Acculturation and Associations with Ultra-processed Food Consumption among Asian Americans: NHANES, 2011-2018

Social Determinants of Health and Allergic Disease Prevalence Among Asian American Children

BACKGROUND

Although racial and ethnic disparities in allergic diseases have previously been observed, the relationship between social determinants of health (SDoH) and allergic disease prevalence among disaggregated Asian American (AsA) subgroups is poorly understood.

OBJECTIVE

To examine the association of SDoH with allergic disease prevalence among disaggregated AsA subgroups.

METHODS

Using the 2011-2018 National Health Interview Survey, we examined caregiver-reported race and ethnicity, SDoH, and allergic diseases. We compared survey-weighted allergic disease prevalence by AsA subgroup. Subgroup-stratified multivariable logistic regression accounting for age, sex, child/parent nativity, and survey year modeled the association between SDoH and allergic disease prevalence. We provide predicted probabilities of having each allergic disease based on exposure to each SDoH.

RESULTS

We examined data from 5042 non-Hispanic AsA children representing 3,264,768 AsA children. Approximately 25% of all AsA children reported at least one allergic disease, ranging from 20% of Asian Indian children to 30% of Filipino/a children. The number of unfavorable SDoH was lowest among Asian Indian and Chinese children (mean 0.7) and highest among "other Asian" children (mean 1.2). In stratified analyses, financial instability and inaccessible healthcare were associated with greater probability of allergic diseases among some, but not all AsA subgroups. Lower parent education level, food insecurity, and rent/other housing arrangement were associated with lower probability of allergic disease among some AsA children.

CONCLUSION

There was heterogeneity in the association of SDoH and allergic disease prevalence among AsA children. Further study of SDoH may inform modifiable environmental factors for allergic disease among AsA children.

The Association of Nativity and Time in the United States on Added Sugar Consumption

Background

Diets high in added sugar are associated with adverse health conditions. Immigrants may have different added sugar intake than nonimmigrants, which may contribute to differential health outcomes.

Objectives

We examined 1) the cross-sectional association between added sugar intake and nativity and time in the United States and 2) prospective association between added sugar intake and all-cause mortality by nativity.

Methods

Cross-sectional analyses were based on 17,489 adults (≥18 y) from the NHANES (2011 to March 2020) and prospective analyses were based on 31,291 adults (≥18 y) from NHANES 2003-2018. Multivariable linear regression models were used to assess the association between added sugar intake as a percent of energy, nativity (US-born compared with non-US-born), and time in the United States (<5 years, 5 to <15 y, 15-30 y, ≥30 y), after adjusting for important confounders. Multivariable Cox regression models were conducted to examine the association between added sugar intake and mortality.

Results

After adjusting for sociodemographic factors and BMI, individuals not born in the United States had 3.29% lower (95% CI: -3.69, -2.90, P < 0.001) added sugar intake as a percent of energy compared with those born in the United States. These associations were consistent across all race/ethnicities. As time in the United States increased, added sugar intake increased significantly (P-trend < 0.001) among non-US-born individuals. Added sugar intake was not significantly associated with lower risk of all-cause mortality in non-US-born individuals or US-born individuals, after adjusting for confounders.

Conclusions

Added sugar intake differed by nativity and time in the United States, underscoring the need to consider place of birth and length of time when characterizing dietary intake.

Social inequalities and dietary patterns: an analysis with adults in the Metropolitan Region of Recife, Brazil

The aim of this study was to identify dietary patterns (DP) and their association with socioeconomic, demographic, lifestyle, and overweight characteristics in adults from the Metropolitan Region of Recife (MRR) in 2015/16 and 2019. A cross-sectional study was conducted with individuals of both sexes, aged 20 to 59 years. DPs were identified using Principal Component Analysis (PCA). Binary logistic regression was used to estimate crude and adjusted odds ratios and 95% confidence intervals (95%CI). Three DPs were identified: Dual, Ultra-processed (UP), and Traditional. The Dual DP explained the highest variance in 2015/16 (15.4%), while in 2019, it was the UP DP (15.1%). In 2015/16, the Dual DP was related to the age groups of 20-29 years and 30-40 years, with no associations in 2019. The Traditional DP was associated with physical activity in 2015/16 and, in 2019, with living with ≥5 people in the household, lower education, and overweight. The dietary patterns in 2019 showed a stronger association with social determinants, indicating a greater influence of these factors on eating habits.

