Changes in dietary habits after migration and consequences for health: a focus on South Asians in Europe

East and South Asian-Specific Blood Pressure Trajectories and Cardiovascular Disease

BACKGROUND

Cardiovascular disease (CVD) risk differs across Asian subgroups, possibly due to differences in hypertension burden. We characterized lifetime blood pressure (BP) trajectories for East and South Asian individuals and compared their associations with CVD risk.

METHODS

Among 148 872 UK Biobank participants with primary care utilization data, life course BP trajectories were fitted as a function of age by sex according to self-identified ethnicity. We determined associations of time-averaged young adulthood (18-39 years), middle age (40-64 years), and later life (≥65 years) systolic BP (SBP) and diastolic BP with incident atherosclerotic CVD risk.

RESULTS

The predicted SBP/diastolic BP (95% CI) at age 30 years was 108 (103-114)/68 (65-71) mm Hg for East Asian and 114 (110-118)/72 (71-73) mm Hg for South Asian individuals. By age 40, South Asian individuals were projected to reach an SBP of 130.0 mm Hg, whereas East Asian individuals reached the equivalent SBP by age 49 years. Among South Asian individuals, each SD increase in young adulthood SBP was associated with a higher atherosclerotic CVD risk with an odds ratio (95% CI) of 1.41 (1.12-1.75), but not among East Asians (Pinteraction=0.01). Midlife SBP was associated with peripheral artery disease among South Asian individuals (odds ratio, 2.08 [95% CI, 1.51-2.88]) and with ischemic stroke among East Asian individuals (odds ratio, 3.84 [95% CI, 1.08-5.07]). Later-life SBP was associated with myocardial infarction risk by 1.52 (1.15-1.92)-fold among South Asians and ischemic stroke by 2.50 (1.06-3.80)-fold among East Asian individuals.

CONCLUSIONS

East and South Asian individuals exhibit distinct BP trajectories that age-differentially associate with incident CVD. Disaggregating Asian subgroups may inform tailored hypertension screening and management.

A systematic review of dietary assessment methods used for South Asian migrants in high-income host countries

AIM

The increased risk of chronic diseases and migration to high-income countries in South Asians has been well established. Considering exposure to changing dietary intake and lifestyle upon migration, accurate nutrition assessment is crucial in this population. The present review aims to summarise dietary assessment methods and nutrient databases for South Asian (SA) migrants in high-income countries.

DATA SYNTHESIS

A systematic search of Medline, Web of Sciences, Embase, CINHAL and Cochrane Central Library databases was conducted in August 2023. Eligible studies were critically appraised using Joanna Briggs Institute Critical Appraisal Tools. Data was extracted using a purpose-built spreadsheet. This systematic review has been registered with PROSPERO (Reg ID: CRD42021274929).

CONCLUSIONS

A total of 12991 studies were identified, of which 46 met the eligibility criteria. Dietary assessment methods were categorised as newly validated, previously validated, and not validated. Only ten studies used a validated culturally appropriate dietary assessment tool. This review shows that FFQ and 24-hour (24hr) dietary recall are the most utilised dietary assessment tools for SA migrants. The findings highlight the limited culturally appropriate dietary assessment tools available for SA migrants. Specific design and validation issues, such as cultural specificity, were identified that researchers should consider when developing new nutritional assessment tools for SA migrants.

Risk Factors Associated With General and Abdominal Obesity Among South Asian Minorities in Hong Kong

South Asians have become a sizable ethnic minority in Hong Kong with unique health and social needs often being overlooked. Elevated obesity risk among South Asians has been highlighted in high-income Western settings; however, relevant local evidence is scarce. This cross-sectional study aims to explore the obesity prevalence and related risk factors among South Asians in Hong Kong. Between June 2022 and February 2023, 535 South Asian adults were recruited via territory-wide health outreach services, and completed a survey and anthropometric measurements on height, weight, and waist circumference. In our female-dominated sample (84.1% female; mean age = 41.0 ± 12.3 years), the observed prevalence of general obesity (body mass index [BMI] ≥ 27.5 kg/m2 for South Asians) and abdominal obesity (waist-to-height ratio [WHtR] > 50%) were 60.2% and 89.4%, respectively. Results from multivariable linear regressions showed that mean BMI and WHtR were significantly higher among women and Pakistani individuals (and Nepalese individuals for BMI only) but lower among better educated and employed respondents. Apart from age, household size, and marital status as common risk factors, having a healthier diet and higher physical activity level were also associated with lower WHtR. Notably, the associations of female gender and Pakistani ethnicity were attenuated after adjustments for socioeconomic and lifestyle factors. In conclusion, there was a high prevalence of obesity in South Asian participants in this study. The identified risk and protective factors could inform targeted services and community-based weight management programs to mitigate obesity and its associated cardiometabolic risks in this fast-growing but vulnerable community.

An Active Learning Model for Promoting Healthy Cooking and Dietary Strategies Among South Asian Children: A Proof-of-Concept Study

Background/Objectives: South Asian children living in Canada have a higher prevalence of cardiovascular disease risk factors compared to their non-South Asian counterparts, and poor dietary habits may contribute to this health disparity. Methods: This study uses a pre-post intervention design to examine the impact of a family-focused, "hands-on" cooking workshop on improving three cooking and dietary strategies: (1) using healthy cooking techniques, (2) practicing portion control, and (3) making healthy substitutions. We recruited 70 South Asian parent-child dyads (n = 140) across four elementary schools in Surrey, British Columbia. The 90 min workshop includes a didactic segment on healthy food preparation and dietary strategies, followed by an interactive cooking session where participants make a healthier version of a traditional Punjabi dish. Results: Among the three dietary strategies measured, both children and parents increased their frequency of using healthy cooking techniques (child p = 0.02; parent p < 0.001) and practicing portion control (child p < 0.001; parent p = 0.02). No changes were reported by either group for making healthy substitutions. Conclusions: Findings suggest that educational approaches that engage the family as a unit and encourage active participation are associated with improvements in cooking and dietary strategies in the South Asian community.

