Public Health Nutrition Editorial Highlight: ‘Changes in dietary intake following a culturally adapted lifestyle intervention among Iraqi immigrants to Sweden at high risk of type 2 diabetes: a randomised trial‘. Authors: Faiza Siddiqui, Vicky Winther, Azra Kurbasic, Emily Sonestedt, Katarina Balcker Lundgren, Staffan Lindeberg, Peter M Nilsson and Louise Bennet

The increase in number of people suffering from type 2 diabetes is a challenge faced by healthcare providers around the world. Although we know that healthy lifestyle plays an important role in diabetes prevention, the dream to halt diabetes has not been realized yet. Different factors contribute to the increased diabetes risk, migration being one of them. Researchers have observed increased diabetes risk in some immigrant groups particularly non-Western immigrants in the Western world. This increased risk is often attributed to calorie dense foods, drinks and snacks and low physical activity levels. Considering the cultural and religious background as well as the socio-economic barriers to lifestyle change while designing interventions, are the keys to achieve lifestyle modification in immigrant groups.

Our research group led by Louise Bennet, MD PhD conducted a culturally adapted lifestyle intervention among Middle-Eastern (ME) immigrants in Malmo, Sweden.  The ME immigrants were represented by Iraqi immigrants comprising one of the largest non-European immigrant group in Sweden today. Our participants (n=96) included both men and women, were obese and at high risk for type 2 diabetes. They were randomly allocated to two groups. The intervention group was offered to participate in seven group sessions including a cooking class over a period of four months whereas  the control group received ‘treatment as usual’ i.e. routine advice on healthy lifestyle habits. Four-day food records were assessed. We found high consumption of dietary fats among ME immigrants (40% of total energy intake vs. 34% of total energy intake in native Swedes) as well as low fiber intake. We also observed a favorable trend towards reduction in energy intake (calories/day) in the intervention group. This was accompanied by a trend towards reduction in intake of carbohydrates, sucrose and total fats (grams/day). However, the changes observed in the intervention group didn’t reach statistical significance when compared to the control group which could possibly be a consequence of a small sample size or/and a short follow up time.

Our study is the first in Europe to study the effects of a culturally adapted intervention and to capture dietary habits in ME immigrants using four-day food records. The small, but favorable, changes in the intervention group lead us to two conclusions: Firstly, the culturally adapted intervention has the potential to modify dietary habits among ME immigrants. Secondly, changing dietary intake in this group is nevertheless a challenging task.

We conclude that future interventions should focus more on identifying barriers to healthy eating as well as identifying components that make these interventions effective. Tools like family involvement and cooking classes could be used more extensively. Further, with regards to diabetes prevention, it is important that dietary advice to ME immigrant groups focusses on decreasing fat intake and increasing fiber intake. Last but not the least, dietary assessment tools like food records should be modified according to the population that are studied to be able to capture cultural practices relating to food preparation.

The paper, ‘Changes in dietary intake following a culturally adapted lifestyle intervention among Iraqi immigrants to Sweden at high risk of type 2 diabetes: a randomised trial‘ is published in the journal Public Health Nutrition and is freely available until 22 October 2017.

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