Ultra-processed food consumption: an exploration of social determinants among Black children of African and Caribbean descent in Ottawa

Consumption of ultra-processed foods (UPF) is a growing concern due to its negative impact on diet quality and health outcomes. To our knowledge, no data on UPF consumption are available for specific racial/ethnic children, including Black children, in Canada. This cross-sectional study aimed to explore the social determinants of UPF consumption among Black children of African and Caribbean descent in Ottawa. It included 174 mothers born in the Caribbean or Sub-Saharan Africa and their children aged 6 to 12. A survey was administered to assess demographic and socio-economic characteristics of mothers, children, and households. Children's dietary intakes were evaluated with a 24 h dietary recall to calculate the proportion of energy from UPF according to the NOVA food classification system. ANOVA and two-step cluster analysis were performed. Identified clusters were compared using chi-square and Student's t tests. Findings indicate that children whose mothers had been living in Canada longer (p < 0.001), whose mothers were family-class immigrants (p = 0.005), and whose households were food secure (p = 0.049), consumed more UPF than their respective counterparts. Cluster analysis revealed two profiles, named settling and established, reinforcing previous associations. Children in the established profile had a mean energy intake from UPF 9% higher than those in the settling profile (p = 0.006). This study provided initial findings on the social determinants of UPF consumption among Black children of African and Caribbean descent. It suggests that immigration-related factors and household food security status shaped UPF consumption of these children.

Who consumes ultra-processed food? A systematic review of sociodemographic determinants of ultra-processed food consumption from nationally representative samples

Ultra-processed food (UPF) intake is associated with increased non-communicable disease risks. However, systematic reports on sociodemographic predictors of UPF intake are lacking. This review aimed to understand UPF consumption based on sociodemographic factors, using nationally representative cohorts. The systematic review was pre-registered (PROSPERO:CRD42022360199), following PRISMA guidelines. PubMed/MEDLINE searches (‘ultra-processed/ultraprocessed’ and ‘ultra-processing/ultraprocessing’) until 7 September 2022 retrieved 1131 results. Inclusion criteria included: observational, nationally representative adult samples, in English, in peer-reviewed journals, assessing the association between sociodemographics and individual-level UPF intake defined by the NOVA classification. Exclusion criteria included: not nationally representative, no assessment of sociodemographics and individual-level UPF intake defined by NOVA. Risk of bias was assessed using the Newcastle–Ottawa Scale (NOS). Fifty-five papers were included, spanning thirty-two countries. All thirteen sociodemographic variables identified were significantly associated with UPF intake in one or more studies. Significant differences in UPF intake were seen across age, race/ethnicity, rural/urbanisation, food insecurity, income and region, with up to 10–20% differences in UPF intake (% total energy). Higher UPF intakes were associated with younger age, urbanisation and being unmarried, single, separated or divorced. Education, income and socioeconomic status showed varying associations, depending on country. Multivariate analyses indicated that associations were independent of other sociodemographics. Household status and gender were generally not associated with UPF intake. NOS averaged 5·7/10. Several characteristics are independently associated with high UPF intake, indicating large sociodemographic variation in non-communicable disease risk. These findings highlight significant public health inequalities associated with UPF intake, and the urgent need for policy action to minimise social injustice-related health inequalities.

The role of acculturation in the accuracy of type 2 diabetes risk perception: National Health and Nutrition Examination Survey 2011-2016

OBJECTIVE

High rates of undiagnosed Type 2 diabetes mellitus (T2DM) necessitate additional efforts to increase risk awareness, particularly among marginalized and immigrant populations. We examined the association of acculturation with the likelihood of accurate perception of T2DM risk in a large nationally representative sample of adults at risk for T2DM.

METHOD

Participants were 5,034 adults, M (SD) age: 53 (23) years, 48% female. Acculturation was operationalized as length of time in the United States, and whether participants predominantly spoke English or their native language at home. Adults were considered to have accurate risk perception if they (a) met American Diabetes Criteria for prediabetes, and (b) self-reported their risk.

RESULTS

Less than half of the sample (33%) accurately perceived their T2DM risk. Logistic regression models adjusting for age, race, sex, education, insurance status, smoking, alcohol use, waist circumference, and family history of T2DM revealed that adults living in the United States up to 15 years were 1.35-2.33 times (ps < .04) as likely to inaccurately perceive their risk for T2DM compared to adults living in the United States > 15 years and United States-born adults. Adults with lower versus higher English proficiency had a 41% (p = .03) increased likelihood of misperceiving their T2DM risk.