Contexts of reception and refugee health: Experiences of foreign-born people in the United States and Belgium

Immigrants' health may differ with the characteristics of the place they resettle. We examined eating patterns and weight status across two differing environments - Atlanta, United States and Brussels, Belgium - collecting information on diet and health from a diverse sample of 111 refugees, asylum-seekers and other migrants. Analyses used descriptive statistics, multivariate regressions, and text analysis. People who had resettled in Atlanta reported higher weight categories than those in Belgium. In both locations, the most commonly adopted items were processed foods (71 % in Atlanta, 45 % in Brussels); many also listed adopting fruits and vegetables (31 % in Atlanta, 14 % in Brussels). Thus, changes in health-related behaviors after migration included both healthy and unhealthy components of the contexts of reception. Longer time since arrival was associated with lower odds of having adopted processed foods and higher odds of having adopted fresh foods, suggesting that dietary change is nuanced with immigrants' integration trajectories.

Longitudinal analysis of lifestyle risk factors, nutrition status and drivers of food choice among urban migrants in Ulaanbaatar, Mongolia, and Almaty, Kazakhstan: a formative study

OBJECTIVE

To quantify and compare concurrent within-person trends in lifestyle risks, nutrition status and drivers of food choice among urban migrants in Central Asia.

DESIGN

We collected panel data on household structure, drivers of food choice, nutrition knowledge and diverse measures of nutrition status and lifestyle risk from urban migrants at 0, 3, 6 and 9 months using harmonised methodology in two cities. Trends were analysed using mixed-effects models and qualitatively compared within and between cities.

SETTING

Ulaanbaatar, Mongolia, and Almaty, Kazakhstan.

PARTICIPANTS

200 adults (22-55 years) who migrated to these cities within the past 2 years.

RESULTS

Adjusting for age and sex, each month since migration was positively associated with fasting TAG in Almaty (0·55 mg/dl; 95 % CI: 0·13, 0·94) and BMI (0·04 kg/m2; 95 % CI: 0·01, 0·07), body fat (0·14 %; 95 % CI: 0·01, 0·26) and fasting glucose (0·04 mmol/l; 95 % CI: 0·02, 0·05) and lipids in Ulaanbaatar (P < 0·05). In Almaty, nutrition knowledge (measured using an objective 20-point scale) declined despite improvements in diet quality (measured by Prime Diet Quality Score). The influence of food availability, price and taste on food choice increased in Almaty (P < 0·05). Upon multivariable adjustment, nutrition knowledge was positively associated with diet quality in Almaty and adherence to 'acculturated' diet patterns in both cities (P < 0·05). Different trends in smoking, sleep quality and generalised anxiety were observed between cities.

CONCLUSIONS

Findings indicate heterogeneous shifts in nutrition, lifestyles and drivers of food choice among urban migrants in Central Asia and provide an evidence base for focused research and advocacy to promote healthy diets and enable nutrition-sensitive food environments.

Addressing the Health Needs of Indian Americans in the Greater Philadelphia Region Through a Scoping Survey: Cancer Screening Assessment

Despite higher income and education, there are profound health disparities among Asian Americans. These disparities are highlighted in particular by screening behaviors for cancer. Between 1998 and 2008, cancer rates increased threefold among Indian Americans, raising concern that cancer screening in this group may be especially low. To better understand cancer screening behavior, we collected data from a total of 157 self-identifying Indian Americans residing in the greater Philadelphia area. Nearly all participants reported having health insurance (98.7%), and most had received a physical exam within a year (87.3%). Only17.4% of the participants were referred for mammography, while 30% of participants over age 30 were referred for ovarian cancer screening. Just 4 participants were recommended for pancreatic cancer screening. The findings contribute new information to the understanding of health needs of Indian Americans residing in the greater Philadelphia region and reveal a need for greater focus on preventive care.

Migration Spurs Changes in the Human Microbiome: a Review

International migration often results in major changes in living environments and lifestyles, and these changes may lead to the observed increases in obesity and diabetes among foreign-born people after resettling in higher-income countries. A possible mechanism linking changes in living environments to the onset of health conditions may be changes in the microbiome. Previous research has shown that unfavorable changes in the composition of the microbiome can increase disposition to diseases such as diabetes, obesity, kidney disease, and inflammatory bowel disease. We investigated the relationship between human migration and microbiome composition through a review using microbiome- and migration-related search terms in PubMed and Web of Science. We included articles examining the gut, oral, or oropharyngeal microbiome in people who migrated internationally. Nine articles met eligibility criteria. All but one examined migration from a non-Western to a Western country. Four of these found a difference in the microbiome of migrants compared with non-migrating residents of their country of birth, seven found differences in the microbiome of migrants compared with the native-born population in the country of resettlement, and five found microbiome differences associated with duration of stay in the country of resettlement. Microbiome composition varies with country of birth, age at migration, time since immigration, and country of resettlement. The results suggest that migration may lead to changes in the microbiome; thus, microbiome characteristics are a plausible pathway to examine changes in health after resettlement in a new country.

