Background: Asian Indians are the 2nd largest Asian immigrants in the U.S. and have higher rates of diabetes, metabolic syndrome, and cardiovascular disease when compared to the general U.S. population and other immigrant groups. Acculturation levels influence the lifestyle practices and studies have reported acculturated individuals have increased risks for chronic diseases.

Aim: Hence, this study explored the mediating role of lifestyle behaviors (physical activity and dietary behavior) between acculturation and cardiometablic risk factors among Asian Indians using the DIA (Diabetes in Indian Americans)national study.

Methods: The sample comprised 1038 randomly selected adult Asian Indians in seven U.S. sites (mean age was 48.54 ±12.8 years). Acculturation was assessed using the English proficiency scores from the Acculturation Scale for Southeast Asians and dietary behavior and physical activity were calculated from the subscales of Health Promotion Lifestyle Profile II. Path analyses with bootstrap methods were used to explore if physical activity or dietary behavior mediates the relationship between acculturation and cardiometabolic risk factors (HbA1c, fasting blood glucose levels, Body Mass Index, systolic and diastolic blood pressure, and lipid profiles [HDL, LDL, total cholesterol, and triglycerides]).

Results: Dietary behavior significantly mediated the relationship between acculturation and HbA1C (β=0.004, p = .047) and physical activity mediated the relationship between acculturation and HDL (β=0.08, p = .011).All other mediation models were not significant (p>.05) based on the nonsignificant indirect effects detected in the models.

Conclusion: Culturally specific dietary education and physical activity interventions for this high risk ethnic group may have potential to reduce cardiometabolic risks. Results provide firm basis for educational program.


N. Mathew Joseph: None. R. Misra: None. J. Wang: None. S. Cron: None. P. Ramaswamy: None.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at