Indian Foods: AAPI’s GuideIndian Foods: AAPI’s Guide
Indian Foods: AAPI’s GuideTo Nutrition, Health and DiabetesSECOND EDITIONEdited byRANJITA MISRAProfessor & Research DirectorCenter for the Study of Health Disparities (CSHD)Member, Intercollegiate Faculty of NutritionTexas A&M UniversityContributorsNirmala AbrahamPadmini BalagopalRita (Shah) BathejaNimesh BhargavaSharmila ChatterjeeMadhu GadiaWahida KarmallyKeya Deshpande KarwankarKarmeen KulkarniTheja MahalingaiahSuraj MathemaRanjita MisraChhaya PatelThakor G PatelSudha RajNirmala RamasubramanianJanaki SenguptaGeeta SikandAllied Publishers Private LimitedNew Delhi Mumbai Kolkata Chennai NagpurAhmedabad Bangalore Hyderabad Lucknowi
Copyright 2011 by AAPIAll rights reserved. Written permission must be secured from AAPI to use or reproduce anypart of this book.ISBN: 978 - 81 - 8424 - 687 - 2Cover page designed byRanjita MisraPhotographs in the cover page were contributed byWahida Karmally, Gerald Lemole, Nutrilite Health Institute, Kunal Patel,TG Patel and Parul TodaiReviewersPadmini Balagopal, Rita Batheja Wahida Karmally, Karmeen Kulkarni, Ranjita Misra,Misra,TG Patel,Patel, SudhaSudha Raj and Nirmala RamasubramanianPublished bySunil SachdevM/s. Allied Publishers Pvt. Ltd., 751, Anna Salai, Chennai – 600 002.The American Association of Physicians of Indian Origin (AAPI)600 Enterprise Drive, Suite 108Oak Brook, IL 60523ii
ContentsPrefaceTG Patel, MD, MACPvAcknowledgementsTG Patel, MD, MACPviiForwardAjeet Singhvi, MD, FACGixChapter 1IntroductionDr. Sudha Raj, PhD, RD1Chapter 2Epidemiology, Risks and complications of DiabetesDr. Ranjita Misra, PhD, CHES & TG Patel, MD, MACP6Chapter 3Preventing Heart Disease in Asian IndiansDr. Geeta Sikand, MA, RD, FADA, CDE, CLS11Chapter 4Renal DietChhaya Patel, MA, RD, CSR23Chapter 5East Indian (Odia and Bengali) CuisineDr. Ranjita Misra, PhD, CHES, FMALRC36Chapter 6South Indian CuisineNirmala Ramasubramanian, MS, RD, CDE40Chapter 7Maharashtrian CuisineKeya Deshpande Karwankar, MS45Chapter 8Gujarati CuisineRita Batheja, MSc, RD, CDN48Chapter 9North Indian CuisineMadhu Gadia, MS, RD, CDE52Chapter 10Nepali CuisineSuraj Mathema, MS, RD, CDE56Chapter 11Low Fat Cooking & How to Modify a recipeNimesh Bhargava, MS, RD, CNSD, MBA60Chapter 12Choosing Healthy SnacksJanaki Sengupta, MSc, RD, CDN, CDE71Chapter 13Desserts of IndiaSharmila Chatterjee, MSc, MS, RD, CDE76iii
Chapter 14Managing your Menu in an Indian RestaurantKarmeen Kulkarni, MS, RD, BC-ADM, CDE79Chapter 15Carbohydrate counting for Indian FoodsKarmeen Kulkarni, MS, RD, BC-ADM, CDE81Chapter 16Healthy Weight: Make it Your Lifestyle! Healthy Choices in Nutrition andPhysical Activity are Most Effective in Fighting ObesityDr. Wahida Karmally, DrPH, RD, CDE, CLS, FNLA84Chapter 17Exchange Lists for Indians with DiabetesChhaya Patel MA, RD, CSR88Chapter 18Selecting Foods from Different Food Groups in the Asian CuisinePadmini Balagopal, PhD, CDE, RD, IBCLC (lead author)95Chapter 19Do Indian Spices and Condiments Have a RoleRole to Play in Preventive Health andTherapeutics?P. Balagopal, W. Karmally, K. Kulkarni, R. Misra and S. Raj97Chapter 20SummaryPadmini Balagopal, PhD, RD, CDE, IBCLC106Appendix 1Gestational Diabetes Sample Meal PlanSharmila Chatterjee, MSc, MS, RD, CDE115Appendix 2Diabetes Numbers at a GlanceNational Diabetes Education Program (NDEP)117Appendix 3Diabetes Mellitus Pocket Reference CardDeveloped by the Diabetes Committee of Indo-US Health Summit118Appendix 4Clinical Preventive Services for Normal Risk AdultsRecommended by the U.S. Preventive Services Task Force120Appendix 5GlossaryTheja Mahalingaiah, MA, RD & Nirmala Abraham, MS, RD122Appendix 6What Can I Eat to Manage my DiabetesEnglishHindiWhat Can I Eat to Manage my Diabetes (Regional 56160164168172
