title: Urbanized South Asians' susceptibility to coronary heart disease: The high-heat food preparation hypothesis.
abstract: OBJECTIVE
  Known risk factors do not fully explain the comparatively high susceptibility to coronary heart disease (CHD) in South Asians (Indian, Pakistani, Bangladeshi, and Sri Lankan populations in South Asia and overseas). The search for explanatory hypotheses and cofactors that raise susceptibility of South Asians to CHD continues. The aim of this study was to propose "the high-heat food preparation hypothesis," where neo-formed contaminants (NFCs) such as trans-fatty acids (TFAs) and advanced glycation end-products (AGEs) are the cofactors.
  
  
  METHODS
  We reviewed the actions of AGEs and TFAs, the burden of these products in tissues and blood in South Asians, the relationship between these products and CHD, the effects of preparing food and reheating oils at high temperatures on NFCs, and the foods and mode of preparation in South Asian and Chinese cuisines.
  
  
  RESULTS
  Animal and human studies show NFCs increase the risk for CHD. Evidence on the consumption and body burden of these products across ethnic groups is not available, and comparable data on the NFC content of the cuisine of South Asians and potential comparison populations (e.g., the Chinese with lower CHD rates) are limited. South Asians' cuisine is dominated by frying and roasting techniques that use high temperatures. South Asian foods have high TFA content primarily through the use of partially hydrogenated fats, reheated oils, and high-heat cooking. Reheating oils greatly increases the TFA content. In comparison, Chinese cuisine involves mostly braising, steaming, and boiling rather than frying.
  
  
  CONCLUSIONS
  We hypothesize that South Asians' susceptibility to CHD is partly attributable to high-heat treated foods producing high NFCs. Research to accrue direct evidence is proposed.
authors: Edinburgh Migration, Ethnicity and Health Research Group, Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
authors: Smitha
authors: S
authors: Kakde
authors: Edinburgh Migration, Ethnicity and Health Research Group, Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK. Electronic address: Raj.Bhopal@ed.ac.uk.
authors: Raj S
authors: RS
authors: Bhopal
authors: National Diabetes, Obesity and Cholesterol Diseases Foundation, SDA, New Delhi, India; Diabetes Foundation (India), SDA, New Delhi, India; Center of Nutrition & Metabolic Research (C-NET), Delhi, India.
authors: Swati
authors: S
authors: Bhardwaj
authors: National Diabetes, Obesity and Cholesterol Diseases Foundation, SDA, New Delhi, India; Diabetes Foundation (India), SDA, New Delhi, India; Center of Nutrition & Metabolic Research (C-NET), Delhi, India; Fortis C-DOC Center for Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India.
authors: Anoop
authors: A
authors: Misra
mesh_terms: D000818:Animals; D044466:Asian People; D001459:Bangladesh / Q000453:epidemiology / Q000208:ethnology; D003296:Cooking; D003327:Coronary Disease / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology* / Q000517:prevention & control; D004032:Diet / Q000009:adverse effects* / Q000208:ethnology; D004198:Disease Susceptibility / Q000208:ethnology; D019317:Evidence-Based Medicine; D005506:Food Contamination / Q000517:prevention & control; D017127:Glycation End Products, Advanced / Q000032:analysis / Q000097:blood / Q000633:toxicity; D006358:Hot Temperature / Q000009:adverse effects; D006801:Humans; D007194:India / Q000453:epidemiology / Q000208:ethnology; D010154:Pakistan / Q000453:epidemiology / Q000208:ethnology; D012307:Risk Factors; D013188:Sri Lanka / Q000453:epidemiology / Q000208:ethnology; D044242:Trans Fatty Acids / Q000032:analysis / Q000097:blood / Q000633:toxicity; D014504:Urban Health / Q000208:ethnology
chemical_list: D017127:Glycation End Products, Advanced; D044242:Trans Fatty Acids
keywords: Advanced glycation-end-products; Coronary heart disease; Fried food; High-heat cooking; Neo-formed contaminants; South Asian diet; South Asians; Trans-fatty acids