Improved dietary variety and adequacy but lower dietary moderation with acculturation in Chinese women in the United States

Looking Across and Within: Immigration as a Unifying Structural Factor Impacting Cardiometabolic Health and Diet

Introduction

Immigration has been identified as an important social determinant of health (SDH), embodying structures and policies that reinforce positions of poverty, stress, and limited social and economic mobility. In the public health literature with regard to diet, immigration is often characterized as an individual-level process (dietary acculturation) and is largely examined in one racial/ethnic subgroup at a time. For this narrative review, we aim to broaden the research discussion by describing SDH common to the immigrant experience and that may serve as barriers to healthy diets.

Methods

A narrative review of peer-reviewed quantitative, qualitative, and mixed methods studies on cardiometabolic health disparities, diet, and immigration was conducted.

Results

Cardiometabolic disease disparities were frequently described by racial/ethnic subgroups instead of country of origin. While cardiovascular disease and obesity risk differed by country of origin, diabetes prevalence was typically higher for immigrant groups vs United States (US)-born individuals. Common barriers to achieving a healthy diet were food insecurity; lack of familiarity with US food procurement practices, food preparation methods, and dietary guidelines; lack of familiarity and distrust of US food processing and storage methods; alternative priorities for food purchasing (eg, freshness, cultural relevance); logistical obstacles (eg, transportation); stress; and ethnic identity maintenance.

Conclusions

To improve the health of immigrant populations, understanding similarities in cardiometabolic health disparities, diet, and barriers to health across immigrant communities-traversing racial/ethnic subgroups-may serve as a useful framework. This framework can guide research, policy, and public health practices to be more cohesive, generalizable, and meaningfully inclusive.

Dietary Characteristics and Influencing Factors on Chinese Immigrants in Canada and the United States: A Scoping Review

BACKGROUND

Chinese immigrants are an integral part of Canadian and American society. Chinese immigrants believe diet to be an important aspect of health, and dietary behaviours in this population have been associated with changes in disease risk factors and disease incidence. This review aims to summarize the characteristics of the dietary behaviours of Chinese immigrants and the associated influencing factors to better inform individual, clinical, and policy decisions.

METHODS

This scoping review was written in accordance with PRISMA guidelines. MEDLINE, PsychINFO, CINAHL, AgeLine, ERIC, ProQuest, Nursing and Allied Health Database, PsychARTICLES, and Sociology Database were utilized for the literature search. Articles were included if they explored dietary or nutritional intake or its influencing factors for Chinese immigrants to Canada or the United States.

RESULTS

A total of 51 papers were included in this review. Among Chinese immigrants in Canada and the United States, the intake of fruits and vegetables, milk and alternatives, and fiber were inadequate against national recommendations. Chinese immigrants showed increased total consumption of food across all food groups and adoption of Western food items. Total caloric intake, meat and alternatives intake, and carbohydrate intake increased with acculturation. Individual factors (demographics, individual preferences, and nutritional awareness), familial factors (familial preferences and values, having young children in the family, and household food environment), and community factors (accessibility and cultural conceptualizations of health and eating) influenced dietary behaviours of Chinese immigrants.

DISCUSSION AND CONCLUSION

Efforts should be undertaken to increase fruit, vegetable, and fibre consumption in this population. As dietary acculturation is inevitable, efforts must also be undertaken to ensure that healthy Western foods are adopted. It is important for healthcare providers to remain culturally sensitive when providing dietary recommendations. This can be achieved through encouragement of healthy ethnocultural foods and acknowledgement and incorporation of traditional health beliefs and values into Western evidence-based principles where possible.

Colorectal Cancer-Related Knowledge, Acculturation, and Healthy Lifestyle Behaviors Among Low-Income Vietnamese Americans in the Greater Philadelphia Metropolitan Area

