Scientific Report of the 2015 Dietary Guidelines Advisory Committee

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Part D. Chapter 3: Individual Diet and Physical Activity Behavior Change

Acculturation

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Immigrants continue to represent a significant proportion of the United States population and evidence indicates that immigrants adopt the dietary habits and disease patterns of host cultures.14 Federal food assistance and nutrition education programs are aware of the need to tailor services and messaging according to the level of acculturation of immigrant communities. It is essential for this acculturation-sensitive tailoring to take into account the level of dietary acculturation and the socio-economic characteristics such as health literacy, language, and other cultural preferences of immigrant communities. Thus, understanding how dietary habits, body weight, and chronic disease outcomes are influenced by the process of acculturation is an important public health issue for the United States. However, because immigrants can take different paths during the process of acculturation, this construct has proven to be difficult to conceptualize and measure. The four paths of acculturation (assimilation, integration, segregation, and marginalization) refer to the degree in which immigrants retain their host culture and adopt the culture of their new country.14 This explains, at least in part, why the evidence from prospective studies continues to be limited in nature, as shown in this chapter.

Question 9: What is the relationship between acculturation and measures of dietary intake? 

Source of evidence: NEL systematic review

Conclusion

Limited evidence from cross-sectional studies suggests that in adults of Latino/Hispanic national origin, particularly among women and persons of Mexican origin, higher acculturation to the United States is associated with lower fruit and vegetable intake, as well as higher intake of fast food. Insufficient evidence is available for children, Asians and African Americans in general, and among populations of diverse Latino/Hispanic national origin to draw a conclusion regarding the association between measures of acculturation and dietary intake. DGAC Grade: Limited

Implications

Federal food assistance and nutrition education programs need to support immigrants in maintaining the healthy dietary habits they had when they arrived and in not acquiring unhealthy dietary patterns as they acculturate to mainstream America. This can be achieved by, among other things, effectively reaching out to immigrant families to facilitate their enrollment in programs such as SNAP and WIC and ensuring access to fresh vegetables and fruits. These community outreach programs are needed because in addition to their risk of adopting unhealthy dietary behaviors, immigrants may also have language limitations and/or a lack of understanding of the program enrollment procedures.

Review of the Evidence

This systematic review included 17 studies, 15 cross-sectional studies,132-146 and two longitudinal studies147, 148 that examined the relationship between multidimensional or multiple proxy measures of acculturation and dietary intake. Study populations included ten Latino/Hispanic populations132-136, 138-140, 144, 145 (five in Mexican Americans) and 132, 133, 135, 136, 140 six Asian populations;137, 141-143, 146, 147 one study included both Asian and Latino/Hispanic populations.148 Two studies included children135, 148 and three studies included only women.134, 138, 140 Study locations included one national140 and one U.S.-Mexican border state study,136 ten studies from California,132, 133, 135, 137-139, 143, 145, 146, 148 and one study each from Massachusetts, Hawaii,147 New York,141 and a Midwestern city.

In adults of Latino/Hispanic national origin, evidence from nine cross-sectional analyses suggests that higher acculturation to the United States is associated with lower adherence to recommended dietary patterns. Among adults of Latino/Hispanic national origin, primarily women and those of Mexican origin, higher acculturation is consistently associated with lower fruit and vegetable intake, as well as higher intake of fast food. In children and youth of Latino/Hispanic national origin, emerging evidence was identified from two cross-sectional studies suggesting a negative association between acculturation and dietary behaviors. In a study of children ages 3 to 5 years who were proxied by caregiver acculturation, acculturation was associated with higher intake of sweets. In a study among adolescents, acculturation was associated with higher intake of fast foods.

Among Asian populations, emerging evidence from five cross-sectional and two longitudinal studies suggests that higher acculturation is associated with lower adherence to recommended dietary patterns. In adults, six studies among Asian populations (mainly Korean, Chinese and Filipino) suggest higher acculturation is associated with higher fast food and alcohol consumption.137, 141-143, 146, 147 One study suggests higher acculturation is associated with increased fast food consumption among Asian adolescents.148

Insufficient evidence is available among children, those of Latino/Hispanic national origin (other than Mexican-Americans), and among immigrant populations from Asia, Africa, Europe, and the Middle East regarding the association between measures of acculturation and dietary intake.

For additional details on this body of evidence, visit: http://NEL.gov/conclusion.cfm?conclusion_statement_id=250436 

Question 10: What is the relationship between acculturation and body weight?

