Do Cultural and Psychosocial Factors Contribute to Type 2 Diabetes Risk? A Look Into Vancouver's South Asian Community.
OBJECTIVES: South Asian immigrants are generally healthy upon arrival, but precipitously develop diabetes after immigration. Whether cultural and psychosocial factors contribute to diabetes risk in this ethnic minority group remains unclear. Existing prediction models focus primarily on clinical and lifestyle factors. This study explored whether nontraditional risk factors are incrementally predictive beyond traditional risk factors in this South Asian community.
METHODS: In this cross-sectional study, we recruited 425 South Asian adults attending Sikh and Hindu temples in Metro Vancouver between July 2013 and June 2014. We measured traditional risk factors, including glycated hemoglobin (A1C), apolipoprotein B, systolic and diastolic blood pressure (BP), waist circumference, weight, body mass index (BMI), dietary patterns and physical activity level. Self-report questionnaires assessed cultural and psychosocial factors, including acculturation, dinnertime (timing of the evening meal), religion and depressive symptoms. We constructed a penalized multivariable linear model with A1C level using the least absolute shrinkage and selection operator (LASSO) approach to overcome issues of overfitting and reduce prediction error of previous diabetes prediction models.
RESULTS: The LASSO model selected 24 risk factors for the optimal model to predict glycemic control. Results revealed that higher degree of acculturation (p=0.007), later dinnertime (p=0.01) and greater depressive symptoms (p=0.038) are important factors in diabetes risk in addition to traditional risk factors (fruit/vegetable/fibre intake, BMI and systolic BP).
CONCLUSIONS: Nontraditional factors, such as cultural practices and emotional functioning, are also important predictors of diabetes risk and should be considered when culturally tailoring diabetes prevention programs.