Development of dietary assessment instruments which can take cultural diversity and dietary acculturation into account: eating in Sweden ('Mat i Sverige')

Since lack of culture-specific foods in dietary assessment methods may bias reported dietary intake, we identified foods and dishes consumed by residents not born in Sweden and describe consequences for reported foods and nutrient intake using a culturally adapted dietary assessment method. Design consisted of cross-sectional data collection using (semi-)qualitative methods of dietary assessment (and national diet survey instrument RiksmatenFlex) with subsequent longitudinal data collection using quantitative methods for method comparison (December 2020-January 2023). Three community-based research groups were recruited that consisted of mothers born in Sweden, Syria/Iraq, and Somalia, with a median age of 34, 37, and 36 years, respectively. Women born in Syria/Iraq and Somalia who had lived in Sweden for approximately 10 years, reported 78 foods to be added to RiksmatenFlex. In a subsequent study phase, 69% of these foods were reported by around 90% of the ethnic minority groups and contributed to 17% of their reported energy intake. However, differences between the three study groups in median self-reported energy intake remained (Sweden 7.19 MJ, Syria/Iraq 5.54 MJ, and Somalia 5.69 MJ). The groups also showed differences in relative energy contribution from fats and carbohydrates, as well as differences in energy intake from food groups such as bread and sweet snacks. We conclude that a dietary assessment instrument containing culture-specific foods could not resolve group differences in reported energy intake, although these foods provided content validity and contributed 17% of energy intake. The dietary habits collected in this study serve to develop new dietary assessment instruments.

Does cardiorespiratory fitness moderate the relationship between overweight, cardiovascular risk markers and mental health among forcibly displaced individuals living in a Greek refugee camp?

Objectives

Refugees may have an increased risk of developing overweight/obesity as they often experience a nutritional transition. Because maintaining good cardiorespiratory fitness can help reduce the negative impact of excess weight on overall health, the objective of this study was to examine whether fitness moderates the relationship between weight status and cardiovascular and mental health outcomes in forcibly displaced individuals living in a Greek refugee camp.

Methods

A sample of 142 forcibly displaced individuals were recruited. Cardiorespiratory fitness was assessed with the submaximal Åstrand-Rhyming bicycle ergometer test. Blood pressure, blood lipids, blood glucose, and hs-CRP were assessed as physical health outcomes, whereas post-traumatic stress disorder, depression and anxiety symptoms, pain, and quality of life were assessed as mental health outcomes. Main and interaction effects were tested via analyses of covariance (ANCOVAs).

Results

Almost 50% of the participants were overweight/obese, more than 60% presented with very poor fitness levels, and the percentage of participants with very poor fitness levels was particularly high among overweight/obese participants. Whereas overweight/obesity was associated with a less favorable body composition and cardiovascular risk profile, poor fitness was associated with a higher percentage of body fat and a lower percentage of muscle mass. Cardiorespiratory fitness did not moderate the relationship between overweight/obesity and most of the assessed health outcomes.

Conclusions

Only limited support was found for the applicability of the fit-but-fat concept to our population of forcibly displaced individuals. Public health services should prioritize measures to prevent overweight/obesity and associated diseases in refugee camps. Moreover, efforts are needed to improve the fitness of camp residents via exercise/sport interventions.

Pre-pregnancy obesity among immigrant and non-immigrant women in Norway: Prevalence, trends, and subgroup variations

INTRODUCTION

This study assessed prevalence and time trends of pre-pregnancy obesity in immigrant and non-immigrant women in Norway and explored the impact of immigrants' length of residence on pre-pregnancy obesity prevalence.

MATERIAL AND METHODS

Observational data from the Medical Birth Registry of Norway and Statistics Norway for the years 2016-2021 were analyzed. Immigrants were categorized by their country of birth and further grouped into seven super regions defined by the Global Burden of Disease study. Pre-pregnancy obesity was defined as a body mass index ≥30.0 kg/m2, with exceptions for certain Asian subgroups (≥27.5 kg/m2). Statistical analysis involved linear regressions for trend analyses and log-binomial regressions for prevalence ratios (PRs).

RESULTS

Among 275 609 pregnancies, 29.6% (N = 81 715) were to immigrant women. Overall, 13.6% were classified with pre-pregnancy obesity: 11.7% among immigrants and 14.4% among non-immigrants. Obesity prevalence increased in both immigrants and non-immigrants during the study period, with an average yearly increase of 0.62% (95% confidence interval [CI]: 0.55, 0.70). Obesity prevalence was especially high in women from Pakistan, Chile, Somalia, Congo, Nigeria, Ghana, Sri Lanka, and India (20.3%-26.9%). Immigrant women from "Sub-Saharan Africa" showed a strong association between longer residence length and higher obesity prevalence (≥11 years (23.1%) vs. <1 year (7.2%); adjusted PR = 2.40; 95% CI: 1.65-3.48), particularly in women from Kenya, Eritrea, and Congo.

CONCLUSIONS

Prevalence of maternal pre-pregnancy obesity increased in both immigrant and non-immigrant women from 2016 to 2021. Several immigrant subgroups displayed a considerably elevated obesity prevalence, placing them at high risk for adverse obesity-related pregnancy outcomes. Particular attention should be directed towards women from "Sub-Saharan Africa", as their obesity prevalence more than doubled with longer residence.