PrefaceIndian Foods: AAPI’s Guide to Nutrition, Health & Diabetes is a labor of love by a group of dedicateddietitians. This booklet has information which will guide Asian Indians and particularly Indian Americansof Indian origin better manage and prevent diabetes, hypertension, obesity and hyperlipidemia. In addition,this book can be used by physicians and other health care professionals who see patients in their clinic usingthe Asian Indian cuisine. I believe this book is a must have for all Indian Americans. It is available on theAmerican Association of Physicians of Indian Origin ((AAPI) website at s Thisrevision is presentedesented to the Indian American ccommunityommunity and physicians as a community service on behalf ofAAPI. The reader will find that this edition has a few added chaptersrs and appendices. The two newchapters include “DoDo Indian Spices and Condiments Have a Role to Play in Preventive Health andTherapeutics” & “Renal Diet.” It is our small effort to help our community take charge to prevent diabetes,hyperlipidemia, and obesity and manage them if present.With best wishes,T.G.Patel, MD, MACPAdvisor, Public Health Committee, AAPIv
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0AcknowledgementThe revised edition of the book was done in a timely manner due to Dr. Ranjita Misra’s leadership andcoordinating efforts. We would also like to thank Padmini Balagopal as the coordinating editor for the firstedition and Rita (Shah) Batheja as co-chair for her invaluable help in bringing together an expert group ofcontributors.I want to personally thank the authors Nirmala Abraham, Padmini Balagopal, Rita Batheja, SharmilaChatterjee, Keya Deshpande, Madhu Gadia, Wahida Karmally, Karmeen Kulkarni, Theja Mahalingaiah,Suraj Mathema, Ranjita Misra, Chhaya Patel, Sudha Raj, Nirmala Ramasubramanian, Janaki Sengupta andGeeta Sikand. These authors took time out of their busy family life, academics and work to revise thisedition of the book. To date, this book is still one of the best resources on preventive health and diseasemanagement on the Asian Indian cuisine presented in a simple and user friendly format. This book can bedownloaded in its entirety from the website www.aapiusa.org/resources/nutrition.aspx for use.The reviewers Padmini Balagopal, Rita Batheja, Wahida KarmallyKarmally,, Karmeen Kulkarni, Ranjita Misra,T.G.Patel, Sudha Raj and Nirmala Ramasubramanian have done a tremendous job in getting the reviewsback in time and in ensuring the accuracy of the material.The Pocket Reference Card for diabetes was created by the DiabeDiabetestes Committee of the Indo-US HealthSummit, a new additions to this book. I want to thank Drs. Ritesh Gupta, Shashank Joshi, Anoop Misra,T.G.Patel and Banshi Saboo, along with the advisors who helped revise this Pocket Reference Card. Thiscommittee consists of Drs. Anuj Bhargava, Arvind Gupta, Neha Gupta, Shilpa Joshi, Sailesh Lodha, MohanMallam, Sundar Mudaliar, Rakesh Parikh, V. Ranga, Jayesh B. Shah, Ronak Shah, Priya Sivaprakasan, andVijay Viswanathan. The Gestational Diabetes meal plan was createcreatedd by Sharmila Chatterjee, another newaddition to this book. I want to thank Padmini Balagopal for creating “What Can I Eat to Manage myDiabetes” and Wahida Karmally and Karmeen Karmally to review the document & the translators of theregional languages (Bengali, Gujarati, Hindi, Kannada, Malayalam, Marathi, Odia, Punjabi, Sindhi, Tamiland Telugu) Rajasri Chatterjee, Kaushik Chatterjee, Sharmila Chatterjee, Alokeraj Banerjee, BalwantSuthar, Rita Batheja, Bharat Shah, Varun Japee, Vanita Manchanda, Uday Meghani, Varsha, Roshan Khaki,Kavitha Simha, Sheela Krishnaswamy, Shaji Tewani, Alex Johnson, Vaishali Mohile, Deepa Inamdar, AnitaMishra, GB Patnaik, Indu Jaiswal, Murali Sadani, Purshotam Sharangdhar, Sushila Sarangdhar, SugunaLakshmi Narayanan, Anuradha Sivasundar, A Narasimha Reddy, Latha Sashi, N Lakshmi, and P JanakiSrinath.Finally, I want to thank all the Indian Americans in the U.S. and Indians in India for helping us to assessdata on our community by participating in different research projeprojects.cts. This book is a tribute to all IndianAmericans and Indians all over.T.G.Patel, MD, MACPvii
