Acculturation and Healthy Lifestyle Among Latinos With Diabetes

Arch G. Mainous; Vanessa A. Diaz; Mark E. Geesey

doi:10.1370/afm.814

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Table 1.

Demographic Characteristics, Access to Care, and Lifestyle Indicators Among Respondents According to SAS Score and Country of Birth^a

		SAS Score			Country of Birth
Measure	Total	0	1–20	P Value^b	Other	United States	P Value^b
SAS = Short Acculturation Scale; BMI = body mass index.
Note: Individuals were considered to be acculturated if they had an SAS score of 1 to 20 or if they were born in the United States.
^a Values are percentages of individuals.
^b Calculated by the χ² test.
^c The 1994 American Diabetes Association dietary recommendations for diabetes.
^d The 2006 American Diabetes Association dietary recommendations for diabetes.
US population estimate, No, %	1,957,778	31.0	69.0	–	63.9	36.1	–
Demographics
Age ≥65 years	23.1	29.8	20.1	.12	21.4	25.4	.34
Male	47.4	31.0	54.7	.006	50.1	44.7	.46
Annual family income ≥$20,000	52.3	42.1	56.5	.03	50.3	57.2	.24
Poverty-income ratio ≥1.0	72.5	68.5	74.1	.42	74.0	70.5	.53
High school graduate	41.7	15.1	53.6	<.001	31.6	61.9	.01
Access to care
Health insurance
Public	38.7	41.9	37.3	.01	34.3	45.3	.13
Private	36.0	20.0	42.8		34.0	41.8
None	25.3	38.1	19.9		31.7	12.9
Have a routine place for care	94.9	89.2	97.4	.01	93.7	97.3	.17
Healthy lifestyle
Current smoker	24.3	17.1	27.4	.22	21.2	28.5	.36
BMI
<25 kg/m²	19.0	16.5	20.1	.88	17.5	20.8	.93
25–29.9 kg/m²	36.8	37.4	36.6		36.3	36.5
≥30 kg/m²	44.2	46.1	43.3		46.2	42.6
Exercise
None	53.2	80.7	40.8	<.001	61.9	36.2	.06
Moderate or vigorous	46.8	19.3	59.2		38.1	63.8
Daily fiber intake
≥20 g^c	31.2	33.2	30.3	.69	32.1	32.3	.98
≥14 g/1,000 kcal^d	17.5	35.4	9.4	.001	21.0	10.7	.04
Daily cholesterol intake
≤300 mg^c	59.8	65.0	57.5	.28	66.9	48.5	.03
<200 mg^d	43.5	50.4	40.3	.23	47.8	38.0	.18
Saturated fat intake
<10% of total kcal^c	53.0	76.3	42.4	.001	62.2	34.0	.001
<7% of total kcal^d	26.4	46.5	17.2	.03	34.1	11.2	.003

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Table 2.

Lifestyle Indicators Among Respondents According to Poverty-Income Ratio, Education, and Health Insurance Status^a

	Poverty-Income Ratio			High School Graduate			Health Insurance Status
Lifestyle Indicator	<1.0	≥1.0	P Value^b	No	Yes	P Value^b	Public	Private	None	P Value^b
BMI = body mass index.
^a Values are percentages of individuals.
^b Calculated with the χ² test.
^c The 1994 American Diabetes Association dietary recommendations for diabetes.
^d The 2006 American Diabetes Association dietary recommendations for diabetes.
Smoker	21.8	26.4	.57	19.2	30.2	.20	23.7	20.7	32.2	.53
BMI
<25 kg/m²	30.2	14.5	.29	18.1	19.4	.98	21.4	15.3	18.5	.10
25–29.9 kg/m²	35.6	38.7		36.7	35.9		42.8	42.4	25.0
≥30 kg/m²	34.2	46.8		45.2	44.7		35.8	42.3	56.5
Exercise
None	56.5	50.2	.41	66.3	33.8	.009	60.4	37.5	64.5	.06
Any	43.5	49.8		33.7	66.2		39.6	62.5	35.5
Fiber intake
≥20 g^c	29.2	35.3	.36	26.7	39.7	.19	30.1	30.8	42.1	.35
≥14 g/1,000 kcal^d	21.2	16.2	.30	22.0	11.1	.06	17.0	12.6	25.1	.29
Daily cholesterol intake
≤300 mg^c	63.1	59.1	.63	70.2	46.7	.02	69.7	30.9	48.0	.09
<200 mg^d	46.8	43.8	.69	50.5	35.7	.06	52.2	45.6	30.4	.13
Saturated fat intake
<10% total kcal^c	49.7	51.5	.88	61.5	39.3	.02	52.1	52.8	46.9	.91
<7% total kcal^d	24.1	26.1	.81	28.4	22.7	.36	22.3	31.3	20.8	.48

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Table 3.

Relative Odds of Healthy Dietary Indicators for Latino Individuals With Diabetes Having an SAS Score of 1 to 20 vs an SAS Score of 0

Dietary Indicator	Odds Ratio (95% Confidence Interval)^a
SAS = Short Acculturation Scale; ADA = American Diabetes Association.
^a All models are adjusted for age-group, sex, family income, education level, health insurance, years with diabetes, whether the individual had a routine place for health care, and whether the individual had retinopathy, hypertension, and high cholesterol.
1994 ADA dietary recommendations
Daily fiber intake ≥20 g	0.58 (0.26–1.30)
Daily cholesterol intake ≤300 mg	1.30 (0.65–2.56)
Saturated fat intake <10% of total kcal	0.13 (0.04–0.41)
2006 ADA dietary recommendations
Daily fiber intake ≥14 g/1,000 kcal	0.19 (0.08–0.48)
Daily cholesterol intake <200 mg	0.70 (0.38–1.30)
Saturated fat intake <7% of total kcal	0.06 (0.02–0.20)

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Table 4.

Relative Odds of Healthy Dietary Indicators for Latino Individuals With Diabetes Born in the United States vs Born Elsewhere

Dietary Indicator	Odds Ratio (95% Confidence Interval)^a
ADA = American Diabetes Association.
^a All models are adjusted for age-group, sex, family income, education level, health insurance, years with diabetes, whether the individual had a routine place for health care, and whether the individual had retinopathy, hypertension, and high cholesterol.
1994 ADA dietary recommendations
Daily fiber intake ≥20 g	1.10 (0.49–2.48)
Daily cholesterol intake ≤300 mg	0.48 (0.22–1.02)
Saturated fat intake <10% of total kcal	0.38 (0.13–1.08)
2006 ADA dietary recommendations
Daily fiber intake ≥14 g/1,000 kcal	0.63 (0.29–1.40)
Daily cholesterol intake <200 mg	0.58 (0.28–1.23)
Saturated fat intake <7% of total kcal	0.15 (0.04–0.54)

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The Article in Brief

Acculturation and Healthy Lifestyle Among Latinos With Diabetes

Arch G. Mainous III, PhD , and colleagues

Background Latinos have higher rates of diabetes than non-Latino whites. Furthermore, diabetes is more common among Latinos who are less acculturated to the majority US culture. This study explores the relationship between acculturation and a healthy lifestyle in Latinos with diabetes in the United States.

What This Study Found Less acculturated Latinos with diabetes tend to have a healthier (high-fiber, low-fat) diet than their more acculturated counterparts. Acculturation appears to have a positive influence on exercise habits, with more-acculturated individuals more likely to report leisure time exercise.

Implications

For Latinos, adopting an �American� diet may not be a desirable change in behavior.
Understanding the process of acculturation is important when encouraging patients to maintain healthy traditional behaviors while adopting beneficial aspects of the mainstream culture.