CONCLUSIONS

Findings suggest that acculturation plays an important role in shaping T2DM risk perceptions among both nonimmigrant and immigrant populations. Increased cognizance of acculturation status (e.g., by healthcare providers) may be warranted to promote early T2DM risk detection and prevention at the population level. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Ultra-processed food intake among South Asians in the United States: Specific vulnerabilities of a growing immigrant population group

South Asians are among the fastest growing immigrant population groups in the United States. Their traditional diets are rich in minimally processed fruits, vegetables, grains, herbs, and spices. However, the proliferation of ultra-processed foods (highly processed, industrially manufactured formulations) around the globe may compromise the nutrition profile of South Asians, threatening to increase their risk of noncommunicable diseases. This commentary discusses the rise in ultra-processed food consumption among South Asians in the United States and hypothesizes that South Asians may be especially vulnerable to the effects of ultra-processed foods due to their unique cardiovascular disease risk profiles. Using these emerging data, we propose several strategies for preventing the overconsumption of ultra-processed foods among South Asian Americans. These include the implementation of policies to encourage the consumption of whole foods over ultra-processed foods and the development of culturally tailored interventions, which include promoting consumption of traditional diets, improving affordability of healthful, culturally appropriate foods, and cultivating healthier food environments for South Asians living in the United States.

Socio-demographic correlates of ultra-processed food consumption in Canada

OBJECTIVE

To characterise consumption of ultra-processed foods and drinks (UPF) across a range of socio-demographic characteristics of Canadians.

DESIGN

Cross-sectional study. The national-level 2015 Canadian Community Health Survey-Nutrition provided data on all foods and drinks consumed on the previous day via a 24-hour dietary recall. All food items were classified according to the type of industrial processing using the NOVA system. Multivariable linear regression models examined associations between a range of socio-demographic characteristics and the mean energy contribution (% of total daily energy intake) from total UPF and UPF subgroups.

SETTING

The ten Canadian provinces.

PARTICIPANTS

Canadians aged 2 or older (n 20 103).

RESULTS

UPF contributed, on average, nearly half (44·9 %) of total daily energy intake of Canadians. Children aged 6-12 and adolescents aged 13-18 consumed over half of total daily energy from UPF (adjusted means of 51·9 % and 50·7 %, respectively). Recent and long-term immigrants consumed a significantly lower share of energy from UPF (adjusted means of 42·2 % and 45·1 %, respectively) compared with non-immigrants (54·4 %), as did the food secure (42·8 %) v. those in moderately (48·1 %) or severely food-insecure households (50·8 %). More modest differences were observed for intake of total UPF and UPF subgroups by sex, education, income adequacy and region of residence.

CONCLUSION

Levels of UPF consumption in 2015 in Canada were pervasive in all socio-demographic groups and highest among children and adolescents, non-immigrants and those living in food-insecure households. These findings can inform public health interventions to reduce UPF consumption and promote healthier diets in various socio-demographic groups.

Social Determinants of Health and Biological Age among Diverse U.S. Adults, NHANES 2011-2018

We examined the sex-specific association between education and income with biological age (BA) and by race/ethnicity. The Klemera-Doubal method was used to calculate BA among 6,213 females and 5,938 males aged 30-75 years who were Hispanic, non-Hispanic (NH) White, NH Black (NHB), or NH Asian (NHA). Compared with a college education, less than a high school education was associated with greater BA by 3.06 years (95% CI: 1.58, 4.54) among females only; associations were strongest among NHB, Hispanic, and NHA females. Compared with an annual income of ≥$75,000, an income <$25,000 was associated with greater BA by 4.95 years (95% CI: 3.42, 6.48) among males and 2.76 years among females (95% CI: 1.51, 4.01); associations were strongest among NHW and NHA adults, and Hispanic males. Targeting upstream sources of structural disadvantage among racial/ethnic minority groups, in conjunction with improvements in income and education, may promote healthy aging in these populations.