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FORWARD BY AJEET R. SINGHVI, PRESIDENT AAPII am pleased to see the publication of the second edition of Indian foods: AAPI’s Guide to Nutrition,Health and Diabetes. The first edition was hugely successful and this edition was overdue and is beingpublished at the right time.Although there are over two thousand books on diabetes listed in the catalog of the Library of Congress(2,218 at the last count), however, there is a paucity of literature that deals with the largest population at risk:The Indian Population. The ancient Ayurvedic treatises by Sushruta and Charaka recommended diet astreatment for diabetes more than two thousand years ago in India. This is as relevant today, if not more so,as it was then. Further, it is not only of great value to Indians here in States but also to the general populationIndia – especially given the expansion of quick service restaurrestaurantsants and the concomitant adoption of a diet ofhighly processed, high calorie, high sugar, high fat, but low nutrient value foods.It will be of special benefit to all to realize that the concept of diet as treatment is centuries old. Through thisconcept, people will discover new and tasty foods that help manage or even reverse their diabetes and otherrelated conditions.This publication is truly unique. The contributors include M.D.s, Ph.Ds, and Registered Dietitians. There isa diet plan to suit every palate and for different ethnic groups and regions. The authors have taken intoaccount the changing environment, customs, and preferences and have made modifications to suit all thesegments of the population and all taste buds in the contemporary society.This book makes us all proud. Health is wealth, and this book takes us a step forward in that direction. I amsure it will be very useful to the reader. I personally congratulate Dr TG Patel, Dr. Ranjita Misra and theirentire team for this superb effort.Sincerely,Ajeet R. Singhvi, MD, FACGPresident, AAPIpresident@aapiusa.orgix
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Chapter 1IntroductionSudha Raj, PhD, RDSince 1965 more than 2 million Asian Indians haveimmigrated to the United States from the Asian subcontinent of India. Recent census report that theirnumbers have increased from 1.6 million in 2000 to2.7 million in 2007. The community continues to beranked the third largest Asian American group inthe United States after Chinese and Filipinos. Fiftypercent of Asian Indians reside in the South andWest followed by 35% in the north-east and theremainder in the Mid-West. Large Asian Indiancommunities are seen in the states of California,Illinois, New Jersey, New York and Texas. Thecommunity consists of academic, medical andtechnical professionals, individuals who own and/orwork in commercial establishments and theirdependents (spouses, children, siblings and elderlyparents who visit from India for extended periods oftime).on all four frontiers share many common featureswith regard to dietary habits and food practicesdespite their unique cuisines.Health problems and nutritional status of AsianIndians in the USSome of the important health problems faced byAsian Indian immigrants include chronicdegenerative diseases such as diabetes, hypertension,cardio-vascular disease and complications arisingfrom any of these conditions. In fact, Asian Indianimmigrants have a significantly higher risk of CVD(cardiovascular disease) with heart disease ratesestimated to be one and one half to four timesgreater than Whites. In addition to the geneticsusceptibility in developing Type 2 diabetes andcardiovascular disease, risk factors such as abnormallipid levels, increased abdominal fat, diets high infat, saturated and trans-fats, simple carbohydratesand sedentary lifestyles contribute to thedevelopment of chronic diseases.The Asian Indian community is diverse with regardto the region of origin in India and the religions theypractice. India can be divided into four majorregions-North, South, East and West. Each regionhas its own distinctive language, dialects, customsand food practices. Hinduism is the predominantreligion practiced by Asian Indians followed byIslam, Buddhism, Jainism, Sikhism, Zorastrianism,Christianity and Judaism. The followers of thesedifferent religions observe different dietary laws andcodes for fasting, and feasting thereby influencingtheir eating patterns. Throughout history, the cultureand