South Asian Foodways in Britain Diversity and Change and the Implications for Health Promotion Tashmin Khamis Aga Khan University, [email protected]
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eCommons@AKU Faculty of Health Sciences, East Africa Faculty of Health Sciences, East Africa January 1996 South Asian foodways in Britain diversity and change and the implications for health promotion Tashmin Khamis Aga Khan University, [email protected] Follow this and additional works at: http://ecommons.aku.edu/eastafrica_fhs_fhs Part of the Nutrition Commons Recommended Citation Khamis, T. (1996). South Asian foodways in Britain diversity and change and the implications for health promotion. Available at: http://ecommons.aku.edu/eastafrica_fhs_fhs/10 SOUTH ASIAN FOODWAYS IN BRITAIN - DIVERSITY AND CHANGE AND THE IMPLICATIONS FOR HEALTH PROMOTION. A THESIS SUBMITTED BY TASHMIN KASSAM KHAMIS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN THE FACULTY OF SCIENCE, UNIVERSITY OF LONDON DEPARTMENT OF NUTRITION AND DIETETICS KING'S COLLEGE, LONDON AUGUST 1996 ABSTRACT 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 non- insulin-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. 3 TABLE OF CONTENTS PAGE ABSTRACT 2 TABLE OF CONTENTS 4 LIST OF TABLES 8 LIST OF FIGURES 13 LIST OF PUBLICATIONS 15 ACKNOWLEDGEMENTS 16 CHAPTER I: BACKGROUND 17 1.1 Introduction 17 1.2 The Asian Community in Britain 17 1.2.1 The History of Migration 18 1.2.2 Defining South Asian 18 1.2.3 Population 20 1.2.4 Indians 20 1.2.5 East African Asians and Ismailis 23 1.2.6 Pakistanis 23 1.2.7 Bangladeshis 24 1.2.8 Socio-economic status 24 25 1.3 Mortality and Morbidity 25 1.3.1 Mortality 27 1.3.2 Coronary Heart Disease 1.3.3 Risk Factors Associated with Coronary Heart Disease 29 29 1.3.3.1 Smoking 1.3.3.2 Haemostasis 29 30 1.3.3.3 Hypertension 1.3.3.4 Plasma Cholesterol and Dietary Fat 30 1.3.3.5 Diet: Fatty acids and Cholesterol oxides 32 33 1.3.3.6 Alcohol 33 1.3.3.7 Physical Activity & Psycho-Social Factors 1.3.3.8 Non Insulin Dependent Diabetes Mellitus 34 1.3.3.9 Obesity and Body Fat Pattern 36 1.3.4 Limitations of the Food Composition Database and the Implications for Nutritional Epidemiology and Health Promotion 37 40 1.4 Traditional Eating Patterns 40 1.4.1 Religious Dietary Strictures 1.4.2 Food Consumption Patterns 43 4 1.5 Changing Food Habits 44 1.5.1 Migration 44 1.5.2 Availability and Acceptability 47 1.5.3 Individual Factors 49 1.5.4 Exposure 50 1.5.5 Generational Differences 50 1.6 The Hypotheses - Aims and Objectives 51 CHAPTER II: METHODS 54 2.1 Introduction 54 54 2.2 Methodology 54 2.2.1 The Assessment of Individual Food Intake 56 2.2.2 The Assessment of Nutrient Composition 2.2.3 The Assessment of Food Habits 57 2.3 Methods Study I-The Bangladeshi, Ismaili and Pakistani Muslim Groups 61 2.3.1 The Study Tools 61 2.3.2 The Pilot Study 63 2.3.3 The Main Study 66 2.4 Methods Study Il-The Punjabi Sikh and Gujerati Hindu Groups 70 CHAPTER III: THE MAIN STUDY POPULATION AND RESPONDENTS CHARACTERISTICS 74 3.1 The Main Study Population 74 75 3.2 Personal Characteristics 75 3.2.1 Age 75 3.2.2 Gender