Diets high in subsidized foods and chronic kidney disease in Hispanic communities in the United States: the Hispanic Community Health Study/Study of Latinos

Prior research shows that diets high in government subsidized foods may be associated with cardiometabolic disease risk factors. Our aim was to evaluate the relationship between diets high in subsidized foods and the development of chronic kidney disease (CKD) and other cardiometabolic risk factors in United States (US) Hispanics/Latinos. Using data from 16,172 Hispanics/Latino's living in the United States, we used the Cochran-Armitage test to assess the relationship between subsidized foods in the diets of participants and baseline characteristics. We used survey-weighted Poisson regression models to examine whether intake of subsidized foods was associated with incident CKD or cardiometabolic risk factors. Several baseline characteristics were associated with higher subsidized food scores. Higher subsidized food scores were not associated with incident CKD or cardiometabolic risk factors. These findings may be useful for future researchers, clinicians, and nutritional policy advocates who are interested in the way Hispanic and Latinos consume foods subsidized by the US government and the structural factors that may shape observed dietary and disease patterns.

Social Determinants of Cardiovascular Risk Factors Among Asian American Subgroups

BACKGROUND

Social determinants of health (SDOH) play a significant role in the development of cardiovascular risk factors. We investigated SDOH associations with cardiovascular risk factors among Asian American subgroups.

METHODS AND RESULTS

We utilized the National Health Interview Survey, a nationally representative survey of US adults, years 2013 to 2018. SDOH variables were categorized into economic stability, neighborhood and social cohesion, food security, education, and health care utilization. SDOH score was created by categorizing 27 SDOH variables as 0 (favorable) or 1 (unfavorable). Self-reported cardiovascular risk factors included diabetes, high cholesterol, high blood pressure, obesity, insufficient physical activity, suboptimal sleep, and nicotine exposure. Among 6395 Asian adults aged ≥18 years, 22.1% self-identified as Filipino, 21.6% as Asian Indian, 21.0% as Chinese, and 35.3% as other Asian. From multivariable-adjusted logistic regression models, each SD increment of SDOH score was associated with higher odds of diabetes among Chinese (odds ratio [OR], 1.45; 95% CI, 1.04-2.03) and Filipino (OR, 1.24; 95% CI, 1.02-1.51) adults; high blood pressure among Filipino adults (OR, 1.28; 95% CI, 1.03-1.60); insufficient physical activity among Asian Indian (OR, 1.42; 95% CI, 1.22-1.65), Chinese (OR, 1.58; 95% CI, 1.33-1.88), and Filipino (OR, 1.24; 95% CI, 1.06-1.46) adults; suboptimal sleep among Asian Indian adults (OR, 1.20; 95% CI, 1.01-1.42); and nicotine exposure among Chinese (OR, 1.56; 95% CI, 1.15-2.11) and Filipino (OR, 1.50; 95% CI, 1.14-1.97) adults.

CONCLUSIONS

Unfavorable SDOH are associated with higher odds of cardiovascular risk factors in Asian American subgroups. Culturally specific interventions addressing SDOH may help improve cardiovascular health among Asian Americans.

Factors Correlated With Ultra-Processed Food (UPF) Intake in Preschool-Aged Children and Association With Weight

OBJECTIVE

Understand the correlates of ultra-processed food (UPF) intake and examine the association of UPF on body mass index in children aged 3-5 years.

DESIGN

Secondary analysis of a prospective cohort of 3-5-year-olds/parent, followed 1-year between March 2014 and October 2016. Usual UPF intake from 2 3-day food records completed 1 year apart, a standardized nutrient database customized with child-specific foods, and a NOVA food classification system was used. Child/parent characteristics and media use were measured via parent-reported surveys. Child weight/height objectively measured.

SETTING

New Hampshire community.

PARTICIPANTS

Six hundred and sixty-seven parent-child dyads were screened, and 624 were enrolled with 90% follow-up.

MAIN OUTCOME MEASURE(S)

Primary outcome: identify correlates of UPF intake.

SECONDARY OUTCOME

determine if UPF intake is associated with body mass index change.

ANALYSIS

Adjusted β linear regression, linear regression, P <0.05.

RESULTS

Ultra-processed food accounted for 67.6% of total caloric intake. In adjusted models, children's UPF intake was positively associated with increasing child age, greater hours watching television, and more frequent parent soda/fast-food intake. Ultra-processed food intake was negatively associated with higher parent education and reported race/ethnicity other than non-Hispanic White. There was no association between UPF intake and weight.

CONCLUSIONS AND IMPLICATIONS

There are several predictors of UPF intake in young children. Family-level interventions could be implemented to encourage the intake of minimally processed foods before and during preschool years.