Sources and determinants of free sugars intake by 5-year-old Australian children in the SMILE cohort

Reducing free sugars intake is important for the prevention of dental caries and obesity in children. The study aimed to determine the amount and sources of free sugars known to contribute to dental caries, and identify sociodemographic determinants of intake by children aged 5 years in Australia. Cross-sectional analysis of dietary data from a cohort study, collected using a customized food frequency questionnaire were used to calculate free sugars intake as grams/day and percentage contribution to Estimated Energy Requirement (EER). The percent contribution of food sources to free sugars intake was derived. Sociodemographic determinants of achieving intakes within WHO thresholds (i.e., <5% and <10% Energy were explored with multinomial logistic regression. Complete data were available for 641 children (347 boys, 294 girls). Median (IQR) free sugars intake (g/day) was 31.6 (21.3-47.6) in boys and 28.1 (19.6-47.9) in girls. The median (IQR) percentage contribution to EER was 7.9 (5.4-12.7); 21% and 42% of children had intakes <5% EER and between 5% and <10%, respectively. The main sources of free sugars were: (1) Cakes, Biscuits and Cereal Bars; (2) Sweetened Milk Products (predominantly yoghurts) and (3) Desserts. Maternal university education, single-parent household, and maternal place of birth being Australia or New Zealand were associated with free sugars intake <5% EER. In conclusion, less than a quarter of 5-year-old children in the SMILE cohort achieved the WHO recommendations to limit free sugars to <5% EER. Strategies to lower free sugars intake could target priority populations such migrants, populations with lower levels of education or health literacy and identify areas for intervention in the wider food environments that children are exposed to.

Using co-design to identify intervention components to address unhealthy dietary and activity behaviours in New Zealand South Asians

There is an urgent need to develop sustainable and impactful interventions to mitigate the high risk of diet-related non-communicable diseases (diet-NCDs) in South Asians living in high-income countries. The current study using a co-design methodology aimed to identify community-led intervention components (solutions) to address barriers and enablers of disease-promoting dietary and physical activity behaviours in New Zealand South Asians. Data were collected from South Asian immigrants aged 25-59 years via three focus group discussions (n = 21) and 10 telephone or face-to-face interviews between 2018 and 2019. The thematic analysis resulted in identifying 22 barrier and enabler codes and 12 solution codes which were summarised under five themes. The key solutions (intervention components) to mitigate the identified target behaviours were providing recipes for using local vegetables in South Asian cuisine, information on the nutritional quality of frozen vegetables and canned lentils, simple home gardening techniques, the saturated fat content of dairy foods, interpreting nutrition labels, optimal portion sizes of foods, and framing low-fat messages positively. Similarly, group-based activities with peer support such as walking, cultural dancing and community sports like cricket, football, and tennis were the identified solutions to increase physical activity levels. The identified solutions for health promoting dietary habits and physical activity levels could be part of any targeted multicomponent health promoting programme to reduce the risk of diet-NCDs in South Asian immigrants.

Effects of Migration on Nutritional Habits: From Turkey to Germany

Background

Dietary habits are influenced by environmental factors. Among these environmental factors are the place of residence, cultural characteristics, food accessibility, and economic status, which can all contribute to changes in the dietary pattern. Migration is another factor that can influence changes in the aspects mentioned above. We aimed to assess the dietary habits of individuals who have migrated from Turkey to Germany in comparison to those living in Turkey.

Methods

In this descriptive and cross-sectional study, 254 individuals were enrolled with 102 individuals in Germany and 152 individuals in Turkey between April 2022 and July 2023. The data collection tools included Socio-demographic Characteristics Forms, Dietary Habits and Health Status Forms, and Food Consumption Frequency Forms. The data was collected online via Google Forms.

Results

There were statistically significant differences in the consumption frequency of processed meats, meat and poultry, sweetened beverages, sugar, desserts and pastries, vegetables, fruits, eggs and grains, olive oil, sunflower oil, hazelnut oil, grains, dairy products, coffee, starch, and carbonated beverages between the two groups (P<0.05). Statistically significant differences were not found in terms of butter and tea consumption frequency.

Conclusion

Overall, the study results have revealed significant differences in dietary habits between Turks living in Germany and those living in Turkey. The most noteworthy dimension of these differences is that individuals living in Turkey exhibit a stronger adherence to the Mediterranean dietary pattern, while those living in Germany tend to follow a Western dietary pattern.

Unraveling the Evolutionary Diet Mismatch and Its Contribution to the Deterioration of Body Composition

Over the millennia, patterns of food consumption have changed; however, foods were always whole foods. Ultra-processed foods (UPFs) have been a very recent development and have become the primary food source for many people. The purpose of this review is to propose the hypothesis that, forsaking the evolutionary dietary environment, and its complex milieu of compounds resulting in an extensive metabolome, contributes to chronic disease in modern humans. This evolutionary metabolome may have contributed to the success of early hominins. This hypothesis is based on the following assumptions: (1) whole foods promote health, (2) essential nutrients cannot explain all the benefits of whole foods, (3) UPFs are much lower in phytonutrients and other compounds compared to whole foods, and (4) evolutionary diets contributed to a more diverse metabolome. Evidence will be presented to support this hypothesis. Nutrition is a matter of systems biology, and investigating the evolutionary metabolome, as compared to the metabolome of modern humans, will help elucidate the hidden connections between diet and health. The effect of the diet on the metabolome may also help shape future dietary guidelines, and help define healthy foods.

Nutrition for dementia prevention: a state of the art update for clinicians

BACKGROUND AND OBJECTIVES

Dementia prevalence continues to rise. It is therefore essential to provide feasible and effective recommendations to encourage healthy brain ageing and reduce dementia risk across the population. Appropriate nutrition represents a potential strategy to mitigate dementia risk and could be recommended by clinicians as part of mid-life health checks and other health initiatives to reduce dementia prevalence. The purpose of this review is to provide a clinician-focused update on the current state of the knowledge on nutrition and dementia prevention.

METHODS

Narrative review.

RESULTS

Strong evidence exists to support the consumption of healthy, plant-based dietary patterns (e.g. Mediterranean, MIND or Nordic diet) for maintaining cognitive function and reducing dementia risk in later life and is supported by dementia prevention guideline from leading public health bodies (e.g. World Health Organization). Emerging evidence suggests potential cognitive benefits of consuming specific nutrients/foods (e.g. n-3 fatty acids or fish, flavonols and B-vitamins) and multi-nutrient compounds (e.g. Fortasyn Connect). Challenges and opportunities for integrating nutritional/dietary interventions for dementia prevention into clinical practice are explored in this review.

