Dietary habits of Asian Indians in relation to length of residence in the United States

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.

Temporal Trends in Cardiovascular Disease Prevalence Among Asian American Subgroups

BACKGROUND

Asian and multiracial individuals represent the 2 fastest growing racial and ethnic groups in the United States, yet most prior studies report Asian American and Native Hawaiian or Other Pacific Islander as a single racial group, with limited data on cardiovascular disease (CVD) prevalence among subgroups. We sought to evaluate temporal trends in CVD burden among disaggregated Asian subgroups.

METHODS AND RESULTS

Patients with CVD based on International Classification of Diseases, Ninth Revision and Tenth Revision (ICD-9 and ICD-10) coding who received care from a mixed-payer health care organization in California between 2008 and 2018 were classified into self-identified racial and ethnic subgroups (non-Hispanic White [NHW], Asian Indian, Chinese, Filipino, Japanese, Korean, Native Hawaiian or Other Pacific Islander, and multiracial groups). Adjusted trends in CVD prevalence over time by subgroup were compared using logistic regression. Among 3 494 071 patient-years, prevalence of CVD increased faster among all subgroups except Japanese and Native Hawaiian or Other Pacific Islander patients (P<0.01 for each, reference: NHW). Filipino patients had the highest overall CVD prevalence, which increased from 34.3% to 45.1% over 11 years (increase from 17.3%-21.9%, P<0.0001, reference: NHW). Asian Indian patients had the fastest increase in CVD prevalence over time (16.9%-23.7%, P<0.0001, reference: NHW). Among subcategories of disease, hypertension increased faster among Asian Indian, Chinese, Filipino, Korean, and multiracial groups (P<0.01 for all, reference: NHW), and coronary artery disease increased faster among Asian Indian, Chinese, Filipino, and Japanese groups (P<0.05 for each, reference: NHW).

CONCLUSIONS

The increasing prevalence of CVD among disaggregated Asian, Native Hawaiian or Other Pacific Islander, and multiracial subgroups over time highlights the importance of tailored approaches to addressing CVD in these diverse subpopulations.

Call for Cultural and Language-Concordant Diabetes Care, Nutrition Education, and Self-Management for South Asian Individuals Living in the US

Ethnic South Asian Americans have the highest relative risk of type 2 diabetes mellitus in the US. Culturally tailored and language-concordant diabetes care and nutrition interventions can potentially promote South Asian diabetes management and disease progression. From our perspective, the extent of their use and evaluation in the US settings remains limited. This Perspective characterizes and evaluates the necessity and outcomes of culturally and linguistically adapted lifestyle interventions targeted toward type 2 diabetes mellitus indicators among South Asian individuals in the US. Suggestions for how this education could be modified include emphasizing the cultural and linguistic knowledge and self-awareness of diabetes educators and the sociological and historical factors that influence the cultural and linguistic orientation of diabetes care professionals and their clients. Such strategies could ensure better diabetes education and self-management among South Asian individuals.

Perceived Role of Asian Indian Fathers in Florida During Mealtimes: Factors to Consider for Their Involvement in Childhood Obesity Prevention

Research has shown that fathers play an important role in children's mealtimes and dietary habits; yet, little is known about the factors that affect how fathers perceive this role, especially among Asian Indians. This study aimed to examine how Asian Indian fathers perceive their role during child mealtimes and the factors that are associated with fathers' mealtime perceptions. Eighty Asian Indian fathers of 6- to 11-year-old children completed an online survey including measures of demographics, acculturation, gender roles, nutrition knowledge, parental self-efficacy, perceived child weight, and the role of father at mealtime (ROFM). Data were analyzed using descriptive statistics and linear regression. Participants perceived a moderately high level of responsibility during child mealtimes. Regression analysis showed that fathers who had higher income, perceived child weight as being higher, and had higher self-efficacy in feeding children healthy food had higher ROFM. Higher father nutrition knowledge was correlated with lower perceived ROFM, indicating a lack of confidence in utilizing their nutrition knowledge during child mealtimes. The results indicate potential targets to improve Asian Indian fathers' involvement during child mealtimes. These results could be utilized to enhance their engagement in child mealtime healthy eating practices and for childhood obesity prevention.

Association between duration of residence and prevalence of type 2 diabetes among male South Asian expatriate workers in the United Arab Emirates: a cross-sectional study

Expatriates account for about 80% of the total population in the United Arab Emirates (UAE). This study aimed to evaluate the hypothesis that prevalence of type 2 diabetes in male South Asian expatriates increases with increased length of residence in the UAE.

DESIGN, SETTINGS AND PARTICIPANTS

This cross-sectional study recruited a representative sample (n=1375) of male South Asian expatriates aged ≥18 years in Al Ain, UAE. Sociodemographic, anthropometric and lifestyle data were obtained using a pilot-tested adapted version of the WHO STEPS instrument.

MAIN OUTCOME MEASURES

Duration of residence was used as a marker for acculturation. Type 2 diabetes was defined as a self-reported physician diagnosis of diabetes or a glycosylated haemoglobin blood level ≥6.5%.

RESULTS

Mean (±SD) age of participants was 34.0±9.9 years. Overall, the prevalence of type 2 diabetes was 8.3% (95% CI 6.8% to 9.8%). Diabetes prevalence was positively associated with longer duration of residence in the UAE, 2.7%, <5 years; 8.2%, 5-10 years; and 18.8%, >10 years. After adjusting for age, nationality, and income and age, expatriates were more likely to develop diabetes if residing in the UAE for 5-10 years (OR=2.18; 95% CI 1.02 to 4.67) or >10 years (OR=3.23; 95% CI 1.52 to 6.85) compared with those residing for <5 years.

CONCLUSIONS

After controlling for potential confounding factors, longer duration of residence was significantly associated with a higher prevalence of type 2 diabetes in male South Asian expatriate workers in the UAE.

Egocentric social networks, lifestyle behaviors, and body size in the Asian Community Health Initiative (CHI) cohort

BACKGROUND

Social networks have been shown to influence lifestyle behaviors in non-Latinx white (NLW) populations. We examined their influence in Asian American, Native Hawaiian and Pacific Islander (AANHPI) women.

