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Filipino Women’s 
Health Study 

 
A thesis presented in partial 

fulfilment of  

the requirements for the degree of 
 

Master of Science 
in 

Nutrition and Dietetics 

 

at Massey University, Albany, 

New Zealand. 

 

 

Liana Norrish 

 

2017



ii 
 

ABSTRACT 

Background: Western acculturation has been shown to be detrimental to health 

outcomes. Recently, more Filipinos are migrating to New Zealand, which may increase 

lifestyle-related chronic diseases. Furthermore, Filipino populations already have a higher 

incidence of chronic disease and less favourable health outcomes than their Western 

counterparts. Understanding their risk will assist development of public health initiatives 

which can be utilised to protect the health of the growing Filipino New Zealand migrant 

population. Aim: The aim of this study was to investigate the risk of developing type 2 

diabetes mellitus and cardiovascular disease among recently immigrated Filipino women 

Method: 62 recently-immigrated Filipino women, aged 19-45, were recruited from 

Auckland, New Zealand. A health and demographic information questionnaire was 

completed. Anthropometric measurements (height, weight, and waist circumference) and 

blood pressure were measured. Both total and percent body fat were determined using 

dual energy X-ray absorptiometry. Fasting glucose, insulin, and lipids were measured. 

Physical activity data was monitored by accelerometers and two-day food diaries were 

completed. Homeostasis Model Assessment 2 was used to quantify insulin resistance. 

The 30-year Framingham Risk Score was used to classify participants into low-,   

medium-, or high-risk of developing cardiovascular disease. Prevalence of metabolic 

syndrome according to the modified National Cholesterol Education Programme criteria 

was determined. Results: Body mass index, waist circumference, and percent body fat 

were positively correlated with higher insulin resistance. Smokers had higher insulin 

resistance than non-smokers. However, 90% of participants had a low long-term risk of 

developing cardiovascular disease and 10% of participants met the metabolic syndrome 

criteria. This study was cross-sectional and provided used self-selection sampling. 

Conclusion: Anthropometric measures and smoking were associated with higher insulin 

resistance in participants. Participants with metabolic syndrome (10%) were at a greater 

risk of developing type 2 diabetes mellitus. This study highlights the risk of diabetes and 

cardiovascular disease development, and the need for further research, in this Filipino 

migrant population. These findings also create a platform for improving New Zealand 

health programmes by targeting appropriate risk factors to improve insulin sensitivity and 

reduce risk of developing diabetes, and will help to raise awareness in the Filipino 

community. 

  



iii 
 

ACKNOWLEDGEMENTS 

First, I would like to acknowledge my almighty God, for his evident faithfulness and 

goodness throughout this time. 

A massive thank you to my academic supervisor Dr Pamela von Hurst. Always in hand 

with a supportive word of encouragement, your patience in answering my many queries 

is truly appreciated. Your knowledge and guidance has been invaluable throughout the 

entire process of my research. I am also very grateful to my co-supervisor Rachel Page, 

with her expertise in metabolic health, provided me with guidance throughout and 

assisted with the final editing of the writing process. 

I am also deeply indebted to Rio Monzales, it was a pleasure and honour working with 

you. I greatly appreciate all the time and hard work you put into recruiting the participants 

and making everything smooth sailing. I would also like to thank Owen Mugridge for 

your help during the data collection process. 

To the 62 participants involved in this study, I would also like to express a profound 

gratitude. This study could not have been successfully conducted without your 

willingness and contribution. 

I would also like to thank my friends and dietetic classmates who made the past two years 

a much richer experience. A special thank you to Melaney, Shivon, Anna, Emily, and 

Danika for the long-lasting friendships and memories we have created. To my inseparable 

classmate, friend, and flatmate, Dushanka, I want to express heartfelt thanks for your 

encouraging words and boundless support. We have been through a rollercoaster journey 

together and I could not imagine doing this without you by my side every step of the way. 

To Ernest, thank you for always listening and being my rock during the stormy times. 