CONCLUSIONS

Appropriate nutrition represents an important factor to help facilitate healthy cognitive ageing and allay dementia risk. The information provided in this article can help clinicians provide informed opinions on appropriate nutritional strategies as part of mid-life Health Checks and other risk reduction initiatives.

Temporal Trends in Cardiovascular Disease Prevalence Among Asian American Subgroups

BACKGROUND

Asian and multiracial individuals represent the 2 fastest growing racial and ethnic groups in the United States, yet most prior studies report Asian American and Native Hawaiian or Other Pacific Islander as a single racial group, with limited data on cardiovascular disease (CVD) prevalence among subgroups. We sought to evaluate temporal trends in CVD burden among disaggregated Asian subgroups.

METHODS AND RESULTS

Patients with CVD based on International Classification of Diseases, Ninth Revision and Tenth Revision (ICD-9 and ICD-10) coding who received care from a mixed-payer health care organization in California between 2008 and 2018 were classified into self-identified racial and ethnic subgroups (non-Hispanic White [NHW], Asian Indian, Chinese, Filipino, Japanese, Korean, Native Hawaiian or Other Pacific Islander, and multiracial groups). Adjusted trends in CVD prevalence over time by subgroup were compared using logistic regression. Among 3 494 071 patient-years, prevalence of CVD increased faster among all subgroups except Japanese and Native Hawaiian or Other Pacific Islander patients (P<0.01 for each, reference: NHW). Filipino patients had the highest overall CVD prevalence, which increased from 34.3% to 45.1% over 11 years (increase from 17.3%-21.9%, P<0.0001, reference: NHW). Asian Indian patients had the fastest increase in CVD prevalence over time (16.9%-23.7%, P<0.0001, reference: NHW). Among subcategories of disease, hypertension increased faster among Asian Indian, Chinese, Filipino, Korean, and multiracial groups (P<0.01 for all, reference: NHW), and coronary artery disease increased faster among Asian Indian, Chinese, Filipino, and Japanese groups (P<0.05 for each, reference: NHW).

CONCLUSIONS

The increasing prevalence of CVD among disaggregated Asian, Native Hawaiian or Other Pacific Islander, and multiracial subgroups over time highlights the importance of tailored approaches to addressing CVD in these diverse subpopulations.

Unhealthy diets increase the likelihood of being overweight or obese among African migrant students in China, but not among African non-migrant students: a cross-sectional study

Background

The impact of non-communicable diseases (NCDs) is disproportionately felt by immigrants from low- to medium-income countries (LMICs), partly due to their dietary habits. To thrive in their new environment, migrants either omit or consume certain food items, which could lead to nutritional deficits. As a result, most migrants experience more NCDs than their compatriots in their native countries. Therefore, we evaluated the difference in dietary habits, quality, and the influencing factors of overweight or obesity among African migrant students in Nanjing (China) and non-migrant students in Africa using cross-sectional data.

Methods

The researchers used the food frequency questionnaire and the global diet quality score metrics to assess food intake and quality, respectively. Then, cross-tabulation was employed to explore the differences between the groups in meal skipping, eating habits, and diet quality. Finally, the factors associated with overweight or obesity were assessed with binary logistic regression stratified by African students in Nanjing and students in their native countries.

Results

Approximately 678 responses were received, mainly between 18-25 years (46.7%) and 26-36 years (45.4 %). The majority of them (52.3%) were international students. The non-migrant African students' diets lacked citrus fruits (22.2%), deep orange fruits (15.4%), deep orange vegetables (18%), cruciferous vegetables (24.6%), and dark leafy vegetables (26.5%). While the African migrant students consumed more high-fat dairy (50.7%), processed meats (23.9%), sweets and ice creams (51.3%), sugar-sweetened beverages (40.5%), and juice (61.5%), p < 0.001. Furthermore, consuming late-night meals constantly [Exp (B) = 39.607, p = 0.049], eating twice a day [Exp (B) = 6.527, p = 0.036], consuming red meat [Exp (B) = 29.287, p = 0.001], processed meats [Exp (B) = 719.979, p = 0.0011], refined grains and baked foods [Exp (B) = 15.752, p = 0.013], and sweets and ice cream [Exp (B) = 193.633, p = 0.006] were factors inducing overweight or obesity among only African migrant students.

Conclusion

Controlling the what (Western diet and nature of late-night meals) and the when of eating can drastically reduce their influence on obesogenic condition formation in African migrant students in China and elsewhere.

Perceived barriers and facilitators to healthy eating among Pakistani women participating in the PakCat program in Catalonia: A qualitative approach

Immigrant women of Pakistani origin are among the most at-risk groups for type 2 diabetes, obesity, and heart failure in Catalonia. As the incidence of these diseases is associated with lifestyle factors, we approached this community with participatory research and conducted six focus groups (N = 36) among Pakistani women participating in the PakCat Program. The research process of this paper adhered to the COREQ checklist. Through the thematic analysis, we identified six main themes: social beliefs and attitudes, family environment, personal factors, dietary acculturation, traditional dietary patterns, and economic factors. We discovered both facilitators and barriers associated with each theme, but the findings indicated that Pakistani women encounter more inhibitors than enablers to following a healthy diet. The determination of these factors can facilitate the reinforcement of the aspects that help Pakistani women to follow a healthy diet and provide adequate tools to overcome the barriers.

Prevalence of obesity, diabetes and hypertension in immigrant populations in northeastern Mexico

Introduction

Hispanic immigrants are a fast-growing population in the United States of America (USA) that disproportionately suffer from chronic diseases. Despite the increasing prevalence of obesity in Latin-American countries, only a few studies have examined the onset of chronic diseases in Mexican and Central American migrants in Mexico.

