Abstract MP57: A South Asian Mediterranean-style Diet Pattern Is Associated With Favorable Measures Of Adiposity And A Lower Risk Of Incident Diabetes: Findings From The Masala Study
Authors: Rai Sharan K , Kanaya Alka M , Kandula Namratha , Sun Qi , Bhupathiraju Shilpa N 
Published: May 2021

Introduction:
South Asians are at a disproportionately high risk for cardiometabolic disease. The Mediterranean diet is associated with reduced risks of type 2 diabetes (T2D) and cardiovascular disease in certain populations, although data among South Asians are lacking. Therefore, we evaluated the association between a novel South Asian Mediterranean style (SAM) diet pattern and a broad panel of cardiometabolic markers from the MASALA study, an ongoing prospective cohort of South Asians in the US.

Methods:
We included 891 participants who completed the baseline visit (2010-13) with reliable responses to a validated ethnic-specific food frequency questionnaire (mean age 55 y; 47% female). We created the SAM score by grouping foods including those specific to this population’s cuisine into 9 pre-defined categories (vegetables, fruits, legumes, nuts, whole grains, red/processed meats, fish, alcohol, and monounsaturated to saturated fat ratio). Participants above the median intake received 1 point per category; red/processed meats were reverse scored and those with alcohol intake 5-25 g/d received 1 point. We summed these for a score from 0-9, with higher scores reflecting greater adherence to a Mediterranean style diet. Participants underwent a clinical exam, carotid ultrasound, cardiac and abdominal CT, and fasting blood tests. We used multivariable linear and logistic regression to examine cross-sectional associations between the SAM score and cardiometabolic risk, adjusting for age, sex, calories, physical activity, smoking status, medical history, income, education level, and cultural beliefs. We additionally adjusted for body mass index (BMI) in the full model. Finally, we examined the association between the SAM score and incident T2D at follow-up (~5 y later).

Results:
Participants with higher SAM scores tended to be older, more likely to have a bachelor’s degree, less likely to report experiences of discrimination, and less likely to be smokers. At baseline, the SAM score was inversely associated with pericardial fat volume (-1.22 ± 0.55 cm
3
per 1-unit increase in SAM score; p value=0.03) in the fully adjusted model. We observed an inverse association between the SAM score and visceral fat, but it was attenuated after additionally adjusting for BMI. There were no associations with subclinical atherosclerosis, glycemia measures, lipids, inflammatory markers, or uric acid. The SAM score was associated with a lower likelihood of obesity (odds ratio [OR] 0.88, 95% confidence interval [CI] 0.79 to 0.98) and fatty liver (OR 0.82, 95% CI 0.68 to 0.98), but not with hypertension. Finally, the SAM score was associated with lower odds of incident T2D (OR 0.75, 95% CI 0.59 to 0.95) at follow-up.

Conclusion:
A greater intake of a Mediterranean style diet that incorporates traditional South Asian foods was associated with favorable measures of adiposity and a lower likelihood of incident T2D.