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General practitioners' perceptions of the illness behaviour and health needs of South Asian women with menorrhagia.

OBJECTIVES: A study of general practitioners' (GPs) perceptions of the health needs of women of South Asian descent who suffer from menorrhagia. METHOD: A qualitative study using semi-structured interviews with 50 GPs in two British towns. FINDINGS: This study suggest that some women of South Asian descent may not consult their GPs even though suffering severe menorrhagia. Moreover, some GPs perceive that women may suffer from anaemia as the result of such illness behaviour. One reason for this reluctance to consult for menorrhagia may be the fact that some women of South Asian descent prefer to be examined by female doctors, yet may attend practices that lack a female partner. The study also shows that South Asian women, who consult male GPs for menorrhagia, are sometimes referred to hospital outpatients without internal examinations, and that women may be reluctant to keep their hospital appointments because of the lack of female gynaecologists. The study also indicates that a shortage of female interpreters may make communication difficult between some health care professionals and their patients, particularly when a complex and sensitive subject such as menorrhagia needs to be discussed. CONCLUSION: Women of South Asian descent may suffer serious problems such as iron deficiency anaemia, partly due to untreated menorrhagia. Since this was a study of GPs' perceptions of the health needs of South Asian women, it is now important to interview women themselves, to learn more about their perceptions of menorrhagia, and their perceptions of any subsequent contact with health care professionals.

Anemia, Iron-Deficiency↗

Iron deficiency anaemia in women of South Asian descent: a qualitative study.

OBJECTIVE: Menorrhagia is thought to be the commonest cause of iron deficiency anaemia in women of reproductive age living in Britain. However, it has been suggested that the high prevalence of iron deficiency anaemia in women of South Asian descent living in Britain is due to religious and cultural restrictions on certain foods. While lack of iron in the diet, or poor iron absorption may well be reasons for this prevalence of iron deficiency anaemia, there may be other complex reasons why South Asian women suffer particularly from this complaint. This study aimed to explore reasons for the relatively high level of iron deficiency anaemia found in South Asian women living in Britain. METHOD: A qualitative study using semi-structured interviews with women of Indian and Pakistani descent living in a town in North West England. FINDINGS: It appears that some South Asian women value a relatively heavy menstrual blood flow because such blood is thought to be 'dirty' and 'impure' and because a scanty period is thought to result in abdominal weight gain and pain. When menstrual blood loss is thought to be 'excessive', women tend to avoid 'hot' foods such as meat, fish and eggs, thus denying themselves a valuable source of iron. When South Asian women believe that they have a serious problem of menorrhagia they may not seek medical help because of the shortage of female general practitioners. Poor communication with doctors and other health care professionals may also affect illness behaviour. CONCLUSION: This study suggests that attitudes to menstruation and menstrual blood may help to account for the relatively high levels of iron deficiency anaemia found in women of South Asian descent living in Britain. Since most of the women interviewed during this research had families who came from Gujarat in Western India, more research is needed to explore the values and beliefs of women coming from other parts of Southern Asia.

Anemia, Iron-Deficiency↗

Moderate fish-oil supplementation reverses low-platelet, long-chain n-3 polyunsaturated fatty acid status and reduces plasma triacylglycerol concentrations in British Indo-Asians.

BACKGROUND: The mechanisms involved in the increased mortality from coronary artery disease in British Indo-Asians are not well understood. OBJECTIVES: This study aimed to investigate whether British Indo-Asian Sikhs have higher plasma triacylglycerol concentrations, lower platelet phospholipid levels, and lower dietary intakes of long-chain n-3 polyunsaturated fatty acids (PUFAs) than do age- and weight-matched Europeans and whether moderate dietary fish-oil intake can reverse these differences. DESIGN: A randomized, double-blind, placebo-controlled, parallel, fish-oil intervention study was performed. After a 2-wk run-in period, 44 Europeans and 40 Indo-Asian Sikhs were randomly assigned to receive either 4.0 g fish oil [1.5 g eicosapentaenoic acid (EPA) and 1.0 g docosahexaenoic acid (DHA)] or 4.0 g olive oil (control) daily for 12 wk. RESULTS: At baseline, the Indo-Asians had significantly higher plasma triacylglycerol, small dense LDL, apolipoprotein B, and dietary and platelet phospholipid n-6 PUFA values and significantly lower long-chain n-3 PUFAs (EPA and DHA) than did the Europeans. A significant decrease in plasma triacylglycerol, plasma apolipoprotein B-48, and platelet phospholipid arachidonic acid concentrations and a significant increase in plasma HDL concentrations and platelet phospholipid EPA and DHA levels were observed after fish-oil supplementation. No significant effect of ethnicity on the responses to fish-oil supplementation was observed. CONCLUSIONS: Moderate fish-oil supplementation contributes to a reversal of lipid abnormalities and low n-3 PUFA levels in Indo-Asians and should be considered as an important, yet simple, dietary manipulation to reduce CAD risk in Indo-Asians with an atherogenic lipoprotein phenotype.