cuisines of India have been influenced by othercivilizations such as the Moghuls, the British andnow the Americans. The neighboring nations ofPakistan, Nepal, Bhutan, Bangladesh and Sri LankaWhat can you do?Your nourishment does not depend on the selectionof any one food. Instead it depends on theconsistent and continuous selection of manydifferent foods on a day to day basis. This bookgives you suggestions on how to plan your diet withAsian Indian cuisine with foods and tips that willhelp to enhance your health.Purpose and organization of this bookletThis book makes an attempt to present some toolsfor patients and the general public to help with1
Indian Foods: AAPI's Guide to Nutrition, Health and Diabetesthe body’s metabolism. Insulin is required to assistthe cells in taking up the needed fuels from theblood.lifestyle changes in the prevention and treatment ofchronic diseases. Highlights of this book include: A brief description of two chronic degenerativediseases- Diabetes and Cardiovascular disease. A description of the different regional cuisinesof India. Within each region we providebackground information to illuminate thecultural context from which the ethnic foodsand food habits have evolved, popular dishes,meal patterns highlighting typical and modifiedmeal patterns for clients with chronic diseases,tips for changes and suggestions for weekendand party planning and tips on how to modify ahigh-fat recipe into a more heart-healthy one.Every chapter talks about weekend eating as thetwo days of feasting and partying can undomany of the benefits of eating healthythroughout the week. A description of common spices used in thevarious cuisines and their health benefits. A section on food exchanges that gives a list ofsome of the common foods and selected fooditems mentioned in the book as well as some ofthe ingredients in this cuisine with its Englishequivalent. Type 2 diabetes is characterized by high bloodglucose and insulin resistance. This disease usuallybegins after the second decade of life. However thewidespread changes in lifestyle and dietary practiceshas resulted in the appearance of this disease at amuch younger age. In the initial stages the pancreasproduces insulin. The person may actually havehigher than average insulin levels but the cells arenot very responsive either because they have fewernumber or malfunctioning receptors that are neededfor the insulin to exert its action. Consequently theblood glucose levels increase thereby stimulating thepancreas to produce insulin. This exhausts the cellsand reduces their ability to function. Generalizedweight gain particularly in the abdominal regionaggravates the condition because the higher body fatnecessitates higher insulin production. Age, genetics,lifestyle and dietary factors promote thedevelopment of the disease.Symptoms of Diabetes include frequent urination,excessive thirst, extreme hunger, unusual weightloss, increased fatigue, irritability and blurred vision.Criteria for diagnosisNutrition advice, tips and guidelines byqualified professionals and reviewers in the fieldof nutrition (you will find a brief write-up aboutthe writer at the end of each chapter).A Primer on Chronic Diseases in Asian Indians Symptoms of diabetes together with casual (anytime of day) plasma glucose concentrations of 200 mg/dl. Fasting plasma glucose (At least 8 hoursfollowing no caloric intake) 126 /dl. Two hour plasma glucose 200 mg/dl duringan oral glucose tolerance test.DiabetesDiabetes is a chronic disorder characterized by highblood glucose and either insufficient or ineffectiveinsulin, depending on the type of diabetes.Criteria for Impaired Glucose levels Type 1 diabetes also known as insulin dependentdiabetes or juvenile onset diabetes typically strikesaround the ages of 8 to 12 years but can occur at anyage. The disease has a strong genetic link. Thepancreas cannot synthesize insulin thereby altering2Fasting plasma glucose levels of 110mg/dl –126 mg/dl or post-prandial glucose levels(2 hrs after meals) of than 140 mg/dl duringan oral glucose tolerance test can be consideredto be in the Impaired blood glucose range.
