Concept, measurement and use of acculturation in health and disease risk studies.

Acculturation, a concept with its root in social science and cultural anthropology, is a process intimately related to health behavior and health status of minority populations in a multicultural society. This paper provides a brief review of the subject of acculturation as it relates to health research, showing that this concept has a potential to identify risk factors that underlie increased prevalence of chronic diseases, particularly in immigrant populations. A proper understanding of this is helpful in designing intervention programs to reduce the burden of such diseases and to increase the quality of life in such populations. The concept is defined with an outline of its history showing its evolution over time. Criteria for measuring acculturation are described to illustrate the need of accommodating its multidimensional features. Drawing examples from health research in US Hispanics, the role of acculturation on health behavior is discussed to document that the discordant findings are at least partially due to either use of incomplete dimensions of the concept, or not accounting for the dynamic aspect of its process. Finally, with illustration of a finding from a study among overweight Mexican American women of South Texas, a model of acculturation study is proposed that may be used in other immigrant populations undergoing the acculturation process.

Sensitivity and specificity of body mass index as a definition of the obesity component of metabolic syndrome.

Metabolic syndrome (MS) is a combination of risk factors that are associated with several chronic diseases. Its components (obesity, dyslipidemia, carbohydrate intolerance, hypertension, microalbumineria) are diverse, whose thresholds vary in different definitions of MS. For example, a World Health Organization (WHO) panel defined the obesity component of MS based on waist-hip ratio, or body mass index (BMI), while the National Cholesterol Education Program (NCEP) defined the obesity component of MS by waist circumference. Since BMI is the common measure of obesity in most epidemiological studies, this research addressed how accurately the obesity component of MS is captured by BMI alone. Data presented showed that in a population with high prevalence of obesity, the specificity of detecting the obesity component of MS by BMI alone is almost 100%, but the sensitivity is low (e.g., < 50%). Individuals with high BMI generally have large waist-hip ratio and wide waist circumference, but the converse is not necessarily true. Consequently, centralized obesity (a risk factor for several chronic diseases) is not always captured by a high BMI alone.

Migration history, health behaviors, and cardiovascular disease risk factors in overweight Mexican-American women.

PURPOSE: This research examined whether the migration history of overweight Mexican-American women had an independent effect on cardiovascular risk factors, or whether it was mediated by health behavior changes. DATA AND METHODS: Cross-sectional data from 390 overweight, non-diabetic Mexican-American women (aged 18 to 65 years), all recruited from Starr County, Texas, were used for this analysis. Migration history was inferred from birthplaces of subjects and relatives, and length of residence in the United States. Health behaviors included tobacco and alcohol use, sleeping, exercise, and dietary practices. The cardiovascular disease risk factor variables (CDRFVs) studied were plasma glucose, abdominal obesity, blood pressures, and blood lipids. A migration history score (MHS) was developed from factor analysis, almost equally contributed to by the 9 migration history variables. Healthy habits were defined by 6 variables, and 3 factors (blood pressures, lipids/glucose, and body fat/glucose) were used for the CDRFVs. FINDINGS AND CONCLUSION: MHS was correlated positively with socioeconomic status, and negatively with family stress. Older women had healthier drinking and sleeping habits. Women with a higher migration history score exhibited poorer exercise habits, and increased blood pressures. After adjusting for the effect of healthy exercise habits on blood pressures, the impact of migration history on blood pressures became non-significant (P>.05), leading to the conclusion that healthy exercise behaviors mediated the negative relationship of MHS with blood pressures. Age was independently positively correlated with all CDRFVs. Age also weakly moderated the negative relationship of MHS and healthy exercise habits.

Obesity and upper body fat distribution in Mexican American children from families with a diabetic proband.

Upper and centralized body fat distribution is associated with non-insulin dependent diabetes mellitus (NIDDM). Few studies have focused on anthropometric characteristics of preadults from families in which there is a diabetic (NIDDM) proband. This study explores the prevalence of upper and centralized body fatness in Mexican American children from the Diabetes Alert study (1981-1983) in Starr County, Texas. Anthropometric data on 165 males and 224 females 9-19 years include measures of adiposity such as skinfold thicknesses and the body mass index (BMI), a measure of overweight. They show rates of obesity two to three times that of White children of comparable age and sex from National Health Surveys. In comparison with U.S. White subjects, Mexican American adults are shorter, have more adiposity and arm muscle mass and have sitting heights and body breadths at the mean of these dimensions for the U.S. POPULATION: Children from Diabetes Alert families show only marginal excess of severe obesity (> 95th percentile of BMI) when compared to the general population of children surveyed in Starr County schools. Girls from these families, but not boys, have excess fatness in the BMI compared to Mexican American children from the Hispanic Health and Nutrition Examination Survey (HHANES); suprailiac skinfold thicknesses are also greater in children of the Diabetes Alert study than in HHANES children. From 1972 through 1982, Mexican American children in South Texas showed an increase in average stature, weight, and the BMI. These data together suggest that excessive obesity exists and may be increasing in children in populations at risk for NIDDM. The prevention of NIDDM in the Mexican American population may be more effective if educational and promotional interventions include the school aged population. © 1993 Wiley-Liss, Inc.