Coronary Disease↗

The performance of the Rose angina questionnaire in South Asian and European origin populations: a comparative study in Newcastle, UK.

BACKGROUND: The Rose angina questionnaire has been extensively used in different cultural settings, but may not perform consistently in different ethnic groups. We set out to assess the performance of the Rose angina questionnaire in UK South Asians compared with Europeans. METHODS: Data on major ECG abnormalities, possible or definite Rose questionnaire angina and diagnosed angina were collected from an age- and sex-stratified random sample of 1509 adults from European, Indian, Pakistani and Bangladeshi ethnic groups. RESULTS: The ECG abnormalities were commoner in South Asians than Europeans (6% versus 2% in men). The prevalence in both South Asian and European men of possible Rose angina and diagnosed angina was 18% and 8%, respectively, but definite Rose angina was less common in South Asians (3% versus 6%). Definite Rose angina showed lower sensitivity for other measures in South Asians than in Europeans: sensitivity for a doctor's diagnosis was 21% in South Asian and 37% in European men. For possible Rose angina, the corresponding figures were 81% and 84%. Similar patterns were seen in women. CONCLUSIONS: The performance of the Rose angina questionnaire was sufficiently inconsistent to warrant further work to achieve greater cross-cultural validity. Possible Rose angina performed more consistently across ethnic groups than definite Rose angina and pending further validation studies may be the most appropriate form to use.

Angina Pectoris↗

Phylogenetic star contraction applied to Asian and Papuan mtDNA evolution.

In the past decade, mitochondrial DNA (mtDNA) of 826 representative East Asians and Papuans has been typed by high-resolution (14-enzyme) restriction fragment length polymorphism (RFLP) analysis. Compared with mtDNA control region sequencing, RFLP typing of the complete human mitochondrial DNA generally yields a cleaner phylogeny, the nodes of which can be dated assuming a molecular clock. We present here a novel star contraction algorithm which rigorously identifies starlike nodes (clusters) diagnostic of prehistoric demographic expansions. Applied to the Asian and Papuan data, we date the out-of-Africa migration of the ancestral mtDNA types that founded all Eurasian (including Papuan) lineages at 54,000 years. While the proto-Papuan mtDNA continued expanding at this time along a southern route to Papua New Guinea, the proto-Eurasian mtDNA appears to have drifted genetically and does not show any comparable demographic expansion until 30,000 years ago. By this time, the East Asian, Indian, and European mtDNA pools seem to have separated from each other, as postulated by the weak Garden of Eden model. The east Asian expansion entered America about 25,000 years ago, but was then restricted on both sides of the Pacific to more southerly latitudes during the Last Glacial Maximum around 20,000 years ago, coinciding with a chronological gap in our expansion dates. Repopulation of northern Asian latitudes occurred after the Last Glacial Maximum, obscuring the ancestral Asian gene pool of Amerinds.

Algorithms↗

What is the risk of coronary heart disease in South Asians? A review of UK research.

OBJECTIVE: The aim of this study was to systematically review the evidence that coronary heart disease risk is higher in South Asians than in comparative 'white' populations, particularly seeking studies of incidence. METHODS: A systematic literature review was carried out using a personal research literature collection, MEDLINE 1966-1998 and citations from references. RESULTS: Of 19 studies, none reported disease incidence. Most studies reported prevalence, mortality rates or health care utilization data. Most studies were on people born on the Indian subcontinent, thus omitting the British-born. Several did not report on women. The strongest evidence of an excess of CHD in South Asians came from mortality data comparing those born in the Indian subcontinent with the whole population of England and Wales. In South Asians coronary heart disease is common and important, but neither the actual disease rates nor the excess risk in relation to the 'white' population are known. Both prevalence and mortality data suggested that the frequency of coronary heart disease in Indians, Pakistanis and Bangladeshis differed. CONCLUSION: Estimates of South Asians' excess risk of coronary heart disease are imprecise and may be too high (if there are data errors) or too low (for comparison with the general population blunts ethnic variations). South Asians are a heterogeneous group yet most studies of CHD report on Bangladeshis, Indians and Pakistanis combined. Indians probably have less CHD than Bangladeshis and Pakistanis. Cohort studies on CHD in South Asians are needed and these should be designed so that data can be combined for future systematic reviews.