IntroductionBody Mass Index and Waist circumference Protein intake is recommended at 10-20% ofcaloric intake with a focus on plant basedsources such as lentils and beans, cereal lentilcombinations and the use of smaller portions oflean meats, poultry and fish. Total fat, saturated fat and cholesterol intakesmust be tailored to meet individualrequirements based on blood lipid profiles.Focus on healthy fats rather than saturated fatsand emphasize avoidance of trans-fats. Diet should focus on the consumption ofcomplex carbohydrates such as whole grains,fruits and vegetables. Consistent and evenlyspaced carbohydrate intake throughout the dayshould be emphasized. In this respectcarbohydrate counting and exchange listsprovided in this book will help. Current guidelines advise moderation of saltintake that is 1500 mg. of sodium/day and nomore than 2300 mg. of sodium/day.A Body Mass Index of 23 and Waistcircumference of 35.4” for men and 31.5” forwomen can put a person at risk for developingdiabetes if there is a genetic predisposition.Blood Pressure HbA1c- 120/80 6.5Complications of diabetesThe accumulation of glucose in the blood leads toacute and chronic complications. Therefore early,aggressive treatment to control blood glucosesignificantly reduces the risk of long term ications include diseases of the: large blood vessels such as atherosclerosis small blood vessels resulting in loss of kidneyfunction as seen in kidney diseases, retinaldegeneration and blindness. nerves resulting in loss of sensation, increasedinfections stemming from unnoticed injuries,and gastrointestinal problems.Metabolic SyndromeMetabolic syndrome is a condition closely related toinsulin resistance. Abdominal obesity and insulinresistance aggravate the disease along withhypertension and abnormal lipid levels.Recommendations for Type1Nutrition is an important part of the treatmentregimen. Nutritional therapy focuses on maintainingoptimal nutrition for growth and development in thechild, educating clients about portion sizes,modifying recipes, controlling blood glucose,preventing and treating related complications. Focusis on meal intake patterns, consistency incarbohydrate intake to minimize glucosefluctuations.Diagnostic criteria put out by the InternationalDiabetes Federation include a waist circumferenceof 90 cms for men and 80 cms for women; atriglyceride level of 150 mg/dl; a HDL-cholesterollevel of 40 mg/dl for men and 50 mg/dl forwomen; a blood pressure of 130/85 mm HG anda fasting plasma glucose of 100 mg/dl or previouslydiagnosed type 2 Diabetes.Recommendations for Type 2Cardiovascular diseaseThe American Diabetes Association recomm-endsthat the distribution of calories between fats andcarbohydrates should be individual-ized according tothe individual’s assessment and treatment plan. More than 50% of cardiovascular clerosis is a generic term used to describethe thickening of the arteries caused by theformation and deposition of an atheroscleroticplaque. The plaque is a fatty fibrous growth thatCalories should be prescribed to maintain areasonable body weight ideal for the person’sage, sex and lifecycle needs.3
Indian Foods: AAPI's Guide to Nutrition, Health and Diabetesultimately becomes calcified and contributes to theblocking of the arterial blood vessel. This results inpoor or restrictive blood flow contributing to the risein blood pressure or hypertension, myocardialinfarction and stroke. Associated conditions includeperipheral vascular disease resulting from the plaqueformation in the leg and congestive heart failure thatimpairs normal cardiac function. Major risk factorsfor cardiovascular disease include age, gender,family history, abnormal lipid profiles such as lowHDL and high LDL cholesterol, hypertension,diabetes, obesity and physical inactivity, cigarettesmoking and an “atherogenic diet” high in saturatedfat, trans fats, cholesterol, processed foods and lowin