Exploring Dietary Patterns and Cardiometabolic Health in South Asian Americans: Insights from the MASALA Study

The MASALA study published in BMJ Nutrition Prevention & Health is a comprehensive investigation into the dietary patterns and cardiometabolic health of South Asian Americans, has revealed valuable insights. By examining various dietary patterns, including the DASH diet, Mediterranean-style diet, and plant-based diets, the study has demonstrated that adopting healthier eating habits can significantly reduce the risk of cardiovascular disease in this population. Key findings include the benefits of consuming more fruits, vegetables, whole grains, and legumes, while limiting red and processed meats, sugar-sweetened beverages, and sodium. The MASALA study also highlights the importance of cultural relevance in dietary recommendations, emphasizing the need to incorporate traditional South Asian foods into healthy eating patterns. Overall, the study's findings provide valuable guidance for individuals and healthcare professionals seeking to improve cardiometabolic health among South Asian Americans.

Key points

1. Dietary Patterns and Cardiometabolic Health: The MASALA study explored the relationship between dietary patterns and cardiometabolic health in South Asian Americans.

2. Cultural Relevance: The study emphasized the importance of considering cultural relevance when assessing dietary patterns and developing recommendations.

3. Plant-Based Diets: The findings highlighted the benefits of promoting plant-based eating patterns for reducing cardiovascular risk.

4. Dietary Quality: The study underscored the importance of focusing on overall dietary quality rather than single nutrients or foods.

5. Acculturation Effects: The research revealed that immigrants tended to have healthier dietary patterns than US-born individuals, suggesting the potential benefits of maintaining traditional dietary habits.

6. Sustainability Considerations: The study acknowledged the growing importance of considering environmental sustainability in dietary recommendations.

7. Future Directions: The MASALA study identified areas for future research, including the need for adapted dietary indices, intervention studies, and further exploration of generational differences and lifestyle factors.

MASALA Study: Key Findings on South Asian American Diet and Health

In recent years, there has been growing interest in understanding the relationship between dietary patterns and cardiometabolic health, particularly among diverse populations. One such group that has garnered attention is South Asian Americans, who have been shown to have a higher risk of cardiovascular disease compared to other ethnic groups. The Mediators of Atherosclerosis in South Asians Living in America (MASALA) study has been at the forefront of investigating these relationships, providing valuable insights into the dietary habits and health outcomes of this population.

Understanding Dietary Patterns

Before delving into the specifics of the MASALA study, it's important to understand what we mean by dietary patterns. These are defined as the quantities, proportions, variety, or combinations of different foods, drinks, and nutrients in diets, and the frequency with which they are habitually consumed. Dietary patterns allow researchers to characterize a population's overall composition and quality of eating behaviors.

There are several ways to derive dietary patterns:

• Data-driven methods (e.g., principal component analysis)

• Score-based methods (e.g., Healthy Eating Index)

• Preference-based methods (e.g., plant-based diets)

The MASALA study focused primarily on score-based dietary patterns, as these can provide actionable guidance for developing intervention approaches to reduce cardiometabolic risk.

The MASALA Study: An Overview

The MASALA study is a prospective cohort study that enrolled community-dwelling individuals of South Asian ancestry living in the United States. Participants were aged 40-84 years and free of known cardiovascular disease at the time of enrollment (2010-2013). The study collected dietary data using the Study of Health Assessment and Risk in Ethnic groups food frequency questionnaire, a 163-item tool validated for assessing dietary intake among South Asian adults.

Key Dietary Patterns Examined in MASALA

The MASALA study investigated several well-established dietary patterns and their associations with cardiometabolic health outcomes. Let's explore each of these patterns and their findings:

• DASH (Dietary Approaches to Stop Hypertension) Diet

  The DASH diet emphasizes the intake of fruits, vegetables, nuts, legumes, dairy, and whole grains while limiting the consumption of red and processed meats, sugar-sweetened beverages, and sodium. This dietary pattern is particularly relevant for South Asian Americans as it allows for the inclusion of both traditional South Asian foods and American influences.

• Key findings from the MASALA study on the DASH diet:

  Participants with more behavioral risk factors for cardiovascular disease had lower overall DASH diet scores.

  Higher adherence to the DASH diet was associated with a 67% lower risk of developing hypertension after 5 years of follow-up.

  These results suggest that promoting a DASH-style diet, inclusive of culturally relevant foods, could be an effective strategy for reducing cardiovascular risk among South Asian adults in the USA.

• Mediterranean-Style Diet

  The Mediterranean-style diet is characterized by high intake of olive oil, fish, and moderate consumption of alcohol (mainly red wine). While this diet has shown benefits in many populations, its direct applicability to South Asian Americans may be limited due to cultural differences in food preferences and availability.

