Minority ethnic groups - understanding diet, weight and type 2 diabetes: scoping review

A scoping review to support our understanding of diet, weight and type 2 diabetes in minority ethnic groups in Scotland, their access and experiences of services to support weight management and type 2 diabetes, and recommendations for change.




Agyemang, C., Meeks, K., Beune, E., Owusu-Dabo, E., Mockenhaupt, F. P., Addo, J., ... & Stronks, K., 2016. Obesity and type 2 diabetes in sub-Saharan Africans–Is the burden in today's Africa similar to African migrants in Europe? The RODAM study. BMC medicine, 14(1), 1-12.

Academic paper. Cross-sectional study among Ghanaian adults living in rural and urban Ghana, and three European cities (Amsterdam, London and Berlin).

Agyemang, C., van der Linden, E. L., & Bennet, L., 2021. Type 2 diabetes burden among migrants in Europe: unravelling the causal pathways. Diabetologia, 64(12), 2665-2675.

Academic paper. Literature review on the burden of T2D on migrants in Europe, its related complications, and potential explanatory mechanisms.

Anderson, J. J., Welsh, P., Ho, F. K., Ferguson, L. D., Welsh, C. E., Pellicori, P., ... and Sattar, N., 2021. Ethnic differences in prevalence of actionable HbA1c levels in UK Biobank: implications for screening. BMJ Open Diabetes Research and Care, 9(1), e002176.

Academic paper. Cross-sectional study analysing baseline UK Biobank data on plasma glycated haemoglobin (HbA1c) to compare the prevalence of pre-diabetes and undiagnosed diabetes mellitus in white, South Asian, black, and Chinese participants. Main results: 1 in 6–7 individuals of black or South Asian ethnicity have actionable values and approximately 1 in 30 are living with undiagnosed diabetes.

BEMIS and Community Food and Health (Scotland), 2013. Strengthening food work across minority ethnic communities: A focus on maternal and infant nutrition. Available at: https://www.bemis.org.uk/documents/cfhs-bemis-maternal-infant-nutrition-report.pdf

BEMIS is the national Ethnic Minorities led umbrella body supporting the development of the Ethnic Minorities Voluntary Sector in Scotland. This is the report of a small scale study designed to:

- provide a snapshot of voluntary and community organisations activity on maternal and infant nutrition across ME communities in Scotland;

- explore the experiences of women from different communities (African, Czech, Polish and Roma) through interviews and focus groups.

Bello, O., Mohandas, C., Shojee-Moradie, F., Jackson, N., Hakim, O., Alberti, K. G. M. M., ... & Goff, L. M., 2019. Black African men with early type 2 diabetes have similar muscle, liver and adipose tissue insulin sensitivity to white European men despite lower visceral fat. Diabetologia, 62(5), 835-844.

Academic paper. Comparison in whole body, skeletal muscle, hepatic and adipose tissue insulin sensitivity between black and white men in London. Main results: insulin resistance is not the chief cause of type 2 diabetes in black African people, as it is for white populations.

Bennett, G., Bardon, L. A., & Gibney, E. R., 2022. A Comparison of Dietary Patterns and Factors Influencing Food Choice among Ethnic Groups Living in One Locality: A Systematic Review. Nutrients, 14(5), 941.

Academic paper. Systematic review of international studies on dietary differences of ethnic groups and the factors that influence their food choices.

Bhopal, R., Fischbacher, C., Povey, C., Chalmers, J., Mueller, G., Steiner, M., ... & Bansal, N., 2011. Cohort profile: Scottish Health and Ethnicity Linkage Study of 4.65 million people exploring ethnic variations in disease in Scotland. International journal of epidemiology, 40(5), 1168-1175.

Academic paper about the Scottish Health and Ethnicity Linkage Study (SHELS), in which population data have been linked to morbidity and mortality records to show differences among ME groups. Main source of health data for ethnic minorities in Scotland.