fruits and vegetables. Recommendations forreducing your risk for cardiovascular diseaseinclude: ReferencesRegular screening for abnormal lipid profilessuch as a high LDL and low HDL levels as wellas monitoring of blood pressure.seeking help from a trained nutritionprofessional (To find a registered dietitian (RD)in your area visit www.eatright.org Click on the“Find a Nutrition Professional” link toward topof the page). A dietitian can help you focus ontherapeutic lifestyle changes such as increasingphysical activity (regular exercise of more thanthirty minutes every day), quitting smoking,alcohol consumption in moderation, stressreduction, dietary modifications such asmoderating total and saturated fat intake,replacing saturated fats with desirablepolyunsaturated fats; increasing the use of plantbased diets with minimal amounts of animalproducts and paying attention to the sodiumcontent of the Accessed Feb. 1, 2011)2.http://factfinder.census.govFeb. 1, 2011)3.Nelms M, Sucher K and Long S. NutritionTherapy and Pathophysiology. ThomsonHigher Education. 2007.4.Misra A. et al. South Asian diets and insulinresistance. Brit. J Nutr. 2009 101, 465-473.5.American Diabetes Association. Diagnosis andClassification of diabetes mellitus. DiabetesCare, 29 (Supplement 1) S43-48, 2006.6.American Diabetes Association. Standards ofmedical care in diabetes. Diabetes Care.(Supplement 1): S4 2006.7.Jonnalagadda SS, Khosla P. Nutrient intake,body composition, blood cholesterol andglucose levels among adult Asian Indians in theUnited States. J. Immigr. Minority Health 2007Jul; 9(3):171-8.8.Enas EA et al. Recommendations of the secondIndo-US health summit on prevention andcontrol of cardio-vascular disease among AsianIndians. Indian Heart J. 61(3): 265-74. 20092007-(AccessedResource for Diabetes Education Material9.www.yourdiabetesinfo.org10. Two Reasons I Find Time to Prevent Diabetes:My Future and Theirs (in Gujarati)11. http://ndep.nih.gov/media/GujaratiTipsheet.pdf12. Two Reasons I Find Time to Prevent Diabetes:My Future and Theirs (Hindi)13. dha Raj PhD RD is a Senior PartPart-time Instructorin the Department of Nutrition Science & Dieteticsin the College for Human Ecology at SyracuseUniversity in Syracuse, New York. Contactinformation 315315-443443-2556 or sraj@syr.edu14. 4 Steps to Control Your Diabetes. For Life.(in Gujarati)15. .aspx?PubId 1354
Introduction16. 4 Steps to Control Your Diabetes. For Life.(in Hindi)30. The Power to Control Diabetes is in YourHands Community Outreach Kit17. .aspx?PubId 14131. x?NdepId NDEP-44k18. Take Care of Your Heart. Manage YourDiabetes (in Gujarati)32. Tips for Teens with Diabetes: Stay at a HealthyWeight19. http://ndep.nih.gov/media/TCH AsAm flyerGuj.pdf33. http://ndep.nih.gov/media/Youth Tips Weight.pdf20. Take Care of Your Heart. Manage YourDiabetes (in Hindi)34. http://ndep.nih.gov/media/Youth Tips WeightBW.pdf21. http://ndep.nih.gov/media/TCH AsAm flyerHin.pdf35. Tips for Teens with Diabetes: Make HealthyFood Choices22. If You Have Diabetes, Know Your Blood SugarNumbers36. http://ndep.nih.gov/media/Youth Tips Eat.pdf37. It's Not Too Late to Prevent Diabetes23. http://ndep.nih.gov/media/KnowNumbers Eng.pdf38. http://ndep.nih.gov/media/nottoolate tips.pdf39. Kanaya AM et al. Prevalence and correlates ofdiabetes in South Asian Indians in the UnitedStates: findings from the metabolic syndromeand atherosclerosis in South Asians living inAmerica study and the Multi-ethnic study ofatherosclerosis.Metab.Syndro.Relat.Disorders. Apr 8 (2): 157-64. 2010.24. Tips to Help You Stay Healthy25. http://ndep.nih.gov/media/TipsFeel Eng.pdf26. Tips for Kids: How to Lower Your Risk forType 2 Diabetes27. 8. Diabetes Numbers at-a-Glance40. Palaniappan L et al. Leading causes of mortalityof Asian Indians in California. Ethnic Dis. 20(1): 53-7 Winter 2010.29. http://ndep.nih.gov/media/NumAtGlance Eng.pdf5