Adult↗

How physically active are South Asians in the United Kingdom? A literature review.

BACKGROUND: Moderate physical activity is protective against coronary heart disease (CHD) and diabetes, both important public health problems among UK South Asian (Indian, Pakistani and Bangladeshi) ethnic groups. We assessed the evidence that physical activity is lower in South Asian groups than in the general population. METHODS: We carried out a systematic literature review of studies describing levels of physical activity and fitness in UK South Asians using MEDLINE, EMBASE, the Cochrane databases, hand searching of relevant journals and review of reference lists. RESULTS: We identified 12 studies in adults and five in children. Various methods were used to assess physical activity and fitness, but all the studies reported lower levels among South Asian groups. The differences were substantial, particularly among women and older people. For example, the Health Survey for England found that Indian, Pakistani and Bangladeshi men were 14, 30 and 45 per cent less likely than the general population to meet current guidelines for physical activity. Limited information was provided about translation and adaptation of questionnaires. CONCLUSION: Levels of physical activity were lower in all South Asian groups than the general population and patterns of activity differed. No studies used validated measures. Insufficient attention has been paid to issues of cross-cultural equivalence. With these caveats, low levels of physical activity among UK South Asian ethnic groups may contribute to their increased risk of diabetes and CHD. Closer attention to validity, translation and adaptation is necessary to monitor changes and assess the effectiveness of interventions to increase physical activity.

Adult↗

Ovarian function in the elephant: luteinizing hormone and progesterone cycles in African and Asian elephants.

Serum samples were collected weekly for 3 yr from two female African elephants, for 18 mo from two other female African elephants, and for 2 yr from two female Asian elephants. Animals were not sedated at the time of blood collection. Ovarian cycles, characterized by changes in progesterone and immunoreactive luteinizing hormone (ILH) concentrations, averaged 15.9 +/- 0.6 wk (N = 25) for African females and 14.7 +/- 0.5 wk for Asian females (N = 10). The length of the active luteal phase averaged 10.0 +/- 0.3 wk for African elephants (range 8-14 wk) and 10.6 +/- 0.6 wk for Asian females (range 9-13 wk). Interluteal phases were 5.9 +/- 0.6 wk for African females and 4.2 +/- 0.5 wk for Asian females. One African female (Maliaca) had two extended interluteal phases, both occurring between the months of February and May. Excluding these two periods, there were no differences in the length of the ovarian cycle or the length of the luteal phase between species of elephant. Serum progesterone in both species ranged from less than 50 pg/ml to 933 pg/ml. Average progesterone concentrations during the luteal phase were significantly lower in African elephants compared with Asian elephants (328 +/- 13, N = 30 cycles vs. 456 +/- 23, N = 14 cycles; p less than 0.001). ILH ranged from nondetectable to 11.6 ng/ml. These data suggest that the length of the ovarian cycle in the African elephant is about 16 wk and confirm that the length of the ovarian cycle in the Asian elephant is about 15 wk.

Animals↗

Variation and quality of self-report health data. Asians and Pacific Islanders compared with other ethnic groups.

Variation in the sociodemographic, system, and disease characteristics of Asians and Pacific Islanders compared with other ethnic groups and the quality of standard self-report measures of health and functioning by ethnic groups were examined. Secondary analysis of self-report data from the Medical Outcomes Study, an observational study of adult outpatients who received care in either prepaid or fee-for-service plans, was used to compare 527 Asians and Pacific Islanders to patients in other ethnic groups (16,989 whites, 2,533 African Americans, 1,009 Latinos, and 446 others). These patients all completed a screening questionnaire after visits with a Medical Outcomes Study clinician. Asians and Pacific Islanders were similar to African Americans and Latinos on most sociodemographic and system characteristics, disease status, and risk factors. Ethnicity was a significant predictor of differences in self-reported health. As a group, Asians and Pacific Islanders had better health or health of equal status compared with whites, but were less satisfied and perceived less sharing in the doctor-patient relationship compared with other ethnic groups. However, results suggest that data from standard functioning measures for Asians should be interpreted with caution and that more work is needed to understand better the social and cultural influences on the health of Asians and Pacific Islanders.

