What is the question?

• The question is: What evidence has been published on the relationship between culturally tailored dietary interventions and diet-related psychosocial factors, dietary intake, diet quality, and health outcomes? The populations of interest for this question include children, adolescents, adults, older adults, and pregnancy and postpartum. 

Why was this question asked?

• This evidence scan was conducted by the 2025 Dietary Guidelines Advisory Committee as part of the process to develop the Dietary Guidelines for Americans, 2025-2030. 

How was this question answered?

• The Committee conducted an evidence scan to answer this question with support from the USDA Nutrition Evidence Systematic Review team.

What is the answer to the question?

• The body of evidence included 178 articles. Most articles were in adults and included both male and female participants. The most frequently assessed outcomes were growth, body composition, and risk of obesity and dietary intake. Many different strategies were used to culturally tailor the interventions; common examples included translating materials into the native language of participants and including community members in designing and implementing the studies. Most articles received funding from the United States or Canadian government.

How up-to-date is this evidence scan?

• This evidence scan is based on articles published between January 1980 and September 2023.

Background

• This evidence scan was conducted by the 2025 Dietary Guidelines Advisory Committee as part of the process to develop the Dietary Guidelines for Americans, 2025-2030. The U.S. Departments of Health and Human Services (HHS) and Agriculture (USDA) appointed the 2025 Dietary Guidelines Advisory Committee (Committee) in January 2023 to review evidence on high priority scientific questions related to diet and health. Their review forms the basis of their independent, science-based advice and recommendations to HHS and USDA, which is considered as the Departments develop the next edition of the Dietary Guidelines. As part of that process, the Committee conducted an evidence scan with support from USDA’s Nutrition Evidence Systematic Review (NESR) team to answer the following question: What evidence has been published on the relationship between culturally tailored dietary interventions and diet-related psychosocial factors, dietary intake, diet quality, and health outcomes? 

Methods

• The Committee conducted an evidence scan using the methodology of the USDA NESR team. The Committee first developed a protocol. The interventions of interest were those that have been culturally tailored, modified, or adapted to alter intake of foods in children, adolescents, adults, older adults, and pregnancy and postpartum. The outcomes were Diet-related psychosocial factors including food-related norms, attitudes, values, and self-efficacy; Dietary intake; Diet quality; Energy intake; Risk factors for cardiovascular disease, including: cholesterol (HDL, LDL), triglycerides, hyperlipidemia, blood pressure (systolic and diastolic), hypertension; and Risk factors for type 2 diabetes, including: fasting blood glucose, fasting insulin, glucose tolerance/insulin resistance, hemoglobin A1c, prediabetes in children, adolescents, adults, and older adults; Growth (in children and adolescents) including: height, weight, stunting, failure to thrive, wasting, BMI-for-age, body circumferences (arm, neck, thigh); Body composition (in children, adolescents, adults, older adults) including: skinfold thickness, fat mass, ectopic fat, fat-free mass or lean mass, waist circumference, waist-to-hip-ratio; Risk of obesity (in children, adolescents, adults, older adults) including: BMI, underweight, normal weight, overweight and/or obesity, weight gain, and weight loss and maintenance (in adults and older adults); Pregnancy and postpartum-related weight change including: adequacy of total gestational weight gain (i.e., in relation to recommendations based on pre-pregnancy BMI) and postpartum weight change. Additional inclusion criteria were established for the following study characteristics: a) use randomized or non-randomized controlled trial study designs, b) be published in English in peer-reviewed journals, c) be conducted in the United States or Canada and d) enroll participants with a range of health statuses. The evidence scan excluded observational studies, studies with infants and young children (birth up to 24 months), studies that exclusively enrolled participants diagnosed with a disease, and studies with interventions that changed consumption of a single food. 
• NESR librarians conducted a literature search in PubMed to identify articles published between January 1980 and September 2023. Two NESR analysts independently screened titles of search results up to a 93% recall rate of citations eligible for full-text screening, as assessed by DistillerSR’s natural language processing capabilities. Two NESR analysts independently performed abstract and full-text screening to determine if inclusion criteria were met.
• NESR analysts extracted data, from each included article, with a second analyst verifying accuracy of the extraction. Two classification frameworks were used to categorize 1) strategies used to culturally tailor interventions and 2) their degree of cultural sensitivity. The Committee reviewed the evidence, with attention given to the overarching themes or key concepts from the findings, similarities and differences between studies, gaps in the existing literature, and opportunities for future directions. 

Results

Summary of the evidence

• 178 articles met inclusion criteria for this review (139 RCTs, 39 NRCTs). Nearly all studies were conducted in the U.S. (172 articles). Analytic sample sizes ranged from n=20 to n=4333. Most studies were in adults only (104 articles), and 67 articles included only children and/or adolescents. Twenty-two articles enrolled or randomized adults and children and/or adolescents. Six articles were in pregnant or postpartum populations. Most articles (127 articles) included both men and women, although in many cases these participant populations were predominantly female. The most common racial and/or ethnic groups (defined as articles with ≥20% of participants from a given racial and/or ethnic group) were Black, African American, or of African Descent (78 articles), and Hispanic or Latinx (71 articles), followed by American Indian, Alaska Native, or Indigenous (27 articles), White (16 articles), Asian (11 articles), and Native Hawaiian or Pacific Islander (3 articles). 
• Most articles reported either a high level of community involvement (71 articles) or at least some community involvement (58 articles) in designing the intervention, and 49 articles did not report involving community members in intervention design. The proportion of articles reporting a high degree of community involvement grew over time. 
• Constituent involving strategies were most frequently used (161 articles), followed by sociocultural (150 articles), peripheral (100 articles), linguistic (83 articles), and evidential (18 articles) strategies. Peripheral and evidential strategies were all considered to be surface-structure, as were all but one linguistic strategy. Constituent involving strategies encompassed a range of surface- and deep-structure levels of cultural sensitivity. Sociocultural strategies were all considered to be deep-structure.
• Growth, body composition, and risk of obesity and dietary intake were the most commonly reported outcomes (117 and 109 articles, respectively). Fewer articles assessed risk of cardiovascular disease (52 articles), diet-related psychosocial factors (50 articles), energy intake (38 articles), risk of type 2 diabetes (35 articles), diet quality (23 articles), and postpartum weight change (4 articles). No articles examined gestational weight gain as an outcome. 
• Most studies were funded by the U.S. or Canadian government (144 articles).
   

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Suggested citation: Odoms-Young A, Stanford FC, Palacios C, Anderson CAM, Andres A, Fisher JO, Gardner CD, Giovannucci E, Hoelscher DM, Jernigan VBB, Raynor HA, Webster A, Fultz A, Bahnfleth C, English L, Higgins M, Lawless M, Momin S, Butera G, Terry N, Obbagy J. Culturally Tailored Dietary Interventions and Diet-Related Psychosocial Factors, Dietary Intake, Diet Quality, and Health Outcomes: An Evidence Scan. November 2024. U.S. Department of Agriculture, Food and Nutrition Service, Center for Nutrition Policy and Promotion, Nutrition Evidence Systematic Review. Available at: https://doi.org/10.52570/NESR.DGAC2025.ES01