Objective

The objective of this study is to determine the prevalence of obesity, diabetes, and hypertension in Central American immigrants who are in the process of traveling through northeastern Mexico to the United States.

Methods

An observational, descriptive, cross-sectional study was conducted among migrants, mostly Central Americans. Migrants who agreed to participate in the study were interviewed face-to-face by researchers to obtain their sociodemographic data. To obtain the prevalence, many health indicators related to obesity, diabetes, and hypertension, including weight, height, fasting glucose, and blood pressure, were measured.

Results

In total, 520 migrants were interviewed; sociodemographic data indicated that most participants were men (76%), from Honduras (72.6%), single (61.2%), and have elementary level of education (48.6%). The somatometric evaluation revealed that 28.9% were diagnosed as overweight, 10.7% with obesity, and 3.3% with malnutrition. Of less prevalence, 8.8% were detected with hypertension and 4.6% had fasting hyperglycemia. The mean participant age was 29.11 ± 10.00 years. For each participant, the average weight was 66.72 ± 13.09 kg; the average height was 1.64 ± 0.08 m; the average body mass index (BMI) was 24.59 ± 4.32; the mean systolic and diastolic pressures were 116.26 ± 15.13 and 74 ± 9.65, respectively; and the average glycemia was 100.97 ± 21.99. El Salvador showed the highest proportion of people with diabetes (14.7%). Women who participated in this study had a higher proportion of obesity (23.4%, p = 0.02) and overweight (36.2%) than men (8.4 and 29.2%, respectively). People from Mexico, Nicaragua, and Honduras reported a high prevalence of overweight participants (63.6, 47.4, and 30.7%, respectively), while people from El Salvador and Nicaragua had a high prevalence of obese participants (23.5 and 21.1%, respectively).

Conclusion

We found significant differences in the rates of obesity, diabetes, and hypertension between groups of Central American migrants and their place of origin, age, educational level, and gender. Our findings highlight the importance of exploring differences within groups of Central American migrants traveling through northeastern Mexico to the United States, which may explain several health indicators.

Cohort profile update: the Norwegian STORK Groruddalen (STORK G) pregnancy and birth cohort-the role of ethnicity and causal pathways for obesity, type 2 diabetes, cardiovascular disease and other health issues

PURPOSE

The STORK Groruddalen cohort was set up in 2008 to explore ethnic differences in: (1) maternal health, primarily gestational diabetes (GDM) and related health issues during pregnancy and post partum, and effects of exposures on risk for type 2 diabetes, cardiovascular disease and other health issues, and (2) offspring's growth and body composition, overweight/obesity and effects of early life exposures.

PARTICIPANTS

823 women (74% of invited) were followed from gestational week (GW) 15. Data were collected from 618 fathers. In total, 59% of women and 53% of fathers had origin from non-Western countries. Maternal mean age was 29.9 years (SD 4.9), and body mass index (BMI) 25.3 kg/m2 (4.9). Data were obtained from 772 women (94%) at GW 28, and 662 women (80%) 14 weeks post partum. Eleven years post partum, 385 women (53% of eligible/47% of original cohort) attended, age was 42.0 years (4.8) and BMI 27.1 kg/m2 (5.1). We have data for 783 children at birth, and for 586 at last time point, mean age 8.6 (0.5) years, weight 30.7 (6.8) kg and length 133.9 (6.3) cm.

FINDINGS TO DATE

We collected questionnaire data from parents, clinical measurements and blood samples from mothers, and data on children's growth (mid-pregnancy to 8 years). Our biobank includes maternal blood and urine samples, biopsy material from placentas and umbilical venous cord blood. We found several clinically important differences in maternal health, with higher risk in ethnic minority groups for GDM, insulin resistance, vitamin D and iron deficiency, depressive symptoms and physical inactivity. Contrasting patterns of fetal growth and risk of overweight/thinness at preschool age were observed across ethnic groups. Maternal GDM, obesity and high gestational weight gain were associated with children's BMI trajectories.

FUTURE PLANS

We will examine the impact of maternal and fetal health and development during pregnancy on long-term outcomes for mothers and offspring.

TRIAL REGISTRATION NUMBER

Project title STORK G-2: Women and Risk of Type 2 Diabetes NCT03870724 (ClinicalTrials.gov).

Dietary management of type 2 diabetes mellitus among South Asian immigrants: A mixed-methods study

AIMS

There is a high prevalence of South Asian immigrants in Australia living with type 2 diabetes mellitus, with the dietary management of the condition presenting as a key challenge. However, their current dietary patterns and barriers to diabetes self-management are unclear. Therefore, this study aims to (i) investigate current dietary patterns and (ii) explore barriers and facilitators to dietary management in this population.

METHODS

A concurrent mixed-methods study comprising three 24-h dietary recalls and a semi-structured interview for each self-identified South Asian immigrant adult with diabetes recruited across Victorian primary care clinics and social media to address the aforementioned two aims. Dietary recall data were converted into food groups using Foodworks, and data analysed in SPSS. Qualitative data were thematically analysed using NVivo.

RESULTS

Among 18 participants recruited, 14, 16 and 17 participants had grain, fruit and dairy intake lower than daily Australian recommendations, respectively. These findings echoed qualitative data that participants viewed diabetes management as reducing carbohydrate intake. Participants reported difficulties incorporating diabetes-related dietary and lifestyle recommendations into their routine and a lack of knowledge about available organisational support. They mentioned challenges in receiving social support from families and friends and relied on support from health professionals. Facilitators included proficiency in nutrition information label reading and self-blood glucose monitoring skills.