METHODS

We included 477 AANHPI women from the Asian Community Health Initiative Study who provided egocentric (degree, density, composition) and epidemiologic (size, types of ties) social network data and data on alcohol intake, physical activity, smoking, diet, and body size. We used logistic regression to evaluate associations of social network measures and dichotomous outcomes, and linear regression for continuous outcomes.

RESULTS

In multivariable-adjusted analyses, higher degree and/or proportion of friends were significantly related to higher Western diet, higher odds of any alcohol consumption, and lower odds of physical inactivity and body mass index (BMI)≥23 kg/m2. Additionally, a higher proportion of NLW in women's networks was related to lower Asian diet but also lower waist size. Community participation was related to higher Western diet and lower Asian diet. By contrast, degree and/or proportion of relatives were positively related to BMI, waist size and to a higher odds of BMI≥23 kg/m2 and of ever smoking 100 cigarettes. Being married was related to fewer alcoholic drinks per week and higher Asian diet. A higher density of relationships with frequent contact was also associated with higher Asian diet.

CONCLUSIONS

AANHPI women with larger proportions of friends and NLWs in their networks had more Western health behaviors and smaller body size. Norms for health behaviors and body size may be influenced by the size, composition, and structure of social networks, relevant to chronic disease prevention.

Do Cultural and Psychosocial Factors Contribute to Type 2 Diabetes Risk? A Look Into Vancouver's South Asian Community

OBJECTIVES

South Asian immigrants are generally healthy upon arrival, but precipitously develop diabetes after immigration. Whether cultural and psychosocial factors contribute to diabetes risk in this ethnic minority group remains unclear. Existing prediction models focus primarily on clinical and lifestyle factors. This study explored whether nontraditional risk factors are incrementally predictive beyond traditional risk factors in this South Asian community.

METHODS

In this cross-sectional study, we recruited 425 South Asian adults attending Sikh and Hindu temples in Metro Vancouver between July 2013 and June 2014. We measured traditional risk factors, including glycated hemoglobin (A1C), apolipoprotein B, systolic and diastolic blood pressure (BP), waist circumference, weight, body mass index (BMI), dietary patterns and physical activity level. Self-report questionnaires assessed cultural and psychosocial factors, including acculturation, dinnertime (timing of the evening meal), religion and depressive symptoms. We constructed a penalized multivariable linear model with A1C level using the least absolute shrinkage and selection operator (LASSO) approach to overcome issues of overfitting and reduce prediction error of previous diabetes prediction models.

RESULTS

The LASSO model selected 24 risk factors for the optimal model to predict glycemic control. Results revealed that higher degree of acculturation (p=0.007), later dinnertime (p=0.01) and greater depressive symptoms (p=0.038) are important factors in diabetes risk in addition to traditional risk factors (fruit/vegetable/fibre intake, BMI and systolic BP).

CONCLUSIONS

Nontraditional factors, such as cultural practices and emotional functioning, are also important predictors of diabetes risk and should be considered when culturally tailoring diabetes prevention programs.

The association of religious affiliation with cholesterol levels among South Asians: the Mediators of Atherosclerosis in South Asians Living in America study

Background

South Asians have disproportionately high rates of cardiovascular disease. Dyslipidemia, a contributing factor, may be influenced by lifestyle, which can vary by religious beliefs. Little is known about South Asian religions and associations with dyslipidemia.

Methods

Cross-sectional analyses of the MASALA study (n = 889). We examined the associations between religious affiliation and cholesterol levels using multivariate linear regression models. We determined whether smoking, alcohol use, physical activity, and dietary pattern mediated these associations.

Results

Mean LDL was 112 ± 32 mg/dL, median HDL was 48 mg/dL (IQR:40–57), and median triglycerides was 118 mg/dL (IQR:88–157). Muslims had higher LDL and triglycerides, and lower HDL, while participants with no religious affiliation had lower LDL and higher HDL. The difference in HDL between Muslims and those with no religious affiliation was partly explained by alcohol consumption.

Conclusions

Religion-specific tailoring of interventions designed to promote healthy lifestyle to reduce cholesterol among South Asians may be useful.

Prevalence of low-calorie sweetener intake in South Asian adults

BACKGROUND

Consumption of low-calorie sweeteners (LCS) has increased in the US and is associated with cardiometabolic risk. No data exist on LCS consumption in South Asians.

AIM

The aim of this study was to assess the prevalence of LCS use across socio-demographic characteristics, chronic disease status, and cardiometabolic risk factors.

METHODS

Cross-sectional analyses were conducted using data from the Mediators of Atherosclerosis in South Asians Living in America study (N = 892; 47% women; mean age = 55 (standard deviation = 9.4) y). Chi-squared and ANOVA tests were used to compare LCS consumption across socio-demographic characteristics and cardiometabolic risk factors.

RESULTS

Twenty-two percent of participants reported LCS use, with higher consumption among men and those with longer residency in the US. LCS use was associated with adiposity and higher odds of hypertension, high cholesterol, and diabetes.

CONCLUSIONS

LCS use is prevalent among South Asians, emphasizing the need for long-term, prospective studies to investigate its role in incident cardiometabolic risk in an already metabolically vulnerable population.

Food Behaviors and Dietary Acculturation of Asian Indians in the US

OBJECTIVE

To examine food behaviors and dietary acculturation of Asian Indians in the US.

DESIGN

Qualitative focus group discussions.

SETTING

Public library and university.

PARTICIPANTS

Thirty Asian Indian adults in a US Midwestern state.

MAIN OUTCOME MEASURES

Participant perceptions of food behaviors and 24-hour modified weekday and weekend dietary recalls.

ANALYSIS

Eight focus group transcripts and participant dietary recalls were independently analyzed by 2 Asian Indian moderators using the constant comparison method.

RESULTS

The sample (n = 16 males and 14 females) consisted of a variable group of Asian Indians from different generations, religions, and places of origin in India. Key themes associated with modification of traditional behaviors were social independence, social network influences, increased health awareness, cost and quality of Asian Indian foods, and time constraints and convenience.

CONCLUSIONS AND IMPLICATIONS

This study elucidated dietary behaviors and factors that contribute to dietary acculturation of Asian Indians, which are important considerations for health professionals. These findings inform researchers regarding the development of culturally appropriate dietary assessment measures targeted at Asian Indian individuals.

