  • Anoop Misra (a1) (a2), Lokesh Khurana (a2), Sumit Isharwal (a3) and Swati Bhardwaj (a1) (a2)

Abstract

A role of dietary nutrients in relation to insulin resistance has been suggested but conclusive evidence in human beings is lacking. Asian Indians and South Asians are prone to develop insulin resistance and the metabolic syndrome. In the present paper, data pertaining to nutrient intake, insulin resistance and cardiovascular risk factors in Asian Indians and South Asians have been reviewed. In these populations, several dietary imbalances have been reported: low intake of MUFA, n-3 PUFA and fibre, and high intake of fats, saturated fats, carbohydrates and trans-fatty acids (mostly related to the widespread use of Vanaspati, a hydrogenated oil). Some data suggest that these nutrient imbalances are associated with insulin resistance, dyslipidaemia and subclinical inflammation in South Asians. Specifically, in children and young individuals, a high intake of n-6 PUFA is correlated with fasting hyperinsulinaemia, and in adults, high-carbohydrate meal consumption was reported to cause hyperinsulinaemia, postprandial hyperglycaemia and hypertriacylglycerolaemia. Dietary supplementation with n-3 PUFA leads to an improved lipid profile but not insulin sensitivity. Inadequate maternal nutrition in pregnancy, low birth weight and childhood ‘catch-up’ obesity may be important for the development of the metabolic syndrome and diabetes. Even in rural populations, who usually consume traditional frugal diets, there is an increasing prevalence of cardiovascular risk factors and the metabolic syndrome due to changes in diets and lifestyle. Nationwide community intervention programmes aimed at creating awareness about the consequences of unhealthy food choices and replacing them by healthy food choices are urgently needed in urban and rural populations in India, other countries in South Asia and in migrant South Asians.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      South Asian diets and insulin resistance
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      South Asian diets and insulin resistance
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      South Asian diets and insulin resistance
      Available formats
      ×

Copyright

Corresponding author

*Corresponding author: Dr Anoop Misra, fax +91 11 4277 6221, email anoopmisra@metabolicresearchindia.com