I cannot end without expressing my sincerest gratitude towards my Mum and Dad, 

without whose unwavering love and support throughout my years of study this thesis 

would not have been possible. Thank you for always believing in me. Finally, I would 

also like to thank my sister, Melinda Norrish, for giving me much needed breaks during 

the research process and always supporting my dreams. 

 

 



iv 
 

TABLE OF CONTENTS 
ABSTRACT .................................................................................................................... II 

ACKNOWLEDGEMENTS ......................................................................................... III 

TABLE OF CONTENTS ............................................................................................. IV 

LIST OF TABLES ...................................................................................................... VII 

LIST OF FIGURES .................................................................................................. VIII 

LIST OF APPENDICES ............................................................................................. IX 

ABBREVIATIONS ........................................................................................................ X 

CHAPTER 1: INTRODUCTION .................................................................................. 1 

1.1 BACKGROUND .............................................................................................................. 1 

1.2 PURPOSE OF THE STUDY ................................................................................................. 4 

1.3 AIMS AND OBJECTIVES ................................................................................................... 4 

1.3.1 Aim .................................................................................................................... 4 

1.3.2 Objectives .......................................................................................................... 4 

1.4 THESIS STRUCTURE ........................................................................................................ 5 

1.5 RESEARCHERS’ CONTRIBUTIONS ....................................................................................... 5 

CHAPTER 2: LITERATURE REVIEW ...................................................................... 6 

2.1 FILIPINO MIGRATION INTO NEW ZEALAND ......................................................................... 6 

2.2 HEALTH OF FILIPINOS IN NEW ZEALAND ............................................................................. 7 

2.3 HEALTH OF IMMIGRATED FILIPINOS IN OTHER WESTERN COUNTRIES ...................................... 8 

2.4 ASIAN HEALTH IN NEW ZEALAND ................................................................................... 10 

2.5 DEFINING METABOLIC SYNDROME (METS) ...................................................................... 11 

2.6 RISK FACTORS FOR TYPE 2 DIABETES MELLITUS AND CARDIOVASCULAR DISEASE ..................... 12 

2.6.1 Risk Assessment of Cardiovascular Disease .................................................... 13 

2.6.2 Age .................................................................................................................. 14 

2.6.3 Atherogenic Dyslipidaemia ............................................................................. 14 

2.6.4 Insulin Resistance ............................................................................................ 15 

2.6.4.1 Measuring Insulin Resistance ............................................................................................ 16 

2.6.5 Hypertension ................................................................................................... 16 



v 
 

2.6.6 Diet .................................................................................................................. 18 

2.6.7 Physical Inactivity ............................................................................................ 20 

2.6.8 Cigarette Smoking ........................................................................................... 22 

2.6.9 Overweight/Obesity ........................................................................................ 23 

2.6.10 Socio-Economic Status .................................................................................. 24 

2.6.11 Sleep Disturbances ........................................................................................ 25 

2.6.12 Genetics ......................................................................................................... 27 

2.7 HEALTH CARE AND COST IMPLICATIONS ........................................................................... 27 

2.8 SUMMARY ................................................................................................................. 28 

REFERENCES ........................................................................ ERROR! BOOKMARK NOT DEFINED. 

CHAPTER 3: RESEARCH STUDY MANUSCRIPT ............................................... 30 

3.1 ABSTRACT.................................................................................................................. 32 

3.2 INTRODUCTION ........................................................................................................... 33 

3.3 MATERIALS AND METHODS ........................................................................................... 34 

3.3.1 Study participants ........................................................................................... 35 

3.3.2 Study design .................................................................................................... 35 

3.3.3 Criteria for the metabolic syndrome ............................................................... 35 

3.3.4 Health and demographic characteristics ........................................................ 35 

3.3.5 Anthropometric measurements ...................................................................... 36 

3.3.6 Total body composition ................................................................................... 36 

3.3.7 Biochemical measurements ............................................................................ 36 

3.3.8 Dietary assessment ......................................................................................... 37 

3.3.9 Physical activity ............................................................................................... 37 

