Association of Acculturation Levels and Prevalence of Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA)

Division of General Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
Diabetes care (Impact Factor: 8.42). 05/2008; 31(8):1621-8. DOI: 10.2337/dc07-2182
Source: PubMed


The prevalence of type 2 diabetes among Hispanic and Asian Americans is increasing. These groups are largely comprised of immigrants who may be undergoing behavioral and lifestyle changes associated with development of diabetes. We studied the association between acculturation and diabetes in a population sample of 708 Mexican-origin Hispanics, 547 non-Mexican-origin Hispanics, and 737 Chinese participants in the Multi-Ethnic Study of Atherosclerosis (MESA).
Diabetes was defined as fasting glucose >/=126 mg/dl and/or use of antidiabetic medications. An acculturation score was calculated for all participants using nativity, years living in the U.S., and language spoken at home. The score ranged from 0 to 5 (0 = least acculturated and 5 = most acculturated). Relative risk regression was used to estimate the association between acculturation and diabetes.
For non-Mexican-origin Hispanics, the prevalence of diabetes was positively associated with acculturation score, after adjustment for sociodemographics. The prevalence of diabetes was significantly higher among the most acculturated versus the least acculturated non-Mexican-origin Hispanics (prevalence ratio 2.49 [95% CI 1.14-5.44]); the higher the acculturation score is, the higher the prevalence of diabetes (P for trend 0.059). This relationship between acculturation and diabetes was partly attenuated after adjustment for BMI or diet. Diabetes prevalence was not related to acculturation among Chinese or Mexican-origin Hispanics.
Among non-Mexican-origin Hispanics in MESA, greater acculturation is associated with higher diabetes prevalence. The relation is at least partly mediated by BMI and diet. Acculturation is a factor that should be considered when predictors of diabetes in racial/ethnic groups are examined.

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    • "Furthermore, maintenance of healthful diets, regular physical activity, and other self-care behaviors may be more difficult for poorer patients (25,26). In contrast, the direct relationship between income and complications in South Asian populations may reflect the effects of acculturation, because wealthier individuals often adopt more westernized lifestyles and diets (27,28). Thus our data show that European populations demonstrate the typical socioeconomic gradient seen in high-income countries, where cardiovascular disease, its risk factors, and other diseases are more common among the poor (29). "
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    • "While disease prevalence has been shown to vary by Hispanic subgroups [11-14], few studies have examined the differential effect of acculturation across Hispanic subgroups defined by country of origin. Acculturation is defined as a multidimensional process through which foreigners adopt the customs of a host country [13]. "
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    • "For example, rates of cardiovascular disease among Latinos increase with the length of time spent living in the United States (Koya & Egede, 2007). Likewise, National Health and Nutrition Examination Survey III (NHANES III) data demonstrate that a significant positive correlation exists between acculturation and rates of type 2 diabetes mellitus among non-Mexican origin Latinos (Kandula et al., 2008). "
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