References

Hide All
1Misra, A, Vikram, NK, Arya, S, et al. (2004) High prevalence of insulin resistance in postpubertal Asian Indian children is associated with adverse truncal body fat patterning, abdominal adiposity and excess body fat. Int J Obes Relat Metab Disord 28, 12171226.
2Misra, A & Vikram, NK (2003) Clinical and pathophysiological consequences of abdominal adiposity and abdominal adipose tissue depots. Nutrition 19, 457466.
3Misra, A, Khurana, L, Vikram, NK, Goel, A & Wasir, JS (2007) Metabolic syndrome in children: current issues and South Asian perspective. Nutrition 23, 895910.
4Misra, A, Misra, R, Wijesuriya, M & Banerjee, D (2007) The metabolic syndrome in South Asians: continuing escalation & possible solutions. Indian J Med Res 125, 345354.
5Wasir, JS & Misra, A (2004) The metabolic syndrome in Asian Indians: the impact of nutritional and socio-economic transition in India. Met Syndr Relat Disord 2, 1423.
6Himsworth, HP (1935) The dietetic factor determining glucose tolerance and sensitivity to insulin of healthy men. Clin Sci 2, 6794.
7Bray, GA, Lovejoy, JC, Smith, SR, DeLany, JP, Lefevre, M, Hwang, D, Ryan, DH & York, DA (2002) The influence of different fats and fatty acids on obesity, insulin resistance and inflammation. J Nutr 132, 24882491.
8Cornish, ML, Chechi, K & Cheema, SK (2006) The role of dietary fats in hypertension, obesity and insulin resistance: a comparative study of animals and humans in fetal and adult life. Curr Nutr Food Sci 2, 2943.
9Misra, A, Sharma, R, Pandey, RM & Khanna, N (2001) Adverse profile of dietary nutrients, anthropometry and lipids in urban slum dwellers of northern India. Eur J Clin Nutr 55, 727734.
10Yagalla, MV, Hoerr, SL, Song, WO, Enas, E & Garg, A (1996) Relationship of diet, abdominal obesity, and physical activity to plasma lipoprotein levels in Asian Indian physicians residing in the United States. J Am Diet Assoc 96, 257261.
11Administrative Committee on Coordination/Subcommittee on Nutrition (United Nations) (1992) Second Report on the World Nutrition Sanitation, vol 2. Hyderabad, India: National Institute of Nutrition.
12Misra, A & Ganda, OP (2007) Migration and its impact on adiposity and type 2 diabetes. Nutrition 23, 696708.
13Gupta, R, Misra, A, Pais, P, Rastogi, P & Gupta, VP (2006) Correlation of regional cardiovascular disease mortality in India with lifestyle and nutritional factors. Int J Cardiol 108, 291300.
14Parker, DR, Weiss, ST, Troisi, R, Cassano, PA, Vokonas, PS & Landsberg, L (1993) Relationship of dietary saturated fatty acids and body habitus to serum insulin concentrations: the Normative Aging Study. Am J Clin Nutr 58, 129136.
15Maron, DJ, Fair, JM & Haskell, WL (1991) Saturated fat intake and insulin resistance in men with coronary artery disease. The Stanford Coronary Risk Intervention Project Investigators and Staff. Circulation 84, 20202027.
16Marshall, JA, Bessesen, DH & Hamman, RF (1997) High saturated fat and low starch and fibre are associated with hyperinsulinaemia in a non-diabetic population: the San Luis Valley Diabetes Study. Diabetologia 40, 430438.
17Isharwal, S, Arya, S, Misra, A, Wasir, JS, Pandey, RM, Rastogi, K, Vikram, NK, Luthra, K & Sharma, R (2008) Dietary nutrients and insulin resistance in urban Asian Indian adolescents and young adults. Ann Nutr Metab 52, 145151.
18Arya, S, Isharwal, S, Misra, A, et al. (2006) C-reactive protein and dietary nutrients in urban Asian Indian adolescents and young adults. Nutrition 22, 865871.
19Merchant, AT, Kelemen, LE, de Koning, L, et al. (2008) Interrelation of saturated fat, trans fat, alcohol intake, and subclinical atherosclerosis. Am J Clin Nutr 87, 168174.
20Feskens, EJ, Bowles, CH & Kromhout, D (1991) Inverse association between fish intake and risk of glucose intolerance in normoglycemic elderly men and women. Diabetes Care 14, 935941.
21Feskens, EJ, Virtanen, SM, Rasanen, L, Tuomilehto, J, Stengard, J, Pekkanen, J, Nissinen, A & Kromhout, D (1995) Dietary factors determining diabetes and impaired glucose tolerance. A 20-year follow-up of the Finnish and Dutch cohorts of the Seven Countries Study. Diabetes Care 18, 11041112.
22Popp-Snijders, C, Schouten, JA, Heine, RJ, van der Meer, J & van der Veen, EA (1987) Dietary supplementation of omega-3 polyunsaturated fatty acids improves insulin sensitivity in non-insulin-dependent diabetes. Diabetes Res 4, 141147.
