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2015 Dietary Guidelines Advisory Committee Systematic Reviews

Systematic Review Question

What is the relationship between acculturation, dietary intake, and risk of type 2 diabetes?

Conclusion Statement

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, as well as limitations in acculturation assessment methodology that did not take into account potential confounders and effect modifiers and lacked standardized assessment of outcomes.

2015 DGAC Grade: Grade Not Assignable

Technical Abstract

Background

The goal of this systematic review was to determine whether acculturation is associated with risk of type 2 diabetes (T2D). Acculturation has been defined both as the “process by which immigrants adopt the attitudes, values, customs, belief, 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

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, as well as limitations in acculturation assessment methodology that did not take into account potential confounders and effect modifiers and lacked standardized assessment of outcomes.

2015 DGAC Grade: Not Assignable

Methods

Literature searches were conducted using PubMed, Embase, and Cochrane databases to identify studies that evaluated the association between acculturation and risk of T2D. 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 US, language preference, place of birth). The outcome was risk of T2D and included the following outcomes: glucose intolerance, insulin resistance and incidence of T2D.

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 six cross-sectional studies that assessed the relationship between multidimensional or multiple proxy measures of acculturation and risk of cardiovascular disease in Latino/Hispanic and Asian populations
  • The studies used different methods to assess acculturation. Four different multidimensional scales were used and one study relied on the assessment of two acculturation proxies. All measures took into consideration language usage, with some only using this proxy and others including additional proxies for acculturation

Limitations

NONE

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. 533-7.
  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.