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Network member characteristics and their perceived dietary behaviors were correlated with dietary patterns of egos. Dietary intervention studies among South Asians should consider social network characteristics as candidate components for dietary intervention.

South Asians are one of the fastest growing ethnic groups in the United States. Previous studies have shown higher risk of cardiovascular disease (CVD) and diabetes among South Asians [14, 15], and there is a paucity of evidence documenting effective interventions to improve diet quality and lower their risks. Current intervention programs focus on changing individual behaviors and based on western biomedical models and diets are not effective at reaching South Asians for several reasons. The vast majority of South Asians are immigrants who follow distinct dietary patterns with strong family and community structures that reinforce existing customs and norms related to foods [16]. Yet, little is known about the influence of social relationships on diet quality and dietary patterns in this high-risk group. Filling knowledge gaps about potential network drivers of diet quality in South Asians can help investigators develop more effective dietary interventions. Therefore, the overall goal of our study was to examine the correlations between social networks and diet quality examined using dietary patterns among South Asians in the U.S..

Socio-demographic characteristics were reported with means and standard deviation (SD) or percentage. The most basic measure of personal network structure was degree: the number of network members reported. The remaining network variables were calculated using information on the first five alters listed in response to the name generator question. The proportion of the social network members with each dietary behavior was calculated and used for analysis. We also calculated the average number of organizational affiliations for each participant.

We used residual diagnostics to assess the linearity of the relationship between dietary pattern scores and perceived dietary intake of network members. Partial correlations were used to assess the correlation between dietary pattern factor score and social network characteristics adjusting for ego age, gender, study site, education, income, marital status, traditional cultural beliefs, caloric intake, social network size, self-rated health, intentional exercise and percent life in the U.S.. When calculating correlations, network characteristics and dietary pattern factor scores were analyzed in their original (continuous) scale in order to better preserve relationships between dietary patterns and network characteristics and also to avoid the loss of statistical power that would be the result of collapsing continuous data into discrete categories.

Social network characteristics and perceived dietary intakes and behaviors of social network members are correlated with dietary patterns in a community-based cohort of middle aged and older South Asians in the U.S.. Higher fruits, vegetables, nuts and legumes dietary pattern scores of egos were associated with a higher proportion of networks consuming vegetables and fruit daily and brown rice or quinoa. Higher scores on the animal protein pattern were associated with a higher proportion of network members following a non-vegetarian style diet and consuming processed meat, diet drinks and fried foods. Finally, higher scores on the fried snacks, sweets and high-fat dairy pattern were associated with a higher proportion of networks consuming more sugar-sweetened beverages, ghee, South Asian sweets, fried and fast foods and less brown rice or quinoa.

Our findings on significant correlations between the fruits, vegetables, nuts and legumes pattern and network intakes of fruits and vegetables were consistent with previously published literature. In a study using data from the Harvard Cancer Prevention Program Project, individuals whose family and friends met the standard of consuming at least 5 servings of fruits and vegetables per day were more likely themselves to consume at least five servings of fruits and vegetables per day [27]. It is important to note that it is not just healthy habits or dietary patterns that may be transmitted between egos and their social networks; in a cross-sectional analysis of dietary behaviors among middle-aged mostly African American public housing women residents showed higher daily added sugar consumption was significantly associated with higher proportion of their networks who had higher daily sugar-sweetened beverage and sweets consumption [12]. Our study supports this finding since there were correlations between perceived consumption of sugar-sweetened beverages, fried foods, fast foods and the less healthy fried snacks, sweets, and high fat pattern in this South Asian cohort, as well as the animal protein pattern and network consumption of processed meat.

The role and influence of social networks on dietary behaviors is an important factor that should not be neglected in lifestyle intervention programs. In a community participatory research project including men and women in the Brazilian Amazon for reducing methylmercury from fish consumption, dietary behavior change for fish intake was associated with increased numbers of discussion partners whom participants could talk with about adoption new fish intake behavior [28]. The Entre Familia: Reflejos de Salud Study also showed that sharing program materials on how to improve dietary behaviors with others was associated with an increase in fiber intake among U.S. Latino families [29]. Dietary behavior change caused by interpersonal interaction within social networks may be explained by the Diffusion of Innovations Theory and Social Comparison Theory [30]. The Diffusion of Innovation Theory focuses on the spread of new ideas within networks, and supports the idea that individuals are more likely to adopt new healthy dietary behaviors if their network members discuss these with them, and individuals are more likely to change their behaviors if they share similar culture, traditions, health practice and environment with their networks [31]. The Social Comparison Theory explains self-evaluation by comparing oneself with others, especially among individuals within a social network. Because network members may have similar values and knowledge, individual behaviors or attitudes towards healthy eating may change or be maintained via communication with or observation of network members behaviors since individuals tend to conform to others in the social group in order to keep appropriate behaviors within the social group [30].

The supportive role of social network members on encouraging healthy eating and healthy foods selection is also important for dietary behavior change. Families and close friends have an influential role on dietary intake because they often eat together and comments on food selected and consumed can be frequent, and individuals can be more motivated on behavior change by the support of families and friends. We recently reported that positive role modeling and support from adult children were important facilitators of healthy dietary changes in older South Asians, suggesting that adult children may be influential network members in South Asian families [32]. Results from the Mexican American mother-daughter dyads of Unidas por la Vida intervention, demonstrated that participants in the intervention group tend to have low glycemic load diet and consume less saturated fat which may be explained by the greater health-related social support and social control persuasion from their network members [33]. Also, intervention program participants can influence others to achieve dietary behavior change. In the Healthy-Living Partnerships to Prevent Diabetes study, participants in the intervention group indicated better perceived change on dietary and physical activity behaviors among their network members who provided social support [34].

This study showed that social network characteristics and perceived dietary behaviors of network members were correlated with dietary patterns of South Asian immigrants in the U.S. Dietary behaviors may spread within social network group and assist in behavior change. Dietary intervention studies among South Asians should consider social network characteristics as candidate components for dietary intervention.

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