Adolescent↗

Phylogeography of the asian elephant (Elephas maximus) based on mitochondrial DNA.

Populations of the Asian elephant (Elephas maximus) have been reduced in size and become highly fragmented during the past 3,000 to 4,000 years. Historical records reveal elephant dispersal by humans via trade and war. How have these anthropogenic impacts affected genetic variation and structure of Asian elephant populations? We sequenced mitochondrial DNA (mtDNA) to assay genetic variation and phylogeography across much of the Asian elephant's range. Initially we compare cytochrome b sequences (cyt b) between nine Asian and five African elephants and use the fossil-based age of their separation (approximately 5 million years ago) to obtain a rate of about 0.013 (95% CI = 0.011-0.018) corrected sequence divergence per million years. We also assess variation in part of the mtDNA control region (CR) and adjacent tRNA genes in 57 Asian elephants from seven countries (Sri Lanka, India, Nepal, Myanmar, Thailand, Malaysia, and Indonesia). Asian elephants have typical levels of mtDNA variation, and coalescence analyses suggest their populations were growing in the late Pleistocene. Reconstructed phylogenies reveal two major clades (A and B) differing on average by HKY85/gamma-corrected distances of 0.020 for cyt b and 0.050 for the CR segment (corresponding to a coalescence time based on our cyt b rate of approximately 1.2 million years). Individuals of both major clades exist in all locations but Indonesia and Malaysia. Most elephants from Malaysia and all from Indonesia are in well-supported, basal clades within clade A. thus supporting their status as evolutionarily significant units (ESUs). The proportion of clade A individuals decreases to the north, which could result from retention and subsequent loss of ancient lineages in long-term stable populations or, perhaps more likely, via recent mixing of two expanding populations that were isolated in the mid-Pleistocene. The distribution of clade A individuals appears to have been impacted by human trade in elephants among Myanmar, Sri Lanka, and India, and the subspecies and ESU statuses of Sri Lankan elephants are not supported by molecular data.

Animals↗

Differences in cortisol concentrations in South Asian and European men living in the United Kingdom.

OBJECTIVE: The metabolic syndrome is more prevalent in South Asians in Britain than in the general population. Furthering our understanding of the underlying mechanisms is important because of the increased risk of cardiovascular disease associated with the metabolic syndrome. As it has been proposed that increased activity of the hypothalamic pituitary adrenal axis might underlie the metabolic syndrome, we hypothesized that plasma cortisol levels would be higher in South Asians and that increased cortisol levels would be associated with cardiovascular risk factors comprising the metabolic syndrome. The aim of the study was to examine ethnic differences in cortisol levels and to compare the relationships between cortisol levels and cardiovascular risk factors in men from different ethnic groups. DESIGN: Cross-sectional population-based study, Newcastle upon Tyne, UK. (Newcastle Heart project). Participants One hundred men, 40-67 years old, of European and South Asian (Indian, Pakistani, Bangladeshi) ancestry, with and without cardiovascular risk factors of the metabolic syndrome. MEASUREMENTS: Measurement of plasma cortisol and corticosteroid binding globulin in stored sera. RESULTS: After adjustment for age and the presence of cardiovascular risk factors, mean cortisol was 27% (95% CI, 10%, 40%) lower in South Asians compared to Europeans. Cortisol levels were higher in all men with cardiovascular risk factors than those without. CONCLUSIONS: Cortisol levels are lower in South Asian than in European men resident in the UK. Despite lower cortisol levels in South Asians, the relations between cortisol and cardiovascular risk factors remain strong.

Adult↗

The Asian birth outcome gap.