Bhopal, R. S., Douglas, A., Wallia, S., Forbes, J. F., Lean, M. E., Gill, J. M., ... & Murray, G. D., 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. The lancet Diabetes & endocrinology, 2(3), 218-227.

Academic paper. Trial in Scotland to asses a weight control and physical activity intervention (PODOSA) in South Asian individuals. Intervention: culturally adapted, family-based lifestyle intervention consisting of 15 visits from a dietitian over 3 years. Main results: weight loss in the intervention group (1.13kg).

Creamer, J., Attridge, M., Ramsden, M., Cannings‐John, R., & Hawthorne, K., 2016. Culturally appropriate health education for Type 2 diabetes in ethnic minority groups: an updated Cochrane Review of randomized controlled trials. Diabetic Medicine, 33(2), 169-183.

Academic paper. Updated systematic review of Hawthorne et al. (2010). A total of 22 new trials were added to the original 11.

CWIN (Central & West Integration Network), 2019. Knowledge into Action – Community-led research that makes a difference. Food security, diet, and obesity – exploring the experiences of ethnic minority groups. Available at: CWIN-fi">CWIN report (communityfoodandhealth.org.uk)

Grey literature. Community-led research project carried out by CWIN and supported by Community Food Health (Scotland) to explore food security within Minority ethnic people in Glasgow.

Dallosso, H., Mandalia, P., Gray, L. J., Chudasama, Y. V., Choudhury, S., Taheri, S., ... & Davies, M. J., 2022. The effectiveness of a structured group education programme for people with established type 2 diabetes in a multi-ethnic population in primary care: A cluster randomised trial. Nutrition, Metabolism and Cardiovascular Diseases.

Academic paper. Cluster randomised trial in Birmingham and Leicester with patients with T2D for at least one year who never attended a group education programme before to test the effectiveness of a structured group education programme in a multi-ethnic population. Results: significant reductions in body weight over 12 months.

Daly, H., Byrne, J., Martin‐Stacey, L., Mandalia, P., Carey, M. E., Hadjiconstantinou, M., ... & Davies, M. J., 2014. 'A Safer Ramadan': developing an integrated approach to support safer fasting and feasting for people with type 2 diabetes. Practical Diabetes, 31(7), 292-297.

Academic paper. Description of developing and delivering 'A Safer Ramadan' intervention for people with T2D.

Davidson, E. M., Krasuska, M., Jenum, A. K., Gill, J. M., Beune, E., Stronks, K., ... & Sheikh, A., 2021. Developing a realist informed framework for cultural adaptation of lifestyle interventions for the prevention of type 2 diabetes in South Asian populations in Europe. Diabetic Medicine, 38(11), e14584.

Academic paper. Realist evaluation of culturally adapted T2D prevention interventions for South Asian living in high-income countries. Aim: to develop a framework that shows 'how' cultural adaptation works, for 'whom' and in 'what contexts'.

Diabetes UK, 2011. Healthy eating for the South Asian community. Available at: https://www.diabetes.org.uk/resources-s3/2017-11/Can.pdf

Diabetes UK guidance for healthy eating for South Asian communities.

Diabetes UK, 2022. Type 2 Diabetes. Know your own risk [online]. Available at: https://riskscore.diabetes.org.uk/start

Website of Diabetes UK. Digital tool to calculate the personal risk of T2D.

Digital Scotland, 2021. Weight Management. Final Report. (Unpublished)

Report of the 8 week Discovery project conducted on behalf of the Scottish Government to explore people's experiences with NHS weight management services in areas of deprivation.

Fischbacher, C. M., Cezard, G., Bhopal, R. S., Pearce, J., & Bansal, N., 2014. Measures of socioeconomic position are not consistently associated with ethnic differences in cardiovascular disease in Scotland: methods from the Scottish Health and Ethnicity Linkage Study (SHELS). International journal of epidemiology, 43(1), 129-139.