The Association of Religious Affiliation with Overweight/Obesity Among South Asians: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study

Religiosity has been associated with greater body weight. Less is known about South Asian religions and associations with weight. Cross-sectional analysis of the MASALA study (n = 906). We examined associations between religious affiliation and overweight/obesity after controlling for age, sex, years lived in the USA, marital status, education, insurance status, health status, and smoking. We determined whether traditional cultural beliefs, physical activity, and dietary pattern mediated this association. The mean BMI was 26 kg/m². Religious affiliation was associated with overweight/obesity for Hindus (OR 2.12; 95 % CI: 1.16, 3.89), Sikhs (OR 4.23; 95 % CI: 1.72, 10.38), and Muslims (OR 2.79; 95 % CI: 1.14, 6.80) compared with no religious affiliation. Traditional cultural beliefs (7 %), dietary pattern (1 %), and physical activity (1 %) mediated 9 % of the relationship. Interventions designed to promote healthy lifestyle changes to reduce the burden of overweight/obesity among South Asians need to be culturally and religiously tailored.

Acculturation and body mass index among marriage-based immigrant Vietnamese women in Korea

OBJECTIVE

This study aimed to analyze the association of socioeconomic factors, acculturation, and body mass index (BMI) as the first large prospective cohort study to determine the state of health of Vietnamese-born migrant women residing in Korea.

METHODS

Participants were Vietnamese marriage-based immigrant women living in Korea. Data (n=1,066) was collected during both periods of baseline (2006-2011) and follow-up (2012-2014) in 34 cities in Korea.

RESULTS

The results show that acculturation stress is relatively low among participants. Current BMI showed a significant difference according to the current age, monthly family income, and psychophysical stress. Depending on age, education level, monthly family income, we identified a significant difference in the annual BMI change. In correlation analysis, current BMI was significantly associated with age at arrival, reading and writing in Korean language adaptation, and psychophysical stress. Annual BMI change was significantly associated with age at arrival and years since immigration.

CONCLUSION

Our analysis revealed that acculturation measured by Acculturative Stress Scale for International Students had no association with current BMI or annual BMI change, but had an association with several socioeconomic statuses. This study had the advantage that subjects had a homogenous background of marriage-based immigrant women, so we could see the association of BMI and acculturation, without considering cofounding factors.

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.

Self-Care for the Prevention and Management of Cardiovascular Disease and Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association

Self-care is defined as a naturalistic decision-making process addressing both the prevention and management of chronic illness, with core elements of self-care maintenance, self-care monitoring, and self-care management. In this scientific statement, we describe the importance of self-care in the American Heart Association mission and vision of building healthier lives, free of cardiovascular diseases and stroke. The evidence supporting specific self-care behaviors such as diet and exercise, barriers to self-care, and the effectiveness of self-care in improving outcomes is reviewed, as is the evidence supporting various individual, family-based, and community-based approaches to improving self-care. Although there are many nuances to the relationships between self-care and outcomes, there is strong evidence that self-care is effective in achieving the goals of the treatment plan and cannot be ignored. As such, greater emphasis should be placed on self-care in evidence-based guidelines.

Changes in dietary intake following a culturally adapted lifestyle intervention among Iraqi immigrants to Sweden at high risk of type 2 diabetes: a randomised trial

Objective

To investigate the effectiveness of a culturally adapted lifestyle intervention for changing dietary intake, particularly energy, fat and fibre intakes, in the intervention group (IG) compared with the control group (CG).

Design

Randomised controlled trial.

Setting

IG (n 50) and CG (n 46). The IG was offered seven group sessions, including one cooking class, over a period of 4 months. The participants filled out 4 d food diaries at the start, mid and end of the study.

Subjects

Iraqi-born residents of Malmö, Sweden, at increased risk for developing diabetes.

Results

At baseline, participants’ fat intake was high (40 % of total energy intake (E%)). The predefined study goals of obtaining <30 E% from fat and ≥15 g fibre/4184 kJ (1000 kcal) were met by very few individuals. In the IG v. the CG, the proportion of individuals obtaining <40 E% from fat (48·4 v. 34·6 %, P=0·65), <10 E% from saturated fat (32·3 v. 11·5 %, P=0·14) and ≥10 g fibre/4184 kJ (45·2 v. 26·9 %, P=0·46) appeared to be higher at the last visit, although the differences were statistically non-significant. A trend towards decreased mean daily intakes of total energy (P=0·03), carbohydrate (P=0·06), sucrose (P=0·02) and fat (P=0·02) was observed within the IG. Differences in changes over time between the groups did not reach statistical significance.

Conclusions

Although no significant differences were observed in the two groups, our data indicate that this culturally adapted programme has the potential to modify dietary intake in Middle Eastern immigrants. The high fat intake in this group should be addressed.

Effectiveness of a Group-Based Culturally Tailored Lifestyle Intervention Program on Changes in Risk Factors for Type 2 Diabetes among Asian Indians in the United States

This study used an experimental, pretest-posttest control group repeated measures design to evaluate the effectiveness of a community-based culturally appropriate lifestyle intervention program to reduce the risk for type 2 diabetes (T2DM) among Gujarati Asian Indians (AIs) in an urban community in the US. Participants included 70 adult AIs in the greater Houston metropolitan area. The primary outcomes were reduction in weight and hemoglobin A1c (HbA1c) and improvement in physical activity. Participants were screened for risk factors and randomly assigned to a 12-week group-based lifestyle intervention program (n = 34) or a control group (n = 36) that received standard print material on diabetes prevention. Participants also completed clinical measures and self-reported questionnaires about physical activity, social, and lifestyle habits at 0, 3, and 6 months. No significant baseline differences were noted between groups. While a significant decline in weight and increase in physical activity was observed in all participants, the intervention group lowered their HbA1c (p < 0.0005) and waist circumference (p = 0.04) significantly as compared to the control group. Findings demonstrated that participation in a culturally tailored, lifestyle intervention program in a community setting can effectively reduce weight, waist circumference, and HbA1c among Gujarati AIs living in the US.