Asians are often considered a single group in epidemiological research. This study examines the extent of differences in maternal risks and birth outcomes for six Asian subgroups. Using linked birth/infant death certificate data from the State of California for the years 1992-97, we assessed maternal socio-economic risks and their effect on birthweight, preterm delivery (PTD), neonatal, post-neonatal and infant mortality for Filipino (87,120), Chinese (67,228), Vietnamese (45,237), Korean (23,431), Cambodian/Laotian (21,239) and Japanese (18,276) live singleton births. The analysis also included information about non-Hispanic whites and non-Hispanic blacks in order to give a sense of the magnitude of risks among Asians. Logistic regression models explored the effect of maternal risk factors and PTD on Asian subgroup differences in neonatal and post-neonatal mortality, using Japanese as the reference group. Across Asian subgroups, the differences ranged from 2.5- to 135-fold for maternal risks, and 2.2-fold for infant mortality rate. PTD was an important contributor to neonatal mortality differences. Maternal risk factors contributed to the disparities in post-neonatal mortality. Significant differences in perinatal health across Asian subgroups deserve ethnicity-specific interventions addressing PTD, teen pregnancy, maternal education, parity and access to prenatal care.

Adult↗

Cooperative program for Asian pediatricians.

The Cooperative Program for Asian Pediatricians (CPAP) is a non-government organization established in 1989 to promote mutual understanding and friendship among young pediatricians in Asian countries. Unlike other government programs and non-government organizations, CPAP is solely facilitating mutual relationships among young inexperienced pediatricians who would otherwise have no chance to travel overseas. It has been funded by donations from members of the alumni association of the Department of Pediatrics at the University of Tokyo and many private companies and individuals. The Cooperative Program for Asian Pediatricians has so far invited 36 Asian pediatricians from 11 countries. By constructing a human network among Asian pediatricians, it is hoped that CPAP will contribute to making international cooperation in the Asian region easier and smoother.

Asia↗

Asian diabetes in Britain: a clinical profile.

The clinical features of large unselected groups of Asian (401) and European (491) patients attending a diabetic clinic were compared. The prevalences of symptomatic ischaemic heart disease, hypertension, retinopathy, and lens opacities were similar in the two groups, despite the shorter known duration and the relative youth of the Asian patients. Pedal pulses were more often absent in Europeans, whereas in the age-group 20-64 years, ankle and knee reflexes were more often unobtainable in Asians. The degree of adiposity was similar in the two groups, but was less in Asian males than females. A first-degree diabetic relative was reported more commonly in Asians than in Europeans. These findings are important in relation to the exceptionally high prevalence of diabetes recently described in the Southall Asian community.

Adult↗

Knowledge of diabetes in Asians and Europeans with and without diabetes: the Coventry Diabetes Study.

Knowledge about the nature, symptoms, complications, and treatment of diabetes was assessed among United Kingdom Europeans and Asians with and without diabetes during the Coventry Diabetes Study. An open questionnaire was validated for use among Asians and Europeans and a 'Knowledge Index' constructed. The questions were answered by 3814 (87%) of 4395 Asians and 3783 (69%) of 5508 Europeans. Among those with known diabetes, 216 (96%) of 223 Asians and 98 (94%) of 104 Europeans answered the questions. The nature of diabetes was unknown in 30% of Europeans and 44% of Asians with diabetes, and 42% and 67%, respectively, could not name a single complication. Most of those without diabetes were unable to name either a complication (Europeans 66%, Asians 89%) or a single symptom (66% and 83%, respectively). The Knowledge Index was highest in Europeans, increased with increasing educational achievement, and was lowest in non-diabetic subjects without a family history of diabetes. Even those with diabetes had a low Knowledge Index.

Adult↗

Prevalence of diabetes in different regional and religious south Asian communities in Coventry.

The prevalence of Type 2 (non-insulin-dependent) diabetes in different South Asian (Asian) communities was compared during the Coventry Diabetes Study, a cross-sectional house to house screening programme for diabetes. Screening was by capillary whole blood glucose measurement with oral glucose tolerance tests when concentrations were greater than or equal to 6.0 mmol l-1 within 2 h of a meal or greater than or equal to 5.0 mmol l-1 2 h or more after a meal and a random 10% of others. Of the 4395 resident Asians, 94% were represented by five communities: Punjabi Sikhs, Punjabi Hindus, Gujerati Moslems, Gujerati Hindus, and Pakistani Moslems. Response to screening was 77-89% and to glucose tolerance test was 59-79%. Differences in anthropometry, socioeconomic circumstances, and migratory patterns were found, but all groups had a higher prevalence of Type 2 diabetes than Europeans. Gujerati Moslems had the highest age-adjusted prevalence (per 1000) of Type 2 diabetes (males: 160 (95% CI 107-228), females: 204 (95% CI 144-283)) when compared with the other Asian groups (males: Punjabi Sikhs 89(72-110), Pakistani Moslems 91(67-120), Gujerati Hindus 84(57-120), Punjabi Hindu 113(74-171); females: Punjabi Sikhs 75(60-94), Pakistani Moslems 103(78-133), Gujerati Hindus 88(62-122), Punjabi Hindu 116(77-174)). That all the Asian groups had a high prevalence of diabetes, in spite of their known dietary, cultural, and socioeconomic differences, suggests that the Asian predisposition to Type 2 diabetes is inherited although environmental factors may be necessary for this to be expressed.