Academic paper. Part of SHELS. It explored the association between ethnicity, cardiovascular diseases and socioeconomic position. Results: across groups, socioeconomic position measures were inconsistently associated with CVD hospitalization or death.

Goff, L. M., 2019. Ethnicity and type 2 diabetes in the UK. Diabetic Medicine, 36(8), 927-938.

Academic paper. Literature review on T2D and ME groups in the UK, including higher prevalence, risk factors, healthcare access and engagement with health interventions.

Goff, L. M., Moore, A. P., Harding, S., & Rivas, C., 2021. Development of Healthy Eating and Active Lifestyles for Diabetes, a culturally tailored diabetes self‐management education and support programme for Black‐British adults: A participatory research approach. Diabetic Medicine, 38(11), e14594.

Academic paper. Participatory action research methods to culturally adapt a T2D intervention for Black-British adults. Results: participatory methods provide a means to understand the needs of specific communities, enabling the development of healthcare interventions that are sensitive to the needs of both service users and providers.

Gov.UK, 2020. Ethnicity facts and figures. Overweight children. Available at: https://www.ethnicity-facts-figures.service.gov.uk/health/diet-and-exercise/overweight-children/latest

UK Government website. Statistics on obesity and overweight rates in children in England, including by ethnicity.

Gov.UK, 2021. Ethnicity facts and figures. Overweight adults. Available at: https://www.ethnicity-facts-figures.service.gov.uk/health/diet-and-exercise/overweight-adults/latest#:~:text=The%20data%20shows%20that%3A,overweight%20or%20obese%20(63.7%25

UK Government website. Statistics on obesity and overweight rates in adults in England, including by ethnicity.

Gutierrez, J., Devia, C., Weiss, L., Chantarat, T., Ruddock, C., Linnell, J., ... & Calman, N., 2014. Health, community, and spirituality: evaluation of a multicultural faith-based diabetes prevention program. The Diabetes Educator, 40(2), 214-222.

Academic paper. Evaluation of a faith-based diabetes prevention programme for Black and Latino people in New York. Results: improvements in knowledge of diabetes and healthy behaviours, including increased physically exercising, eating fruit and vegetables and eating less fast food. Significant weight loss.

Hawthorne, K., Robles, Y., Cannings‐John, R., & Edwards, A. G. K., 2010. Culturally appropriate health education for Type 2 diabetes in ethnic minority groups: a systematic and narrative review of randomized controlled trials. Diabetic Medicine, 27(6), 613-623.

Academic paper. Systematic review with meta-analysis and narrative review of culturally appropriate health education interventions for T2D. Only RCTs, all ME groups in high-income countries.

Lean, M. E., Leslie, W. S., Barnes, A. C., Brosnahan, N., Thom, G., McCombie, L., ... & Taylor, R. (2019). Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. The lancet Diabetes & endocrinology, 7(5), 344-355.

Academic paper. RCT to assess the remission of type 2 diabetes during a primary care-led weight-management programme.

Leung, G., and Stanner, S., 2011. Diets of minority ethnic groups in the UK: influence on chronic disease risk and implications for prevention. Nutrition Bulletin, 36(2), 161-198.

Briefing paper (British Nutrition Foundation) on South Asian, Black African-Caribbean, Chinese communities in the UK and:

- their health profile (including T2D and obesity) and dietary habits;

- the factors affecting their food choices;

- their traditional diets;

- successful nutrition interventions.

Marmot, M., 2010. Fair society: healthy lives. In: Strategic review of health inequalities in England Post-2010.

Review of health inequalities in England.

Mbanya, J. C., Cruickshank, J. K., Forrester, T., Balkau, B., Ngogang, J. Y., Riste, L., ... & Wilks, R., 1999. Standardized comparison of glucose intolerance in west African-origin populations of rural and urban Cameroon, Jamaica, and Caribbean migrants to Britain. Diabetes Care, 22(3), 434-440.