The association of duration of residence in the United States with cardiovascular disease risk factors among South Asian immigrants

South Asians are disproportionately impacted by cardiovascular disease (CVD). Our objective was to examine the association between duration of residence in the US and CVD risk factors among South Asian adult immigrants. Multivariate logistic regression analyses using pooled data from the 2005, 2007, 2009 California Health Interview Surveys. Duration of residence in the US < 15 years was significantly associated with overweight/obese BMI (OR 0.59; 95% CI 0.35, 0.98 for 5 to < 10 years), daily consumption of 5+ servings of fruits/vegetables (OR 0.37; 95% CI 0.15, 0.94 for 10 to < 15 years), and sedentary lifestyle (OR 2.11; 95% CI 1.17, 3.81 for 10 to < 15 years) compared with duration of residence ≥ 15 years after adjusting for illness burden, healthcare access, and socio-demographic characteristics. Duration of residence was not significantly associated with other CVD risk factors. Duration of residence is an important correlate of overweight/obesity and other risk factors among South Asian immigrants.

Dietary acculturation among the South-Asian Surinamese population in the Netherlands: the HELIUS study

OBJECTIVE

To test Koctürk's model of dietary change among South-Asian Surinamese in the Netherlands. The model categorizes foods into staple, complementary and accessory foods and postulates that dietary change after migration begins with accessory foods while foods associated with ethnic identity (staple foods) change at a slower rate.

DESIGN

Cross-sectional data from the HELIUS study. Dietary intake was assessed with an FFQ. Acculturation was based on social contacts and sense of belonging and was translated into four strategies of acculturation: assimilation, integration, separation and marginalization. Other indicators of acculturation included residence duration, age at migration and migration generation status.

SETTING

Amsterdam, the Netherlands.

SUBJECTS

Participants of Dutch (n 1456) and South-Asian Surinamese origin (n 968).

RESULTS

Across all acculturation strategies, South-Asian Surinamese participants reported significantly higher intakes of rice (staple food) and chicken (complementary food) and significantly lower intakes of red meat and vegetables (complementary foods) and cookies and sweets (accessory food) than Dutch participants. Men, second-generation and assimilated South-Asian Surinamese were inclined towards Dutch foods such as potato, pasta and red meat. Accessory foods like fruits showed variation across acculturation strategies.

CONCLUSIONS

Consistent with the Koctürk model, the intake of staple foods was stable among South-Asian Surinamese irrespective of acculturation strategy while the intake of accessory foods like fruit varied. Contrary to expectations, South-Asian Surinamese showed consistently high intakes of complementary foods like chicken and fish irrespective of acculturation strategy. Public health practitioners should take into consideration the complex and dynamic nature of dietary acculturation.

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.

Type 2 diabetes in migrant south Asians: mechanisms, mitigation, and management

South Asians, particularly when living in high-income countries, are at a substantially elevated risk of type 2 diabetes compared with white Europeans, and typically develop the disease 5-10 years earlier and at a lower BMI. Migrant south Asians seem to be more insulin resistant than white Europeans across the life course and potentially experience β-cell exhaustion at a younger age. Differences in adiposity (high percentage of body fat and high proportion of deep subcutaneous and visceral fat) and skeletal muscle (low percentage of lean mass and low cardiorespiratory fitness) are likely to contribute these factors. No clear evidence is available suggesting genetic factors make a major contribution to the increased risk of diabetes in south Asians, but epigenetic factors might have a role. Irrespective of future mechanistic discoveries, south Asians need to be encouraged and helped-by various culturally appropriate methods--to maintain a high physical activity level and low bodyweight across the life course to prevent diabetes. In clinical terms, cardiovascular risks have attenuated over time in migrant south Asians with diabetes but retinopathy and renal complication risks remain high because of the high levels of glycaemia and rapid glycaemic deterioration noted in this population. We review these aspects and suggest areas for future research.

Baseline Socio-demographic characteristics and self-reported diet and physical activity shifts among recent immigrants participating in the randomized controlled lifestyle intervention: "Live Well"

The goal of this paper is to describe the baseline characteristics of Live Well (intervention to prevent weight gain in recent immigrant mother-child dyads from Brazil, Haiti, and Latin America) participants, and to explore self-reported changes in diet and physical activity post-immigration. Baseline data from 383 mothers were used for this study. Dyads attended a measurement day where they completed self-administered surveys collecting information about socio-demographics, diet, physical activity, other psychosocial variables, and height and weight. Haitian mothers' socio-demographic profile differed significantly from that of Brazilians' and Latinas': they have been in the US for a shorter period of time, have higher rates of unemployment, are less likely to be married, more likely to have ≥3 children, more likely to be obese, and have immigrated for family or other reasons. In multivariate models, self-reported changes in diet and physical activity since migrating to the US were significantly associated with BMI with non-linear relationships identified. Future research is needed to understand how diet and physical activity change while acculturating to the US and explore the adoption of both healthy and unhealthy dietary changes.

Acculturation and dietary patterns among residents of Surinamese origin in the Netherlands: the HELIUS dietary pattern study

OBJECTIVE

Insight into the role of acculturation in dietary patterns is important to inform the development of nutrition programmes that target ethnic minority groups. Therefore, the present study aimed to investigate how the adherence to dietary patterns within an ethnic minority population in the Netherlands varies by acculturation level compared with the host population.

DESIGN

Cross-sectional study using data of the HELIUS study. Dietary patterns were assessed with an ethnic-specific FFQ. Acculturation was operationalized using unidimensional proxies (residence duration, age at migration and generation status) as well as on the basis of the bidimensional perspective, defined by four distinct acculturation strategies: assimilation, integration, separation and marginalization.

SETTING

Amsterdam, the Netherlands.

SUBJECTS

Participants of Dutch (n 1370) and Surinamese (n 1727) origin.

RESULTS

Three dietary patterns were identified: (i) 'noodle/rice dishes and white meat' (traditional Surinamese pattern); (ii) 'red meat, snacks and sweets'; and (iii) 'vegetables, fruit and nuts'. Surinamese-origin respondents adhered more to the traditional Surinamese pattern than the other dietary patterns. Neither the unidimensional proxies nor the bidimensional acculturation strategies demonstrated consistent associations with dietary patterns.

