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Diabetes Care Publish Ahead of Print published online ahead of print May 5, 2008
DOI: 10.2337/dc07-2182
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Original Research

Association of acculturation levels and prevalence of diabetes mellitus in the Multi-ethnic Study of Atherosclerosis (MESA)

Namratha R. Kandula, MD, MPH1, Ana V. Diez-Roux, MD, PhD2, Cheeling Chan, MS3, Martha L. Daviglus, MD, PhD3, Sharon A. Jackson, PhD4, Hanyu Ni, PhD, MPH5 and Pamela J. Schreiner, MS, MS, PhD6

1Northwestern University, Feinberg School of Medicine, Division of General Internal Medicine
2University of Michigan, Department of Epidemiology
3Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine
4Contractor, Northrop Grumman, Centers for Disease Control and Prevention
5Division of Epidemiology and Clinical Application, National Heart, Lung, and Blood Institute, National Institutes of Health
6University of Minnesota, Division of Epidemiology & Community Health

ABSTRACT

Objective: The prevalence of type 2 diabetes mellitus (DM) 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 DM. We studied the association between acculturation and DM 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.

Research Design and Methods: DM was defined as fasting glucose ≥126 mg/dl and/or use of anti-diabetic 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 0-5; 0=least acculturated and 5=most acculturated. Relative risk regression was used to estimate the association between acculturation and DM.

Results: For non-Mexican-origin Hispanics, the prevalence of DM was positively associated with acculturation score, after adjusting for socio-demographics. The prevalence of DM was significantly higher among the most acculturated vs. the least acculturated non-Mexican-origin Hispanics (Prevalence ratio= 2.49; 95% CI=1.14 –5.44); the higher the acculturation score, the higher the prevalence of DM (P-value for trend=0.059). This relationship between acculturation and DM was partly attenuated after adjusting for BMI or diet. Diabetes prevalence was not related to acculturation among Chinese or Mexican-origin Hispanics.

Conclusion: Among non-Mexican-origin Hispanics in MESA, greater acculturation is associated with higher DM prevalence. The relation is at least partly mediated by BMI and diet. Acculturation is a factor that should be considered when examining predictors of DM in racial/ethnic groups.


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