Academic paper. Statistical comparison of the prevalence of glucose intolerance in genetically similar African-origin populations within Cameroon, Jamaica and Caribbean migrants living in Britain.

Moore, A. P., Rivas, C. A., Harding, S., & Goff, L. M., 2022. Misalignment: understanding the challenge of engaging with self-management advice for people living with diabetes in UK Black African and Caribbean communities. Health Education Journal, 00178969221108563.

Academic paper. Qualitative work to explore the perspective of those living with diabetes within UK Black African and Caribbean communities. Aim: to understand how the cultural salience of self-management advice could be improved. Methods: focus groups with 41 participants.

Nam, S., Janson, S. L., Stotts, N. A., Chesla, C., & Kroon, L., 2012. Effect of culturally tailored diabetes education in ethnic minorities with type 2 diabetes: a meta-analysis. Journal of Cardiovascular Nursing, 27(6), 505-518.

Academic paper. Meta-analysis of RCTs on culturally tailored diabetes education interventions. Results: ethnic minorities benefit more from culturally tailored diabetes education interventions compared with the usual care.

Narayan, K. M., & Kanaya, A. M., 2020. Why are South Asians prone to type 2 diabetes? A hypothesis based on underexplored pathways. Diabetologia, 63(6), 1103-1109.

Academic paper. Literature review exploring the biological factors that explain the high prevalence of T2D in South Asian populations.

Negandhi, P. H., Ghouri, N., Colhoun, H. M., Fischbacher, C. M., Lindsay, R. S., McKnight, J. A., ... & Scottish Diabetes Research Network Epidemiology Group., 2013. Ethnic differences in glycaemic control in people with type 2 diabetes mellitus living in Scotland. Plos one, 8(12), e83292.

Academic paper. Use of population-based data to investigate the relationships between ethnicity and glycaemic control in men and women with T2D living in Scotland.

NHS Scotland, 2022. MyDiabetes, My way.

Interactive diabetes website to help support people who have diabetes and their family and friends.

NICE (National Institute for Health and care Excellence), 2011. Type 2 Diabetes prevention: population and community-level interventions. Available at: https://www.nice.org.uk/guidance/ph35#path=view%3A/pathways/preventing-type-2-diabetes/national-strategy-and-policy-to-prevent-type-2-diabetes.xml&content=view-node%3Anodes-conveying-healthier-lifestyle-messages-to-the-whole-pop

Guidelines for preventing type 2 diabetes in adult populations and communities who are at high risk. It aims to promote a healthy diet and physical activity, and recommends how to tailor services for people in ME communities.

NICE (National Institute for Health and care Excellence), 2012. Type 2 diabetes: prevention in people at high risk. Available at: https://www.nice.org.uk/guidance/ph38/chapter/Recommendations

Guidelines to identify adults at high risk of type 2 diabetes and to provide them with an effective and appropriate intensive lifestyle-change programme to prevent or delay the onset of T2D.

NICE (National Institute for Health and care Excellence), 2014. Obesity: identification, assessment and management. Available at: https://www.nice.org.uk/guidance/cg189/resources/obesity-identification-assessment-and-management-pdf-35109821097925

Guidelines to identify and manage adults' obesity.

Ntuk, U. E., Gill, J. M., Mackay, D. F., Sattar, N., & Pell, J. P., 2014. Ethnic-specific obesity cutoffs for diabetes risk: cross-sectional study of 490,288 UK biobank participants. Diabetes care, 37(9), 2500-2507.

Academic paper. Comparison of the relationship between adiposity and prevalent diabetes across ethnic groups in the UK Biobank. Results: biological ethnic differences in BMI risk thresholds for diabetes.

O'Mara-Eves, A., Brunton, G., McDaid, G., Oliver, S., Kavanagh, J., Jamal, F., ... & Thomas, J., 2013. Community engagement to reduce inequalities in health: a systematic review, meta-analysis and economic analysis. Public Health Research, 1(4)

Academic paper. Systematic review on community engagement approaches that improve the health of disadvantaged populations and/or reduce inequalities in health.