CONCLUSIONS

The lack of consistent association between acculturation and dietary patterns in the present study indicates that dietary patterns are quite robust. Understanding the continued adherence to traditional dietary patterns when developing dietary interventions in ethnic minority groups is warranted.

Dietary intakes among South Asian adults differ by length of residence in the USA

OBJECTIVE

To examine whether nutrient and food intakes among South Asian adult immigrants differ by length of residence in the USA.

DESIGN

Cross-sectional analysis to examine differences in nutrient and food intakes by length of residence in the USA. Dietary data were collected using an interviewer-administered, culturally appropriate FFQ, while self-reported length of residence was assessed using a questionnaire and modelled as tertiles.

SETTING

The Mediators of Atherosclerosis in South Asians Living in America (MASALA) study.

SUBJECTS

Eight hundred and seventy-four South Asians (mean age=55 (sd 9) years; 47 % women; range of length of residence in the USA=2-58 years), part of the baseline examination of the MASALA study.

RESULTS

Intakes of fat, including saturated and trans fats, dietary cholesterol and n-6 fatty acids, were directly associated with length of residence, while intakes of energy, carbohydrate, glycaemic index and load, protein, dietary fibre, folate and K were inversely associated with length of residence (P trend <0·05). A longer length of residence in the USA was also associated with higher intakes of alcoholic beverages, mixed dishes including pizza and pasta, fats and oils, and lower intakes of beans and lentils, breads, grains and flour products, milk and dairy products, rice, starchy vegetables and sugar, candy and jam (P for differences across groups <0·05).

CONCLUSIONS

Length of residence in the USA influences diet and nutrient intakes among South Asian adult immigrants and should be considered when investigating and planning dietary interventions to mitigate chronic disease risk.

Changing food habits in a South Indian Hindu Brahmin community: a case of transitioning gender roles and family dynamics

This study was conducted to explore the perceptions of 20 South Indian Hindu Brahmin women on the factors influencing their food habits upon immigrating to America. The competing demands of juggling a new career and managing their family's nutritional needs at the same time, all without the support of extended family members, played an important role in steering these women away from cooking traditional healthy meals, and resorting to fast foods instead. Intervention strategies should be directed toward improving the barriers to eating healthy that were specifically identified within the confines of shifting gender roles and limited family support networks.

Diabetes and associated complications in the South Asian population

The rising prevalence of diabetes in South Asians has significant health and economic implications. South Asians are predisposed to the development of diabetes due to biologic causes which are exacerbated by lifestyle and environmental factors. Furthermore, they experience significant morbidity and mortality from complications of diabetes, most notably coronary artery disease, cerebrovascular disease, and chronic kidney disease. Therefore, understanding the pathophysiology and genetics of diabetes risk factors and its associated complications in South Asians is paramount to curbing the diabetes epidemic. With this understanding, the appropriate screening, preventative and therapeutic strategies can be implemented and further developed. In this review, we discuss in detail the biologic and lifestyle factors that predispose South Asians to diabetes and review the epidemiology and pathophysiology of microvascular and macrovascular complications of diabetes in South Asians. We also review the ongoing and completed diabetes prevention and management studies in South Asians.

Correlates of prediabetes and type II diabetes in US South Asians: findings from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study

PURPOSE

In this study, we aim to elucidate the role of sociodemographic, lifestyle, and cultural factors in prediabetes and diabetes in South Asian immigrants to the United States, a population at high risk of type II diabetes.

METHODS

We performed a cross-sectional analysis of a community-based cohort of 899 South Asians without known cardiovascular disease from the Mediators of Atherosclerosis in South Asians Living in America study. Glycemic status was determined by fasting glucose, 2-hour postchallenge glucose, and use of diabetes medication. We used multinomial logistic regression models to estimate the independent associations of sociodemographic, lifestyle, and cultural factors with prediabetes and diabetes, adjusting for confounders identified using directed acyclic graphs.

RESULTS

Approximately 33% of participants had prediabetes and 25% had diabetes. In multivariate analyses, an independent correlate of prediabetes was low exercise. Additional covariates associated with diabetes included lower family income, less education, high chronic psychological burden score, and greater time spent watching television; and fasting monthly or annually was inversely associated with diabetes prevalence.

CONCLUSIONS

We found several modifiable risk factors associated with prediabetes and diabetes that may help guide diabetes prevention interventions for South Asian immigrants to the United States.

Festival foods in the immigrant diet

Dietary acculturation for immigrant groups has largely been attributed to the "Westernization" of indigenous diets, as characterized by an increased consumption of unhealthy American foods (i.e., fast foods, hamburgers). However, acculturation and adoption of western dietary habits may not fully explain new dietary patterns among racial/ethnic minority immigrants. The immigrant diet may change in such a way that it elaborates on specific ethnic traditions in addition to the incorporation of Western food habits. In this paper, we explore the role that festival foods, those foods that were once eaten a few times a year and on special occasions, play in the regular diet of immigrants to the US. This paper will focus on the overconsumption of ethnic festival foods, which are often high in carbohydrates, animal protein, sugar and fat, as opposed to Western "junk" food, as an explanation for the increased risk of cardiometabolic disorders among new immigrant groups.

A Systematic Review of Obesity Prevention Intervention Studies among Immigrant Populations in the US

The aim of this review was to systematically assess the effectiveness of obesity prevention and control interventions in US immigrant populations across the life course, from preschool-age to adults. A systematic review of relevant studies was undertaken and eligible articles included. The initial search identified 684 potentially relevant articles, of which only 20 articles met the selection criteria, representing 20 unique studies. They were divided into interventions that targeted adults (n=7), interventions that targeted children (n=5) and pilot studies (n=8). The majority of interventions targeted Latinos, predominately Mexican-origin populations. Among the interventions targeting adults, five had an effect on obesity related outcomes. However, they tended to use less rigorous study designs. Among the interventions that targeted children, three had a positive effect on obesity-related outcomes. Three of the eight pilot studies had an effect on obesity-related outcomes. There is a paucity of data on effective interventions but a great need to address obesity prevention to help inform health policies and programs to reduce migration-related obesity inequalities.