23Giacco, R, Cuomo, V, Vessby, B, Uusitupa, M, Hermansen, K, Meyer, BJ, Riccardi, G & Rivellese, AA (2007) Fish oil, insulin sensitivity, insulin secretion and glucose tolerance in healthy people: is there any effect of fish oil supplementation in relation to the type of background diet and habitual dietary intake of n-6 and n-3 fatty acids? Nutr Metab Cardiovasc Dis 17, 572580.
24Fasching, P, Ratheiser, K, Waldhausl, W, Rohac, M, Osterrode, W, Nowotny, P & Vierhapper, H (1991) Metabolic effects of fish-oil supplementation in patients with impaired glucose tolerance. Diabetes 40, 583589.
25Vessby, B, Unsitupa, M, Hermansen, K, et al. (2001) Substituting dietary saturated for monounsaturated fat impairs insulin sensitivity in healthy men and women: The KANWU Study. Diabetologia 44, 312319.
26Sevak, L, McKeigue, PM & Marmot, MG (1994) Relationship of hyperinsulinemia to dietary intake in South Asian and European men. Am J Clin Nutr 59, 10691074.
27Lovegrove, JA, Lovegrove, SS, Lesauvage, SV, Brady, LM, Saini, N, Minihane, AM & Williams, CM (2004) Moderate fish-oil supplementation reverses low-platelet, long-chain n-3 polyunsaturated fatty acid status and reduces plasma triacylglycerol concentrations in British Indo-Asians. Am J Clin Nutr 79, 974982.
28Das, UN (2002) Nutritional deficiencies and the prevalence of syndrome X in South Asians. Nutrition 18, 282.
29Ghafoorunissa, (1998) Requirements of dietary fats to meet nutritional needs & prevent the risk of atherosclerosis – an Indian perspective. Indian J Med Res 108, 191202.
30Misra, A, Chaudhary, D, Vikram, NK, Mittal, V, Devi, JR, Pandey, RM, Khanna, N, Sharma, R & Peshin, S (2002) Insulin resistance and clustering of atherogenic risk factors in women belonging to low socio-economic strata in urban slums of North India. Diabetes Res Clin Pract 56, 7375.
31Brady, LM, Lovegrove, SS, Lesauvage, SV, Gower, BA, Minihane, AM, Williams, CM & Lovegrove, JA (2004) Increased n-6 polyunsaturated fatty acids do not attenuate the effects of long-chain n-3 polyunsaturated fatty acids on insulin sensitivity or triacylglycerol reduction in Indian Asians. Am J Clin Nutr 79, 983991.
32Minihane, AM, Brady, LM, Lovegrove, SS, Lesauvage, SV, Williams, CM & Lovegrove, JA (2005) Lack of effect of dietary n-6 : n-3 PUFA ratio on plasma lipids and markers of insulin responses in Indian Asians living in the UK. Eur J Nutr 44, 2632.
33Bulliyya, G (2000) Fish intake and blood lipids in fish eating vs non-fish eating communities of coastal south India. Clin Nutr 19, 165170.
34Bulliyya, G, Reddy, PC, Reddy, KN & Reddanna, P (1994) Fatty acid profile and the atherogenic risk in fish consuming and non fish consuming people. Indian J Med Sci 48, 256260.
35Garg, A (1998) High-monounsaturated fat diets for patients with diabetes mellitus: a meta-analysis. Am J Clin Nutr 67, Suppl. 3, 577S582S.
36Garg, A, Bonanome, A, Grundy, SM, Zhang, ZJ & Unger, RH (1988) Comparison of a high-carbohydrate diet with a high-monounsaturated-fat diet in patients with non-insulin-dependent diabetes mellitus. N Engl J Med 391, 829834.
37Dimopoulos, N, Watson, M, Sakamoto, K & Hundal, HS (2006) Differential effects of palmitate and palmitoleate on insulin action and glucose utilization in rat L6 skeletal muscle cells. Biochem J 399, 473481.
38Udipi, SA, Karandikar, S, Mukherjee, R, Agarwal, S & Ghugre, PS (2006) Variations in fat and fatty acid intakes of adult males from three regions of India. Indian J Public Health 50, 179186.
39Singhal, S, Gupta, P, Mathur, B, Banda, S, Dandia, R & Gupta, R (1998) Educational status and dietary fat and anti-oxidant intake in urban subjects. J Assoc Physicians India 46, 684688.
40Mohan, V, Shanthirani, S, Deepa, R, Premalatha, G, Sastry, NG & Saroja, R (2001) Intra-urban differences in the prevalence of the metabolic syndrome in southern India – the Chennai Urban Population Study (CUPS no. 4). Diabet Med 18, 280287.
41Ascherio, A, Katan, MB, Zock, PL, Stampfer, MJ & Willett, WC (1999) Trans fatty acids and coronary heart disease. N Engl J Med 340, 19941998.
42Salmeron, J, Hu, FB, Manson, JE, Stampfer, MJ, Colditz, GA, Rimm, EB & Willett, WC (2001) Dietary fat intake and risk of type 2 diabetes in women. Am J Clin Nutr 73, 10191026.
43Christiansen, E, Schnider, S, Palmvig, B, Tauber-Lassen, E & Pedersen, O (1997) Intake of a diet high in trans monounsaturated fatty acids or saturated fatty acids. Effects on postprandial insulinemia and glycemia in obese patients with NIDDM. Diabetes Care 20, 881887.