Colorectal cancer (CRC) is the second and fourth most common cancer in Vietnamese American women and men, respectively. Recent research has highlighted the importance of modifiable lifestyle behaviors such as smoking, alcohol use, dietary behaviors, and physical activities in CRC prevention for the general population. However, it is not well understood how well Vietnamese Americans knew about CRC prevention and risk factors, and whether there were any disparities in knowledge within this vulnerable population. This study examined whether comprehensive measures of acculturation and knowledge of CRC risk are associated with different health behaviors, specifically physical activity, protective dietary behaviors, and risky dietary behaviors in Vietnamese Americans. We recruited 374 Vietnamese Americans aged 50 or above from community-based organizations in the Vietnamese American communities in the greater Philadelphia metropolitan area. Through a cross-sectional survey, we collected data on their knowledge of CRC prevention and risk factors, acculturation-related factors, and sociodemographic characteristics. We found limited knowledge of CRC prevention and risk factors, and suboptimal physical activity and healthy dietary behaviors in the Vietnamese Americans. We also found that higher levels of knowledge about CRC and risk factors were associated with less unhealthy diets but not with more protective diets or physical activity. Acculturation was not significantly associated with overall dietary behaviors in our study. Our findings addressed gaps in current literature concerning the impact of knowledge about CRC risk factors and acculturation on different dimensions of dietary behaviors as well as physical activity. Research and practical implications were discussed.

Food, culture, and identity in multicultural societies: Insights from Singapore

The choice of food practices can be influenced by one's identity in many societies, but has mostly been evaluated in light of the maintenance of cultural identity in migrant populations. This study focused on understanding the influence of identity on food practices among individuals in multicultural societies. We conducted 18 focus group discussions (n = 130) among Indian, Chinese and Malay women in Singapore. Focus group transcripts were analysed using Thematic Analysis both inductively and deductively. Deductive analysis was framed within a Social Representations Approach, a social psychological theory that allows a deeper understanding of the contextual aspects of identity. Participants highlighted the central position of food in social events, cultural celebrations, and persistent traditional beliefs about health (such as 'hot-cold balance'). These beliefs extended to the perception of certain traditional foods possessing medicinal properties. Importantly, the consumption of these traditional foods was accepted as necessary for the maintenance of health by the women. We propose that while cultural food practices are integral to identity preservation and identity continuity for Singaporean women from all three racial groups, this is different to other multicultural societies such as Canada where communities preserve their cultural food practices, in part, due to fear of cultural identity loss. In addition, cross-cultural food practices are readily adopted in participants' daily lives for a number of reasons such as the promotion of health, convenience, and variety. At times, this adoption blurred boundaries between different cultural cuisines. Food practices in multicultural societies like Singapore are thus a reflection of everyday multiculturalism, multicultural social policies, and attitudes towards traditional healthful food practices, and these aspects need to be considered in the development of public health policies and interventions.

Acculturation and Diet Among Chinese American Immigrants in New York City

BACKGROUND

There are limited data on the social and cultural determinants of dietary intake in Chinese Americans. Over 560,000 New York City residents are Chinese American, and there has been a growing trend over the past 30 y of permanent migration from China to the USA.

OBJECTIVES

The purpose of this secondary data analysis is to describe associations between diet, measured by self-report, and diet quality, with level of acculturation in a cross-sectional sample of urban-dwelling Chinese American immigrants.

METHODS

This was a cross-sectional study involving 2071 foreign-born Chinese American adults. Acculturation was assessed using the Stephenson Multigroup Acculturation Scale, diet using a Chinese-adapted FFQ, and diet quality using the Alternative Healthy Eating Index (AHEI). Multivariable regression was used to assess associations between ethnic (ESI; Chinese) and dominant (DSI; American) society immersion scores with self-reported dietary measures.

RESULTS

No significant associations were found between acculturation and overall AHEI score. Higher ESI and DSI scores were associated with higher vegetable, fruit, and nut/legume scores; a higher DSI score only was associated with higher whole grain and PUFA scores. A 1-unit increase in the ESI score was associated with a 0.005 (P = 0.009) lower red and processed meat component score, whereas a 1-unit increase in DSI score was associated with a 0.01 (P = 0.025) higher red and processed meat component score.

CONCLUSIONS

Assessment of acculturation level may help to tailor dietary strategies that are appropriate to what Chinese American immigrant communities are consuming to more effectively decrease the risk of chronic disease.