and Generation 76 3.2.3 Marital Status 3.2.4 Religion 76 3.3 Country of Birth, Length of Stay and Previous Urbanisation Experience 76 3.3.1 Place of Birth 76 3.3.2 Length of Stay in the UK 77 3.3.3 Previous Urbanisation Experience 77 3.4 Educational Background and Language Proficiency 79 3.5 Socio-economic Status and Housing 83 3.6 Morbidity 84 3.7 Conclusions 85 5 CHAPTER IV: EATING PATTERNS 87 4.1 Overview of Meal Complexity 87 4.2 Meal and Snack Patterns: 89 I) Time of consumption II) Meal preparation III) Commonly consumed foods IV) Dfferences in consumption by day J'9 Differences in consumption by generation 4.2.1 Breakfast 89 94 4.2.2 The Mid Day Meal 4.2.3 The Evening Meal 100 4.2.4 Snacks 109 4.3 Outside Eating Patterns 115 4.4 Special Occasion Dishes 119 4.5 Acculturation of food habits 121 4.6 Conclusions 126 CHAPTER V: FACTORS AFFECTING FOOD SELECTION 130 130 5.1 Food Purchasing Habits Characteristics of the Food Purchaser 130 5.1.1 Bulk Buying 130 5.1.2 5.1.3 Frequency of Food Purchasing 132 Food Preparation 135 5.2 135 5.2.1 Characteristics of the Food Preparer 5.2.2 Types of Food Prepared 136 138 5.3 Food and Health 5.3.1 Food Avoidance 139 5.4 Religious Food Observances 142 5.5 Exposure 144 Participation in Leisure Activities and Exposure to the 5.5.1 Host Culture 144 Relationship of Exposure to the Host Culture to Acculturation 5.5.2 in Food Habits 150 5.6 Conclusions 157 6 CHAPTER VI: NUTRIENT COMPOSITION OF SOUTH ASIAN DISHES 160 6.1 Commonly Consumed Traditional Dishes 160 6.1.1 Bangladeshi, Pakistani and Ismaili Muslim Groups 160 6.1.2 Pakistani Muslims outside of and within London; A comparison of Mirpuris and Non-Mirpuris 165 6.1.3 Punjabi Sikh and Gujerati Hindu Groups 167 6.2 Variation in the Nutrient Composition of Traditional Dishes 171 6.2.1 Variation in recipes within a group 172 6.2.2 Variation in recipes between groups 178 6.3 Direct Laboratory Analysis 181 6.3.1 Commonly Consumed Purchased Dishes 181 6.3.2 Variation in Nutrient Composition by Calculated and Direct Analysis 184 6.3.3 Raw Bangladeshi Fish 185 6.4 Applications of the Nutrient Composition Data on Commonly Consumed Traditional Foods 191 6.5 Conclusions 194 CHAPTER VII: DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS 196 7.1 Introduction 196 7.2 Implications of the Food Composition for Promotion of Healthy Eating amongst South Asians Communities in Britain 197 7.3 Implications of the Food Habits Data for Health Promotion for the Muslim Groups 198 7.3.1 The Ismaili Community 199 7.3.2 The Bangladeshi Community 201 7.3.3 The Pakistani Community 203 7.4 Strategies Designed to Change Eating Habits 205 7.5 Recommendations for Future Research 207 REFERENCES 209 GLOSSARY 231 APPENDICES 234 PUBLICATIONS Back Pocket 7 LIST OF TABLES TABLE PAGE 1.1 Population of Great Britain: by ethnic group and age 21 1.2 Areas of largest concentration of Pakistani, Indian and Bangladeshi communities in Britain 22 1.3 PMRs for classified groups of diseases by ethnic groups 26 1.4 Mortality for Coronaiy Heart Disease in South Asians overseas 28 1.5 Cigarette smoking amongst South Asians in the UK 29 1.6 Plasma