South Asian foodways in Britain - diversity and change and the implications for health promotion

People originating from the Indian sub-continent (South Asians) make up the largest ethnic minority group in Britain and suffer from higher rates of coronary heart disease (CIII)) and noninsulin- dependent diabetes mellitus (NIDDM) than the general population. The classic risk factors (other than diabetes and insulin resistance) do not explain these elevated rates. Insulin resistance is associated with central obesity, which is more prevalent amongst South Asians than Europeans and the most effective dietary means of preventing or reversing obesity is by reducing fat and energy intake. However it has been hypothesized that regional origins and religious differences within the South Asian community would result in differences in a) food related behaviours of selected South Asian groups b) the foods commonly consumed by the various South Asian groups and c) the nutrient composition of their traditional dishes, such that dietary intake of fat could be modified by use of selected traditional recipes and dishes. Any attempt to develop effective health promotion programmes would require a knowledge of these differences. In order to test these hypotheses two main studies were undertaken. Firstly, the traditional dishes most commonly consumed by members of five South Asian groups (Bangladeshi Muslims, Pakistani Muslims, Ismaili (East African Asians) Muslims, Punjabi Sikhs and Gujerati Hindus) were identified and their nutrient composition ascertained either by calculation from recipes for home-made dishes or by direct analysis in the case of purchased foods. Secondly, food related behaviour was examined in three Muslim groups (Bangladeshis, Pakistanis and Ismailis). Wide diversity was apparent in the food related behaviour of the three Muslim groups studied. Whilst first generation females were the main food preparers in all the Muslim groups, food purchasing was the responsibility of first generation males in the Bangladeshi and, to a lesser extent, the Pakistani groups. Religious food laws were strictly adhered to by the Bangladeshi and Pakistani communities, although there was an apparent weakening in religious influences over food amongst the second generation. Acculturation in eating patterns was seen across the Muslim groups. Whilst most change was observed in the meals of least importance (eg. breakfast), traditional eating habits persisted for the main meal of the day. The Ismaili group had the most westernised diet and appeared to be aware of healthy eating messages. In contrast the Bangladeshi community adhered to traditional foodways, though large generational differences were seen in the acculturation of food habits in the Bangladeshi and Pakistani groups. Factors associated with this change were exposure to the host culture, education and employment patterns. 2 Results showed wide diversity in both foods consumed by different groups and nutrient composition of traditional dishes. Of the 170 dishes (633 recipes) analysed for nutrient composition, only one was common to all five groups under study i.e mixed vegetable curry. Of the 29 dishes common to two or more groups, recipes from the Bangladeshi Muslim, Gujerati Hindu and Pakistani Muslim groups generally had higher fat contents than those of the Punjabi Sikh and Ismaili Muslim groups. By selecting lower fat versions of traditional recipes it was demonstrated that a 7% reduction in % energy from fat could be achieved in the Bangladeshi and Pakistani groups. Based on the findings of the studies the implications for the design of dietary intervention programmes appropriate for different groups within the South Asian community are discussed