International migration and dietary change in Mexican women from a social practice framework

Migration from lower- and middle-income to high-income countries is associated with dietary change, and especially with the adoption of a modern, less healthy diet. In this article we analyze the dietary changes experienced by Mexican migrants, employing as a theoretical framework the concept of social practice. According to this framework, practices integrate material elements, meanings and competences that provide their conditions of possibility. Practices are shared by members of social groups, and interact with other competing or reinforcing practices. Between 2014 and 2015, we conducted semi-structured interviews with 27 women, international return migrants living in Tijuana, Mexico. The interview guide asked about history of migration and dietary change. We found three main areas of dietary change: from subsistence farming to ready meals, abundance vs. restriction, and adoption of new food items. The first one was associated with changes in food procurement and female work: when moving from rural to urban areas, participants substituted self-produced for purchased food; and as migrant women joined the labor force, consumption of ready meals increased. The second was the result of changes in income: participants of lower socioeconomic position modified the logic of food acquisition from restriction to abundance and back, depending on the available resources. The third change was relatively minor, with occasional consumption of new dishes or food items, and was associated with exposure to different cuisines and with learning how to cook them. Public health efforts to improve the migrants' diets should take into account the constitutive elements of dietary practices, instead of isolating individuals from their social contexts.

Ethnic Drinking Culture, Acculturation, and Enculturation in Relation to Alcohol Drinking Behavior Among Marriage-Based Male Immigrants in Taiwan

Drinking behavior among immigrants could be influenced by drinking-related cultural norms in their country of origin and host country. This study examined the association of ethnic drinking culture, acculturation, and enculturation with alcohol drinking among male immigrants in Taiwan. This cross-sectional survey recruited 188 male immigrants. Ethnic drinking culture was divided into dry and wet according to per capita alcohol consumption and abstinent rate in the countries of origin in reference to that in Taiwan. A scale, Bidimensional Acculturation Scale for Marriage-Based Immigrants, was developed to measure acculturation (adaptation to the host culture) and enculturation (maintenance of the original culture). Drinking patterns (abstinent, low-risk drinking, and hazardous drinking) were determined by scores on the Alcohol Use Disorder Identification Test. There was a significant interaction between ethnic drinking culture and enculturation/acculturation on drinking patterns. Multinomial logistic regression models identified that for those from dry ethnic drinking cultures, a high level of acculturation was associated with increased low-risk drinking, while a high level of enculturation was associated with decreased low-risk drinking. For those from wet ethnic drinking cultures, a low level of acculturation and high level of enculturation were associated with increased hazardous drinking. High family socioeconomic status was associated with increased drinking, while perceived insufficient family income was positively associated with hazardous use. To prevent hazardous use of alcohol, health education should be targeted at immigrant men who drink, especially among those who have economic problems, are from wet ethnic drinking cultures, and demonstrate low adaptation to the host culture.

The food similarity index: a new measure of dietary acculturation based on dietary recall data

This study introduces a flexible indicator of dietary acculturation that measures immigrants' eating behavior relative to U.S.-born persons. Using 24-hour dietary recall data from the continuous National Health and Nutrition Examination Survey pooled across multiple years from 1999/00 through 2009/10, we developed and tested the validity of the "Food Similarity Index" (FSI), which indicates the similarity of the foods consumed by individuals to the foods most commonly consumed by same-aged U.S-born persons of all racial/ethnic groups. We demonstrate its utility here for children and adults of four racial-ethnic groups. FSI was positively associated with the consumption of common American foods and negatively associated with eating Hispanic and Asian foods. In addition, FSI was associated with generational status among all racial/ethnic groups and duration of U.S. residence among Hispanics. FSI was also negatively associated with the Healthy Eating Index 2010. The FSI enables researchers to compare immigrants' dietary patterns over generations and across groups. It can be used to study how dietary acculturation shapes health risk factors and diseases.

Acculturation and dietary change among Chinese immigrant women in the United States

US Chinese immigrants undergo a transition to increased chronic disease risk commonly attributed to acculturative and dietary changes. Longitudinal data to confirm this are lacking. We examined acculturation and diet over time in 312 Chinese immigrant women in Philadelphia, recruited October 2005 to April 2008 and followed with interviews and dietary recalls until April 2010. Associations were modeled using generalized estimating equations to account for repeated measures over time. Increasing length of US residence was associated with a small (~1%/year) but significant increase in acculturation score (p < 0.0001), which in turn was significantly associated with increased energy density of the diet, percent of energy from fat, and sugar intake, and lower dietary moderation score. These findings provide longitudinal evidence that acculturation increases with length of US residence and is accompanied by dietary changes. However, the changes were small enough that their health impact is unclear. Factors besides acculturation that affect immigrant health and that affect the acculturation trajectory itself warrant investigation.

