The Mediterranean diet has long been celebrated for its health benefits, including a reduced risk of type 2 diabetes (T2D) and cardiovascular disease (CVD). While much of the research has focused on Western populations, a growing body of evidence suggests that adapting the Mediterranean diet to incorporate Asian culinary traditions can be equally, if not more, beneficial for Asian populations. This article explores the benefits of an Asian Mediterranean diet, drawing on recent studies and expert insights to provide a comprehensive overview of this dietary approach.
Introduction: Addressing the Health Disparities in South Asians
Type 2 diabetes (T2D) has reached epidemic proportions globally, with a particularly pronounced impact on South Asian populations. South Asians, who comprise a significant portion of the world's population with ancestry from Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka, face a heightened risk of developing T2D due to factors such as insulin resistance. Visceral fat, a common characteristic among South Asians, often leads to insufficient and ineffective insulin production, resulting in elevated blood glucose levels.
The South Asian Mediterranean-Style (SAM) Diet: A Culturally Relevant Approach
Recognizing the need for a culturally tailored dietary approach, researchers have developed the South Asian Mediterranean-style (SAM) diet. This adapted dietary pattern incorporates foods commonly consumed in South Asia while adhering to the core principles of the Mediterranean diet. The SAM diet emphasizes plant-based foods such as vegetables, fruits, legumes, nuts, and whole grains, while limiting red meat, processed foods, and sweets. Healthy fats, such as sesame, peanut, and mustard seed oil, are incorporated to align with South Asian culinary preferences.
Constructing the SAM Score
To assess adherence to the SAM diet, a scoring system was developed based on nine predefined food categories: vegetables, fruits, legumes, nuts, whole grains, red/processed meats, fish, alcohol, and the ratio of monounsaturated to saturated fats. Participants who consumed greater than the median intake for each category received one point, with red/processed meats being reversely scored. This scoring system allowed researchers to quantify the relationship between SAM diet adherence and various health outcomes.
Key Findings from the MASALA Study: Evidence for the SAM Diet's Benefits
The MASALA (Mediators of Atherosclerosis in South Asians Living in America) study, a community-based prospective cohort study of South Asian men and women living in the San Francisco Bay Area and greater Chicago area, provided valuable insights into the benefits of the SAM diet. The study enrolled 906 participants between October 2010 and March 2013, excluding those with cardiovascular disease at baseline.
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Baseline Associations: Improved Cardiometabolic Risk Factors
At baseline, higher adherence to the SAM diet was associated with several favorable cardiometabolic risk factors, including:
- Lower HbA1c levels
- Lower pericardial fat volume
- Lower likelihood of obesity
- Lower likelihood of fatty liver
These associations remained significant even after adjusting for potential confounders such as age, sex, socioeconomic status, lifestyle factors, and medication use.
Prospective Associations: Reduced Risk of Incident Type 2 Diabetes
After approximately 5 years of follow-up, the MASALA study identified 45 cases of incident diabetes. For each 1-unit increase in SAM score, the odds of developing T2D were 25% lower. This finding suggests that the SAM diet can play a significant role in preventing the onset of T2D in South Asian populations.
The Importance of Addressing Ectopic Fat in South Asians
Ectopic fat, the accumulation of fat in tissues other than adipose tissue, is a major independent risk factor for cardiometabolic diseases, including T2D. South Asians tend to have a less favorable body composition profile characterized by greater levels of ectopic fat depots, such as intermuscular and hepatic fat. This may partly explain the disparities in CVD and T2D risk observed in this population. The inverse associations between a higher SAM score and measures of ectopic fat observed in the MASALA study highlight the potential of this dietary pattern to mitigate these disparities.
Adapting the Mediterranean Diet for Asian Populations: Key Considerations
While the Mediterranean diet offers numerous health benefits, its traditional form may not be readily adaptable to Asian culinary traditions and dietary preferences. The Asian Mediterranean diet seeks to bridge this gap by incorporating culturally relevant foods and flavors while maintaining the core principles of the Mediterranean diet.
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Incorporating Asian Staples
The Asian Mediterranean diet recognizes the importance of incorporating staple foods commonly consumed in Asian countries. For example, rice, a staple grain in many Asian diets, can be replaced with whole grains such as barley or brown rice to increase fiber intake and improve glycemic control. Similarly, traditional Asian cooking oils, such as sesame oil, peanut oil, and mustard seed oil, can be used in moderation as healthy sources of fat.
Emphasizing Plant-Based Protein Sources
Given the high prevalence of vegetarianism among South Asians, the Asian Mediterranean diet places a strong emphasis on plant-based protein sources such as legumes, lentils, and tofu. These foods provide essential nutrients while aligning with cultural dietary practices.