Osei-Kwasi, H. A., Nicolaou, M., Powell, K., Terragni, L., Maes, L., Stronks, K., ... & Holdsworth, M., 2016. Systematic mapping review of the factors influencing dietary behaviour in ethnic minority groups living in Europe: a DEDIPAC study. International Journal of Behavioral Nutrition and Physical Activity, 13(1), 1-17.

Systematic review to map the broad range of factors that influence the dietary behaviours of ME groups living in Europe. Results: 37 studies (19 qualitative and 18 quantitative), including 9 in the UK. 63 factors sorted into 7 clusters: social and cultural environment factors, food beliefs and perceptions, psychosocial factors, social and material resources, accessibility of food, migration context and body factors.

Paradies, Y., Ben, J., Denson, N., Elias, A., Priest, N., Pieterse, A., ... & Gee, G., 2015. Racism as a determinant of health: a systematic review and meta-analysis. PloS one, 10(9), e0138511.

Academic paper. Meta-analysis on the relationship between reported racism and mental and physical health outcomes. Results: 293 studies predominantly in the US. Racism is significantly related to poorer health, with the relationship being stronger for poor mental health and weaker for poor physical health. Regarding the latter, only overweight-related outcomes were significantly associated with racism.

Public Health England (PHE), 2015. A systematic review and meta-analysis assessing the effectiveness of pragmatic lifestyle interventions for the prevention of type 2 diabetes mellitus in routine practice. London: Public Health England.

Policy publication. Systematic review and meta-analysis to assess the effectiveness of interventions for the prevention of T2D in high risk populations.

Public Health Scotland, 2021. Referrals to NHS Board Commissioned Weight Management Services (Tier 2 and Tier 3). (1st October – 30th September 2020

First report on referrals to weight management services in Scotland.

Ramachandran, A., Snehalatha, C., Dharmaraj, D., & Viswanathan, M., 1992. Prevalence of glucose intolerance in Asian Indians: urban-rural difference and significance of upper body adiposity. Diabetes care, 15(10), 1348-1355.

Academic paper. Statistical comparison between Asian Indian groups living in different contexts.

Ross, J. A. D., Barron, E., McGough, B., Valabhji, J., Daff, K., Irwin, J., ... & Murray, E., 2022. Uptake and impact of the English National Health Service digital diabetes prevention programme: observational study. BMJ Open Diabetes Research and Care, 10(3), e002736.

Academic paper. Evaluation of the impact of a pilot digital stream of the diabetes prevention programme Healthier You in England. Results: participation in the digital programme was associated with clinically significant reductions in weight and HbA1c. Digital diabetes prevention can be effective and reach a wider audience (including ME groups).

Satia-Abouta, J., Patterson, R. E., Neuhouser, M. L., & Elder, J., 2002. Dietary acculturation: applications to nutrition research and dietetics. Journal of the American Dietetic Association, 102(8), 1105-1118.

Academic paper. Review and theoretical paper on the dietary acculturation of migrants in the US – the process by which migrants adopt the dietary practices of the host country.

ScotPHO, 2020. Ethnic minorities: key points. Available at: https://www.scotpho.org.uk/population-groups/ethnic-minorities/key-points/

Section of ScotPHO website. Information about ME groups in Scotland, including biggest ME group, ethnicity coding, health. Last updated in June 2020.

ScotPHO, 2021. Diabetes: key points. Available at: https://www.scotpho.org.uk/health-wellbeing-and-disease/diabetes/key-points/

Section of ScotPHO website. Key points about diabetes. Last reviewed in December 2021.

Scottish Diabetes Survey 2020. Available at: https://www.diabetesinscotland.org.uk/wp-content/uploads/2022/01/Diabetes-Scottish-Diabetes-Survey-2020.pdf

The Scottish Diabetes Survey is carried out yearly and provides a comprehensive view on diabetes prevalence across the whole population of Scotland.

