In honor of Asian American & Pacific Islanders (AAPI) Heritage Month, we are taking an in-depth look at the biggest nutritional challenges for AAPI. This includes looking at chronic disease risk, prevalency, and specific nutritional advice for improved outcomes in the AAPI population.
What countries are included in Asian American & Pacific Islander Heritage month?
Not sure if this information applies to you?
Asian/Pacific refers to the entire Asian content, which includes 47 countries, in addition to (1):
- Pacific Islands of Melanesia (New Guinea, New Caledonia, Vanuatu, Fiji, and the Soloman Islands)
- Micronesia (Marianas, Guam, Wake Island, Palau, Marshall Islands, Kiribati, Nauru and the Federated States of Micronesia)
- Polynesia (New Zealand, Hawaiian Islands, Rotuma, Midway Islands, Somoa, American Samoa, Tonga, Tuvalu, Cook Islands, French Polynesia, and Easter Island)
Chronic Disease Prevalence In AAPI
The Asian/Pacific population accounts for nearly 6% of the United States population (2). While many studies focus on racial health disparities among African Americans and Hispanic populations, there are limited studies that dive into the same issues with the AAPI population.
The following information is based on the current research and studies available on the biggest nutritional challenges for AAPI. Unfortunately, the number of studies specifically addressing the Pacific Islander and Southeast Asian population is few and far between and Asian American is often used as the population term in existing studies.
A CDC report from 2015-2018 showed in Asian American adults aged over 20 years, the following percent were considered obese (3):
- 14.2% of men
- 16% of women
A CDC report from 2015-2018 showed:
- 49.4% of men
- 43.6% of women
This report included any who measured high blood pressure and/or were taking antihypertensive medication aged over 20 (3).
Alternatively, when not accounting for those taking medication, other studies have stated that closer to 19-27% of Asian Americans have hypertension (4,5).
A 2022 study showed the prevalence percentages of AAPI individuals within a healthy BMI range diagnosed with diabetes compared to that of White individuals (6):
Percent of men with a healthy BMI diagnosed with diabetes:
- 5% White
- 10% Chinese
- 25% Filipino
- 28% South Asian
Percent of women with a healthy BMI diagnosed with diabetes:
- 2% White
- 6% Chinese
- 13% Filipina
- 14% South Asian
The overall prevalence of diabetes in Asian Americans compared to Whites is 40% higher (4).
Chronic Kidney Disease
A 2019 study showed that Asian Americans makeup 5.5% of all patients receiving dialysis in the U.S. (4).
Another study stated that end-stage renal disease is 9.5 times greater in Native Hawaiians and 1.3 times greater in Asian Americans when compared to non-Hispanic white individuals (7).
What Causes Chronic Disease in AAPI?
While chronic diseases have many contributing factors including environment, lifestyle, genetics, and more, there are some trends seen among the AAPI population that may help explain the increased risk for certain chronic diseases.
High Visceral Fat Levels
Most people have an idea of what “fat” looks like from an appearance standpoint. Yet, when we discuss fat in healthcare terms, there are two different kinds: visceral fat and subcutaneous fat.
Subcutaneous fat is the kind that most people are worried about around the time of summer vacations. It is the fat that is stored just underneath the skin. While unwanted by most, it is not as worrisome as the alternative.
Visceral fat is the kind that surrounds your internal organs. This can pose a much greater health risk than subcutaneous. You cannot visibly see or feel this type of fat, but waist circumference is usually the first indicator that you may be at an unhealthy level.
Studies have shown that Asian Americans, on average, carry 3-5% more body fat than Caucasians with the same BMI. Sometimes even presenting a lower BMI with higher visceral fat (8).
High visceral fat levels lead to an increased risk of diabetes, which in turn, also increases risk for chronic kidney disease, obesity, and hypertension.
Having a “Healthy” BMI
While having a healthy BMI is not in itself a risk factor, it can contribute to the common issue of health problems being missed and going undiagnosed.
Many healthcare providers will not screen for type 2 diabetes unless a patient has a BMI of over 25 (9). So, whereas someone of another race may be flagged for diabetes due to having a higher BMI and gets to proceed with further diagnostic testing, a person of AAPI descent is much more likely to miss this care because they are more likely to fall within a healthy BMI range.
This puts the AAPI population at a higher risk for going undiagnosed for both prediabetes and diabetes alike. Research has suggested that diabetes screenings for asymptomatic Asian Americans be changed to a BMI of greater than 23 instead (9).
While the traditional Asian diet structure consisting heavily of fresh seafood, soy foods, low dairy, fruits, and vegetables is associated with positive health effects, one of the biggest nutritional challenges for AAPI in the U.S. is due to adapting a more Americanized diet.
A 2019 study showed that Asian Americans are eating more processed food and fast food compared to Whites. This high intake of processed foods, combined with the fact that the staple of many Asian dishes is soy sauce, may also explain the average sodium intake of 4600mg in Asian Americans. This is double the recommended amount of 2300mg per day by the Dietary Guidelines for Americans and over 3 times that of the recommended amount for those with high blood pressure (1500mg) by the American Heart Association.
An increased intake of sodium leads can contribute to an increased risk of hypertension, which in turn is one of the leading causes of chronic kidney disease (right along with diabetes).
How to Make Healthier Choices with Asian Foods
Choose Low Sodium/Reduced Sodium Items
Many Asian condiments can be high in sodium with soy sauce being the main perpetrator. Look for the “lower sodium”, “reduced sodium”, or “no salt added” versions of any packaged foods. Low sodium is becoming a popular option across many products including soy sauce, chips, crackers, broths, canned goods, and more.
Be sure to see my other post on my Top 12 Low Sodium Asian Sauces for ideas!
Start with Simple Swaps
Don’t set the goal of changing your entire lifestyle overnight. Start small, like replacing typical rice noodles with vegetable noodles or shirataki noodles in a dish that you already prepare normally.
Choosing steamed over fried items can also be a great place to start, whether it be dumplings or tempura. Get more ideas for healthy swaps in my other blog post, 8 Simple Swaps for a Healthy & Happy Lunar New Year
Add Vegetables to Your Meals
It can be easier to focus on what you can add to your meals first before thinking about what can be taken away. For example, if you normally would only have pork dumplings for a meal, try adding a side of steamed vegetables to go along with it.
If including vegetables into regular meals is new for you, adding pickled vegetables is a great place to start! They are crispy, flavorful, have a long shelf-life, and can be completely customized to your taste preferences if you make them yourself. They make for a great topping on just about any existing dish you have- stir fry, soup, curry, rolls, and more!
While kimchi is the most well-known type of pickled vegetable condiment, there are many more to choose from inspired by different Asian countries. Find my blog post on Asian Pickled Vegetables for more ideas.
While celebrating Asian American & Pacific Islander Heritage month, it is important to also know & understand the biggest nutritional challenges for AAPI and the community. Asian Americans have a known increased risk for diabetes, hypertension, and chronic kidney disease. High visceral fat levels, high sodium intake, and receiving inadequate or missed diagnoses are all contributing factors to an increased risk of chronic disease. Making healthier choices while keeping traditional Asian foods in your life is possible with small changes, adding vegetables to your meal, and choosing reduced sodium options when buying packaged foods.