The association between acculturation and dietary patterns of South Asian immigrants

Dietary acculturation, specifically the adoption of western dietary habits, may result in adverse health effects such as obesity and type 2 diabetes. Therefore, it is necessary to explore the role of acculturation in dietary patterns as well as awareness and knowledge of healthy nutrition among South Asian immigrants. This is an especially important population to target as South Asians have higher prevalence rates of type 2 diabetes and cardiovascular disease, which may be magnified with immigration. The current investigation is a sub-study of the Multi-Cultural Community Health Assessment Trial (M-CHAT). There were 207 participants of South Asian origin included in the initial study, 129 were born outside of Canada and had immigrated after the age of 18. The length of residence in Canada was used as a marker for acculturation. A questionnaire addressing perceived changes in dietary patterns, food preparation, and nutrition knowledge and awareness since immigration was used to assess dietary practices. The association between length of residence and variables related to perceived changes in dietary patterns was explored with Spearman correlation and significant associations were subsequently analyzed with ordinal logistic regression analysis adjusted for age, sex, education and body mass index. South Asian immigrants in Canada reported a variety of positive dietary practices, including an increased consumption of fruits and vegetables and an improvement in food preparation (including an increase in grilling and a decrease in deep frying when cooking). However, there was a reported increase in the consumption of convenience foods, sugar-sweetened beverages, red meat and in dining out. South Asian immigrants in Canada reported a variety of positive dietary practices including an improvement in food preparation. Future health promotion strategies should encourage cultural sensitivity in efforts to reduce the consumption of sugar-sweetened beverage, convenience foods and to encourage eating at home rather than dining out.

Immigrating to the US: what Brazilian, Latin American and Haitian women have to say about changes to their lifestyle that may be associated with obesity

Our goal was to explore the perceived determinants of obesity in Brazilian, Latin American and Haitian women. This is part of an ongoing community-based participatory intervention. Focus groups by immigrant group were conducted and themes extracted. Women expressed differences in beliefs, attitudes, and barriers regarding diet and physical activity in the US versus their home country. Participants thought food in the US is "less natural," there is less time for preparation, and there is more variety. The weather is a barrier to physical activity in the US and work is more physically demanding. Job-related efforts were not considered physical activity. They reported higher levels of stress, less control of their time and less social support in the US. Providing immigrants with appropriate support and education early in the acculturation process has the potential to help prevent obesity.

The association of religiosity with overweight/obese body mass index among Asian Indian immigrants in California

OBJECTIVE

The aim of this study was to examine the association between religiosity and overweight or obese body mass index among a multi-religious group of Asian Indian immigrants residing in California.

METHODS

We examined cross-sectional survey data obtained from in-language telephone interviews with 3228 mostly immigrant Asian Indians in the 2004 California Asian Indian Tobacco Survey using multivariate logistic regression.

RESULTS

High self-identified religiosity was significantly associated with higher BMI after adjusting for socio-demographic and acculturation measures. Highly religious Asian Indians had 1.53 greater odds (95% CI: 1.18, 2.00) of being overweight or obese than low religiosity immigrants, though this varied by religious affiliation. Religiosity was associated with greater odds of being overweight/obese for Hindus (OR 1.54; 95% CI: 1.08, 2.22) and Sikhs (OR 1.88; 95% CI: 1.07, 3.30), but not for Muslims (OR 0.69; 95% CI: 0.28, 1.70).

CONCLUSIONS

Religiosity in Hindus and Sikhs, but not immigrant Muslims, appears to be independently associated with greater body mass index among Asian Indians. If this finding is confirmed, future research should identify potentially mutable mechanisms by which religion-specific religiosity affects overweight/obesity risk.

Incidence of type 2 diabetes by place of birth in the Multi-Ethnic Study of Atherosclerosis (MESA)

Incidence of diabetes among US foreign-born individuals is not well studied. Data were from the Multi Ethnic Study of Atherosclerosis. Cox proportional hazards regression was used to examine diabetes risk by race/ethnicity, place of birth, and duration of residence among foreign-born. Foreign-born Latinos had a higher risk of incident diabetes compared to US-born Latinos (hazard ratio (HR) 1.79 [95 % confidence interval (CI) 1.00-3.21]). Latinos born in Mexico (HR, 2.26 [95 % CI, 1.18-4.33]) had higher risk of incident diabetes compared to US-born Latinos. Foreign-born living in the US ≥20 years had a higher adjusted risk of incident diabetes compared to those in the US for <20 years (HR, 1.60 [95 % CI, 1.05-2.55]). Incident diabetes may be higher among foreign-born compared to native born; incident diabetes may also be higher among those immigrants who have lived in the US for longer periods of time. Future studies should characterize individuals by race/ethnicity and place of birth to account for differences in biology and time spent in the US.

Acculturation and glycemic control of Asian Indian adults with type 2 diabetes

The prevalence of type 2 diabetes is disproportionately high among Asian Indians (AI), one of the fastest growing immigrant groups in the United States (US). Poorly controlled diabetes associated with inadequate self-management increases complications and thus medical costs. Acculturation may be an important determinant of diabetes self-management and hence control. This study examined the association between the degree of acculturation and glycemic control as measured by Hemoglobin A1c in AI adults with type 2 diabetes. A mixed method (quantitative and qualitative) study was conducted among 30 AI adults with type 2 diabetes. Acculturation assessment using the Suinn-Lew Asian Self-identity Instrument was followed by socio-demographic questions, self-reported anthropometric measures, and open ended diabetes self-care questions. A two-step multiple regression analysis and content analysis of verbatim interview transcriptions were conducted. Interactions of acculturation with body mass index (interaction b = 1.11; p = 0.01), annual household income (interaction b = 7.19; p = .01), and diabetes duration (interaction b = .30; p = .02) significantly predicted higher HbA1c levels (R(2) change = .368; F change = 4.21; p = .02). From the qualitative interviews, the following were regarded as US specific facilitators for glycemic control: excellent health care system and facilities, availability of healthy food choices and self-monitoring devices, medical insurance benefits, good quality medications, and improved health awareness. Cultural orientation might be important for patient tailored interventions targeting AI with type 2 diabetes. Therefore, interventions targeted at Asian Indians with diabetes should include culture specific adaptations to nutrition education and support.