3.3.10 Blood pressure ............................................................................................... 37 

3.3.11 Insulin resistance ........................................................................................... 37 

3.3.12 Cardiovascular risk assessment .................................................................... 38 

3.3.13 Statistical analysis ......................................................................................... 38 

3.4 RESULTS .................................................................................................................... 38 

3.5 DISCUSSION ............................................................................................................... 42 

3.6 ACKNOWLEDGEMENTS ................................................................................................. 46 

3.7 AUTHORS DISCLOSURES ............................................................................................... 46 



vi 
 

REFERENCES .................................................................................................................... 46 

CHAPTER 4: CONCLUSION-RECOMMENDATION ........................................... 53 

4.1 OVERVIEW ................................................................................................................. 53 

4.2 STRENGTHS ................................................................................................................ 53 

4.3 LIMITATIONS .............................................................................................................. 54 

4.4 FINAL RECOMMENDATIONS ........................................................................................... 55 

REFERENCES .................................................................................................................... 56 

APPENDICES ............................................................................................................... 72 

  



vii 
 

LIST OF TABLES 

TABLE 1.1 Researchers’ contributions  .........................................................................  5 

TABLE 2.1 Clinical diagnosis of metabolic syndrome using the modified NCEP ATP 
III definition  ..................................................................................................................  14 

TABLE 2.2 Traditional Filipino Foods  ........................................................................  21 

TABLE 3.1 WHO International BMI Classification ....................................................  52 

TABLE 3.2 Characteristics of all participants ..............................................................  55 

TABLE 3.3 Blood pressure and biochemical measurements of all participants  ..........  56 

TABLE 3.4 HOMA2-score and Framingham 30-year cardiovascular risk score of all 

participants  ....................................................................................................................  57 

TABLE 3.5 Dietary intake of all participants  ..............................................................  56 

 

 
  



viii 
 

LIST OF FIGURES 

FIGURE 1.1 Trends in diabetes prevalence in the Philippines and in New Zealand  ....  2 

FIGURE 2.1 Filipino Ethnic Group in New Zealand from the 2001, 2006, and 2013 
Censuses  ..........................................................................................................................  6 

FIGURE 2.2 Proportional mortality in the Philippines and New Zealand  ....................  9 

FIGURE 2.3 Adults with multiple chronic conditions in the United States, by non-
Hispanic Asian subgroup, 2010-2014  ...........................................................................  11 



ix 
 

LIST OF APPENDICES 

APPENDIX A Consent Form  ....................................................................................... 73 

APPENDIX B Information Sheet  ................................................................................. 74 

APPENDIX C Health and Demographics Questionnaire  ............................................. 78 

APPENDIX D 2-Day Food Diary  ................................................................................. 83 

APPENDIX E Physical Activity Diary  ......................................................................... 96 



x 
 

ABBREVIATIONS 

AHA   American Heart Association 

AMDR  Acceptable Macronutrient Distribution Range 

BMI   Body Mass Index 

CHIS   California Health Interview Survey 

CVD   Coronary Heart Disease 

cm   Centimetre 

CVD   Cardiovascular Disease 

DXA   Dual-Energy X-Ray Absorptiometry 

FNRI   Food and Nutrition Research Institute 

IDF   International Diabetes Foundation 

kg   Kilogram 

m   Metre 

MetS   Metabolic Syndrome 

MOH   Ministry of Health 

NCEP ATP III National Cholesterol Education Programme Adult Treatment 

Panel III 

NHIS  National Health Interview Survey 

NHLBI  National Heart, Lung and Blood Institute  

NRV   Nutrient Reference Value 

T2DM   Type 2 Diabetes Mellitus 

VAT    Visceral Adipose Tissue 

WC   Waist Circumference 

WHO   World Health Organisation 

WHR   Waist-to-Hip Ratio