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It is a well-known fact that Asian people tend to have lower muscle mass than people from other parts of the world. This is particularly true for South Asians, who have been found to have lower lean tissue (or muscle) mass relative to their height. This phenomenon has been observed in both South Asian men and women when compared to their Aboriginal, Chinese, and European counterparts. The reasons for this are not entirely clear, but it is thought that it may be due in part to multigenerational undernutrition, adaptation to a hot climate, or a combination of genetic and epigenetic factors. This low muscle mass, coupled with a higher amount of visceral fat, puts South Asians at a higher risk for various metabolic diseases such as heart disease and Type 2 diabetes.
| Characteristics | Values |
|---|---|
| Low lean mass among Asians | Contemporary South Asians have lower lean mass (organ and muscle mass) relative to height and total body mass than Europeans. |
| High fat mass | South Asians have a phenotype of high fat mass and low lean mass, which may account for greater levels of insulin and homeostasis model assessment than other ethnic groups. |
| Insulin resistance | South Asians have much higher rates of insulin resistance and associated diseases than other ethnic groups. |
| Higher risk of metabolic diseases | Low muscle mass and high visceral belly fat put South Asians at higher risk of various metabolic diseases like heart disease and Type 2 diabetes. |
| Sarcopenia | Sarcopenia, a well-known geriatric syndrome, is defined as the age-related loss of muscle mass plus declined muscle function. The reported prevalence of sarcopenia in Asia was lower than in Western countries, ranging from 2.5% to 45.7%. |
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What You'll Learn
South Asians have less muscle mass
South Asians have lower levels of muscle mass and strength compared to White Europeans. This is a longstanding characteristic that has been observed in South Asian skeletons from the early Holocene, and it may be due to multigenerational undernutrition or adaptation to the hot, equatorial climate of the region. South Asians also have a higher risk of developing type 2 diabetes due to their lower muscle mass, which is further exacerbated by obesity.
Several studies have compared the effects of resistance exercise training on muscle mass and function in South Asians and White Europeans. These studies found that South Asians experienced similar increases in muscle mass and strength as White Europeans, with no significant differences in responses between the ethnic groups. For example, one study showed that thigh muscle mass increased significantly for both groups after 12 weeks of resistance exercise training, with no significant differences in responses between South Asians and White Europeans.
However, some differences were observed in the metabolic responses to resistance exercise training between the two groups. South Asians showed less favorable responses in total body fat, visceral fat, and subcutaneous fat, as well as in systolic blood pressure and VO2max. Additionally, South Asians exhibited an attenuated increase in upper body strength compared to White Europeans.
The reasons for these differential responses to resistance exercise training are not yet clear and require further investigation. However, it is evident that South Asians can benefit from increases in muscle mass and function, particularly through resistance exercises.
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The Asian-Indian Phenotype
The phenotype is also associated with abdominal obesity, where fat accumulates in the deep subcutaneous tissue and visceral fat depots, resulting in higher transmembrane fatty acid fluxes. This leads to a higher incidence of dysglycaemia, atherogenic dyslipidemia, and accelerated vascular disease. Additionally, the Asian-Indian Phenotype is characterised by higher levels of intramyocyte fat deposition in skeletal muscle and adipose tissue, which is believed to contribute to the development of insulin resistance.
The origins of the Asian-Indian Phenotype are not fully understood, but various hypotheses have been proposed. One hypothesis suggests that it may be due to multigenerational undernutrition, as indicated by the persistence of low lean mass among South Asians over generations. Another hypothesis proposes that adaptation to a hot, equatorial climate may have led to the selection of lower body mass to reduce thermal load. Additionally, climatic unpredictability and unreliable food resources may also have contributed to the development of lower lean mass as an adaptation.
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Insulin resistance
Several studies have shown that South Asians are more prone to insulin resistance and type 2 diabetes than other ethnic groups. For instance, a study of Singaporean males found that Asian Indians had the highest prevalence of T2DM at 17.2%, followed by Malays at 16.6% and Chinese at 9.7%. Another study of South Asian and European men with similar BMI and body fat percentages found that the South Asian group exhibited reduced insulin sensitivity by 26%.
There are several proposed reasons for the higher prevalence of insulin resistance among South Asians. One hypothesis is that South Asians have a lower ability to secrete insulin, which means they have fewer compensatory reserves when exposed to unhealthy lifestyles. Another factor could be that South Asians have lower muscle mass on average, which is significant because muscle is the primary storage compartment for glucose after eating. In addition, South Asians may have a specific propensity for ectopic hepatic fat accumulation and intramyocellular fat deposition, which further disrupts insulin action.