Dietary acculturation of Arab immigrants in the Greater Toronto Area

PURPOSE

We explored the eating habits of Arab immigrants to determine whether they have maintained their traditional diet or have consumed a more Westernized diet since immigrating to Canada.

METHODS

Arab immigrants who had been in Canada for at least eight years and were currently living in the Greater Toronto Area were recruited. A sample of 24 Arab immigrants completed a mailed, self-administered questionnaire, and six participated in a focus group. The focus group discussion was transcribed verbatim and results were recorded. Latent content analysis was used to analyze, code, and categorize emerging themes.

RESULTS

Arab immigrants consumed a mixture of both Arabic and Western food and perceived their current diet to be healthier than it was before they immigrated to Canada. Factors that influenced their food choices included increased nutrition health awareness, differences in food preferences and preparation methods, and preservation of dietary practices in the new environment.

CONCLUSIONS

Our findings will help dietitians who work with Arab immigrants to become more aware of factors that motivate this group's food choices, and to create nutrition programs that are more culturally sensitive.

Barriers to lifestyle behavioral change in migrant South Asian populations

The purpose of this literature review is to describe and assess the cultural barriers to behavior change in migrant South Asians, given the high morbidity and mortality associated with cardiovascular disease in this population. We reviewed studies that explored the relationship between South Asian culture in the Diaspora and lifestyle behaviors. Our review produced 91 studies, of which 25 discussed the relationship between various aspects of South Asians' belief system and their approach to modifying lifestyle habits. We identify 6 specific categories of beliefs which play the largest role in the difficulties South Asians describe with behavior change: gender roles, body image, physical activity misconceptions, cultural priorities, cultural identity, and explanatory model of disease. Future research and interventions should account for these cultural factors to successfully improve dietary habits and physical activity levels in migrant South Asian populations.

Type 2 diabetes in South Asians: similarities and differences with white Caucasian and other populations

Type 2 diabetes mellitus (T2DM) is one of the leading causes of morbidity and mortality. While all ethnic groups are affected, the prevalence of T2DM in South Asians, both in their home countries and abroad, is extremely high and is continuing to rise rapidly. Innate biological susceptibilities coupled with rapid changes in physical activity, diet, and other lifestyle behaviors are contributing factors propelling the increased burden of disease in this population. The large scope of this problem calls for investigations into the cause of increased susceptibility and preventative efforts at both the individual and population level that are aggressive, culturally sensitive, and start early. In this review, we outline the biological and environmental factors that place South Asians at elevated risk for T2DM, compared with Caucasian and other ethnic groups.

Acculturation and gestational weight gain in a predominantly Puerto Rican population

Background

Identifying risk factors that affect excess weight gain during pregnancy is critical, especially among women who are at a higher risk for obesity. The goal of this study was to determine if acculturation, a possible risk factor, was associated with gestational weight gain in a predominantly Puerto Rican population.

Methods

We utilized data from Proyecto Buena Salud, a prospective cohort study of Hispanic women in Western Massachusetts, United States. Height, weight and gestational age were abstracted from medical records among participants with full-term pregnancies (n=952). Gestational weight gain was calculated as the difference between delivery and prepregnancy weight. Acculturation (measured via a psychological acculturation scale, generation in the US, place of birth and spoken language preference) was assessed in early pregnancy.

Results

Adjusting for age, parity, perceived stress, gestational age, and prepregnancy weight, women who had at least one parent born in Puerto Rico/Dominican Republic (PR/DR) and both grandparents born in PR/DR had a significantly higher mean total gestational weight gain (0.9 kg for at least one parent born in PR/DR and 2.2kg for grandparents born in PR/DR) and rate of weight gain (0.03 kg/wk for at least one parent born in PR/DR and 0.06 kg/wk for grandparents born in PR/DR) vs. women who were of PR/DR born. Similarly, women born in the US had significantly higher mean total gestational weight gain (1.0 kg) and rate of weight gain (0.03 kg/wk) vs. women who were PR/ DR born. Spoken language preference and psychological acculturation were not significantly associated with total or rate of pregnancy weight gain.

Conclusion

We found that psychological acculturation was not associated with gestational weight gain while place of birth and higher generation in the US were significantly associated with higher gestational weight gain. We interpret these findings to suggest the potential importance of the US “obesogenic” environment in influencing unhealthy pregnancy weight gains over specific aspects of psychological acculturation.

Factors That Influence Food Amount Ratings by White, Hispanic, and Asian Samples

OBJECTIVE

Two studies explored in nonclinical samples variables that may influence meal size assessments.

RESEARCH METHODS AND PROCEDURES

In Study 1, the contribution of dietary restraint, weight, depressive symptoms, and gender to ratings on the Food Amount Rating Scale was examined in 153 white women and 121 white men; in Study 2, the contribution of dietary restraint, weight, ethnicity, and ethnic group identification to Food Amount Rating Scale ratings was examined in 67 Asian, 81 Hispanic, and 107 white women.

RESULTS

Study 1 indicated that food amounts were rated as larger when rated by male rather than female raters (male rater, mean=62.37, SD=1.14; female rater, mean=59.28, SD=0.89), for female rather than male targets (male target, mean=56.16, SD=0.97; female target, mean=64.87, SD=1.02), and by restrained rather than unrestrained eaters (restrained, mean=63.14, SD=1.11; unrestrained, mean=58.69, SD=0.91). Study 2 indicated that food amounts were rated as larger when rated by restrained eaters (restrained, mean=67.53, SD=1.21; unrestrained, mean=64.99, SD=1.09), Hispanic women (Asian, mean=64.59, SD=1.61; Hispanic, mean=68.71, SD=1.30; white, mean=65.41, SD=1.34), and underweight women (underweight, mean=70.38, SD=1.68; normal weight, mean=64.52, SD=0.93; overweight: mean=64.23, SD=1.64).

DISCUSSION

Food amount judgments may be influenced by personal characteristics. Future research should examine whether variation in food amount judgments is related to dieting behavior, disordered eating, or obesity.

Dietary intake and rural-urban migration in India: a cross-sectional study

Background

Migration from rural areas of India contributes to urbanisation and lifestyle change, and dietary changes may increase the risk of obesity and chronic diseases. We tested the hypothesis that rural-to-urban migrants have different macronutrient and food group intake to rural non-migrants, and that migrants have a diet more similar to urban non-migrants.