  To address this, researchers developed a South Asian Mediterranean (SAM) diet score, combining ethnic-specific foods for South Asians with foods commonly associated with the Mediterranean diet.

  Findings related to the SAM diet score:

  Higher adherence to the SAM diet was associated with lower glycated hemoglobin levels and lower pericardial fat volume at baseline.

  Each 1-unit increase in SAM score was associated with a 25% lower odds of incident type 2 diabetes over 5 years of follow-up.

These results indicate that a culturally adapted Mediterranean-style diet could have potential benefits for cardiometabolic health in South Asian Americans.

Healthy Eating Index (HEI) and Alternative Healthy Eating Index (AHEI)

The HEI is a measure of overall diet quality that aligns with the Dietary Guidelines for Americans. While the HEI itself has not been extensively studied in the MASALA cohort, the Alternative Healthy Eating Index (AHEI) has been examined.

Key findings related to the AHEI:

• South Asian Americans in the MASALA study consumed greater amounts of vegetables, fruits, whole grains, nuts, and legumes compared to other ethnic groups in the Multi-Ethnic Study of Atherosclerosis (MESA).

• South Asian Americans had lower consumption of omega-3 fatty acids and polyunsaturated fatty acids.

• Immigrants consistently had higher AHEI-2010 scores compared to US-born individuals.

These findings highlight both strengths and areas for improvement in the dietary patterns of South Asian Americans.

Plant-Based Diet Indices

Researchers derived three plant-based diet indices within the MASALA cohort:

• Overall plant-based diet index (PDI)

• Healthful plant-based diet index (hPDI)

• Unhealthful plant-based diet index (uPDI)

Findings related to plant-based diet indices:

• Higher PDI and hPDI scores were associated with lower insulin resistance, lower LDL cholesterol, lower weight, and lower BMI at baseline.

• Higher hPDI scores were also associated with lower glycated hemoglobin, higher adiponectin, smaller visceral fat area, and smaller pericardial fat volume.

• Each 5-unit increase in hPDI score was associated with a 24% lower likelihood of fatty liver and a 12% lower likelihood of obesity.

• No significant associations were found between uPDI scores and cardiometabolic risks.

These results suggest that promoting a healthy plant-based diet could have significant benefits for cardiometabolic health in South Asian Americans.

Planetary Health Diet Index

The Planetary Health Diet Index, based on the EAT-Lancet Commission's recommendations, aims to create dietary targets that align with both environmental sustainability and human health goals. This index considers not only nutrient density but also the environmental impact of foods and food systems.

While research using this index in the MASALA cohort is ongoing, it represents an important direction for future studies, considering the growing importance of sustainable diets in the context of global climate change.

Current Dietary Intake in South Asian Americans

The MASALA study also provided insights into the current dietary habits of South Asian Americans, particularly in relation to the 2021 American Heart Association (AHA) recommendations. On average, MASALA participants consume:

• 2 servings of fruits daily

• 4 servings of vegetables daily

• 2 servings of whole grains daily

• Low intake of red/processed meat (less than 1.5 servings per week)

• Low alcohol consumption (45% of men and 19% of women consume at least one serving weekly)

These findings suggest that while South Asian Americans are meeting or exceeding some AHA recommendations (e.g., fruit and vegetable intake), there may be room for improvement in other areas, such as whole grain consumption.

Implications for Cardiometabolic Health

The findings from the MASALA study have important implications for understanding and improving cardiometabolic health among South Asian Americans:

• Cultural Relevance: The study highlights the importance of considering culturally relevant foods when assessing dietary patterns and developing recommendations. For example, the adaptation of the Mediterranean diet to create the South Asian Mediterranean (SAM) diet score demonstrates how traditional dietary patterns can be modified to suit different cultural contexts.

• Plant-Based Diets: The strong associations between healthful plant-based diets and improved cardiometabolic outcomes suggest that promoting plant-based eating patterns could be an effective strategy for reducing cardiovascular risk in this population.

• Dietary Quality: The study emphasizes the importance of focusing on overall dietary quality rather than single nutrients or foods. The benefits observed with adherence to dietary patterns like DASH and the healthful plant-based diet underscore this point.

• Acculturation Effects: The finding that immigrants had higher AHEI scores compared to US-born individuals suggests that maintaining certain aspects of traditional diets may be beneficial for health. However, it also highlights the need for targeted interventions to support healthy eating habits among second-generation and later South Asian Americans.

• Sustainability Considerations: The ongoing research using the Planetary Health Diet Index reflects a growing awareness of the need to consider both human health and environmental sustainability in dietary recommendations.

