Household social position, socio-cultural orientation and diabetes risk in obese African-American youth

Background: Type 2 diabetes and prediabetes have emerged as significant health issues in overweight/obese African-American pediatric populations. It is unclear whether social-contextual factors are directly linked to diabetes risk in minority youth. The primary aim of this study was to examine the relationships between household social position, socio-cultural orientation, insulin sensitivity and pancreatic beta-cell function in African-American children and adolescents. Methods: A convenience sample of 43 overweight/obese African-American boys and girls aged 8-18 years living in the greater Los Angeles area were included in this analysis. Household social position was calculated using the Hollingshead Two-Factor Index of Social Position. Socio-cultural orientation was assessed using a modified version of the Acculturation, Habits, and Interests Multicultural Scale for Adolescents questionnaire. Insulin sensitivity and pancreatic beta-cell compensation were derived from an intravenous glucose tolerance test. Results: Integration (the ability to integrate aspects of their own family's culture with those of mainstream white-American culture) was positively associated with acute insulin response (r=0.49, p<0.05) and disposition index (r=0.50, p<0.01). No significant relationships were observed between household social position and diabetes risk. Conclusions: Socio-cultural orientation appears to play a distinct role in the pathophysiology of type 2 diabetes in overweight/obese African-American youth. For African-American youth, the psychological strain of integrating into mainstream white-American society was associated with increased diabetes risk (represented as increased acute insulin response and disposition index). Behavioral interventions and public policies are needed to better address the increased diabetes risk associated with integrating into mainstream white-American society in African-American youth.