Cross-cultural comparison of perspectives on healthy eating among Chinese and American undergraduate students

Background

Understanding views about what constitutes a healthy diet in diverse populations may inform design of culturally tailored behavior change interventions. The objective of this study was to describe perspectives on healthy eating among Chinese and American young adults and identify similarities and differences between these groups.

Methods

Chinese (n = 55) and American (n = 57) undergraduate students in Changsha, Hunan, China and Honolulu, Hawai’i, U.S.A. composed one- to two-paragraph responses to the following prompt: “What does the phrase ‘a healthy diet’ mean to you?” Researchers used content analysis to identify predominant themes using Dedoose (version 5.2.0, SocioCultural Research Consultants, LLC, Los Angeles, CA, 2015). Three researchers independently coded essays and grouped codes with similar content. The team then identified themes and sorted them in discussion. Two researchers then deductively coded the entire data set using eight codes developed from the initial coding and calculated total code counts for each group of participants.

Results

Chinese students mentioned physical outcomes, such as maintaining immunity and digestive health. Timing of eating, with regular meals and greater intake during day than night, was emphasized. American students described balancing among food groups and balancing consumption with exercise, with physical activity considered essential. Students also stated that food components such as sugar, salt and fat should be avoided in large quantities. Similarities included principles such as moderation and fruits and vegetables as nutritious, and differences included foods to be restricted and meal timing. While both groups emphasized specific foods and guiding dietary principles, several distinctions in viewpoints emerged.

Conclusions

The diverse views may reflect food-related messages to which participants are exposed both through the media and educational systems in their respective countries. Future studies may further examine themes that may not typically be addressed in nutrition education programs in diverse populations of young adults. Gaining greater knowledge of the ways in which healthy eating is viewed will allow for development of interventions that are sensitive to the traditional values and predominant views of health in various groups.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3680-y) contains supplementary material, which is available to authorized users.

It is Hard to Swim Upstream: Dietary Acculturation Among Mexican-Origin Children

Health and immigration researchers often implicate dietary acculturation in explanations of Mexican children of immigrants' weight gain after moving to the U.S., but rarely explore how diet is shaped by immigrants' structural incorporation. We used data from the 1999/00-2009/10 National Health and Nutrition Examination Survey to assess how indicators of Mexican-origin children's acculturation and structural incorporation influence two outcomes: how healthy and how "Americanized" children's diets are. Indicators of acculturation were strongly associated with more Americanized and less healthy diets. However, structural incorporation indicators were mostly unrelated to diet outcomes net of acculturation. An exception was that parental education was positively associated with consuming a healthy diet. Finally, children of natives consumed more Americanized, unhealthy diets than children of immigrants and these differences were largely explained by differences in the acculturation. Children of natives would have consumed an even less healthy diet were it not for their higher levels of parental education. Overall, the results suggest that the process of adapting to the U.S. life style is associated with the loss of cultural culinary preferences and less healthy eating behaviors despite improvements in socioeconomic status.

Acculturation and Insulin Resistance among US Chinese Immigrant Women

OBJECTIVE

Chinese immigrants in the United States undergo a transition to increased chronic disease risk commonly attributed to acculturative changes. Longitudinal data to confirm this are lacking. We examined acculturation in relation to insulin resistance in a sample of Chinese immigrant women to determine differences by level of education and possible mediation by anthropometry and diet.

DESIGN

Longitudinal study.

SETTING

Philadelphia, Pennsylvania.

PARTICIPANTS

305 Chinese immigrant women recruited October 2005 to April 2008 and followed until April 2010.

MAIN OUTCOME MEASURES

Association of acculturation, measured using the General Ethnicity Questionnaire - American version (GEQA), with homeostasis model assessment (HOMA) score as an indicator of insulin resistance, modeled using generalized estimating equations to account for repeated measures over time.

RESULTS

GEQA was associated with log HOMA score, but only in women with <9 years of education (beta [SE] = .09 [.04], P=.02; interaction P=.02). The association persisted with adjustment for body mass index, waist circumference, and dietary variables.

CONCLUSIONS

These findings provide longitudinal evidence that insulin resistance increases with acculturation. However, the association was apparent only in less-educated immigrants and may be mediated by a pathway other than changes in anthropometry and diet.