Source of evidence: NEL systematic review

Conclusion

Limited evidence suggests a relationship between higher acculturation to the United States and increased body weight. This relationship varies by national origin and gender. Specifically, findings were mixed in both Asian and Latino/Hispanic populations. In Asians, the association was stronger in women than men and in Latino/Hispanic populations; associations were stronger in Mexican-born women. DGAC Grade: Limited

Implications

Federal food assistance and nutrition education programs need to support immigrants against the risk of becoming overweight or obese as they acculturate to mainstream America. This can be achieved by among other things, effectively reaching out to immigrant families to facilitate their enrollment in programs such as SNAP and WIC and ensuring access to low-energy and high-nutrient dense dietary patterns rich in vegetables and fruits and whole grain foods. These community outreach programs are needed because in addition to their risk of adopting unhealthy dietary behaviors, immigrants may also have language limitations and/or a lack of understanding of the program enrollment procedures.

Review of the Evidence

This systematic review includes 13 studies:133, 137, 141, 143, 144, 146, 147, 149-154, 12 cross-sectional studies,133, 137, 141, 143, 144, 146, 149-154 and one longitudinal study.147 The populations included seven Asian,137, 141, 143, 146, 147, 150, 151, five Latino/Hispanic (four Mexican-American and one Puerto Rican),133, 144, 149, 152, 153 and included adults ranging in age from 35 to 75 years. Five studies were analyzed by gender.141, 143, 146, 153, 154 Three of the studies included national samples,149, 152, 154 five studies were from California,133, 137, 143, 146, 153 and one study each was from Hawaii,147 Louisiana,151 Maryland,150 Massachusetts,144 New York.141 Two studies included samples from the country of origin (Vietnam and Korea).143, 151

Among Asian populations, the majority of the data suggest a positive relationship between acculturation and increased body weight, but results are not consistent. Among Latinos/Hispanic populations, the association has been documented mostly among women of Mexican origin.

For additional details on this body of evidence, visit: http://NEL.gov/conclusion.cfm?conclusion_statement_id=250437 

Question 11: What is the relationship between acculturation and risk of cardiovascular disease (CVD)?

Source of evidence: NEL systematic review

Conclusion

No conclusion can be drawn regarding the relationship between acculturation to the United States and the risk of CVD. This is due to the small number of studies, wide variation in methodology used to assess acculturation, and limited representation of ethnic groups in the body of evidence. Very limited evidence from a small number of cross-sectional studies conducted in Latino/Hispanic populations suggest a positive relationship between language acculturation and elevation in LDL cholesterol and no relationship between acculturation and blood pressure. Insufficient evidence is available for other race/ethnic populations and among children for these outcomes and other CVD outcomes. DGAC Grade: Grade not assignable

Implications

The DGAC determined that a grade was not assignable due to the insufficient evidence for this question. Therefore, no implications were developed.

Review of the Evidence

This systematic review includes six cross-sectional studies in adult men and women between the ages of 40 to 60 years.144, 154-158 The study populations included five Latino/Hispanic144, 155-158 and one multicultural population154 and the data were predominately derived from large, multi-state or national data sets.

Three studies found a positive relationship between language acculturation and elevated blood lipid levels,154, 156, 157 but results varied by acculturation indicator. Two studies assessed the association between acculturation and blood pressure in Latino/Hispanic populations and no association was found.156, 157 Two studies assessed the relationship between acculturation and hypertension in Latino/Hispanic and a multicultural population and found no association.144, 154 Two studies suggest a positive association between language acculturation and CVD risk factors,155, 158 but results varied as a function of language acculturation indicator used. The studies used different methods to assess acculturation, including three studies that used multidimensional scales144, 155, 157 and three studies that relied on the assessment of acculturation proxies.154, 156, 158 

The preponderance of evidence was in predominately Mexican American populations, but other Hispanic/Latino national origin groups were represented.

For additional details on this body of evidence, visit: http://NEL.gov/conclusion.cfm?conclusion_statement_id=250438 

Question 12: What is the relationship between acculturation and risk of type 2 diabetes?

Source of evidence: NEL systematic review

Conclusion

Conclusions regarding the relationship between acculturation and type 2 diabetes cannot be drawn due to limited evidence from a very small number of cross-sectional studies and study populations, limitations in acculturation assessment methodology that did not take into account potential confounders and effect modifiers, and lack of standardized assessment of outcomes. DGAC Grade: Grade not assignable

Implications

The DGAC determined that a grade was not assignable due to the insufficient evidence for this question. Therefore, no implications were developed.

Review of the Evidence

This systematic review included four cross-sectional studies.144, 152, 159, 160 Two of the studies used National Health and Nutrition Examination Survey (NHANES) data on Hispanic/Latino participants,152, 160 one study used the Multi-Ethnic Study of Atherosclerosis (MESA) cohort,159 which included Mexican, other Hispanic, and Chinese populations, and one study used the Boston Puerto Rican Health Study cohort.144

The studies used different methods to assess acculturation. Four different multidimensional scales were used144, 159, 160 and one study relied on the assessment of two acculturation proxies.152 All measures took into consideration language usage with some only using this proxy and others including additional proxies for acculturation.

For additional details on this body of evidence, visit: http://NEL.gov/conclusion.cfm?conclusion_statement_id=250439 

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