Background: Asian Indian adults in the U.S. (~1% of the total population) have a high prevalence of type 2 diabetes (ranging from 17%-29%) and other diet-related problems. A key associative factor could be unhealthy changes in dietary practices because exposure to the host culture may potentially negatively change dietary behaviors and food preparation practices (dietary acculturation). An assessment of dietary acculturation using an appropriate and culturally sensitive measure is therefore critical for understanding if and how dietary changes occur in those who relocate to another country. This will facilitate the efficacy of culturally sensitive interventions. Specific aims: The three specific aims of this study were: (i) to qualitatively examine the factors influencing the dietary acculturation behaviors of Asian Indian adults in the U.S., (ii) to develop a culturally sensitive, reliable and valid Asian Indian Dietary Acculturation Measure (AIDAM), and (iii) to examine the relationship between AIDAM scores and the risk for type 2 diabetes among Asian Indians. Methods: For specific aim 1, eight audio-taped focus group discussions (2-5 members/ group) and assessment of typical weekday and weekend 24 hour dietary recalls were conducted with 30 Asian Indian adults in Michigan. Verbatim focus group transcripts and dietary recalls were qualitatively analyzed for generating themes. To accomplish specific aim 2, themes that evolved from the focus group discussions were used to generate items for the AIDAM, which was revised by 10 experts in nutrition/survey research and pre-tested with 12 Asian Indians. A web-based study was conducted with 225 Asian Indians in the U.S. to determine the reliability and validity of AIDAM. A Rasch rating scale model was used to determine reliability and construct validity. To achieve specific aim 3, the Finnish Diabetes Risk Score (FINDRISC), a validated tool to determine diabetes risk in 10 years was completed with the web-survey. The associations between AIDAM and FINDRISC scores were examined using correlations and relative risk ratios.Results: The key reported factors that emerged relative to modification of traditional eating behaviors were: social independence, social network influences, increased health awareness, sub-standard taste and increased cost of Asian Indian foods, time constraints, and convenience (specific aim 1). These findings were used for generating AIDAM items. The estimates from Rasch model analysis showed the 50 item AIDAM to be a reliable and valid measure with reliability of 0.88. The infit and outfit MNSQ statistics of the items were within the range of 0.58 - 0.61 indicating good model fit (specific aim 2). Comparison of AIDAM with FINDRISC scores showed that adaptation to the U.S. dietary practices by Asian Indians (AIDAM scores >2.8) increased the likelihood of developing type 2 diabetes (relative risk 1.6, confidence interval 1.02-2.51) (specific aim 3). Conclusion: This dissertation: (i) documented dietary behaviors and influential factors of Asian Indian adults over time in the U.S., (ii) utilized findings for the development of a validated dietary acculturation assessment tool, and (iii) showed the association of AIDAM with type 2 diabetes risk. These findings are relevant for nutrition/health professionals to better understand Asian Indian food choices over time and health implications.
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