Scottish Government, 2012. Scottish Health Survey (SHeS) Topic report: Equality Groups.

Policy report. Analysis of health conditions per equality group – gender, age, ethnic group, religion, disability, sexual orientation. Scottish Health Survey data has been combined from four consecutive years (2008-2011) in order to allow more in-depth analysis of smaller populations (which would not be possible for individual survey years).

Scottish Government 2018 - A Healthier Future. Framework for the Prevention, Early detection and Early Intervention of type 2 diabetes.

Policy document on T2D. Focus on weight management as excess weight is the main modifiable risk factor for type 2 diabetes.

Scottish Government, 2021. Race Equality Immediate Priorities Plan.

Policy document. Report on the progress made on the actions taken to implement the recommendations of the Expert Reference Group for Covid-19 and Ethnicity.

Tillin, T., Hughes, A. D., Mayet, J., Whincup, P., Sattar, N., Forouhi, N. G., ... & Chaturvedi, N., 2013. The relationship between metabolic risk factors and incident cardiovascular disease in Europeans, South Asians, and African Caribbeans: SABRE (Southall and Brent Revisited)—a prospective population-based study. Journal of the American College of Cardiology, 61(17), 1777-1786.

Academic paper. Assessment of cardiovascular risk factors for a sample of European, South Asian and African Caribbean groups living in London.

Valabhji, J., Barron, E., Bradley, D., Bakhai, C., Fagg, J., O'Neill, S., ... & Smith, J., 2020. Early outcomes from the English National health service diabetes prevention programme. Diabetes Care, 43(1), 152-160.

Academic paper. Evaluation of Healthier You: National Health Service Diabetes Prevention Programme in England. Assessment of weight and HbA1c changes.

Wallia, S., Bhopal, R. S., Douglas, A., Bhopal, R., Sharma, A., Hutchison, A., ... & Sheikh, A., 2013. Culturally adapting the prevention of diabetes and obesity in South Asians (PODOSA) trial. Health promotion international, 29(4), 768-779.

Academic paper. Description of the culturally adaptation of the intervention assessed in Bhopal et al., 2014 - Prevention of Diabetes and Obesity in South Asian (PODOSA). Culturally adaptation of the Finnish Diabetes Prevention programme.

Walsh, D., Buchanan, D., Douglas, A., Erdman, J., Fischbacher, C., McCartney, G., ... and Whyte, B., 2019. Increasingly diverse: the changing ethnic profiles of Scotland and Glasgow and the implications for population health. Applied Spatial Analysis and Policy, 12(4), 983-1009.

Academic paper. Literature review on ethnicity and health in Scotland.

Williams, D. R., Lawrence, J. A., & Davis, B. A., 2019a. Racism and health: evidence and needed research. Annual review of public health, 40, 105-125.

Academic paper. Literature review on how racism can affect health and racial/ethnic inequities in health, including structural racism and discrimination.

Williams, D. R., Lawrence, J. A., Davis, B. A., & Vu, C., 2019b. Understanding how discrimination can affect health. Health services research, 54, 1374-1388.

Academic paper. Review of literature reviews and meta-analyses from 2013 to 2019 to understand how discrimination affects health. Results: 29 studies (US and international). Experiences of discrimination reported by adults are adversely related to mental health and indicators of physical health (e.g. overweight), including preclinical indicators of disease, health behaviours, utilisation of care, and adherence to medical regimens.

Wilson, C., Alam, R., Latif, S., Knighting, K., Williamson, S., & Beaver, K., 2012. Patient access to healthcare services and optimisation of self‐management for ethnic minority populations living with diabetes: a systematic review. Health & social care in the community, 20(1), 1-19.

Academic paper. Systematic review on patient self-management and

access to healthcare services for ethnic minority groups living with diabetes.


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