CONCLUSION

Enhancing the accessibility to organisational support, facilitating the adaption of dietary recommendations into individuals' routines, and strengthening support from health professionals are essential components in intervention development to improve diabetes management for South Asians.

Post-Migration Changes in Dietary Patterns and Physical Activity among Adult Foreign Residents in Niigata Prefecture, Japan: A Mixed-Methods Study

The migrant population of Japan is gradually increasing, but it is not well known how and why diet and physical activity (PA) change post-migration. Therefore, this study used a mixed-method approach to investigate the changes in dietary patterns and PA through a web- and paper-based survey (n = 128) and understand the contextual factors for those changes through semi-structured interviews (n = 21). Descriptive and thematic analyses of quantitative and qualitative data were conducted, respectively. The majority of survey (57.8%) and interview (66.7%) participants were female, and the mean duration of stay in Japan was 5 and 3.6 years, respectively. The survey revealed an increased consumption of foods attached to Japanese culture, frozen and microwavable food, and a reduced consumption of fruits. We identified environmental (availability, accessibility, and affordability of foods; food safety and diet-related information; and climate), individual (living status; post-migration lifestyle; and food preferences and limitations), or socio-cultural (relationships with Japanese people; cultural differences; and religious influences) factors that impact diet changes. Language proficiency and the duration of stay shape dietary behaviors. Determinants of PA changes were climate, lifestyle, and the influence of Japanese culture. In conclusion, immigrants in Japan experience post-migration diet and PA changes, and this study adds knowledge about how and why such changes occur.

Dietary Acculturation and Food Habit Changes among Chinese Immigrants in Portugal

Chinese individuals who immigrate to a Western country tend to change their eating patterns and behaviors depending on how long they live in the host country. This is dietary acculturation, and it can have a positive or negative impact on eating habits. Thus, we aimed to characterize the dietary acculturation of the Chinese immigrant community in Portugal and check the trend of the direction of this acculturation. The study involved 213 immigrants and assessed food consumption, meal patterns, and dietary acculturation. A mean Western acculturation score of 70.1 ± 8.9. was identified and 71.4% had a high Western acculturation score. No one had low or very high Western acculturation. Participants who have a higher level of acculturation tend to have higher energy and fat intake. The likelihood of mixing meals, including, and combining, Chinese and Portuguese meals and foods is associated with time spent in Portugal. Efforts should be made to encourage Chinese immigrants to make a positive dietary transition during their acculturation process.

Comparison of cardiovascular disease risk factors among FiLWHEL (2014-2016), NNS (2013) and KNHANES (2013-2015) women

OBJECTIVES

This study assessed the CVD risk factors among Filipino women (FW) in Korea and compared them with FW in the Philippines and women in Korea (KW).

METHODS

A cohort of 504 women from the Filipino Women's Health and Diet Study (FiLWHEL) aged 20-57 years old were age-matched (1:1 ratio) with women from the 2013 National Nutrition Survey in the Philippines and the 2013-2015 Korean National Health and Nutrition Examination Survey. Anthropometric data, blood pressure (BP), lipid and glucose levels were compared across the four populations by calculating the odds ratio (OR)s and 95% confidence interval (CI)s using conditional logistic regression models.

RESULTS

Compared to KW, FW in Korea and FW in the Philippines were more than 2 and 3 times higher odds of having obesity for BMI ≥ 30 kg/m² and waist circumference ≥ 88 cm, respectively. However, FW in Korea had the highest odds (OR 5.51, 95% CI 3.18-9.56) of having hypertension compared to KW. FW in the Philippines had the highest odds of having dyslipidemia (compared to KW, total cholesterol ≥ 200 mg/dL: OR 8.83, 95% CI 5.30-14.71; LDL-C ≥ 130 mg/dL: OR 3.25, 95% CI 2.13-4.98; and triglyceride ≥ 150 mg/dL: OR 2.59, 95% CI 1.59-4.22), but FW in Korea and KW had similar prevalence of dyslipidemia.

CONCLUSIONS

FW in Korea had higher prevalence of obesity and hypertension, with similar prevalence of dyslipidemia compared to KW in this sample. FW in the Philippines had higher prevalence of dyslipidemia compared to FW in Korea. Further prospective studies are warranted to examine the CVD risk factors among continental and native-born Filipino women.

Identification and Management of Atherosclerotic Cardiovascular Disease Risk in South Asian Populations in the U.S

South Asians (SAs, individuals with ancestry from Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka) are among the fastest growing ethnic subgroups in the United States. SAs typically experience a high prevalence of diabetes, abdominal obesity, and hypertension, among other cardiovascular disease risk factors, which are often under recognized and undermanaged. The excess coronary heart disease risk in this growing population must be critically assessed and managed with culturally appropriate preventive services. Accordingly, this scientific document prepared by a multidisciplinary group of clinicians and investigators in cardiology, internal medicine, pharmacy, and SA-centric researchers describes key characteristics of traditional and nontraditional cardiovascular disease risk factors, compares and contrasts available risk assessment tools, discusses the role of blood-based biomarkers and coronary artery calcium to enhance risk assessment and prevention strategies, and provides evidenced-based approaches and interventions that may reduce coronary heart disease disparities in this higher-risk population.