Genetics also plays a role in insulin resistance among South Asians. For instance, South Asian men have been found to have a higher percentage of total body fat for a given BMI compared to Caucasian men, and they accumulate this fat in truncal adipose tissue. In addition, South Asians have been shown to have a relative increase in a polymorphism of ENPP1/PC-1, which is associated with increased insulin resistance.
Lifestyle factors can also contribute to insulin resistance in South Asians. For example, South Asians tend to consume high-carb meals, which result in chronically elevated insulin levels. Over time, the muscles become increasingly insulin-resistant, followed by the liver and fat cells. This progression can eventually lead to prediabetes and type 2 diabetes. Therefore, it is recommended that South Asian adults get screened for diabetes by age 35, especially if they have other risk factors present.
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Metabolic diseases
Several studies have found that South Asians have lower lean tissue mass relative to height, which increases their susceptibility to type 2 diabetes and cardiovascular disease. This phenomenon has persisted for multiple generations, even after migration to other parts of the world, indicating a possible heritable component. The exact causes are unknown, but various hypotheses have been proposed, including adaptation to a hot, equatorial climate and unpredictable food resources.
Asian populations, in general, have been found to have a higher risk of metabolic syndrome, a cluster of metabolic risk factors that increase the likelihood of cardiovascular disease and type 2 diabetes. This is true even when they have a lower body mass index (BMI) than other populations. The prevalence of metabolic syndrome in Asian populations ranges from 10 to 30%, with some studies reporting even higher rates among South Asian immigrants in the US.
Racial and ethnic differences in the relationship between BMI and metabolic syndrome have been observed, with Asian Americans having a greater prevalence of the syndrome despite lower BMI. International studies have shown that Asian populations in China, Korea, the Philippines, Singapore, and Taiwan have an increased risk of type 2 diabetes and cardiovascular disease at lower BMI levels than European populations. As a result, the World Health Organization (WHO) has recommended lower BMI ranges for overweight and obese individuals in Asian populations.
The higher risk of metabolic syndrome in Asian populations may be due to a combination of genetic and environmental factors. Lifestyle interventions focusing on healthy eating and physical activity have been found to be effective in preventing and treating metabolic syndrome. However, physical activity levels among Asian immigrants in the UK tend to be lower than those of the majority population, which may contribute to their increased risk.
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Sarcopenia
The Asian Working Group for Sarcopenia (AWGS) has developed consensus criteria for the diagnosis of sarcopenia in Asia, which requires measurements of muscle mass, muscle strength, and physical performance. The reported prevalence of sarcopenia in Asia is generally lower than in Western countries, ranging from 2.5% to 45.7%. However, Asian people tend to have lower muscle mass, weaker grip strength, slower gait speed, and higher body fat mass with central distribution.
The aetiology of sarcopenia in Asians may be multifactorial, involving genetic, environmental, and lifestyle factors. For example, studies have suggested that the low lean mass characteristic of South Asians may be due to multigenerational undernutrition or adaptation to a hot, equatorial climate. Additionally, the impact of sarcopenia in Asia is compounded by the high prevalence of central obesity, especially in women.
The management of sarcopenia in Asians focuses on prevention and treatment through exercise, diet, and nutrition. While no medications are currently proven to treat sarcopenia, a life course program for good nutrition and physical activity would be beneficial for preventing and managing the condition. Furthermore, the AWGS recommends sarcopenia screening for older people and in certain clinical conditions and healthcare settings to facilitate the implementation of sarcopenia in clinical practice.
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Frequently asked questions
Research shows that South Asians have lower levels of lean tissue (or muscle) relative to height when compared to other ethnic groups.
The reasons for South Asians having less muscle are not entirely clear. However, various hypotheses have been proposed. One theory suggests that adapting to a predominantly hot, equatorial climate may have led to the selection of lower body mass, as less muscle means less heat produced. Another theory suggests that climatic unpredictability might have resulted in lower lean mass as an adaptation to unreliable food resources.
South Asians are at a higher risk of developing metabolic diseases such as heart disease and Type 2 diabetes due to a combination of low muscle mass and high visceral belly fat. They also have higher levels of insulin resistance, which can lead to high blood sugar and Type 2 diabetes. Additionally, South Asians may develop NCDs at a lower BMI than other populations due to their lower muscle mass.
Diet and exercise play a crucial role in mitigating the health risks associated with low muscle mass. Prioritizing strength training and building muscle can improve insulin sensitivity and overall health. A balanced diet that reduces sugary and fried snacks can also help maintain a healthy weight.
