Background

The goal of this systematic review was to determine whether acculturation is associated with measures of body weight. Acculturation has been defined both as the “process by which immigrants adopt the attitudes, values, customs, beliefs and behaviors of a new culture.”¹ and as the “gradual exchange between immigrants’ original attitudes and behavior and those of the host culture”¹  Acculturation is relevant for individual dietary behaviors because evidence suggests that the healthy lifestyles with which recent immigrants arrive deteriorate as they integrate or assimilate into mainstream American culture.²  Moreover, evidence suggests that to be effective in helping immigrants retain their healthy lifestyles, nutrition education and food assistance programs must be tailored to their different levels of acculturation.²

Conclusion statement

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.

2015 DGAC Grade: Limited

Methods

Literature searches were conducted using PubMed, Embase and Cochrane databases to identify studies that evaluated the association between acculturation and body weight. Studies that met the following criteria were included in the review: cross-sectional and cohort studies; human subjects aged two years and older who were healthy or at elevated chronic disease risk; studies conducted in the United States with participants residing within the United States and when available, participants residing in the country of origin; and studies published in English in peer-reviewed journals January 2004 to January 2014. The exposure was acculturation measured by acculturation scales, or more than one proxy for acculturation (e.g., time living in the United States, language preference, place of birth). The outcome was obesity; overweight; body mass index (BMI); and measures of weight, growth and body composition including waist circumference, body weight, percent body fat, weight-for-age, length/stature-for-age, weight for stature, BMI-for-age and BMI Z-score.

Data from each included article were extracted and risk of bias was assessed. The evidence was qualitatively synthesized, a conclusion statement was developed and the strength of the evidence (grade) was assessed using pre-established criteria including evaluation of the quality and risk of bias, quantity, consistency, magnitude of effect and generalizability of available evidence.

Findings

• This evidence review includes 13 studies, 12 cross-sectional studies and one longitudinal study that examine the relationship between multidimensional or multiple proxy measures of acculturation and body weight in predominantly Latino/Hispanic and Asian populations
• Seven studies included Asian populations (predominantly of Vietnamese, Chinese, Korean or Filipino origin) and two of these studies included subjects from the United States and the country of origin. Five studies included Latino/Hispanic populations (predominately of Mexican American origin). One study included subject from four global regions.
• Among Asian populations, the majority of the data suggests a positive relationship between acculturation and increased body weight, but results are not consistent
• Among Latino/Hispanic populations, the association has been documented mostly among women of Mexican origin
• The preponderance of the evidence is in middle-aged adults; no studies addressed the association between acculturation and growth or weight status in children or older adults

Limitations

• The preponderance of the evidence is from cross-sectional studies, thus causality inferences cannot be made and it is unknown whether the relationship changes over time.
• Methodological limitations included use of multiple acculturation proxies, which may not capture the complexity of the construct, use of non-validated multidimensional acculturation scales, and self-reported weight and height.

References

1. Abraido-Lanza AF, White K, Vasques E. Immigrant populations and health. In: Anderson N, editor. Encyclopedia of Health and Behavior. Newbury Park, CA: Sage; 2004; p. 533-37.
2. Perez-Escamilla R. Food insecurity in children: impact on physical, psychoemotional and social development. In: Ross CA, Caballero RJ, Cousins RJ, Tucker KL, Ziegler TR, editors. Modern Nutrition in Health and Disease. Baltimore, MD: Lippincott Williams & Wilkins; 2013: p. 1006-15.