Studies show that at a normal body weight – usually considered a body mass index, or a BMI less than 25 – all people of Asian descent, including Chinese, Filipino and the Japanese are more likely to wear this type of dangerous fat. Despite lower obesity rates than whites, the rate of type 2 diabetes is twice as high among Americans of Asian descent.

Masala researchers found that heart risks tended to be greater in Southeast Asia. In a recent study, in the Annals of Internal Medicine, 44% of normal-weight South Asians examined had at least two metabolic abnormalities, such as high blood sugar, high triglyceride levels, high blood pressure, or low blood pressure. HDL cholesterol, Percentage of whites of normal weight.

Masala researchers also discovered that using the standard cut point to screen for diabetes, a B.M.I. 25 or more, doctors would neglect up to one-third of South Asians with the disease. "Many of them may never get to this B.M.I. and they will have diabetes for years, "said Dr. Kanaya.

The results prompted the American Diabetes Association to publish in 2015 updated guidelines reducing the screening threshold for diabetes to B.M.I. of 23 for Americans of Asian descent. A public awareness campaign, organized by the National Council of Pacific Island Physicians, Screen at 23, has drawn attention to this problem. At least three states, including California, Massachusetts and Hawaii, have adopted policies to promote more aggressive health screening. Americans of Asian origin. Representative Pramila Jayapal of Washington, the first Indo-American woman to serve in the House, recently introduced a bill to increase funding for cardiovascular awareness and research in South Asia.

Most participants in the Masala study are first-generation immigrants, and researchers found that their cultural practices also affected their disease rates. Cardiovascular risks were generally highest in two groups: those with very close ties to traditional South Asian religious, cultural and dietary customs, and those who vigorously adopted the Western lifestyle. Low risk researchers are what researchers call bicultural, retaining some aspects of traditional South Asian culture while adopting some healthy Western habits.

This difference is reflected in their eating behavior. Nearly 40% of Masala participants are vegetarians, a common practice in India and widely regarded in the West as heart healthy. But vegetarians who eat traditional South Asian foods like fried snacks, sugary drinks and high-fat dairy products have worse cardiovascular health than those who eat what researchers call a "cautious" diet with more than fruits, vegetables, nuts, beans and vegetables. whole grains (and, for non-vegetarians, fish and chicken). People who go on a Western diet with red and processed meat, alcohol, refined carbohydrates and few fruits and vegetables also have greater metabolic risk factors.

Dr. Namratha Kandula, an investigator at Masala in Northwestern, said she hoped to study Masala participants' children afterwards because they tended to influence the health and lifestyle of their parents. Researchers also want to know if the health risks of second-generation South Asians are low. similar or not. But for now, some experts say their goal is to increase contact with South Asians who may be at risk and neglecting their health.

"As a resident of the South Asian Bay Area, I see that we are very much focused on success and academic success in our families," Dr. Khandelwal told Stanford. "But we do not necessarily consider our success in health, and your health is something you can not easily find."