Acculturation and changes in dietary behavior and anthropometric measures among Chinese international students in South Korea

BACKGROUND/OBJECTIVES

International students face dissimilar food environments, which could lead to changes in dietary behaviors and anthropometric characteristics between before and after migration. We sought to examine the risk factors, including dietary behaviors, acculturation, and demographic characteristics, related to overweight subjects residing in South Korea.

SUBJECTS/METHODS

We conducted a cross-sectional study, collecting data from 142 Chinese international students (63 males, 79 females) in 2013.

RESULTS

The mean age of the subjects was 25.4 years, and almost half of them immigrated to South Korea to earn a master's degree or doctoral degree (n = 70, 49.3%). Chinese international students showed an increase in skipping meals and eating speed, but a decrease in the frequency of fruit and vegetable consumption in South Korea compared to when they lived in China. We found a statistically significant increase in weight (69.4 → 73.9 kg) and BMI (22.4 → 23.8 kg/m²) for male subjects (P < 0.001) but no change for female subjects. We also found that overweight subjects were more likely to be highly acculturated and male compared with normal-weight subjects.

CONCLUSION

Among Chinese international students living in South Korea, male and more highly acculturated subjects are more vulnerable to weight gain. This study provides useful information to design tailored nutrition intervention programs for Chinese international students.

Comparison of two indices of diet quality with acculturation factors and demographics in Haitian Americans

This study examined associations of language preference and length of stay in the United States and diet among 132 Haitian Americans aged ≥35, born in Haiti. Two dietary indices, Healthy Eating Index (HEI) and Alternative Healthy Eating Index (AHEI), were used to assess dietary quality. Years in the United States (>15 years; B = 0.063, p = .012) and female gender (B = 5.63, p = .028) were positively associated with AHEI. Lower HEI scores were associated with speaking no English (B = -6.11, p = .026). Participants reporting an income under 20,000/yr had lower AHEI scores (B = -7.63, p = .014). Concurrent use of these indices would provide a screening tool for nutrition intervention. Public health programs targeting low-cost resources, such as community gardening, are recommended to reduce health disparities among this population.

Acculturative stress and inflammation among Chinese immigrant women

OBJECTIVE

Among Chinese immigrant populations, increasing duration of US residence is associated with elevated risk for various chronic diseases. Although life-style changes after migration have been extensively studied in immigrant populations, the psychosocial impact of acculturative stress on biological markers of health is less understood. Thus, the purpose of the present study is to examine associations between acculturative stress and inflammatory markers in a Chinese immigrant population.

METHODS

Study participants (n = 407 foreign-born Chinese American women) completed questionnaires assessing levels of stress, including acculturative stress and positive and negative life events in the previous year. Participant height and weight were measured using standard protocols, and blood samples were drawn for assessment of circulating serum levels of C-reactive protein (CRP) and soluble tumor necrosis factor receptor 2 (sTNFR2).

RESULTS

Higher levels of acculturative stress were significantly associated with higher levels of CRP (B = 0.07, 95% confidence interval = 0.01-0.13, p = .031) and sTNFR2 (B = 0.02, 95% confidence interval = 0.004-0.03, p = .012), adjusting for age and body mass index. The latter association was no longer statistically significant when overall acculturation (i.e., identification with American culture) was included in the model. Life events were not associated with CRP or sTNFR2.

CONCLUSIONS

This is one of the first studies to demonstrate that acculturative stress is associated with inflammatory markers in a Chinese immigrant population. Replication in other immigrant samples is needed to fully establish the biological correlates and clinical consequences of acculturative stress.

Racial/ethnic disparities in association between dietary quality and incident diabetes in postmenopausal women in the United States: the Women's Health Initiative 1993-2005

OBJECTIVE

To examine the association of dietary quality and risk of incident diabetes overall and by race/ethnicity among postmenopausal women enrolled in the Women's Health Initiative (WHI).

RESEARCH METHODS AND PROCEDURES

The WHI recruited 161,808 postmenopausal women between 1993 and 1998, and followed them until 2005. Incident diabetes was determined annually over an average of 7.6 years from enrollment. At baseline, all participants completed a Food Frequency Questionnaire (FFQ). Dietary quality was assessed by the Alternate Healthy Eating Index (AHEI), calculated from the baseline FFQ responses.