Chapter 2Epidemiology, Risks, and Complications ofType 2 Diabetes MellitusRanjita Misra, PhD, CHES, FMALRC & TG Patel, MD, MACPby environmental triggers such as physical inactivity,excessive calorie intake, and obesity.Prevalence and Risk FactorsThe prevalence (all cases) and incidence (new cases)of type 2 diabetes (T2DM) and pre-diabetes [asdefined by impaired fasting glucose (IFG) orimpaired glucose tolerance (IGT)] are rapidlyincreasing both in developed and developingcountries. The global burden of T2DM is morepronounced in India than any other country in theworld. An estimated 57 million adult Indians willhave diabetes by 2025, with the conditionmanifesting at an earlier age and lower body massindex. Although, the higher prevalence of T2DM inAsian Indians can be attributable to establishedcauses such as growing levels of obesity and physicalinactivity, various epidemiological studies haveshown that these factors alone are not sufficient toexplain this trend. One important factor contributingto increased prevalence of T2DM in Asian Indiansis excessive insulin resistance. Insulin resistance ishighly prevalent in Asian Indians despite low rates ofobesity. While insulin resistance is very ogic abnorm-ality results in decreasedglucose transport in muscle, elevated hepatic glucoseproduction, and increased breakdown of fatresulting in hyperglycemia. Indians seem to have agenetic predisposition towards insulin resistance witha low BMI and high central adiposity, sometimesalso known as the ‘Yudkin-Yajnik’ paradox. Thisincreased genetic susceptibility is further enhancedThe main etiological (causal) risk factors for T2DMare older age, obesity, family history, physicalinactivity and dietary factors such as a highproportion of energy consumed as saturated fat andlow intake of fruit and vegetables. The rapid rise andepidemiological transition of T2DM in India,especially in urban areas, is associated withwesternized lifestyle. Changes in the traditionallifestyles, dietary patterns and technologicaladvancement have resulted in a pronouncedphysical inactivity and the affluence of society haslead to consumption of diets rich in fat, sugar andcalories. The observation of an association betweenlow birth weight and risk of diabetes in later life hasalso led to the development of an alternative to thethrifty genotype hypothesis. It is hypothesized thatthe risk of T2DM is programmed by fetal nutritionand the pattern of early growth. The causal nature ofthese associations is strengthened by studies thatshow the incidence of diabetes is reduced byinterventions aimed at reducing weight, increasingactivity and improving diet.With more than a billion people India is also hometo significantly diverse groups of people in terms ofethnicity, caste and religion, socioeconomic status,educational level, and lifestyle and food habits.Studies on prevalence of T2DM show the rates inrural areas is significantly lower (3-6%) as compared6
Epidemiology, Risks, and Complications of Type 2 Diabetes Mellitusto urban areas (8-14%) in India. Pre-diabetes ratesare slightly higher than T2DM prevalence but followa similar pattern with urban prevalence significantlygreater than the rural populations.Althoughprevalence of T2DM is lower than urban areas,rural Indians have higher glycosylated hemoglobinlevel (A1c) or poor control of the disease resulting inhigher complications and mortality. Communitybased diabetes prevention program in a rural Indiancommunity also found rural youths, 10-18 years ofage, had higher level of pre-diabetes. Lack ofknowledge of T2DM and its associatedcomplications, access to care & medical services, loweducational level and income are primary factors forelevated mortality of diabetic patients in rural India.Studies on South Asians (includes Asian Indians,Pakistanis, Bangladeshis, Sri Lankans, Nepalese,Maldives, and Bhutan) immigrants in the UnitedKingdom, Canada, Australia, and Africa show ahigher prevalence of