44Anand, SS, Enas, EA, Pogue, J, Haffner, S, Pearson, T & Yusuf, S (1998) Elevated lipoprotein(a) levels in South Asians in North America. Metabolism 47, 182184.
45Holman, RT & Johnston, SB (1983) Essential fatty acid deficiencies in man. In Dietary Fats and Health, pp. 247266 [Perkins, EG and Visek, WJ, editors]. Champaign, IL: American Oil Chemists' Society.
46Borkman, M, Campbell, LV, Chisholm, DJ & Storlien, LH (1991) Comparison of the effects on insulin sensitivity of high carbohydrate and high fat diets in normal subjects. J Clin Endocrinol Metab 72, 432437.
47Samaha, FF, Iqbal, N, Seshadri, P, Chicano, KL, Daily, DA, McGrory, J, Williams, T, Williams, M, Gracely, EJ & Stern, L (2003) A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med 348, 20742081.
48Burden, ML, Samanta, A, Spalding, D & Burden, AC (1994) A comparison of the glycaemic and insulinaemic effects of an Asian and a European meal. Pract Diabetes Int 11, 208211.
49Greenhalgh, PM (1997) Diabetes in British south Asians: nature, nurture, and culture. Diabet Med 14, 1018.
50Misra, A & Vikram, NK (2004) Insulin resistance syndrome (metabolic syndrome) and obesity in Asian Indians: evidence and implications. Nutrition 20, 482491.
51Devi, JR, Arya, S, Khanna, N, Pandey, RM, Sharma, R, Vikram, NK, Misra, A & Guleria, R (2003) Postmenopausal women in urban slums in southern Delhi are obese and dyslipidemic. J Assoc Physicians India 50, 1559.
52Shobana, R, Snehalatha, C, Latha, E, Vijay, V & Ramachandran, A (1998) Dietary profile of urban south Indians and its relations with glycaemic status. Diabetes Res Clin Pract 42, 181186.
53Kamath, SK, Hussain, EA, Amin, D, Mortillaro, E, West, B, Peterson, CT, Aryee, F, Murillo, G & Alekel, DL (1999) Cardiovascular disease risk factors in 2 distinct ethnic groups: Indian and Pakistani compared with American premenopausal women. Am J Clin Nutr 69, 621631.
54Willett, WC (2006) The Mediterranean diet: science and practice. Public Health Nutr 9, 105110.
55Esmaillzadeh, A, Kimiagar, M, Mehrabi, Y, Azadbakht, L, Hu, FB & Willett, WC (2006) Fruit and vegetable intakes, C-reactive protein, and the metabolic syndrome. Am J Clin Nutr 84, 14891497.
56Mitra, SR, Mazumder, DN, Basu, A, Block, G, Haque, R, Samanta, S, Ghosh, N, Smith, MM, von Ehrenstein, OS & Smith, AH (2004) Nutritional factors and susceptibility to arsenic-caused skin lesions in West Bengal, India. Environ Health Perspect 112, 11041109.
57Pushpamma, P, Geervani, P & Rani, MU (1982) Food intake and nutrient adequacy of rural population of Andhra Pradesh, India. Hum Nutr Appl Nutr 36A, 293301.
58Panwar, B & Punia, D (1998) Food intake of rural pregnant women of Haryana State, northern India: relationship with education and income. Int J Food Sci Nutr 49, 243247.
59Jonnalagadda, SS & Diwan, S (2002) Regional variations in dietary intake and body mass index of first-generation Asian-Indian immigrants in the United States. J Am Diet Assoc 102, 12861289.
60Bhatnagar, D (1988) Glucose tolerance in north Indians taking a high fibre diet. Eur J Clin Nutr 42, 10231027.
61Saris, NE, Mervaala, E, Karppanen, H, Khawaja, JA & Lewenstam, A (2000) Magnesium. An update on physiological, clinical and analytical aspects. Clin Chim Acta 294, 126.
62Barbagallo, M, Dominguez, LJ, Galioto, A, Ferlisi, A, Cani, C, Malfa, L, Pineo, A, Busardo, A & Paolisso, G (2003) Role of magnesium in insulin action, diabetes and cardio-metabolic syndrome X. Mol Aspects Med 24, 3952.
63Liese, AD, Roach, AK, Sparks, KC, Marquart, L, D'Agostino, RB Jr & Mayer-Davis, EJ (2003) Whole-grain intake and insulin sensitivity: the Insulin Resistance Atherosclerosis Study. Am J Clin Nutr 78, 965971.
64Meyer, KA, Kushi, LH, Jacobs, DR Jr, Slavin, J, Sellers, TA & Folsom, AR (2000) Carbohydrates, dietary fiber, and incident type 2 diabetes in older women. Am J Clin Nutr 71, 921930.
65Fung, TT, Hu, FB, Pereira, MA, Liu, S, Stampfer, MJ, Colditz, GA & Willett, WC (2002) Whole-grain intake and the risk of type 2 diabetes: a prospective study in men. Am J Clin Nutr 76, 535540.
66Kelsay, JL, Frazier, CW, Prather, ES, Canary, JJ, Clark, WM & Powell, AS (1988) Impact of variation in carbohydrate intake on mineral utilization by vegetarians. Am J Clin Nutr 48, 875879.
67Jonnalagadda, SS & Khosla, P (2007) Nutrient intake, body composition, blood cholesterol and glucose levels among adult Asian Indians in the United States. J Immigr Minor Health 9, 171178.