Methods and findings

The diets of migrants of rural origin, their rural dwelling sibs, and those of urban origin together with their urban dwelling sibs were assessed by an interviewer-administered semi-quantitative food frequency questionnaire. A total of 6,509 participants were included. Median energy intake in the rural, migrant and urban groups was 2731, 3078, and 3224 kcal respectively for men, and 2153, 2504, and 2644 kcal for women (p<0.001). A similar trend was seen for overall intake of fat, protein and carbohydrates (p<0.001), though differences in the proportion of energy from these nutrients were <2%. Migrant and urban participants reported up to 80% higher fruit and vegetable intake than rural participants (p<0.001), and up to 35% higher sugar intake (p<0.001). Meat and dairy intake were higher in migrant and urban participants than rural participants (p<0.001), but varied by region. Sibling-pair analyses confirmed these results. There was no evidence of associations with time in urban area.

Conclusions

Rural to urban migration appears to be associated with both positive (higher fruit and vegetables intake) and negative (higher energy and fat intake) dietary changes. These changes may be of relevance to cardiovascular health and warrant public health interventions.

Food system access, shopping behavior, and influences on purchasing groceries in adult Hmong living in Minnesota

PURPOSE

To investigate influences on shopping and eating behavior of Hmong adults living in St. Paul/Minneapolis, Minnesota.

DESIGN AND SETTING

Conducted a mapping project, food surveys, food frequency questionnaire (FFQ), and focus groups (n = 11).

SUBJECTS

Subjects were assigned to three groups. The B-TL(1) group was made up of subjects who were born in Thailand/Laos and had lived in the US < or =5 years (n = 19). The B-TL(2) group was made up of subjects who were born in Thailand/Laos, had food memories, and had lived in the US >5 years (n = 20). The B-US group was made up of subjects who were born and/or raised in the US (n = 30).

METHODS

Using Geographical Informational Systems software, 15 grocery stores were mapped and surveyed. Food prices were compared with the consumer price index (CPI). The FFQ assessed food consumption patterns. Focus group transcripts were evaluated for themes and coded. Degree of acculturation was assessed by adapting a previously developed instrument.

RESULTS

The population is concentrated in St. Paul, coinciding with store density. Limited foods had CPIs and some CPIs were outdated. B-US had significantly higher levels of dietary acculturation than B-TL(2) and B-TL(1), with B-TL(2) also having a higher dietary acculturation level compared with B-TL(1). Acculturation of the Hmong into the American food system, determinants of store type, and Hmong food's having a mainstream factor were identified themes.

CONCLUSIONS

B-US and B-TL(2) shopped at American stores more than did B-TL(1) because of convenience, one-stop shopping, and increased English fluency. Hmong foods have entered the American food system and are sold at Asian and American stores.

Masculinities, diet and senior Punjabi Sikh immigrant men: food for Western thought?

The high rates of diabetes and cardiovascular disease among Punjabi Sikh (PS) men are often linked to diet. Although some high fat and sugar foods in both traditional and Western foods negatively influence these illnesses, little is known about what underpins PS immigrant men's dietary practices. This article details the connections between masculinities and diet to reveal how varying gendered ideals can inform and influence the practices of senior PS Canadian immigrant men who attended community-based men's groups. Participants' masculine ideals and their alignment to those ideals were deeply rooted in spirituality and traditional cultures, which shaped the use of specific foods and beverages, yet there was also evidence that the availability and affordability of dairy products and alcohol in Canada strongly influenced men's diets. While the men's group leaders educated attendees about diet, ideologies reinforcing ties between femininities and the cooking of meals often prevailed. Linkages between participants' masculine ideals and dietary practices were both similar and discordant with the findings reported in studies of Western men. The findings drawn from this study may direct what, how and where dietary messages are targeted to senior PS Canadian immigrant men.

The weight of US residence among immigrants: a systematic review

As the number of immigrants in the USA continues to rise, it becomes increasingly important to understand how their health differs from native-born individuals. Obesity is a public health concern and a component of health that may differ and change in important ways in immigrants. This research synthesizes the current literature on the relationship between immigrant duration of residence in the USA and body weight. Five databases from the health and social sciences were searched for all pertinent publications. Fifteen articles met inclusion criteria, 14 of which reported a significant, positive relationship between body mass index and duration of residence in the USA (all P-values <0.10). Two studies reported a threshold effect of weight gain after 10 years of US residence, and another study reported that body mass index peaks after 21 years of duration for men and after 15 years for women. The results of this review suggest that weight gain prevention programmes would be beneficial for many immigrants within the first decade of residence in the USA. Prevention efforts may be more successful if nativity and acculturation are considered in addition to race/ethnicity. Future research is needed to identify the specific mechanisms through which living in the USA may adversely affect health outcomes.

Cultural and social influences on food consumption in dutch residents of Turkish and moroccan origin: a qualitative study

OBJECTIVE

To explore the social and cultural influences on food intake in 2 non-Western migrant origin groups. The authors were particularly interested in the influence of the traditional culture and its relevance within the context of migration and associated changes in social, economic and cultural context, including acculturation.

DESIGN

Qualitative focus group discussions.

SETTING

City of Amsterdam, the Netherlands.

PARTICIPANTS

Young adults of Turkish and Moroccan migrant origin.

PHENOMENON OF INTEREST

Social and cultural influences on food intake.

ANALYSIS

Focus groups were recorded, transcribed, and analyzed using framework analysis.

RESULTS

A dominant theme that emerged is that of hospitality and the central role of food herein. Hospitality is rooted within the cultural and religious tradition of both groups. Additional themes that emerged were: cultural identity; migration and lifestyle change; and acculturation.

CONCLUSIONS AND IMPLICATIONS

Among Dutch residents of Turkish and Moroccan migrant origin, the central role of food in culture coupled with the changes that come about as a result of migration create an environment of abundance that can lead to overeating, which may impact energy balance and overweight development. These results indicate that younger members of migrant origin populations continue to value their traditional food cultures, underpinning the need for interventions to be culturally sensitive.