The British population has one of the highest rates of cardiovascular disease in the world, and people from the Indian subcontinent living in Britain are amongst the most susceptible to heart attacks and strokes. The research team from the University, Sandwell District General Hospital near Birmingham and the All India Institute of Medical Sciences in Delhi has therefore carried out a study, to measure directly the change in cardiovascular risk factors associated with migration to Britain.
In the three-year project, funded by the British Heart Foundation, the team studied 537 Gujaratis; comparing the lifestyles, eating and physical exercise patterns of those living in Sandwell with those remaining in their villages of origin in Gujarat.
"We found that people who had migrated to Sandwell were at considerably greater risk of CVD," said Professor Kennedy Cruickshank. "On average people in Britain had much higher body mass, blood pressure, blood cholesterol and inflammation levels, because they consumed more calories in the form of fat and relatively less unrefined carbohydrates.
"Our findings suggest that time-pressured, urban lifestyles in the UK involve a greater fat and calorie intake than would be typical in Gujarat, due to the prevalence here of processed and convenience foods and red meat. In combination with Western lifestyle differences and labour-saving devices, the result is often obesity and associated health risks.
To our surprise, levels of physical activity did not actually differ between the sites, probably because nutritional intake in India was quite low. The greater dietary intake identified in the UK needs to be matched by more physical activity".
Drs Jeetesh Patel & Elizabeth Hughes, who ran the work in Sandwell, added: "Diabetes and sugar intolerance were common in both India and Britain, but in Britain were more likely to occur in association with raised blood pressure and raised cholesterol." CVD has already been found to be the leading cause of mortality in people of Indian origin migrating to South Africa, Singapore, California and Canada. Even within India, the adoption of a more westernised lifestyle in the cities means that 8 -10% of the urban population succumb to the disease - compared with just 3 - 4% of rural people.
"People migrating from South Asia to the West need to be aware of the risks associated with the change in lifestyle they will experience," said the University's Dr Deepak Bhatnagar. "Along with the rest of the population they should strive to maintain a healthy diet high in fruit and vegetables, whole grains, fish and poultry and low in fats and refined sugars. Specific efforts by both men and crucially women to take more exercise are also needed."
Dr Prabhakaran, the clinical scientist running the study from AIIMS in Delhi added: "Clearly, people in what was rural India are at increasingly high risk of vascular disease and diabetes, even at what used to be considered relatively low levels of fatness. That risk is exaggerated when people migrate."
Professor Paul Durrington, senior author of the report, concluded: "The most important message for people of Indian origin living in Britain is that we found a lot of untreated risk factors, such as high blood pressure and cholesterol and undiscovered diabetes. Community leaders and the NHS should encourage all South Asian origin communities to make much greater use of medical services that screen for these factors whilst young, which could prevent a lot of unnecessary disease."
There are some health benefits to the British lifestyle though, as the study found that smoking was less prevalent among Gujaratis migrating to Britain than those remaining in India. "This is probably due to a greater awareness of the ill-effects of smoking in the West, and its decreasing social acceptability," explained Professor Durrington.
Notes for Editors
Several papers have been published on this research recently, including 'Impact of migration on coronary heart disease risk factors: Comparison of Gujaratis in Britain and their contemporaries in villages of origin in India' in the journal Atherosclerosis (available online at: http://dx.
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