68Boucher, BJ, Mannan, N, Noonan, K, Hales, CN & Evans, SJ (1995) Glucose intolerance and impairment of insulin secretion in relation to vitamin D deficiency in east London Asians. Diabetologia 38, 12391245.
69Rao, S, Yajnik, CS, Kanade, A, et al. (2001) Intake of micronutrient-rich foods in rural Indian mothers is associated with the size of their babies at birth: Pune Maternal Nutrition Study. J Nutr 131, 12171224.
70UNICEF (2002) UNICEF: Progress since the World Summit for Children: a statistical review.http://www.unicef.org/specialsession/about/sgreport-pdf/sgreport_adapted_stats_eng.pdf.
71Yajnik, CS (2004) Early life origins of insulin resistance and type 2 diabetes in India and other Asian countries. J Nutr 134, 205210.
72Bhargava, SK, Sachdev, HS, Fall, CH, Osmond, C, Lakshmy, R, Barker, DJ, Biswas, SK, Ramji, S, Prabhakaran, D & Reddy, KS (2004) Relation of serial changes in childhood body-mass index to impaired glucose tolerance in young adulthood. N Engl J Med 350, 865875.
73Sachdev, HS, Fall, CH, Osmond, C, Lakshmy, R, Dey Biswas, SK, Leary, SD, Reddy, KS, Barker, DJ & Bhargava, SK (2005) Anthropometric indicators of body composition in young adults: relation to size at birth and serial measurements of body mass index in childhood in the New Delhi birth cohort. Am J Clin Nutr 82, 456466.
74Eaton, PM, Wharton, PA & Wharton, BA (1984) Nutrient intake of pregnant Asian women at Sorrento Maternity Hospital, Birmingham. Br J Nutr 52, 457468.
75Yajnik, CS, Deshpande, SS, Jackson, AA, et al. (2008) Vitamin B(12) and folate concentrations during pregnancy and insulin resistance in the offspring: the Pune Maternal Nutrition Study. Diabetologia 51, 2938.
76Misra, A, Pandey, RM, Devi, JR, Sharma, R, Vikram, NK & Khanna, N (2001) High prevalence of diabetes, obesity and dyslipidaemia in urban slum population in northern India. Int J Obes Relat Metab Disord 25, 17221729.
77Chadha, SL, Gopinath, N & Shekhawat, S (1997) Urban-rural differences in the prevalence of coronary heart disease and its risk factors in Delhi. Bull World Health Organ 75, 3138.
78Chow, CK, Naidu, S, Raju, K, Raju, R, Joshi, R, Sullivan, D, Celermajer, DS & Neal, BC (2008) Significant lipid, adiposity and metabolic abnormalities amongst 4535 Indians from a developing region of rural Andhra Pradesh. Atherosclerosis 196, 943952.
79Malhotra, SL (1973) Diabetes mellitus in Indian male railway doctors from south and north of India and in migrants with special reference to causation. J Assoc Physicians India 21, 661670.
80Ramachandran, A, Snehalatha, C, Mary, S, Mukesh, B, Bhaskar, AD & Vijay, V (2006) The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia 49, 289297.
81Balagopal, P, Kamalamma, N, Patel, TG & Misra, R (2008) A community-based diabetes prevention and management education program in a rural village in India. Diabetes Care 31, 10971104.
82Rush, EC, Chandu, V & Plank, LD (2007) Reduction of abdominal fat and chronic disease factors by lifestyle change in migrant Asian Indians older than 50 years. Asia Pac J Clin Nutr 16, 671676.
83Bhardwaj, S, Misra, A, Khurana, L, Gulati, S, Shah, P & Vikram, NK (2008) Childhood obesity in Asian Indians: a burgeoning cause of insulin resistance, diabetes and sub-clinical inflammation. Asia Pac J Clin Nutr 17, Suppl. 1, 172175.
84World Diabetes Foundation (2007) Primary prevention in Indian schools.http://www.worlddiabetesfoundation.org/composite-1279.htm.
85Pasricha, S (2000) Count What You Eat. Hyderabad, India: National Institute of Nutrition.
86Raina, U, Kashyap, S, Narula, V, Thomas, S, Suvira, , Vir, S & Chopra, S (2007) Basic Food Preparations, 3rd ed.Hyderabad, India: Orient Longman.
87Ghafoorunisa, & Krishnaswamy, K (2004) Diet and Heart Disease. Hyderabad, India: National Institute of Nutrition.
88Gopalan, C, Rama Sastri, BV & Balasubramanian, SC (2007) Nutritive Value of Indian Foods (revised and updated by BS Narasinga Rao, YG Deosthale and KC Pant). Hyderabad, India: National Institute of Nutrition.
89Expert Group of Indian Council of Medical Research (2004) Requirements and Recommended Dietary Allowances for Indians. Hyderabad, India: National Institute of Nutrition.

Keywords

South Asian diets and insulin resistance

  • Anoop Misra (a1) (a2), Lokesh Khurana (a2), Sumit Isharwal (a3) and Swati Bhardwaj (a1) (a2)

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed