Festival foods in the immigrant diet

Exploring Disparities in Dietary Quality Among Young Children Across Diverse Racial, Ethnic, and Immigrant Households

Background: Although racial, ethnic minorities, and immigrants are more likely to have poor diet-related health outcomes, few studies have compared children's dietary quality across diverse households, which is the formative step to designing targeted interventions. The current study evaluates and compares the dietary quality of young children from diverse racial, ethnic, and immigrant households in Nebraska. Methods: Cross-sectional survey data were collected from adults living in Nebraska with at least one 2-6-year-old child residing in their household via an online survey regarding their federal assistance program participation and dietary quality of child(ren) residing in their household, measured using the short Healthy Eating Index (sHEI). Results: With nearly two-third participating in a federal assistance program, the sample includes respondents from diverse households (n = 1,277) including first-generation immigrant (n = 61), non-immigrant Hispanic (n = 538), non-immigrant non-Hispanic White (n = 509), non-immigrant non-Hispanic Black or African American (n = 120), and non-Hispanic American Indian or Native Hawaiian (n = 49). Based on analysis of covariance controlling for demographic variables, children from immigrant households had lower mean sHEI score 43.9 as compared to non-immigrant Hispanic 46.4, non-immigrant non-Hispanic White 47.1, non-immigrant non-Hispanic Black or African American 50.2, and non-Hispanic American Indian or Native Hawaiian 48.9. Racial/ethnic/immigrant household group differences were also observed for some sHEI component scores. Conclusions: Children from immigrant and non-immigrant Hispanic households had significantly lower sHEI scores on some subcomponents compared with other groups. Findings emphasize the need for additional research and culturally responsive multilevel nutrition interventions.

Reassessing Established Assumptions of Dietary Habits in the USA in the Context of Migration and Acculturation: a Qualitative Study of Latino Immigrants

INTRODUCTION

The growing prevalence of obesity in the USA disproportionately affects Latinos compared to non-Latino Whites. Immigration and acculturation have been associated with unhealthy dietary shifts among Latino immigrants, a phenomenon known as dietary acculturation. Emerging evidence points to a more nuanced relationship between dietary habits, immigration, and acculturation, highlighting the need for a more current comprehension of dietary acculturation.

OBJECTIVE

We explored how Latino immigrants' experiences in migrating to the USA have affected their perceived dietary habits and their experiences of how supportive the USA is in establishing healthy practices compared to their native country.

METHODS

Employing a descriptive qualitative study design, we conducted semi-structured interviews with 19 Latinos who had participated in a lifestyle change program between 2016 and 2019. We used thematic analysis to analyze the data and report emerging themes.

RESULTS

Participants expressed divergent perceptions of their dietary habits post-immigration. Some affirmed prevailing assumptions of dietary acculturation, citing deteriorating diet quality in the USA in the context of a faster pace of life, healthier options in the native country, and shifts in the food environment that prevented access to healthy foods. Conversely, others held opposing views, attributing their perceived improved diet to unhealthy dietary habits in Latin America, coupled with increased access to and affordability of healthy foods in the USA.

CONCLUSION

Our study contributes to the evolving understanding of dietary acculturation among Latino immigrants and provides a more nuanced and updated understanding of this process that reflects their current experiences in acculturating to the USA.

The influence of multicultural experience on attitudes towards new foods in the U.S

Many people are resuming overseas sojourns for tourism, studying abroad, and emigration to foreign countries, contributing to the increasingly diverse population in the United States. Thanks to the growing ethnic and racial diversity, American consumers can access global cuisine and are exposed to different cultures and media influences. Previous studies have highlighted the significance of comprehending the cultures of ethnic minorities and their cultural dimensions in the context of marketing context. There is still a research gap in discussing the effect of multicultural experience on attitudes towards foods. This study evaluates the role of sociocultural factors, such as traveling and sojourning and multicultural sensitivity, on consumers' attitudes toward new foods in the United States. The results show significant effects of sociocultural factors and consumers' perceptions of cultural differences on consumers' openness to new foods. The findings provide insights into the food industry and policymakers regarding approvals and market strategies for introducing new and foreign imported foods. Additionally, the results help retail and restaurant entrepreneurs better target their intended market and consumers.

Acculturating to multiculturalism: a new dimension of dietary acculturation among Asian American, Native Hawaiian, and Pacific Islander women in the San Francisco Bay Area, USA

BACKGROUND

Dietary acculturation is the process by which diet and dietary practises from the environment of origin are retained or changed and/or those prevalent in a new environment are adopted. Despite rapid population growth the U.S., knowledge gaps exist on characterising dietary acculturation among Asian American, Native Hawaiian, and Pacific Islander communities (AANHPI). This study characterise dietary patterns in a sample representative of AANHPI on key demographic characteristics.

METHODS

Data were from a 2013-2014 population-based case-control study in the San Francisco Bay Area, U.S. Survey items were adapted from dietary acculturation scales developed for AANHPI populations. Validated measures assessed social capital, social standing, discrimination and immigration experiences. A principal components factor analysis was conducted to characterise dietary patterns of acculturation.

RESULTS

Three dietary patterns were identified: "Asian," "Western," and a distinct "Multicultural" factor. Respondents reporting a high-Asian diet tended to also report smaller social networks, higher levels of stress, and, among those born outside of the U.S., an educational standing that was better before immigration. Respondents reporting a high-Western diet tended to also report the highest level of discrimination. Those reporting a high-Multicultural diet tended to report higher neighbourhood collective efficacy.

CONCLUSIONS

The finding of a distinct "Multicultural" factor beyond the typical "Asian" and "Western" factors may reflect the multidirectional relationships between culture, diet, and dietary behavior, in which origin and destination cultures interact in complex ways and where foods from multiple ethnicities intermix.

Understanding the determinants of sweet taste liking in the African and East Asian ancestry groups in the U.S.-A study protocol

BACKGROUND

The liking for sweet taste is a powerful driver for consuming added sugars, and therefore, understanding how sweet liking is formed is a critical step in devising strategies to lower added sugars consumption. However, current research on the influence of genetic and environmental factors on sweet liking is mostly based on research conducted with individuals of European ancestry. Whether these results can be generalized to people of other ancestry groups warrants investigation.

METHODS

We will determine the differences in allele frequencies in sweet-related genetic variants and their effects on sweet liking in 426 adults of either African or East Asian ancestry, who have the highest and lowest average added sugars intake, respectively, among ancestry groups in the U.S. We will collect information on participants' sweet-liking phenotype, added sugars intake (sweetness exposure), anthropometric measures, place-of-birth, and for immigrants, duration of time living in the U.S. and age when immigrated. Ancestry-specific polygenic scores of sweet liking will be computed based on the effect sizes of the sweet-related genetic variants on the sweet-liking phenotype for each ancestry group. The predictive validity of the polygenic scores will be tested using individuals of African and East Asian ancestry from the UK Biobank. We will also compare sweet liking between U.S.-born individuals and immigrants within each ancestry group to test whether differences in environmental sweetness exposure during childhood affect sweet liking in adulthood.

DISCUSSION

Expanding genetic research on taste to individuals from ancestry groups traditionally underrepresented in such research is consistent with equity goals in sensory and nutrition science. Findings from this study will help in the development of a more personalized nutrition approach for diverse populations.

TRIAL REGISTRATION

This protocol has been preregistered with the Center for Open Science (https://doi.org/10.17605/OSF.IO/WPR9E).

Understanding the Determinants of Sweet Liking in the African and East Asian Ancestry Groups in the U.S. - A Study Protocol

Background

The liking for sweet taste is a powerful driver for consuming added sugars, and therefore, understanding how sweet liking is formed is a critical step in devising strategies to lower added sugars consumption. However, current research on the influence of genetic and environmental factors on sweet liking is mostly based on research conducted with individuals of European ancestry. Whether these results can be generalized to people of other ancestry groups warrants investigation.

Methods

We will determine the differences in allele frequencies in sweet-related genetic variants and their effects on sweet liking in 426 adults of either African or East Asian ancestry, who have the highest and lowest average added sugars intake, respectively, among ancestry groups in the U.S. We will collect information on participants' sweet-liking phenotype, added sugars intake (sweetness exposure), anthropometric measures, place-of-birth, and for immigrants, duration of time living in the U.S. and age when immigrated. Ancestry-specific polygenic scores of sweet liking will be computed based on the effect sizes of the sweet-related genetic variants on the sweet-liking phenotype for each ancestry group. The predictive validity of the polygenic scores will be tested using individuals of African and East Asian ancestry from the UK Biobank. We will also compare sweet liking between U.S.-born individuals and immigrants within each ancestry group to test whether differences in environmental sweetness exposure during childhood affect sweet liking in adulthood.

Discussion

Expanding genetic research on taste to individuals from ancestry groups traditionally underrepresented in such research is consistent with equity goals in sensory and nutrition science. Findings from this study will help in the development of a more personalized nutrition approach for diverse populations.

Trial registration

This protocol has been preregistered with the Center for Open Science (https://doi.org/10.17605/OSF.IO/WPR9E) and is approved by the City University of New York Human Research Protection Program (IRB#: 2023-0064-Brooklyn).

Post-migration food habits of New Zealand South Asian migrants: Implications for health promotion practice

Introduction

South Asian migrants in western countries have a high risk for diet related diseases post-migration. Hence knowledge on food habits that change post-migration, which are detrimental to health, are critical for health promotion initiatives to reduce this disease burden.

Objective

to describe food consumption changes post-migration according to sex and duration of residence in New Zealand among South Asian migrants.

Methods

A cross-sectional mail survey of 150 self-selected people of South Asian ethnicity aged 25-59 years in New Zealand.

Results

The study achieved responses from 112 participants (75%) with a mean age of 36 (7.5) years. Consumption of green leafy vegetables reduced post-migration for females and in new migrants (P < 0.05). Fruit consumption increased in both genders and across duration of residence (P < 0.05). Only 15% of males and 36% of females met the 3 + a day recommendation for vegetable consumption. Consumption of traditional breads, breakfast items and rice (males) decreased whilst that of breakfast cereals increased (P < 0.05). Consumption of low-fat milk, cheese, ice-cream, butter (females) and margarine increased, whilst ghee decreased (P < 0.05). Consumption of fish, lentils, traditional sweets and savouries decreased, whilst meat, processed meat, chicken, potato chips, cakes and pastries (females) and alcohol (males) increased (P < 0.05), post-migration. Thirty-three percent of males and 24% of females consumed takeaways "weekly or more often", with the majority (male: 51%; female: 36%) consuming European foods such as pizzas and pastas. Thirteen percent of males and 26% of females consumed festival foods "weekly or more often." More than half the participants were obese with BMI increasing with duration of residence (P = 0.025).

Conclusions

A food-based health promotion initiative focused on inadequate consumption of fruits and vegetables, increased consumption of dairy foods such as cheese and ice cream, and high fat European takeaway foods would be warranted particularly in new South Asian migrants.

Are recommended dietary patterns equitable?

OBJECTIVE

Dietary recommendations (DR) in the USA may be inadequate at improving diets in racial/ethnic minority communities and may require redesign of the systems driving their development over the long term. Meanwhile, cultural adaptation of evidence-based DR may be an important strategy for mitigating nutrition disparities, but less is known about the adaptability of these recommendations to meet the needs of diverse groups. We examined the content and origin of major DRs - aspects that provide context on their potential universality across populations and evaluated their potential for cultural adaptation.

DESIGN

Case studies of Dietary Approaches to Stop Hypertension (DASH), the Mediterranean diet (MD), the EAT-Lancet diet (EAT) and the NOVA classification system.

SETTING

United States.

PARTICIPANTS

Racial/ethnic minority populations.

RESULTS

Current DR differ in their origin/evolution but are similar in their reductionist emphasis on physical health. DASH has been successfully adapted for some cultures but may be challenged by the need for intensive resources; MD may be more beneficial if applied as part of a broader set of food procurement/preparation practices than as just diet alone; EAT-Lancet adaptation may not honor existing country-specific practices that are already beneficial to human and environmental health (e.g. traditional/plant-based diets); evidence for cultural adaptation is limited with NOVA, but classification of levels of food processing has potential for widespread application.

CONCLUSIONS

For DR to equitably support diverse populations, they must move beyond a Eurocentric or 'general population' framing, be more inclusive of cultural differences and honour social practices to improve diet and reduce disparities.

Intergenerational differences in dietary acculturation among Ghanaian immigrants living in New York City: a qualitative study

Dietary acculturation may explain the increasing risk of diet-related diseases among African immigrants in the United States (US). We interviewed twenty-five Ghanaian immigrants (Youth n 13, Age (Mean ± sd) 20 y ± 5⋅4, Parents (n 6) and Grandparents (n 6) age 58⋅7 ± 9⋅7) living in New York City (NYC) to (a) understand how cultural practices and the acculturation experience influence dietary patterns of Ghanaian immigrants and (b) identify intergenerational differences in dietary acculturation among Ghanaian youth, parents and grandparents. Dietary acculturation began in Ghana, continued in NYC and was perceived as a positive process. At the interpersonal level, parents encouraged youth to embrace school lunch and foods outside the home. In contrast, parents preferred home-cooked Ghanaian meals, yet busy schedules limited time for cooking and shared meals. At the community level, greater purchasing power in NYC led to increased calories, and youth welcomed individual choice as schools and fast food exposed them to new foods. Global forces facilitated nutrition transition in Ghana as fast and packaged foods became omnipresent in urban settings. Adults sought to maintain cultural foodways while facilitating dietary acculturation for youth. Both traditional and global diets evolved as youth and adults adopted new food and healthy social norms in the US.

Increasing obesity odds among foreign-born New Yorkers are not explained by eating out, age at arrival, or duration of residence: results from NYC HANES 2004 and 2013/2014

BACKGROUND

Among the foreign-born in the United States (US) dietary acculturation and eating out may increase obesity risk. Using the 2004 (N = 1952) and 2013/14 (N = 1481) New York City (NYC) Health and Nutrition Examination Surveys, we compared for the foreign-born and US-born by survey year: 1) odds of obesity; 2) association between eating out and obesity and 3) effect of age at arrival and duration of residence among the foreign-born. Weighted logistic regression estimated odds of obesity.

RESULTS

Compared to the US-born, the foreign-born had lower odds of obesity in 2004, (aOR = 0.51 (95%CI 0.37-0.70), P = <.0001). Odds were no different in 2013/14. In 2013/14 the foreign-born who ate out had lower obesity odds (aOR = 0.49 (95%CI 0.31-0.77), P = 0.0022). The foreign-born living in the US≥10 years had greater odds of obesity in 2004 (aOR = 1.73 (95%CI 1.08-2.79), P = 0.0233) but not in 2013/14.

CONCLUSIONS

Eating out does not explain increasing obesity odds among the foreign-born.

Stepwise tailoring and test-retest of reproducibility of an ethnic-specific FFQ to estimate nutrient intakes for South Asians in New Zealand

OBJECTIVE

To develop and test-retest the reproducibility of an ethnic-specific FFQ to estimate nutrient intakes for South Asians (SA) in New Zealand (NZ).

DESIGN

Using culturally appropriate methods, the NZFFQ, a validated dietary assessment tool for NZ adults, was modified to include SA food items by analysing foods consumed by SA participants of the Adult Nutrition Survey, in-person audit of ethnic food stores and a web scan of ethnic food store websites in NZ. This was further refined via three focus group discussions, and the resulting New Zealand South Asian Food Frequency Questionnaire (NZSAFFQ) was tested for reproducibility.

SETTING

Auckland and Dunedin, NZ.

PARTICIPANTS

Twenty-nine and 110 males and females aged 25-59 years of SA ethnicity participated in the focus group discussions and the test-retest, respectively.

RESULTS

The development phase resulted in a SA-specific FFQ comprising of 11 food groups and 180 food items. Test-retest of the NZSAFFQ showed good reproducibility between the two FFQ administrations, 6 months apart. Most reproducibility coefficients were within or higher than the acceptable range of 0·5-0·7. The lowest intraclass correlation coefficients (ICC) were observed for β-carotene (0·47), vitamin B12 (0·50), fructose (0·55), vitamin C (0·57) and selenium (0·58), and the highest ICC were observed for alcohol (0·81), iodine (0·79) and folate (0·77). The ICC for fat ranged from 0·70 for saturated fats to 0·77 for polyunsaturated fats. The ICC for protein and energy were 0·68 and 0·72, respectively.

CONCLUSIONS

The developed FFQ showed good reproducibility to estimate nutrient intakes and warrants the need for validation of the instrument.

Engaging Ethnic Restaurants to Improve Community Nutrition Environments: A Qualitative Study with Hispanic Caribbean Restaurants in New York City

This study used interviews with New York City Hispanic Caribbean (HC) restaurant owners, managers, and cooks/chefs (n=19) to examine perceptions concerning the healthfulness of the HC diet and diet-related disparities in the HC community, and document factors potentially influencing their engagement in community nutrition interventions. The interviews revealed high awareness of diet-related issues. Respondents had mixed notions concerning their role in improving community food environments, noting important barriers for collaboration to consider in future interventions. The study underscores the important role of ethnic restaurants, providing information to facilitate engagement with this largely untapped sector in immigrant/ethnic communities in the US.

Nutrition Interventions for Type 2 Diabetes in Chinese Populations: A Scoping Review

Developing culturally appropriate diabetes nutrition interventions for immigrants could be facilitated knowing what is successful in the home country and other relevant countries. The primary purpose of this scoping review was to identify the design and delivery methods of nutrition interventions for Chinese populations with type 2 diabetes, in their home countries and as immigrants to western countries. A total of 14 articles was retrieved and included. Overall, the approaches used in China often were modelled on intensive lifestyle programs although alternative strategies were also identified. Most interventions were not focussed solely on nutrition, and only a few were conducted in community settings. Most of the interventions were delivered in a group format, while those conducted in China also included individual counselling, particularly for nutrition. In addition, the diabetes and nutrition-related outcomes, cultural relevance and acceptability, and other factors that influenced protocol compliance were considered. Improvements in blood glucose control were observed in participants in all interventions where it was measured. Participants reported increased nutritional knowledge but nutritional behaviour was generally not well documented. Trials conducted in the United States emphasized the importance of cultural adaptation of intervention programs, particularly with respect to dietary patterns and specific foods. Practice-transferable characteristics are highlighted. Research gaps included trials conducted in community settings with pragmatic implementation and evaluation, comparative trials of interventions to gauge relative effectiveness, and measuring and reporting dietary outcomes for better understanding of the impact on dietary behaviours and their relationship to health outcomes.

Dietary Patterns in Chinese Americans are Associated with Cardiovascular Disease Risk Factors, the Chinese American Cardiovascular Health Assessment (CHA CHA)

Little is known about the dietary patterns of Chinese Americans. Understanding their dietary patterns can provide insights for addressing cardiovascular disease (CVD) risk among Chinese American immigrants. The objective of this study was to identify dietary patterns among Chinese American immigrants living in New York City (NYC) and to describe associations with demographic and CVD risk factors. A validated Food Frequency Questionnaire assessed usual dietary intake in Chinese American immigrants living in NYC as part of the Chinese American Cardiovascular Health Assessment (CHA CHA) in 2010-2011 (n = 1973, age range 21-89 years). Principal components analysis with varimax rotation retaining three factors with eigenvalues > 1.5 identified dietary patterns. Multivariable linear regression models tested associations between CVD risk factors and dietary pattern scores. In multivariable analyses, each unit of increase in the Sweets factor was associated with 0.76 ± 0.33 (mean ± SD) mg/dL higher HDL cholesterol and a 6.2 ± 2.7% increase in HOMA-IR. In contrast, each unit increase in the Fried Noodles factor was associated with a 0.27 ± 0.11 inch greater waist circumference, - 0.89 ± 0.40 mg/dL lower HDL cholesterol, and also a 6.9 ± 2.6% increase in HOMA-IR. Each unit increase in the Vegetables factor was associated with a - 1.40 ± 0.43 mmHg and - 0.95 ± 0.27 mm Hg decrease in systolic and diastolic blood pressure, respectively. Dietary patterns are significantly associated with CVD risk factors among Chinese American immigrants in NYC. Future work will inform how dietary patterns relate to level of acculturation in order to guide the development of dietary interventions to reduce CVD risk.

"It's Sort Of, Like, in My Family's Blood": Exploring Latino Pre-adolescent Children and Their Parents' Perceived Cultural Influences on Food Practices

This study examined the perceived connections between culture and food practices among Latino pre-adolescents (n = 17) and their parents (n = 15) through semi-structured interviews. Results show that pre-adolescents have formed perceptions concerning the association between their eating behaviors and cultural background that coincide with their parent's notions. Participants associated culture to both healthy and unhealthy food practices. Latin American food environments were described as healthier than in the US. The interviews revealed conflict between traditional foods preferences and perceptions of health, underscoring the need for better approaches to help Latino families navigate US food environments, while also preserving healthful traditional food practices.

"Men like to Eat More Rice and Beans and Things like That": The Influence of Childhood Experience and Life Course Events on Dietary Acculturation

Life course perspective provides a framework for examining the immigrant experience within the context of globalization and transnationalism. Life course perspective states that individuals develop food choice trajectories based on childhood experiences with food. This study examined the influence of childhood experiences and life events on eating behaviors of Dominican born women in Santo Domingo, Dominican Republic, and New York City. Findings revealed that women developed traditional or non-traditional food choice trajectories. These food choice trajectories remained stable through transition points, such as immigration, marriage, and divorce. Women discussed changes in the amount of food that was eaten, which may explain weight gain after immigration. These findings highlight the limitations of acculturation theory in understanding the eating behaviors of immigrants and provide an alternative explanation for weight gain after immigration.

A cross-sectional analysis of dietary protein intake and body composition among Chinese Americans

Favourable body composition has been associated with higher dietary protein intake. However, little is known regarding this relationship in a population of Chinese Americans (CHA), who have lower BMI compared with other populations. The aim of the present study was to assess the relationship between dietary protein intake, fat mass (FM) and fat-free mass (FFM) in CHA. Data were from the Chinese American Cardiovascular Health Assessment (CHA CHA) 2010-2011 (n 1707); dietary intake was assessed using an adapted and validated FFQ. Body composition was assessed using bioelectrical impedance analysis. The associations between protein intake (% energy intake) and BMI, percentage FM (FM%), percentage FFM (FFM%), FM index (FMI) and FFM index (FFMI) were examined using multiple linear regression adjusted for age, sex, physical activity, acculturation, total energy intake, sedentary time, smoking status, education, employment and income. There was a significant positive association between dietary protein and BMI (B = 0·056, 95 % CI 0·017, 0·104; P = 0·005), FM (B = 0·106, 95 % CI 0·029, 0·184; P = 0·007), FM% (B = 0·112, 95 % CI 0·031, 0·194; P = 0·007) and FMI (B = 0·045, 95 % CI 0·016, 0·073; P = 0·002). There was a significant negative association between dietary protein and FFM% (B = -0·116, 95 % CI -0·196, -0·036; P = 0·004). In conclusion, higher dietary protein intake was associated with higher adiposity; however, absolute FFM and FFMI were not associated with dietary protein intake. Future work examining the relationship between protein source (i.e. animal) and body composition is warranted in this population of CHA.

Dietary Assimilation among Mexican Children in Immigrant Households: Code-switching and Healthy Eating across Social Institutions

Immigrant health assimilation is often framed as a linear, individualistic process. Yet new assimilation theory and structural theories of health behavior imply variation in health assimilation as immigrants and their families interact with different US social institutions throughout the day. We test this idea by analyzing how two indicators of dietary assimilation-food acculturation and healthy eating-vary throughout the day as Mexican children in immigrant households consume food in different institutional settings. Using individual fixed-effects models and data from the National Health and Nutrition Examination Survey, we find that Mexican children in immigrant households (N = 2,337) engage in "dietary code-switching," eating more acculturated but not necessarily less healthy food in schools and more acculturated but less healthy food in restaurants compared to homes. Findings advance theory and knowledge about how social institutions condition dietary assimilation in particular and health assimilation more broadly.

Atherosclerotic Cardiovascular Disease in South Asians in the United States: Epidemiology, Risk Factors, and Treatments: A Scientific Statement From the American Heart Association

South Asians (from Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka) make up one quarter of the world's population and are one of the fastest-growing ethnic groups in the United States. Although native South Asians share genetic and cultural risk factors with South Asians abroad, South Asians in the United States can differ in socioeconomic status, education, healthcare behaviors, attitudes, and health insurance, which can affect their risk and the treatment and outcomes of atherosclerotic cardiovascular disease (ASCVD). South Asians have higher proportional mortality rates from ASCVD compared with other Asian groups and non-Hispanic whites, in contrast to the finding that Asian Americans (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) aggregated as a group are at lower risk of ASCVD, largely because of the lower risk observed in East Asian populations. Literature relevant to South Asian populations regarding demographics and risk factors, health behaviors, and interventions, including physical activity, diet, medications, and community strategies, is summarized. The evidence to date is that the biology of ASCVD is complex but is no different in South Asians than in any other racial/ethnic group. A majority of the risk in South Asians can be explained by the increased prevalence of known risk factors, especially those related to insulin resistance, and no unique risk factors in this population have been found. This scientific statement focuses on how ASCVD risk factors affect the South Asian population in order to make recommendations for clinical strategies to reduce disease and for directions for future research to reduce ASCVD in this population.

Somali, Latino and Hmong parents' perceptions and approaches about raising healthy-weight children: a community-based participatory research study

OBJECTIVE

Immigrants in the USA are confronted with health disparities, including childhood obesity and obesity-related chronic diseases. We aimed to identify perceptions of childhood body weight, approaches to raising healthy children and desires for supportive programmes of Somali, Latino and Hmong (SLM) parents in the Twin Cities, Minnesota, USA.

DESIGN

Using community-based participatory research, ten focus groups (FG) were conducted with sixty-seven parents (n 28 Somali, three FG; n 19 Latino, four FG; n 20 Hmong, three FG) of 3-12-year-old children in their native language. Demographic information was collected.

RESULTS

SLM parents perceived that health is not necessarily weight-based; childhood obesity is caused by overeating, eating unhealthy foods and sedentary activities; traditional foods are generally healthy while American foods are generally unhealthy; and healthy children are inherently physically active. Parents identified their goals as feeding children so they would be healthy and happy, helping them be active and safe, and teaching them to cook traditional foods to be self-sufficient and maintain their cultural identity. Parents were challenged by children's unhealthy food and sedentary preferences, their own uncertainties about healthy foods and behaviours, and structural factors. Parents thought interventions could help them with these challenges, including information about healthy foods, age-appropriate portion sizes, safe places to be active and strategies tailored to their cultural norms.

CONCLUSIONS

SLM parents are trying to raise healthy-weight children based on their understanding of children's health, weight, diet and physical activity, while dealing with social, economic and environmental challenges and trying to maintain cultural identity and traditions.

Frequency of Intake and Type of Away-from- Home Foods Consumed Are Associated with Diet Quality in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Background

Away-from-home foods (AFHFs) influence diet quality, a modifiable obesity risk factor, with limited generalizable evidence in Hispanic/Latino adults.

Objective

We investigated associations between AFHF intake with diet quality and overweight or obesity among US Hispanic/Latino adults.

Methods

Cross-sectional baseline (2008-2011) analyses included adults (n = 16,045) aged 18-74 y in the national Hispanic Community Health Study/Study of Latinos. Participants self-reported AFHF consumption frequency from 10 different settings and dietary intake (2-d 24-h recall). The Alternate Healthy Eating Index-2010 (AHEI-2010) was used to measure diet quality; higher scores indicated a healthier diet and scores were categorized into tertiles. WHO classifications categorized overweight [body mass index (BMI; kg/m2): 25.0-29.9] and obesity (BMI ≥30). Multivariate-adjusted associations of AFHF frequency or type with AHEI-2010, overweight, or obesity were assessed by using complex survey logistic regression (ORs and 95% CIs).

Results

Almost half of participants (47.1%) reported eating AFHFs ≥5 times/wk. The mean ± SE AHEI-2010 score was 47.5 ± 0.2. More than one-third (37.2%) were classified as overweight and 39.6% classified as obese. Compared with consuming AFHFs ≥5 times/wk, consuming AFHFs <1 time/wk or 1-2 times/wk was associated with greater odds of being in higher AHEI-2010 tertiles, indicating a healthier diet [<1 time/wk-tertile 2: OR (95% CI): 1.6 (1.4, 1.9); tertile 3: 2.5 (2.1, 3.1); 1-2 times/wk-tertile 2: OR (95% CI): 1.4 (1.2, 1.6); tertile 3: 1.5 (1.2, 1.8)]. Consumption of AFHFs ≥1 time/wk from each AFHF setting, compared with consumption of any AFHFs <1 time/wk was associated with lower odds of being in higher AHEI-2010 tertiles. Increasing AFHF intake frequency was not associated with odds of overweight or obesity. Eating from on-street vendors ≥1 time/wk was associated with obesity (OR: 1.5; 95% CI: 1.1, 2.0).

Conclusions

Consumption of AFHFs was prevalent among Hispanic/Latino adults and was associated with poorer diet quality. Findings may help to identify dietary targets to improve diet quality and prevent obesity in US Hispanics/Latinos.

Application of Photovoice with Focus Groups to Explore Dietary Behaviors of Older Filipino Adults with Cardiovascular Disease

Filipino Americans have high rates of cardiovascular diseases (CVD). This study explored the dietary behaviors, a modifiable risk factor, of Filipinos with CVD. Filipinos with CVD were recruited and trained to do Photovoice. Participants took photos to depict their "food experience," defined as their daily dietary activities. Participants then shared their photos during focus groups. Focus group transcripts were analyzed using an iterative, grounded theory approach. Among 38 Filipino participants, the mean age was 70 years old and all were foreign-born. Major themes included efforts to retain connection to Filipino culture through food, and dietary habits shaped by cultural health beliefs. Many believed that traditional dietary practices increased CVD risk. Receiving a CVD diagnosis and clinician advice changed their dietary behaviors. Household members, the physical environment, and economic constraints also influenced dietary behaviors. Photovoice is feasible among older Filipinos and may enhance understanding of drivers of dietary behaviors.

Vegetarian Diet and Cardiometabolic Risk among Asian Indians in the United States

Research studies have shown that plant-based diets confer cardiovascular and metabolic health benefits. Asian Indians (AIs) in the US (who have often followed plant-based diets) have elevated risk for chronic diseases such as diabetes, metabolic syndrome, and obesity suggesting ethnic vulnerability that imply genetic and/or lifestyle causative links. This study explored the association between this ethnic group and diabetes, obesity, and metabolic syndrome after controlling for demographics, acculturation, family history of diabetes, and lifestyle and clinical risk factors. The sample comprised of 1038 randomly selected adult AIs in seven US sites. Prevalence and metabolic syndrome was estimated, and obesity was calculated using the WHO Asian criteria. Multivariate analysis included multinomial logistic regression. The mean age and length of residency in the US were 47 and 18.5 years, respectively. The majority of respondents were vegetarians (62%) and educated. A vegetarian lifestyle was associated with females, food label users, respondents with poor/fair current health status, less acculturated, and those who reported their diet had not changed after coming to the US. Vegetarian status was a protective factor and lowered the risk for diabetes but not for metabolic syndrome and obesity in the regression model. Results provide a firm basis for educational programs.

Questioning the Dietary Acculturation Paradox: A Mixed-Methods Study of the Relationship between Food and Ethnic Identity in a Group of Mexican-American Women

BACKGROUND

Epidemiological studies have described an "acculturation paradox." Increased acculturation to the United States is associated with increased consumption of dietary fat and decreased consumption of fruits/vegetables.

OBJECTIVE

To expand understanding of the dietary acculturation paradox, this study examined how bicultural Mexican-American women construct ethnic identity and how these identities and identity-making processes relate to perceptions of health and nutrition.

DESIGN

We utilized embedded mixed methods (in-depth interviews; survey).

PARTICIPANTS/SETTING

We analyzed a purposive sample of English-speaking Mexican-American women aged 18 to 29 years (n=24) in rural California to assess ethnic identity and diet beliefs.

RESULTS

Participants described food as central to expressing cultural identity, usually in terms of family interactions. Mexican food traditions were characterized as unhealthy; many preferred American foods, which were seen as healthier. Specifically, Mexican-American women perceived Mexican patterns of food preparation and consumption as unhealthy. In addition, traditional Mexican foods described as unhealthy were once considered special-occasion foods. Among the participants who expressed a desire to eat healthfully, to do so meant to reject Mexican ways of eating.

CONCLUSIONS

This study raises questions about the nature of the "dietary acculturation paradox." While food-the eating of Mexican foods-is central to the maintenance of ethnic identity throughout acculturation, negative perceptions about the healthfulness of Mexican foods introduce tension into Mexican-American women's self-identification. This study suggests a subtle contradiction that may help to explain the dietary acculturation paradox: While previous research has suggested that as Mexicans acculturate to the United States they adopt unhealthy diets, this study finds evidence that they do so at least in part due to perceptions that American diets are healthier than Mexican diets. Implications for interventions to improve Latinos' diets include an emphasis on the family and use of Spanish linguistic cues. Finally, messages that simply advocate for "traditional" diets should be reconsidered because that message is discordant with perceptions of the healthfulness of such foods.

Are Experiences of Discrimination Related to Poorer Dietary Intakes Among South Asians in the MASALA Study?

OBJECTIVE

To examine associations between self-reported discrimination and dietary intakes among South Asian (SA) people.

METHODS

Data from the Mediators of Atherosclerosis in South Asians Living in America study were used to analyze the relationship between self-reported discrimination and dietary behaviors (n = 866). Self-reported discrimination was measured with the 9-item continuous Everyday Discrimination Scale. Diet was measured with a culturally tailored, validated, 163-item food frequency questionnaire for SA individuals. Dietary variables examined in these analyses included weekly consumption of fruits and vegetables and sweets. The researchers employed multiple logistic and linear regression models.

RESULTS

Self-reported discrimination was unrelated to fruit and vegetable intake but was positively associated with consumption of sweets per week (P = .001).

CONCLUSIONS AND IMPLICATIONS

Increased consumption of sweets may be a mechanism for SA individuals to cope with stressful experiences of discrimination. Further research examining discrimination and health behavior-related coping strategies among SA people is needed.

Concept analysis of dietary biculturalism in Filipino immigrants within the context of cardiovascular risk

BACKGROUND

Dietary biculturalism is an emerging phenomenon among the Filipino immigrant population. Determining the concept of dietary biculturalism on this specific population will unravel some of the obscurities of emerging dietary patterns within the context of cardiovascular risk.

PURPOSE

The purpose of this article is to provide a concept analysis of dietary biculturalism within the health context of cardiovascular risk using Walker and Avant's method as an organizing framework.

METHODS

A detailed literature review was performed on the basis of population specificity (Filipinos) use of dietary patterns as variable and theoretical literary models of acculturation.

FINDINGS

The generalizability of published research on this issue is problematic since researchers have not addressed the unhealthy traditional foods component that one may consume in addition to the Western foods.

NURSING IMPLICATIONS

Nurse researchers should focus on the detrimental effects of unhealthy traditional foods that may be relevant in explaining some of the cardiovascular risk factors affecting this population. Nurses and practitioners should take care to query not only about the frequency of ethnic food consumption, but also types, and amounts among their Filipino patients.

Obesity in International Migrant Populations

PURPOSE OF REVIEW

This review examines the risk of obesity in migrant groups-specifically migrants from countries with lower prevalence of obesity to countries with higher prevalence of obesity. We examine obesity prevalence within migrant groups compared with native populations and the evidence on factors that might shape obesity risk in these migrant groups.

RECENT FINDINGS

Migrants may arrive in new countries with a health advantage including generally a healthier body weight. Genetic and epi-genetic factors, as well as body size preference, socio-economic factors, and stress exposure, may play a role in increasing unhealthy weight gain in migrant populations. This unhealthy weight gain leads to similar or greater obesity risk in migrant populations compared with native populations 10-15 years after migration. Meeting the challenge of prevention and treatment of obesity in diverse populations will require greater attention to minority groups in research in the future.

Asian American Dietary Sources of Sodium and Salt Behaviors Compared with Other Racial/ethnic Groups, NHANES, 2011-2012

OBJECTIVE

Asian Americans consume more sodium than other racial/ethnic groups. The purpose of this analysis was to describe major sources of sodium intake to inform sodium reduction initiatives.

METHODS

Cross-sectional data on adults (aged >18 years) from the National Health and Nutrition Examination Survey (NHANES) 2011-2012 with one 24-hour dietary recall were analyzed (n=5,076). Population proportions were calculated from "What We Eat in America" (WWEIA) food categories.

RESULTS

Asian Americans had a higher sodium density vs adults of other racial/ethnic groups (means in mg/1000kcal: Asian American, 2031.1; Hispanic,1691.6; White: 1666.5; Black: 1655.5; P<.05, all). Half of sodium consumed by Asian Americans came from the top 10 food categories, in contrast to Hispanics (43.6%), Whites (39.0%), and Blacks (36.0%). Four food categories were a top source of sodium for Hispanics, Whites, Blacks, and others, but not among Asian Americans: cold cuts and cured meats; meat mixed dishes; eggs and omelets; and cheese. The top three food category sources of sodium among Asians were soups, rice, and yeast breads accounting for 28.9% of dietary sodium. Asian Americans were less likely to add salt at the table, but used salt in food preparation 'very often' (P for both <.01).

CONCLUSIONS

Mean sodium consumption and sources vary across racial/ethnic groups with highest consumption in Asian Americans. Given the smaller number of food categories contributing to sodium intake in Asian Americans, results imply that targeted activities on a few food items would have a large impact on reducing sodium intake in this group.

Evaluation of Factorial Validity and Reliability of a Food Behavior Checklist for Low-Income Filipinos

OBJECTIVE

To examine factorial validity, test-retest reliability, and internal consistency of a Tagalog-language food behavior checklist (FBC) for a low-income Filipino population.

METHODS

Participants (n = 160) completed the FBC on 2 occasions 3 weeks apart. Factor structure was examined using principal component analysis. For internal consistency, Cronbach α was calculated. For test-retest reliability, Spearman correlation or intraclass correlation coefficient (ICC) was calculated between scores at the 2 points.

RESULTS

All but 1 item loaded on 6 factors: fruit and vegetable quantity, fruit and vegetable variety, fast food, sweetened beverage, healthy fat, and diet quality. Cronbach α was .75 for the total scale (range, .39-.76 for subscales). Spearman correlation was 0.78 (ICC, 0.79) for the total scale (range, 0.66-0.80 [ICC, 0.68-0.80] for subscales).

CONCLUSIONS AND IMPLICATIONS

The FBC demonstrated adequate factorial validity, test-retest reliability, and internal consistency. With additional testing, the FBC may be used to evaluate the US Department of Agriculture's nutrition education programs for Tagalog speakers.

Ethnic-group socioeconomic status as an indicator of community-level disadvantage: A study of overweight/obesity in Asian American adolescents

Asian American children and adolescents are an under-investigated subpopulation in obesity research. Informed by a wide socioeconomic diversity among Asian American ethnic groups, this study explored ethnic-group socioeconomic status (SES) as an indicator of community-level disadvantage that may influence overweight/obesity in Asian American adolescents. We hypothesized that ethnic-group SES was inversely associated with overweight/obesity in Asian American adolescents. Multiple logistic regression models were fitted using a sample of 1525 Asian American adolescents ages 12-17 from pooled 2007-2012 California Health Interview Survey (CHIS) data. Age, gender, nativity, individual-level SES (income and education), and two lifestyle variables (fast food consumption and physical activity) were controlled for. We found that adolescents in high- or middle-level SES ethnic groups were far less likely to be overweight/obese than those in low-SES ethnic groups. Further, these relationships were more pronounced for foreign-born adolescents but not significant for U.S.-born adolescents. Ethnic-group SES may be a meaningful indicator of community-level socioeconomic disparities that influence the health of Asian Americans and, potentially, other populations with high proportions of immigrants of diverse socioeconomic and ethnic backgrounds.

Prevalence of Diabetes among Migrant Women and Duration of Residence in the United Arab Emirates: A Cross Sectional Study

Background

The prevalence rate of type 2 diabetes mellitus (T2DM) is one of the highest in United Arab Emirates (UAE), however data for the expatriate population is limited. This study aimed to identify the prevalence of T2DM amongst migrant women and test the hypothesis that acculturation (measured by years of residency) is associated with an increased risk of T2DM.

Methods

This was a cross-sectional study and we recruited a representative sample (n = 599, 75% participation rate) of migrant women aged 18 years and over in Al Ain, UAE. The American Diabetes Association criteria were used to diagnose T2DM. An adapted WHO STEPS questionnaire was used to collect socio-demographic, lifestyle and clinical data. Logistic regression analysis was performed to identify correlates of T2DM including length of UAE residence.

Results

The mean age of participants was 34.1 (± 9.5) years. Of the study participants, based on HbA1C levels, 18.6% (95% CI: 13.9–24.4) had prediabetes and 10.7% (95% CI: 7.2–15.6) had T2DM. Prevalence of prediabetes was 8.5% for Filipinos, 16.7% for Arabs and 30.3% for South Asians. Similarly the prevalence of T2DM was 1.7% for Filipinos, 12.2% for Arabs and 16.7% for South Asians. Significant correlates of overall T2DM (measured and known diabetes) included length of UAE residence for more than 10 years (Adjusted Odds Ratio [AOR] 2.74, 95% CI: 1.21–6.20), age ≥40 years (AOR = 3.48, 95% CI: 1.53–7.87) and South Asian nationality (AOR 2.10, 95% CI: 0.94–4.70).

Conclusion

Diabetes is a significant public health problem among migrant women in the UAE, particularly for South Asians. Longer length of residence in the UAE is associated with a higher prevalence of diabetes.

"We like Fried Things": Negotiating Health and Taste among Hispanic Caribbean Communities in New York City

The study was conducted to understand fried-food (FF) consumption among Hispanic Caribbean (HC) communities in New York City. Data were collected through qualitative interviews with 23 adults self-identified as Cuban, Dominican, or Puerto Rican. Most informants considered FFs an important part of their traditional diet. Potential explanations included taste, cost, convenience, and the emotive values attached to FF. FF consumption was contextualized in local foodscapes. Results include strategies to diminish FF consumption and differences across HC groups and migratory generations. The relevance for future nutrition interventions addressing health disparities in this community is discussed.

Improving Access to Healthy Foods for Asian Americans, Native Hawaiians, and Pacific Islanders: Lessons Learned from the STRIVE Program

Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) experience a large burden from certain chronic disease-related risk factors. The STRIVE Program funded four AANHPI community-based organizations (CBOs) to implement culturally adapted community gardens and farmers' markets to increase access to healthy foods. Key CBO informant interviews were conducted to understand processes and lessons learned.

Duration of US Residence Is Associated With Overweight Risk in Filipino Immigrants Living in New York Metro Area

We examined the association between years living in the United States and overweight risk among a community sample of Filipino adult immigrants living in the New York metropolitan area. We found a significant and adverse association between years living in the United States and overweight risk. Compared with Filipinos who lived in the United States less than 5 years, those who lived in the United States 10 years or longer had a higher overweight risk; this association was present only among Filipinos who migrated to New York metropolitan area at 30 years of age or younger. Studies on causal mechanisms explaining this pattern are needed.

Dietary Acculturation among Filipino Americans

Acculturation, the subsequent changes that occur in one culture after continuous first hand contact with another culture, impacts the dietary habits and health risks of individuals. This study examines the acculturation, dietary habits and anthropometric measurements in a sample of 210 first generation Filipino American immigrants in New Jersey (NJ). Acculturation was measured using the Short Acculturation Scale for Filipino Americans (ASASFA). Dietary acculturation was measured using the Dietary Acculturation Questionnaire for Filipino Americans (DAQFA) and dietary intake was determined using the Block's Brief Food Frequency Questionnaire (BFFQ). Anthropometric measurements were obtained including weight, height and waist circumference. Acculturation had a significant negative relationship with Filipino Dietary acculturation. Western dietary acculturation was significantly correlated with caloric intake (r(208) = 0.193, p < 0.01), percentage fat intake (r(208) = 0.154, p < 0.05), percentage carbohydrate intake (r(208) = -0.172, p < 0.05), Body Mass Index (BMI) (r(208) = 0.216, p < 0.01) and waist circumference (r(208) = 0.161, p < 0.01). There was no significant correlation between Filipino dietary acculturation, dietary intake and anthropometric measurements. The results showed that Filipino American immigrants have increased risks including increased BMI, waist circumference and increased fat intake. Over all, this research highlighted some dietary changes and their effects on dietary intake and health status.

Understanding experiences of participating in a weight loss lifestyle intervention trial: a qualitative evaluation of South Asians at high risk of diabetes

OBJECTIVE

To explore the reasons for enrolling, experiences of participating and reasons for remaining in a family-based, cluster randomised controlled trial of a dietitian-delivered lifestyle modification intervention aiming to reduce obesity in South Asians at high risk of developing diabetes.

DESIGN

Qualitative study using narrative interviews of a purposive sample of trial participants following completion of the intervention. Data were thematically analysed.

SETTING

The intervention was conducted in Scotland and resulted in a modest decrease in weight, but did not statistically reduce the incidence of diabetes.

PARTICIPANTS

We conducted 21 narrative interviews with 24 participants (20 trial participants and four family volunteers).

RESULTS

Many participants were motivated to participate because of: known family history of diabetes and the desire to better understand diabetes-related risks to their own and their family's health; ways to mitigate these risks and to benefit from personalised monitoring. Home-based interventions, communication in the participant's chosen language(s) and continuity in dietitians supported their continuing engagement with the trial. Adaptations in food choices were initially accommodated by participants, although social and faith-based responsibilities were reported as important barriers to persevering with agreed dietary goals. Many participants reported that increasing their level of physical activity was difficult given their long working hours, physically demanding employment and domestic commitments; this being compounded by Scotland's challenging climate and a related reluctance to exercise in the outdoors.

CONCLUSIONS

Although participants had strong personal interests in participation and found the information provided by dietitians useful, they nonetheless struggled to incorporate the dietary and exercise recommendations into their daily lives. In particular, increasing levels of physical exercise was described as an additional and in some cases unachievable burden. Consideration needs to be given to strengthening and supporting lifestyle interventions with community-based approaches in order to help overcome wider social and environmental factors.

Asian Indian views on diet and health in the United States: importance of understanding cultural and social factors to address disparities

This study describes Asian Indian immigrant perspectives surrounding dietary beliefs and practices to identify intervention targets for diabetes and heart disease prevention. Participants were asked about conceptualizations of relationships between culture, food, and health during 4 focus groups (n = 38). Findings reveal influences of beliefs from respondents' native India, preservation of cultural practices within the US social structure, conflicts with subsequent generations, and reinterpretation of health-related knowledge through a lens, hybridizing both "native" and "host" contexts. Galvanization of ethnically valued beliefs incorporating family and community structures is needed for multipronged approaches to reduce disproportionate burdens of disease among this understudied minority community.