RESULTS

There were 10,307 incident cases of self-reported treated diabetes over 1,172,761 person-years of follow-up. Most participants did not meet the AHEI dietary goals; that is, only 0.1% of women met or exceeded the recommended consumption of vegetables, and few (17.3%) met or exceeded the recommended level for total fiber. After adjusting for potential confounders, women in the highest quintile of the AHEI score were 24% less likely to develop diabetes relative to women in the lowest quintile of AHEI [hazard ratio (HR)=0.76 (95% CI: 0.70-0.82)]. This association was observed in Whites [HR=0.74 (95% CI: 0.68-0.82)] and Hispanics [HR=0.68 (95% CI: 0.46-0.99)], but not in Blacks [HR=0.85 (95% CI: 0.69-1.05)] or Asians [HR=0.88 (95% CI: 0.57-1.38)].

CONCLUSION

These findings support a protective role of healthful eating choices in reducing the risk of developing diabetes, after adjusting for other lifestyle factors, in White and Hispanic postmenopausal women. Future studies are needed to investigate the relationship between dietary quality and risk of diabetes among Blacks and Asians in relationship to other lifestyle factors.

Dietary sodium intakes and food sources of sodium in Canadian-born and Asian-born individuals of Chinese ethnicity at a Canadian university campus

OBJECTIVE

To document the sodium intake and food sources of sodium of Canadian-born Chinese (CBC) and Asian-born Chinese (ABC) individuals at a Canadian university campus.

PARTICIPANTS

Healthy adults aged 18-58 years originating from Canada, China, Hong Kong, or Taiwan were recruited from the University of Alberta (n=40 CBC, n=41 ABC) between May and December 2010.

METHODS

Two in-person multipass 24-hour dietary recall interviews were administered for 1 weekday and 1 weekend day.

RESULTS

The mean sodium intake was 3,623±1,406 mg/day. The major food sources of sodium were commercially prepared and processed foods for both CBC and ABC (59.9% and 54.7% of sodium, respectively). Condiments contributed substantially to dietary sodium intake of CBC and ABC (27.8% and 35.1% of sodium, respectively).

CONCLUSIONS

Efforts to reduce dietary sodium among students and other adults of Chinese ethnicity should focus on limiting consumption of commercially processed foods and moderation in discretionary use of salt and soy sauce.

Prevalence of Childhood Obesity among Young Multiethnic Children from a Health Maintenance Organization in Hawaii

BACKGROUND

Pacific Islander, Asian, and mixed-ethnicity children are not described in national nutrition and health surveys.

METHODS

Data on BMI values of 4608 5- to 8-year-old children available from Kaiser Permanente Hawaii electronic medical records in 2010 were analyzed for prevalence of overweight and obesity and for ethnic differences in BMI and risk for overweight and obesity, controlling for age, sex, neighborhood education level, and on a subset (n=2169) that further controlled for maternal education and maternal age. Kaiser Permanente data allow for reporting of multiple ethnicities.

RESULTS

Data revealed that 33% of this child population was of mixed ethnic ancestry. Prevalence of overweight and obesity was 32.6% (12.9% overweight and 19.7% obese). However, Samoan children and children of Native Hawaiian, Filipino, and mixed ethnic ancestries had higher levels of overweight and obesity than whites or Asians. Higher neighborhood education level, higher maternal education level, and older maternal age were associated with decreased risk of overweight and obesity, except for children whose mothers were between 21 and 30 years old, who had a higher risk for obesity than those whose mothers were under 20 years of age (odds ratio=1.34).

CONCLUSIONS

Populations of mixed ethnicities in the Pacific region deserve further study related to healthy body size and acculturation to environment and lifestyle.

Acculturation, education, nutrition education, and household composition are related to dietary practices among Cambodian refugee women in Lowell, MA

Refugees in the United States have higher rates of some chronic diseases than US-born residents or other first-generation immigrants. This may be partially a result of dietary practices in the United States. There is limited information about which factors are related to dietary practices in refugee populations, particularly those who have been in the United States for 10 to 20 years. Research with Cambodian communities may be useful for examining the relationship between refugee characteristics and dietary practices. Two focus groups (n=11) and a survey (n=150) of Cambodian refugee women were conducted in Lowell, MA, from 2007 to 2008. χ(2) analyses, t tests, and analysis of variance tests were used to describe differences in dietary practices (24-hour recall and a targeted qualitative food assessment) by group characteristics. Higher acculturation was related to higher likelihood of eating brown rice/whole grains, and to lower likelihood of eating high-sodium Asian sauces. Higher education was related to higher likelihood of eating vegetables and fruits and to eating white rice fewer times. Nutrition education and receiving dietary advice from a health care provider were related to higher likelihood of eating whole grains/brown rice. Having a child at home was related to a higher likelihood of eating fast food. Among Cambodian refugees who have been in the United States for 10 to 20 years, dietary practices appear to have a relationship with acculturation (positive association), the interrupted education common to refugees (negative association), nutrition education from either programs or health care providers (positive association), and having a child at home (negative association).

