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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

  • Faiza Siddiqui (a1), Vicky Winther (a1), Azra Kurbasic (a2), Emily Sonestedt (a3), Katarina Balcker Lundgren (a1), Staffan Lindeberg (a4), Peter M Nilsson (a1) and Louise Bennet (a1) (a5)...



To investigate the effectiveness of a culturally adapted lifestyle intervention for changing dietary intake, particularly energy, fat and fibre intakes, in the intervention group (IG) compared with the control group (CG).


Randomised controlled trial.


IG (n 50) and CG (n 46). The IG was offered seven group sessions, including one cooking class, over a period of 4 months. The participants filled out 4 d food diaries at the start, mid and end of the study.


Iraqi-born residents of Malmö, Sweden, at increased risk for developing diabetes.


At baseline, participants’ fat intake was high (40 % of total energy intake (E%)). The predefined study goals of obtaining <30 E% from fat and ≥15 g fibre/4184 kJ (1000 kcal) were met by very few individuals. In the IG v. the CG, the proportion of individuals obtaining <40 E% from fat (48·4 v. 34·6 %, P=0·65), <10 E% from saturated fat (32·3 v. 11·5 %, P=0·14) and ≥10 g fibre/4184 kJ (45·2 v. 26·9 %, P=0·46) appeared to be higher at the last visit, although the differences were statistically non-significant. A trend towards decreased mean daily intakes of total energy (P=0·03), carbohydrate (P=0·06), sucrose (P=0·02) and fat (P=0·02) was observed within the IG. Differences in changes over time between the groups did not reach statistical significance.


Although no significant differences were observed in the two groups, our data indicate that this culturally adapted programme has the potential to modify dietary intake in Middle Eastern immigrants. The high fat intake in this group should be addressed.

