BOSTON — April 12, 2002 — Diabetes affects 10 percent of the Asian American and Pacific Islander American population - making them almost two times more likely than whites to have the disease. Diabetes is also the fifth leading killer of Americans of Asian or Pacific Islander descent between the ages of 45 to 64.

Why? "While not a lot of research has been done to date, we think the dramatic rise may be a result of a more Westernized lifestyle," says William Hsu, MD, of Joslin Diabetes Center in Boston. "Asian Americans are eating a more Westernized diet that includes a lot more high calorie foods and animal fat than their ancestors and relatives in Asia ate," he notes. "And they are leading a more sedentary lifestyle. If you superimpose these lifestyle differences on a population that is genetically more likely to develop diabetes, it's not surprising that we are seeing more diabetes in Asian Americans and Pacific Islanders."

The diet that Chinese people eat in China, for example, is much different from the stereotypical diet one experiences in a typical Chinese restaurant in the US, Dr. Hsu notes. In China, meals are rice-based with plenty of vegetables and fruit. Meat is treated more like a side dish or for flavoring. Just the opposite occurs in the United States, with most American meals placing the heaviest emphasis on the meat portion of the meal. This emphasis results in meals that are significantly higher in calories and fat.

Most of the growth in diabetes in Asian Americans is type 2 diabetes, which develops primarily in people who are over 40, overweight, and have a family history of the disease. Type 2 diabetes is increasingly occurring in young people, including children, due to obesity and sedentary lifestyle.

Type 2 diabetes can remain undiagnosed for many years. Undiagnosed, untreated, or poorly managed diabetes can lead to a host of complications over time, including heart disease, stroke, blindness, kidney disease, impotence, nerve damage leading to painful neuropathy, and poor circulation that may result in amputations.

For Asian Americans, just as for most other Americans, the key to delaying diabetes or avoiding it all together is in keeping weight in a target range, losing weight if needed, exercising regularly, and eating a well balanced diet that contains lots of fruits and vegetables. Below are recipes for two Chinese dishes from Joslin that suggest how a well-balanced, traditional Chinese meal can be put together to help people with diabetes — or those at risk — keep their weight, and their diabetes, under better control. The recipes were provided by Diana King of Dover, MA, working in conjunction with Joslin's Nutrition Services Staff in Boston.

Joslin's new website for Asian Americans with diabetes contains a wide range of content to help those with diabetes manage their disease better. A new recipe feature will be added soon. Much of this information is useful for anyone with diabetes, while certain sections are specific to Asian Americans. All can be accessed by going to www.joslin.org/api/.

There are plenty of options with the following two tasty Asian dishes. They can be served individually with steamed white rice, or as a meal by themselves. Or you can serve both of the dishes at a single meal, along with steamed white rice.

This delicious dish can be served with steamed white rice and serves four people. Utensils needed include a heat-resistant pie plate or soufflé dish of approximately 9 inches in diameter, such as a Pyrex pie dish or French white soufflé dish. You also will need a wok with a cover or a large (8 qt.) pan with wide mouth and cover. You will need a steam basket stand or any adaptations (such as a large empty tuna fish can without the top and bottom) for propping the dish up in water while being steamed in the pan or wok.

1 pound of fresh salmon fillet
2 slices of fresh ginger, cut into small thin strips
2 sprigs of scallion, cut into small diagonal pieces
1 1/2 tablespoon of fish sauce (bottles of liquid anchovy sauce are found in Asian food stores)
1 teaspoon of sesame oil

Place salmon fillet with skin side down in a 9-inch dish. The fish may be cut into two or more pieces to fit in the dish. Spread 1 1/2 tablespoon of fish sauce on top of fish. Spread the teaspoon of sesame oil on fish. Sprinkle the sliced ginger and scallion pieces over the fish. In wok/pot, place steam basket stand and 4 cups of water. Place the heat-resistant dish of fish on steaming stand and put cover on the wok/pot. Heat the wok/pot until water boils for steaming. Steam with the wok/pot covered for approximately 10 to 15 minutes, depending on thickness of fillet. It's done when the meat "flakes" apart with a fork. Serve with steamed white rice.

Makes 4 servings.

JOSLIN CHOICES: 4 very-low-fat protein, 1/2 fat
PER SERVING: 188 calories (33% calories from fat), 7 g total fat (1 g saturated fat), 30 g protein, 0 carbohydrates, 0 dietary fiber, 108 mg cholesterol, 594 mg sodium, 646 mg potassium

SERVING SIZE PER PERSON: 1 cup

JOSLIN CHOICES: 3 1/2 carbohydrates
PER SERVING: 242 calories (0 calories from fat), 0 total fat (0 saturated fat), 4 g protein, 53 g carbohydrates, 0 dietary fiber, 0 cholesterol, 0 sodium, 48 mg potassium

This tasty vegetable dish makes a meal itself when served with steamed white rice. It also makes a nice accompaniment to the Steamed Salmon With Scallions recipe above, or it can be served with another favorite entree.

1 pound of fresh string beans, with small stem ends removed and cut or broken in half
6-8 cloves of garlic (depending on size and taste), crushed and flattened, with skin removed
2 tablespoons of canola oil
1/4 teaspoon of salt

Place 1 1/2 tablespoons oil into pot and heat on medium heat until drop of water dances. Put cut string beans into pot (BE CAREFUL of oil splattering) and cover with lid. Cook for about 10-15 minutes, occasionally lifting cover to sauté (stir) string beans until they are browned and tender. Season with 1/4 teaspoonful of salt. Remove string beans from pan and set aside. Using same pan, place 1/2 tablespoon oil and heat on low temperature. Add flattened garlic cloves and sauté until soft, being careful not to burn them. Add the cooked string beans back into pot with the garlic. Mix and serve.

Make 4 servings. May be served with steamed white rice. (See rice nutrient information above).

JOSLIN CHOICES: 1 vegetable, 1 fat
PER SERVING: 105 calories (56% calories from fat), 7 g total fat (1 g saturated fat), 2 g protein, 10 g carbohydrates, 4 g dietary fiber, 0 cholesterol, 149 mg sodium, 344 mg potassium