Stress is associated with unfavorable patterns of dietary intake among female chinese immigrants

BACKGROUND

Chinese immigrants experience increased risk for weight gain and chronic disease after US migration. Whether psychosocial stress affects their eating behavior is unknown.

PURPOSE

The purpose of this study is to examine psychosocial stress and dietary intake among 426 Chinese immigrant women in the Philadelphia region.

METHODS

Participants completed 4 days of dietary recalls and questionnaires assessing positive and negative life events in the past year and migration-related stressors.

RESULTS

In hierarchical linear regression models, positive life events were associated with higher energy intake (β = 21.1, p =  0.04). Migration-related stress was associated with lower total gram (β  = -11.3, p < 0.0001) and overall grain (β  = -0.18, p = 0.03) intake and higher energy density (β = 0.002, p = 0.04) and percent energy from fat (β = 0.06, p = 0.05).

CONCLUSIONS

Migration-related stress did not increase overall intake in terms of energy and total grams but selectively increased fat intake and energy density. Such dietary habits may have implications for future chronic disease risk in this immigrant population.

Socio-economic position and lower dietary moderation among Chinese immigrant women in the USA

OBJECTIVE

To examine associations of education and occupation, as indicators of socio-economic position (SEP), with dietary intake and diet quality in a sample of Chinese immigrant women.

DESIGN

Cross-sectional. Data collection included four days of dietary recalls and information on education and current occupation for participants and their spouses.

SETTING

Philadelphia, PA, USA.

SUBJECTS

Chinese immigrant women (n 423) recruited from October 2005 to April 2008.

RESULTS

In multivariate models, both higher education level and occupation category were significantly associated with higher energy density and intake of energy and sugar. Education was additionally associated with intake of sugar-sweetened beverages (P = 0·01) and lower dietary moderation (P = 0·01). With joint categorization based on both education and occupation, we observed significant trends indicating higher energy density (P = 0·004) and higher intake of energy (P = 0·001) and sugar (P = 0·04), but less dietary moderation (P = 0·02) with higher SEP.

CONCLUSIONS

In this sample of US Chinese immigrants, higher SEP as indicated by education level and occupation category was associated with differences in dietary intake and with less dietary moderation. While higher SEP is typically linked to healthier diet in higher-income nations, in these immigrants the association of SEP with diet follows the pattern of their country of origin - a lower-income country undergoing the nutrition transition.

Adiposity, adult weight gain and mammographic breast density in US Chinese women

The association of adiposity with dense tissue area in the breast is unclear, but suggests a mechanism by which adiposity might increase breast cancer risk. We examined associations of body mass index (BMI), usual BMI from age 20 to 29, waist circumference and adult weight gain with breast density in a sample of premenopausal United States Chinese immigrant women. Analyses included 415 participants in a longitudinal breast density study in Philadelphia. In addition to detailed questionnaire information, data collection included measures of anthropometry, and assessment of mammographic breast density using a computer-assisted method. We used multivariate linear regression to quantify cross-sectional associations with dense and nondense tissue area and percent breast density assessed at baseline. In adjusted models, BMI and waist circumference were significantly positively associated with nondense tissue area and inversely associated with percent density. BMI was also significantly positively associated with dense tissue area. Adult weight gain was associated with dense tissue area after adjusting for weight from age 20 to 29. In stratified analyses, BMI and adult weight gain were significantly associated with dense tissue area among women with BMI < 23 kg/m², and BMI was associated with nondense tissue area among women with BMI ≥ 23 kg/m². In this sample, adiposity and weight gain were associated with dense breast tissue area, although associations differed by level of adiposity. Given the potential implications of these findings for breast cancer prevention in premenopausal women, comparable studies in other population groups and with longitudinal data are needed. Reasons for the noted differences in associations by level of adiposity also warrant further investigation.