Understanding saturated fat knowledge and dietary behaviours among South Asians who self-reported hypercholesterolemia: A mixed-methods study

South Asians experience a disproportionate burden of early and aggressive atherosclerotic cardiovascular disease (ASCVD) (1) . Their diets are typically high in refined carbohydrates and saturated fats, and epidemiological evidence suggests a link between high saturated fat intake and increased ASCVD risk (2) . This study aimed to explore the knowledge and dietary behaviours related to saturated fat among SAs who self-reported hypercholesterolemia. Twenty South Asian adults who self-reported hypercholesterolemia were recruited through stakeholder engagement and advertisements in cultural and religious organisations. Demographic and dietary information were collected via an online Qualtrics survey (n = 20), and knowledge and behaviours related to saturated fat were explored through semi-structured telephone interviews (n = 19), which were thematically analysed. Participants included 12 of Indian ethnicity (India, Fiji, and NZ-born), five Sri Lankan, two Nepali, and one Afghan. Fourteen were male and six were female, with a mean age of 40 years (SD 9.8). Most expressed concern about their elevated cholesterol levels, particularly concerning family histories of cardiac events. Interview data revealed widespread confusion about whether saturated fats were harmful. Dairy products, particularly milk and yoghurt, were the main sources of saturated fat. Following diagnosis, many participants switched from standard (blue top) to reduced fat (light blue top) milk after receiving general advice from their health professional. Nevertheless, few recognised that frequently consumed yoghurts (e.g., Gopala) were high in saturated fat. Ghee use was also prevalent, motivated either by cultural practices or beliefs that it is a healthier fat. Coconut oil consumption was less common, but coconut milk consumption, especially among Sri Lankan and South Indian participants was widespread, with limited awareness of its saturated fat content. Knowledge of saturated fat sources was generally low, contributing to continued consumption of high-saturated-fat foods. These findings highlight the need for culturally tailored dietary education and resources to improve awareness and reduce ASCVD risk in South Asian populations.