The Relationship of Acculturation to Cardiometabolic Risk Factors among U.S. South Asians—Findings from the MASALA Study

Background: Immigration and the process of acculturation can lead to behavioral changes that exacerbate or reduce diabetes development. We investigated the association between acculturation strategies and cardiometabolic risk (CMR) factors among South Asian (SA) immigrants living in the U.S.

Methods: Participants (n=849) in the Mediators of Atherosclerosis in SA Living in America (MASALA) study were categorized into 3 acculturation strategy classes based on self-reported questionnaire responses: separation (preference for SA culture), assimilation (preference for U.S. culture), and integration (similar preference for SA and U.S. cultures). Adjusted linear regression models examined associations of acculturation strategies with fasting and 2 hour glucose, lipids, blood pressure, waist circumference (WC), and body composition.

Results: Overall, 22.4, 19.6, and 58% of men and 23.7, 26.2, and 50.1% of women were in separation, assimilation, and integration classes; respectively. Participants in the assimilation class had significantly lower levels of obesity, 2 hour glucose, insulin, HOMA-IR, triglycerides (TG), visceral fat, and higher HDL than those in the separation class (all p<0.05). In sex-stratified analyses, after adjusting for education, income, other socioeconomic variables, physical activity, caloric intake, depression, smoking, and alcohol intake, women in the assimilation class continued to have significantly lower TG and higher HDL levels compared to women in the separation class [β (95% CI): -23.7 (-41.9, -5.5) and 7.5 (2.9, 12.1); respectively]. There was no significant association between acculturation and CMR factors in men.

Conclusion: SA women who employed an assimilation strategy had a more favorable CMR profile compared to women using a separation strategy. Future research should investigate the behavioral pathways linking acculturation strategies with CMR and potential incorporation into prevention interventions.