T2DM and CVD as well. Inthe United States, the Diabetes among IndianAmericans (DIA) national study showed prevalencerate of T2DM and pre-diabetes among immigrantAsian Indians as 17.4% and 33% respectively, higherthan other racial/ethnic groups in the United States.Table 1: Prevalence of diabetes among rural Indians, urban Indians and Indian AmericansFasting Blood Glucose LevelsUS SiteSelf-reported DiagnosedT2DM casesUndiagnosed casesNumberof casesMeanSD145137.0342.7336156.0335.58A1c LevelsMeanSD 8.0 8.06.841.3084.4%15.6%7.281.3580.6%19.4%MeanSD 8.0 8.0Total number of respondent 1038; Prevalence of Diabetes 17.44%;Prevalence of Pre-diabetes 32.9%Numberof casesMeanSDSelf-reported DiagnosedT2DM cases57134.1047.686.851.2279.4%20.6%Undiagnosed cases12152.1743.527.110.6983.4%16.6%Urban IndiaTotal number of respondent 508; Prevalence of Diabetes 13.6%;Prevalence of Pre-diabetes 23.4%Numberof casesMeanSDMeanSD 8.0 8.0Self-reported DiagnosedT2DM cases35137.0342.736.841.3084.4%15.6%Undiagnosed cases13235.77185.367.281.3580.6%19.4%Rural IndiaTotal number of respondents 532; Prevalence of Diabetes 9.
Indian Foods: AAPI’s Guide to Nutrition, Health & dietitians. This booklet has information which will guide Asian Indians and particularly Indian Americans of Indian origin better manage and prevent diabetes, hypertension, obesity and hyperlipidemia. this book can be used by physicians the Asian Indian cuisine.
As a group, AAPIs have a higher level of educational attainment than whites, blacks, and Latinos. Over half of AAPI workers have a four-year college degree or more. At the same time, AAPI workers are less likely than white workers to have a high school degree. AAPI workers are also the only one of the four major racial and ethnic groups where men
Through technical assistance, training, and educational resources, the National Resource Center on AAPI Aging works with aging organizations to accomplish this goal, thereby
55 years and older by providing job training through temporary paid work experiences that lead to unsub- sidized employment. In the past year, NAPCA served over 1,600 older workers and partnered with 550 local nonprofits and/or government agencies, contributing 1.33M of in-kind support back into the communities. NAPCA
The National Asian Pacific Center on Aging (“NAPCA”) is a nonprofit organization with the mission to preserve and promote the dignity, well-being, and quality of life of Asian Americans and Pacific Islanders (“AAPI”) as they age. AAPI aging adults are a diverse group who represent over 50 ethnicities and a
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Testimony Studies on Diet and Foods, was soon exhausted. A new and enlarged volume, titled Counsels on Diet and Foods, Appeared in 1938. It was referred to as a “second edition,” and was prepared under the direction of the Board of Trustees of the Ellen G. White Estate. A third edition, printed in a smaller pageFile Size: 1MBPage Count: 408Explore furtherCounsels on Diet and Foods — Ellen G. White Writingsm.egwwritings.orgCounsels on Diet and Foods — Ellen G. White Writingsm.egwwritings.orgEllen G. White Estate: A STUDY GUIDE - Counsels on Diet .whiteestate.orgCounsels on Diet and Foods (1938) Version 105www.centrowhite.org.brRecommended to you b
Acid Alkaline Food Chart Acidic and Alkaline Foods Try to eat 80% (or more) alkalizing foods and 20% (or less) acidifying foods Note: * “Acid but Alkalizing” foods are weak acid foods that contain weak acids. While their pH is acidic, these foods
Introduction to Digital Logic with Laboratory Exercises 6 A Global Text. This book is licensed under a Creative Commons Attribution 3.0 License Preface This lab manual provides an introduction to digital logic, starting with simple gates and building up to state machines. Students should have a solid understanding of algebra as well as a rudimentary understanding of basic electricity including .