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1. Narayan, KM, Gregg, EW, Fagot-Campagna, A et al. (2000) Diabetes – a common, growing, serious, costly, and potentially preventable public health problem. Diabetes Res Clin Pract 50, Suppl. 2, S77S84.
2. Lirussi, F (2010) The global challenge of type 2 diabetes and the strategies for response in ethnic minority groups. Diabetes Metab Res Rev 26, 421432.
3. Hu, FB (2011) Globalization of diabetes: the role of diet, lifestyle, and genes. Diabetes Care 34, 12491257.
4. Holmboe-Ottesen, G & Wandel, M (2012) Changes in dietary habits after migration and consequences for health: a focus on South Asians in Europe. Food Nutr Res 56, 188191.
5. Raj, S, Ganganna, P & Bowering, J (1999) Dietary habits of Asian Indians in relation to length of residence in the United States. J Am Diet Assoc 99, 11061108.
6. Lesser, IA, Gasevic, D & Lear, SA (2014) The association between acculturation and dietary patterns of South Asian immigrants. PLoS One 9, e88495.
7. Pan, XR, Li, GW, Hu, YH et al. (1997) Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 20, 537544.
8. Tuomilehto, J, Lindstrom, J, Eriksson, JG et al. (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344, 13431350.
9. Knowler, WC, Barrett-Connor, E, Fowler, SE et al. (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346, 393403.
10. Li, G, Zhang, P, Wang, J et al. (2008) The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet 371, 17831789.
11. Yoon, U, Kwok, LL & Magkidis, A (2013) Efficacy of lifestyle interventions in reducing diabetes incidence in patients with impaired glucose tolerance: a systematic review of randomized controlled trials. Metabolism 62, 303314.
12. Lindstrom, J, Peltonen, M, Eriksson, JG et al. (2006) High-fibre, low-fat diet predicts long-term weight loss and decreased type 2 diabetes risk: the Finnish Diabetes Prevention Study. Diabetologia 49, 912920.
13. Kandula, NR, Dave, S, De Chavez, PJ et al. (2015) Translating a heart disease lifestyle intervention into the community: the South Asian Heart Lifestyle Intervention (SAHELI) study; a randomized control trial. BMC Public Health 15, 1064.
14. Bhopal, RS, Douglas, A, Wallia, S et al. (2014) Effect of a lifestyle intervention on weight change in south Asian individuals in the UK at high risk of type 2 diabetes: a family-cluster randomised controlled trial. Lancet Diabetes Endocrinol 2, 218227.
15. Saha, S, Leijon, M, Gerdtham, U et al. (2013) A culturally adapted lifestyle intervention addressing a Middle Eastern immigrant population at risk of diabetes, the MEDIM (impact of Migration and Ethnicity on Diabetes In Malmo): study protocol for a randomized controlled trial. Trials 14, 279.
16. Johansen, KS, Bjorge, B, Hjellset, VT et al. (2010) Changes in food habits and motivation for healthy eating among Pakistani women living in Norway: results from the InnvaDiab-DEPLAN study. Public Health Nutr 13, 858867.
17. Delavari, M, Sonderlund, AL, Mellor, D et al. (2015) Migration, acculturation and environment: determinants of obesity among Iranian migrants in Australia. Int J Environ Res Public Health 12, 10831098.
18. SAS Institute (2011) SAS/STAT User’s Guide, Version 9.3. Cary, NC: SAS Institute.
19. Bennet, L, Groop, L, Lindblad, U et al. (2014) Ethnicity is an independent risk indicator when estimating diabetes risk with FINDRISC scores: a cross sectional study comparing immigrants from the Middle East and native Swedes. Prim Care Diabetes 8, 231238.
20. Siddiqui, F, Kurbasic, A, Lindblad, U et al. (2017) Effects of a culturally adapted lifestyle intervention on cardio-metabolic outcomes: a randomized controlled trial in Iraqi immigrants to Sweden at high risk for type 2 diabetes. Metabolism (Epublication ahead of print version).
21. Alberti, KG, Eckel, RH, Grundy, SM et al. (2009) Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120, 16401645.
22. World Health Organization (1999) Definition, Diagnosis and Classification of Diabetes Mellitus and Its Complications. Report of a WHO Consultation. Part 1: Diagnosis and Classification of Diabetes Mellitus. Geneva: WHO.
23. Diabetes Prevention Program (DPP) Research Group (2002) The Diabetes Prevention Program (DPP): description of lifestyle intervention. Diabetes Care 25, 21652171.
24. Paulweber, B, Valensi, P, Lindstrom, J et al. (2010) A European evidence-based guideline for the prevention of type 2 diabetes. Horm Metab Res 42, Suppl. 1, S3S36.
25. Lindstrom, J, Neumann, A, Sheppard, KE et al. (2010) Take action to prevent diabetes – the IMAGE toolkit for the prevention of type 2 diabetes in Europe. Horm Metab Res 42, Suppl. 1, S37S55.
26. Lindstrom, J, Ilanne-Parikka, P, Peltonen, M et al. (2006) Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet 368, 16731679.
27. Statistics Sweden (2011) Finding statistics. (accessed June 2015).
28. Diet and Nutrition Data. Computer programs for nutrition calculation (2007) Dietist XP Pro. (accessed June 2015).
29. Levesque, CS, Williams, GC, Elliot, D et al. (2007) Validating the theoretical structure of the Treatment Self-Regulation Questionnaire (TSRQ) across three different health behaviors. Health Educ Res 22, 691702.
30. Craig, C, Marshall, A, Sjöström, M et al. (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35, 13811395.
31. IPAQ Group (2004) Guidelines for data processing and analysis of the International Physical Activity Questionnaire (IPAQ) – Short and Long Forms. (accessed November 2015).
32. Marascuilo, LA & Serlin, RC (1979) Tests and contrasts for comparing change parameters for a multiple sample McNemar data model. Br J Math Stat Psychol 32, 105112.
33. Hoenig, JM & Heisey, DM (2001) The abuse of power. Am Stat 55, 1924.
34. The Nordic Council (2012) Nordic Nutrition Recommendations. (accessed May 2016).
35. Nordmann, AJ, Nordmann, A, Briel, M et al. (2006) Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med 166, 285293.
36. Clifton, P, Colquhoun, D, Hewat, C et al. (2009) Dietary intervention to lower serum cholesterol. Aust Fam Physician 38, 424429.
37. Riccardi, G, Giacco, R & Rivellese, AA (2004) Dietary fat, insulin sensitivity and the metabolic syndrome. Clin Nutr 23, 447456.
38. Bray, GA & Popkin, BM (1998) Dietary fat intake does affect obesity!. Am J Clin Nutr 68, 11571173.
39. Hu, FB, van Dam, RM & Liu, S (2001) Diet and risk of type II diabetes: the role of types of fat and carbohydrate. Diabetologia 44, 805817.
40. Bennet, L, Agardh, CD & Lindblad, U (2013) Cardiovascular disease in relation to diabetes status in immigrants from the Middle East compared to native Swedes: a cross-sectional study. BMC Public Health 13, 1133.
41. Livsmedelsverket (2012) Riksmaten – vuxna 2010–11. Livsmedels- och näringsintag bland vuxna i Sverige (accessed May 2016).
42. Jaber, LA, Pinelli, NR, Brown, MB et al. (2011) Feasibility of group lifestyle intervention for diabetes prevention in Arab Americans. Diabetes Res Clin Pract 91, 307315.
43. Freimer, N, Echenberg, D & Kretchmer, N (1983) Cultural variation – nutritional and clinical implications. West J Med 139, 928933.
44. Gilbert, PA & Khokhar, S (2008) Changing dietary habits of ethnic groups in Europe and implications for health. Nutr Rev 66, 203215.
45. Daryani, A, Basu, S, Becker, W et al. (2007) Antioxidant intake, oxidative stress and inflammation among immigrant women from the Middle East living in Sweden: associations with cardiovascular risk factors. Nutr Metab Cardiovasc Dis 17, 748756.
46. Weickert, MO & Pfeiffer, AF (2008) Metabolic effects of dietary fiber consumption and prevention of diabetes. J Nutr 138, 439442.
47. Lafay, L, Mennen, L, Basdevant, A et al. (2000) Does energy intake underreporting involve all kinds of food or only specific food items? Results from the Fleurbaix Laventie Ville Sante (FLVS) study. Int J Obes Relat Metab Disord 24, 15001506.
48. Daryani, A, Kocturk, T, Andersson, A et al. (2006) Reported macronutrient intake and metabolic risk factors: immigrant women from Iran and Turkey compared with native Swedish women. Scand J Food Nutr 50, 166172.
49. Pryer, JA, Vrijheid, M, Nichols, R et al. (1997) Who are the ‘low energy reporters’ in the dietary and nutritional survey of British adults? Int J Epidemiol 26, 146154.
50. Kruger, R, Stonehouse, W, von Hurst, PR et al. (2012) Combining food records with in-depth probing interviews improves quality of dietary intake reporting in a group of South Asian women. Aust N Z J Public Health 36, 135140.
51. Raberg Kjollesdal, MK, Telle Hjellset, V, Bjorge, B et al. (2010) Barriers to healthy eating among Norwegian-Pakistani women participating in a culturally adapted intervention. Scand J Public Health 38, Suppl. 5, 5259.
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