Diabetic epidemic in Asian American population

Written by Young-Jik Lee, M.D. Sunday, 26 April 2009 14:09

Diabetes is a rapidly growing health concern among Asian Americans affecting 10% of total population. Asian Americans are more likely to develop diabetes than Causians despite relatively lower body weight.(1) Also, Asian Americans are known to be at higher risk for metabolic syndrome which can be a predisposing condition to diabetes and other chronic illnesses. Interestingly, the rate of Asian American diabetic patients is notably higher than the rate of Asian diabetic population living in Asia.

What are the roles of visceral fat as a culprit of diabetes?
Abdominal fat can be categorized into subcutaneous fat( fat outside abdominal muscle) and visceral fat( intraabdominal fat). It should be recognized that there are ethnic differences in abdominal visceral fat volume. Studies showed that Asians have more abdominal visceral fat than Caucasians.(2-3)
While subcutaneous fat has very little effect on our health, visceral fat secrets a variety of proteins, called adipocytokines, that can directly contribute to develop diabetes, high cholesterol, high blood pressure, and other metabolic syndrome.(4-5) It has been well known that metabolic syndrome is closely linked to cardiovascular disease.

Why Asian Americans are more vulnerable to diabetes?
The cause of diabetes is genetic and environmental influences. 90-95% of Asian American diabetic population has type 2 diabetes and it is more closely linked to environmental factors.
For instances, Asians have had a long history of eating white rice as a main diet. Since majority of people in old Asia lived on farm industry, they would need more calories and white rice is the highest calorie source than any other food. Rice has twice higher glycemic index than pasta. .(6) In highly industrialized society, such as in Unites States where most people do not metabolize enough calories while they work, most of Asian Americans still consume white rice as a main diet. Excessive calories would accumulate in the body(especially in the visceral fat) and the visceral fat will produce harmful proteins that cause diabetes.

What should we do to prevent further diabetic epidemic in Asian American community?
First of all, there needs to be more public awareness among Asian American society in regards to diet modification. Study showed that unpurified grain, such as brown rice, whole grain bread, is helpful to prevent diabetes and reduce visceral fat. Without changing current diet(mainly white rice), you will need more frequent exercise if you work in the office and spends quite amount of your time in the car.
Dr. Lee is a board certified in Internal Medicine and had an additional training in Pulmonary disease. Currently, he runs one of the busiest practices in Los Angeles and his practice serves patients of varying ethnic background, including Koreans, Filipino, Chinese, Latinos, Caucasians and Blacks. He is currently an active staff in Good Samaritan Hospital in Los Angeles and has served various community organizations. He has published weekly health columns in Koreatimes since 2005 and spoke in various Korean media to comment on health issues in the community.

References

1. Shai I; Jiang R; Manson JE; Stampfer MJ; Willett WC; Colditz GA; Hu FB. Ethnicity, obesity, and the risk of type 2 diabetes in women’s 20 year follow-up study. Diabetes Care. 2006 Jul:29(7):1585-90
2. Park YW, Allison DB, Heymsfield SB, GallagherD. Larger amounts of visceral adipose tissue in Asian Americans. Obes Res. 2001;9:381-387.
3. Fain JN, Madan AK, Hiler ML, Cheema P, Bahouth SW. Comparison of the release of adipokines by adipose tissue, adipose tissue matrix, and adipocytes from visceral and subcutaneous abdominal adipose tissues of obese humans. Endocrinology. 2004;145:2273-2282.
4. Shimomura I, Funahashi T, Takahashi M, et al. Enhanced expression of PAI-1 in visceral fat:possible contributor to vascular disease in obesity. Nat Med. 1996;2:800-803.
5. Fried Sk, Bunkin DA, Green Berg AS. Omental and subcutaneous adipose tissues of obese subjects release interleukin-6:depot difference and regulation by glucocorticoid. J Clin Endocrinol Metab. 1998;83:847-850.
6. see http://www.glycemicindex.com/