Cardiovascular Health, Lifestyle Factors, and Social Determinants in Asian Subpopulations in the United States

Asian Americans are often aggregated in national public health surveillance efforts, which may conceal important differences in the health status of subgroups that are included in this highly diverse population. Little is known about how cardiovascular health varies across Asian subpopulations and the extent to which lifestyle and social risk factors contribute to any observed differences. This national study used data from the National Health Interview Survey to evaluate the burden of cardiovascular risk factors (hypertension, hyperlipidemia, diabetes mellitus) and cardiovascular diseases (heart attack, coronary heart disease, angina, stroke) across Asian groups (Chinese, Asian Indian, Filipino, Other Asian), and determine whether differences are related to lifestyle factors and/or social determinants of health. The weighted study population included 13,592,178 Asian adults. Filipino adults were more likely to have hypertension than Chinese adults (29.4% vs 15.4%; adjusted odds ratio [OR] 2.40, 95% confidence interval [1.91 to 3.02]), as were Asian Indians (15.7%; OR 1.59 [1.25 to 2.02]). These patterns were similar for hyperlipidemia and diabetes mellitus. For cardiovascular diseases, Filipino adults were significantly more likely to have coronary heart disease (4.2% vs 1.9%; OR 2.19 [1.32 to 3.56]), heart attack (2.6% vs 0.9%; OR 2.79 [1.44 to 5.41]), angina (1.8% vs 0.9%; OR 2.15 [1.06 to 4.32]), and stroke (2.1% vs 0.8%; OR 2.54 [1.42 to 4.55]) compared with Chinese adults, whereas there were no differences compared with Asian Indian adults. Adjustments for lifestyle factors and social determinants completely attenuated differences in coronary heart disease, heart attack, and angina among subpopulations. In conclusion, these findings demonstrate that cardiovascular risk factors and diseases vary significantly across Asian subpopulations, with Filipino adults experiencing the highest burden and Chinese adults the lowest, and that differences in cardiovascular disease are largely attenuated after adjustment for lifestyle and social determinants.

'We know what he likes, even if he doesn't know': how the children of South Asian immigrants characterize and influence the diets of their parents

Foreign-born (first-generation) South Asians face a growing diet-related chronic disease burden. Little is known about whether the adult US-born (second-generation) children of South Asian immigrants can provide unique insights as changemakers in their parents' dietary behaviors. This study aims to assess how second-generation South Asians describe and influence the dietary behaviors of their parents. Between October and November 2020, 32 second-generation South Asians [mean age 22.4 (SD 2.9), 53% female] participated in online interviews centered around factors involved in their (and their parents) eating behaviors. Thematic analysis revealed three types of parental dietary drivers (socioecological factors that impact the dietary choices of parents): goal-oriented (i.e., parents' dietary intentionality), capacity-related (e.g., environmental barriers) and sociocultural (cultural familiarity, religion and traditions). Participants described three major mechanisms of influence: recommending new foods, cooking for parents, and bringing new foods home. These influences primarily occurred in the household and often involved participants leveraging their own nutritional knowledge and preferences to expand dietary diversity and healthier behaviors among their parents. Evidence suggests that second-generation South Asians may act as powerful agents of dietary change within their households and can provide novel insights to help address and overcome sociocultural, linguistic, and other structural barriers to better understanding and intervening in the health of the South Asian community.

Associations Between Ultra-processed Food Consumption and Cardiometabolic Health Among Older US Adults: Comparing Older Asian Americans to Older Adults From Other Major Race-Ethnic Groups

Using data from the National Health and Nutrition Examination Survey (2001-2018; N = 19,602), this study examined whether ultra-processed food (UPF) consumption is associated with cardiometabolic health (obesity, hypertension, high cholesterol, and diabetes), among White, Black, Hispanic, and Asian Americans (AA) US adults 50 or older. Diet was assessed using 24 hour dietary recall. NOVA dietary classification system was used to calculate the percentage of caloric intake derived from UPFs. Cardiometabolic information was assessed through physical examination, blood tests, and self-reported medication information. A median of 54% (IQR: 40%, 68%) of caloric intake was attributed to UPFs and was lowest for AAs (34%, IQR: 20%, 49%) and highest for White adults (56%; IQR: 42, 69%). In multivariable adjusted models, UPF consumption was associated with greater odds of obesity, high cholesterol, and diabetes. UPF consumption is associated with poor cardiometabolic health among all US older adults. For AAs, UPFs may be particularly obesogenic.