Adult↗

British South Asians aged 13-16 years have higher fasting glucose and insulin levels than Europeans.

AIM: To examine whether plasma glucose, insulin resistance and markers of adiposity differed between British adolescents of South Asian and European origin. METHODS: School-based cross-sectional study (1998-2000), in which detailed measurements of adiposity, fasting plasma glucose and serum insulin were made in 90 South Asian and 1248 European pupils (overall 69% response rate). RESULTS: Compared with Europeans, South Asian subjects had higher mean fasting insulin levels (percentage mean difference 17.2%, 95% confidence interval 7.2-26.1%, P = 0.001), a higher mean fasting glucose (mean difference 0.19 mmol/l, 95% confidence interval 0.08-0.29 mmol/l, P = 0.0005) and a higher prevalence of impaired fasting glucose (> or = 6.1 mmol/l) (5.6% vs. 1.5%, odds ratio 3.9, 95% confidence interval 1.4-10.9, P = 0.004). Although South Asian children tended to have slightly higher indices of adiposity than Europeans (other than body mass index), the differences in glucose and insulin levels persisted after adjustment for adiposity and for pubertal status. CONCLUSIONS: The predisposition to Type 2 diabetes observed in South Asian adults is apparent before adult life. Establishing the contributions of the childhood and fetal environments and of genetic factors to the development of these ethnic differences is an important priority. Prevention of Type 2 diabetes in British South Asians needs to begin before adult life.

Adipose Tissue↗

Genetic relationship between the 3'-VNTR and diallelic apolipoprotein B gene polymorphisms: haplotype analysis in individuals of European and south Asian origin.

The genetic relationship amongst apolipoprotein B (apo B) gene polymorphisms (signal peptide insertion/deletion (Leu-Ala-Leu-16/-14), XbaI (Thr2488), EcoRI (Glu4154----Lys), Asn4311----Ser, 3'-VNTR) has been investigated in samples of South Asian (Indian) and Swedish individuals. The frequency distribution of alleles at all these sites was found to be significantly different between the South Asian and the Swedish samples (deletion allele: 0.20 v. 0.31, X+ (presence of XbaI cutting site): 0.29 v. 0.55, R- (absence of EcoRI cutting site): 0.11 v. 0.19, Ser4311: 0.45 v. 0.19). The distribution of allele frequencies at the VNTR site was bimodal in both populations. However, in South Asians, the most common allele was a 35 repeat unit allele, whilst in the Swedish sample, and in all other reports from Caucasian samples the 37 repeat unit allele was the most frequent (South Asian v. Swedish: 35 allele: 0.36 v. 0.19, 37 allele: 0.25 v. 0.48). Furthermore, four new alleles at the apo B gene 3'-VNTR site (15, 17, 32, 38 repeat unit alleles) were observed in South Asians, of which two (15 and 17 repeat unit alleles) were well outside the bimodal distribution. In both samples, strong linkage disequilibrium and allelic association were detected between alleles at the 3'-VNTR and each of the other sites, and also between the ins/del and XbaI sites and between the XbaI and Asn4311----Ser sites. The same five common haplotypes as defined by ins/del, XbaI, EcoRI and Asn4311----Ser were found to be present in both samples comprising 97 and 99% of the haplotypes observed in the South Asian and Swedish samples respectively. Detailed analysis revealed the predominant occurrence of certain 3'-VNTR alleles on specific haplotypes and demonstrates the usefulness of the VNTR site for haplotyping and representative association studies. A model for the evolutionary relationship of the major haplotypes including the 3'-VNTR site is presented. These findings support a mechanism of replication slippage as a major factor for the generation of new alleles at the apo B 3'-VNTR locus rather than unequal crossing over.

Adult↗