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2015 Dietary Guidelines Advisory Committee Systematic Reviews

Systematic Review Question

What is the relationship between acculturation and dietary intake?

Conclusion Statement

Limited evidence from cross-sectional studies suggests that in adults of Latino/Hispanic national origin, particularly women and those 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.

2015 DGAC Grade: Limited

Technical Abstract

Background

The goal of this systematic review was to determine whether acculturation is associated with measures of dietary intake. 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 from cross-sectional studies suggests that in adults of Latino/Hispanic national origin, particularly women and those 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.

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 dietary intake. 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 diet quality, foods, food groups, macronutrient intakes or proportions.

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 17 studies, 15 cross-sectional and two longitudinal studies that examine the association between multidimensional or multiple proxy measures of acculturation and dietary intake in Latino/Hispanic and Asian populations
  • 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 foods
    • In children and youth of Latino/Hispanic national origin, emerging evidence from two cross-sectional studies suggests an association between acculturation and diet behaviors. A study with three-year-olds to five-year-olds (proxied by caregiver acculturation) indicated an association with higher sweets intake and a study among adolescents, indicated an association with higher intake of fast foods.
  • Among Asian populations, emerging evidence from five cross-sectional and two longitudinal studies suggest that higher acculturation to the United States 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
    • One study suggests higher acculturation is associated with increased fast food consumption among Asian adolescents.
  • 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.

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
  • Acculturation measures differed substantially across studies and very few studies used multidimensional acculturation scales

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. 533-537.

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.