Challenges and Future Directions

While the MASALA study has provided valuable insights, several challenges and areas for future research remain:

• Adaptation of Existing Indices: Some existing dietary indices, such as the HEI, may need to be adapted to better reflect the dietary patterns and cultural preferences of South Asian Americans. For example, the robust legume intake common in South Asian diets may not be adequately captured in some scoring systems.

• Long-Term Health Outcomes: Continued follow-up of the MASALA cohort will be crucial to understanding the long-term impacts of various dietary patterns on cardiovascular disease incidence and mortality.

• Intervention Studies: While the observational data from MASALA is valuable, intervention studies are needed to test the effectiveness of specific dietary recommendations in reducing cardiometabolic risk in this population.

• Accessibility and Affordability: Future research should also consider the accessibility and affordability of recommended dietary patterns. For example, while the Mediterranean diet has shown health benefits, its reliance on ingredients like olive oil may make it less accessible or affordable for some South Asian Americans.

Conclusion

The MASALA study has provided crucial insights into the dietary patterns and cardiometabolic health of South Asian Americans, a population at higher risk for cardiovascular disease. The findings underscore the importance of culturally relevant, plant-forward dietary patterns in promoting cardiometabolic health. They also highlight the need for tailored dietary recommendations that consider both traditional South Asian foods and the realities of life in the United States.

As research in this area continues, it holds the promise of developing more effective, culturally appropriate strategies for preventing and managing cardiovascular disease among South Asian Americans. By building on the foundation laid by the MASALA study, future research can contribute to reducing health disparities and improving overall health outcomes in this diverse and growing population.# Exploring Dietary Patterns and Cardiometabolic Health in South Asian Americans: Insights from the MASALA Study

In recent years, there has been growing interest in understanding the relationship between dietary patterns and cardiometabolic health, particularly among diverse populations. One such group that has garnered attention is South Asian Americans, who have been shown to have a higher risk of cardiovascular disease compared to other ethnic groups. The Mediators of Atherosclerosis in South Asians Living in America (MASALA) study has been at the forefront of investigating these relationships, providing valuable insights into the dietary habits and health outcomes of this population.

Faqs

1. What is the MASALA study?

The MASALA study, or Mediators of Atherosclerosis in South Asians Living in America, is a prospective cohort study that investigates the relationship between dietary patterns and cardiometabolic health in South Asian Americans. It aims to provide insights into how dietary habits can influence the risk of cardiovascular disease in this population.

2. Why is the MASALA study important?

South Asian Americans have a higher risk of cardiovascular disease compared to other ethnic groups. The MASALA study provides valuable information on how dietary patterns can be modified to reduce this risk. It offers evidence-based recommendations for individuals and healthcare professionals seeking to improve cardiometabolic health in this population.

3. What are the key dietary patterns examined in the MASALA study?

The study examined several well-established dietary patterns, including:

• DASH (Dietary Approaches to Stop Hypertension) diet

• Mediterranean-style diet

• Healthy Eating Index (HEI) and Alternative Healthy Eating Index (AHEI)

• Plant-based diet indices

• Planetary Health Diet Index

4. What are the main findings of the MASALA study?

The study found that adopting healthier dietary patterns, such as consuming more fruits, vegetables, whole grains, and legumes, while limiting red and processed meats, sugar-sweetened beverages, and sodium, can significantly reduce the risk of cardiovascular disease in South Asian Americans. Additionally, the study emphasized the importance of cultural relevance in dietary recommendations and the potential benefits of plant-based diets.

5. How can individuals and healthcare professionals benefit from the MASALA study?

The MASALA study provides evidence-based recommendations for improving cardiometabolic health in South Asian Americans. Individuals can use these recommendations to make informed choices about their diet and lifestyle. Healthcare professionals can incorporate these findings into their clinical practice to provide personalized guidance to their patients.

6. What are the limitations of the MASALA study?

The MASALA study, like any observational study, has limitations. It cannot establish a definitive cause-and-effect relationship between dietary patterns and cardiovascular disease. Additionally, the study may not be representative of the entire South Asian American population.

7. What are the future directions for research in this area?

Future research may focus on:

• Adapting existing dietary indices to better reflect the dietary patterns of South Asian Americans

• Conducting intervention studies to test the effectiveness of specific dietary recommendations

• Exploring generational differences and the impact of lifestyle factors on cardiometabolic health

• Considering the environmental sustainability of dietary choices

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Journal Reference

Beasley, J. M., Hussain, B. M., Gadgil, M. D., Talegawkar, S. A., Parekh, N., Bhupathiraju, S. N., Islam, N. S., & Kanaya, A. M. (2024). Dietary patterns in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study: comparisons across methodologies. BMJ Nutrition Prevention & Health, e000853. https://doi.org/10.1136/bmjnph-2023-000853

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