Utilizing Aromatic Herbs and Spices
Aromatic herbs and spices play a crucial role in Asian cuisine, adding flavor and potential health benefits to meals. Ginger, coriander, turmeric, and cumin are just a few examples of herbs and spices that can be incorporated into the Asian Mediterranean diet to enhance both taste and nutritional value.
Scientific Evidence Supporting the Asian Mediterranean Diet
A growing body of evidence supports the benefits of adapting the Mediterranean diet to incorporate Asian culinary traditions. Studies have shown that Asian diets that align with Mediterranean diet principles are associated with improved cardiovascular health and reduced risk of chronic diseases.
The Japanese "1975 Diet"
The traditional Japanese diet, often referred to as the "1975 diet," shares many characteristics with the Mediterranean diet. It emphasizes vegetables, fruit, fish, soybeans and soybean products, and green tea, while limiting meat consumption. Meta-analyses of prospective cohort studies have shown that adherence to the Japanese-style diet is associated with a decreased risk of CVD.
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The Korean Mediterranean-Style Diet
A Korean Mediterranean-style diet, characterized by high seafood intake, has been shown to reduce insulin resistance, LDL cholesterol, fatty liver index, and inflammation in a randomized crossover trial. This dietary pattern incorporates core Mediterranean diet principles, such as a high intake of vegetables, fruits, nuts, and olive oil, while incorporating Korean staples such as seafood and kimchi.
The Chinese Diet Emphasizing Legumes, Nuts, and Vegetables
In Chinese cohorts, diets rich in legumes, nuts, and vegetables have been associated with reduced cardiovascular events. Studies have shown that increasing intake of these plant-based foods can significantly decrease heart disease mortality.
Promising Asian Ingredients for a Heart-Healthy Asian Mediterranean Diet
Several common Asian food ingredients have been shown to have significant cardiometabolic benefits and are promising for use in an Asian adaptation of the Mediterranean diet.
Nuts and Seeds: Peanuts and Cashew Nuts
While the Mediterranean diet recommends the consumption of nuts such as almonds, hazelnuts, and walnuts, nut consumption in Asia tends to be higher for certain types of nuts, such as peanuts and cashew nuts. Studies have shown that increasing peanut consumption is associated with a significant decrease in cardiovascular mortality and morbidity, even at levels lower than those recommended in the traditional Mediterranean diet.
Soy and Tofu: A Versatile Protein Source
Soybeans and tofu are staples in many Asian diets and are excellent sources of plant-based protein. Studies have shown that soy consumption can improve lipid profiles, lower blood pressure, and reduce the risk of heart disease.
Green Tea: A Powerful Antioxidant
Green tea is a popular beverage in many Asian countries and is rich in antioxidants. Studies have shown that green tea consumption can improve cardiovascular health, reduce the risk of stroke, and lower cholesterol levels.
Mushrooms: A Nutritional Powerhouse
Mushrooms are a versatile ingredient in Asian cuisine and are packed with nutrients. Studies have shown that mushroom consumption can improve immune function, lower cholesterol levels, and reduce the risk of cancer.
The Heart-Healthy Asian Mediterranean (HHAM) Dietary Pattern: A Synthesis of Evidence
Based on the available evidence, a Heart-Healthy Asian Mediterranean (HHAM) dietary pattern can be formulated to promote cardiovascular health in Asian populations. This dietary pattern incorporates the core principles of the Mediterranean diet while incorporating culturally relevant Asian foods and flavors.
Key Components of the HHAM Diet
- Abundant vegetables and fruits: Aim for at least five servings per day, incorporating a variety of colorful vegetables and fruits.
- Whole grains: Choose whole grains such as brown rice, barley, and quinoa over refined grains.
- Legumes: Include legumes such as lentils, chickpeas, and kidney beans in your diet several times per week.
- Nuts and seeds: Consume a handful of nuts and seeds each day, focusing on peanuts, cashew nuts, and sesame seeds.
- Healthy fats: Use healthy cooking oils such as sesame oil, peanut oil, and olive oil in moderation.
- Fish and seafood: Consume fish and seafood at least twice per week, opting for fatty fish such as salmon and tuna.
- Poultry and eggs: Consume poultry and eggs in moderation.
- Red meat: Limit red meat consumption to once or twice per month.
- Dairy products: Consume dairy products in moderation, choosing low-fat options.
- Aromatic herbs and spices: Use a variety of aromatic herbs and spices to flavor your meals, reducing the need for salt.
- Green tea: Drink green tea regularly for its antioxidant benefits.
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