Trends of cardiovascular health in Asian American individuals: A national health and nutrition examination survey study

Objective

Oversampling of Asian American individuals in the National Health and Nutrition Examination Survey (NHANES) provides a unique opportunity to assess the population-level cardiovascular health (CVH) in the fastest-growing racial group in the US.

Methods

The Life's Essential 8 (LE8) score and its components were calculated in self-reported Asian American individuals ≥20 years of age and free of cardiovascular disease in the NHANES cycles from 2011-March 2020. Multivariable adjusted linear and logistic regression models were used for analysis.

Results

Among 2,059 Asian American individuals, the weighted mean LE8 score was 69.1 (0.4) with US-born [69.0 (0.8)] and foreign-born individuals [69.1 (0.4)] having similar CVH. From 2011 to March 2020, CVH in the overall population [69.7 (0.8) to 68.1 (0.8); Ptrend: 0.009] and foreign-born individuals [69.7 (0.8) to 67.7 (0.8); Ptrend: 0.005] declined. Decreasing trends were noted in the body mass index score irrespective of stratification and in the blood pressure scores in the overall population and foreign-born Asian American individuals. Compared with US-born individuals, the odds of ideal levels of smoking [ORadj:<5 years: 2.23 (95%CI: 1.45-3.44); 5-15 years: 1.97 (95%CI: 1.27-3.05); 15-30 years: 1.61 (95%CI: 1.11-2.34); ≥30 years: 1.69(95%CI:1.20-2.36)] and diet [ORadj: <5 years: 1.87 (95%CI: 1.26-2.79); 5-15 years: 2.00 (95%CI: 1.38-2.89); 15-30 years: 1.74 (95%CI: 1.14-2.68)] were higher in foreign-born individuals. Foreign-born individuals had lower odds of ideal physical activity levels [ORadj: 5-15 years: 0.55 (95%CI: 0.39-0.79); 15-30 years: 0.68 (95%CI: 0.49-0.95)] and ideal cholesterol levels [ORadj: 5-15 years: 0.59 (95%CI: 0.42-0.82); 15-30 years: 0.54 (95%CI :0.38-0.76); ≥30 years: 0.52 (95%CI: 0.38-0.76)].

Conclusion

The CVH in Asian American individuals declined from 2011 to March 2020. The odds of ideal CVH decreased with increasing duration of stay in the US, with foreign-born individuals residing in the US for ≥30 years having ∼28% lower odds of ideal CVH compared with US-born individuals.

Relationships Among Acculturation Using Two Different Language Variables, Diet Quality, and Accuracy of Diet Quality Assessment in Non-Hispanic Asians Residing in the United States

BACKGROUND

Evidence suggests acculturation can increase risks of poor diet, obesity, and chronic diseases. Yet questions remain regarding acculturation proxy measures and associations with diet quality in Asian Americans.

OBJECTIVE

Primary objectives included estimating percentages of Asian Americans with low, moderate, and high acculturation using two proxy measures of acculturation based on different language variables and determining if diet quality differences existed among acculturation levels using the two proxy acculturation measures.

METHODS

Study sample included 1,275 Asian participants ≥16 years of age from National Health and Nutrition Examination Survey 2015-2018. Nativity/length of US residence, immigration age, language spoken at home (home), and language of dietary recall (recall) were used as proxy measures for two acculturation scales. Replicate 24-hour dietary recalls were conducted and diet quality was assessed using 2015 Healthy Eating Index (HEI-2015). Statistical methods for complex survey designs were used for analysis.

RESULTS

Using home and recall language, 26% vs 9% of participants were classified with low, 50% vs 63% with moderate, and 24% vs 28% with high acculturation. On the home language scale, participants with low and/or moderate acculturation had higher scores (0.5-5.5 points) for vegetables, fruits, whole grains, seafood and plant protein, saturated fats, added sugars, and total HEI-2015 than participants with high acculturation; participants with low acculturation had lower refined grains score (1.2 points) than participants with high acculturation. Results were similar for the recall language scale except differences between participants with moderate and high acculturation also were observed for fatty acids.

CONCLUSIONS

Although percentages of Asian Americans classified with low, moderate, and high acculturation differed between two proxy measures for acculturation, diet quality differences among acculturation groups were remarkably similar between the two proxy measures. Hence, use of either language variable may yield comparable results regarding relationships between acculturation and diet in Asian Americans.