Obesity among Asian American people in the United States: A review

Standard measures of obesity, i.e., body weight and BMI, suggest that Asian American people have a lower obesity prevalence than other racial groups in the United States. However, Asian American people face a unique challenge in their pattern of adiposity with central obesity, which raises the risk for multiple comorbidities, such as type 2 diabetes, metabolic syndrome, and cardiovascular disease, at a lower BMI compared with other populations. Several organizations recommend lower BMI cutoffs for obesity in Asian people (BMI ≥25.0 or ≥27.5 kg/m² ) instead of the standard ≥30.0 kg/m² threshold. The risks of obesity and related comorbidities in this population are further influenced by diet, physical activity, perceptions of health, and access to information and therapies. Asian-specific parameters for assessing obesity should become a standard part of clinical practice. Asian American people should equally be offered subgroup-specific tailored interventions owing to heterogeneity of this population. Access to medications and surgery should be improved, in part by updating US indications for therapies to reflect race-specific obesity thresholds and through inclusion of Asian American people of all subtypes with lower BMI values in clinical trials.

Determinants of minimum dietary diversity of lactating mothers in rural northern region of Bangladesh: A community-based cross-sectional study

Background

Breastfeeding requires additional diversified foods for the nutritional requirements of mothers and children, especially in preventing micronutrient deficiencies. The minimum dietary diversity for women (MDD-W) is a proxy indicator of micronutrient adequacy for women.

Objectives

This study aimed to identify the determinants associated with MDD in lactating women.

Methods

A community-based cross-sectional study was conducted among lactating mothers having at least one live birth in last three years from two districts of Bangladesh between 31st May 2021 and 9th June 2021. Dietary and socio-demographic information was obtained using a single 24-h recall and socio-economic status questionnaires. MDD was defined as at least four food groups consumed in the last 24 hours. In binary logistic regression, adjusted models were used to assess the relationship between MDD and socio-economic factors.

Results

The mean Dietary Diversity Score (DDS) was 3.9 ± 1.2. The MDD was met by 29.7% of women. Respondent's ages 20-24 years [Adjusted Odds Ratio (AOR) = 0.5; 95% CI: 0.3-0.9], 25-34 years [AOR = 0.5; 95% CI: 0.3-0.8], and 35-49 years [AOR = 0.5; 95% CI: 0.2-0.9], husband's academic qualifications more than 12 years [AOR = 1.9; 95% CI: 1.0-3.7], family income more than 15000 BDT per month [AOR = 2.3; 95% CI: 1.2-4.3], and husband's profession as a day labor [AOR = 0.5; 95% CI: 0.3-0.7] were significant factors to have MDD.

Conclusions

DDS and MDD were very poor among the mothers, whereas women's age, husband's education, and the family's monthly income were independent determinants of MDD. Special interventions may be needed to improve MDD.

How and Why Diets Change Post-Migration: A Qualitative Exploration of Dietary Acculturation among Recent Chinese Immigrants in Australia

Chinese immigrants living in Western countries are at increased risk for cardiometabolic diseases. Dietary acculturation has been implicated as a potential contributor, but little is known about why diets change post-migration. The purpose of this qualitative research study was to explore how and why diets change post-migration for Chinese immigrants living in Australia. Eleven participants undertook semi-structured interviews exploring and comparing their diets when they lived in China to their post-migration diets. Thematic analysis revealed that participants exhibited changed social structures of meal preparation, and made unacknowledged dietary changes, such as recipe modification, to maintain their traditional Chinese diet post-migration. Implications of both deliberate and unrecognized dietary changes post-migration include connections to increased risk for metabolic disease post-migration.

Influence of Sweeteners (Sucrose, Sucralose, and Stevia) on Bioactive Compounds in a Model System Study for Citrus–Maqui Beverages

Recently, new formulations of beverages with low sugar and high bioactive compound contents are being demanded because of their association with metabolic health. However, the sweeteners’ influences on the bioactive compounds remain underexplored. In this sense, this work aims to evaluate the interactions between different bioactive compounds such as flavonoids, vitamin C, and sweeteners (sucrose, stevia, and sucralose) in a functional citrus–maqui beverage. For this purpose, the phytochemical behavior was studied, in model system solutions, during one-month storage at 4 °C. The results obtained corroborated previous descriptions of the interactions between these compounds. However, when studying the bioactives in the model solutions, the loss of flavanones in the citrus solution increased up to 29%, while anthocyanin losses decreased to 27%. The vitamin C losses ranged from 100% (beverage) to 46% (ascorbic acid solution). Regardless, an influence of the sweeteners was observed. Sucrose reduced the anthocyanin and flavanone losses in both model solutions and the beverage, while sucralose increased flavanone loss. Finally, all sweeteners increased vitamin C degradation (up to 75%) when compared to the model solution. In conclusion, sweeteners added to beverages should be taken into account, depending on the bioactive compounds that should be preserved during storage.

The Burden of Cancer, Government Strategic Policies, and Challenges in Pakistan: A Comprehensive Review

Cancer is a severe condition characterized by uncontrolled cell division and increasing reported mortality and diagnostic cases. In 2040, an estimated 28.4 million cancer cases are expected to happen globally. In 2020, an estimated 19.3 million new cancer cases (18.1 million excluding non-melanoma skin cancer) had been diagnosed worldwide, with around 10.0 million cancer deaths. Breast cancer cases have increased by 2.26 million, lung cancer by 2.21 million, stomach by 1.089 million, liver by 0.96 million, and colon cancer by 1.93 million. Cancer is becoming more prevalent in Pakistan, with 19 million new cancer cases recorded in 2020. Food adulteration, gutkha, paan, and nutritional deficiencies are major cancer risk factors that interplay with cancer pathogenesis in this country. Government policies and legislation, cancer treatment challenges, and prevention must be revised seriously. This review presents the current cancer epidemiology in Pakistan to better understand cancer basis. It summarizes current cancer risk factors, causes, and the strategies and policies of the country against cancer.

Knowledge, Attitudes and Practices of Indian Immigrants in Australia towards Oral Cancer and Their Perceived Role of General Practitioners: A Cross-Sectional Study

Oral cancer is highly prevalent in the Indian subcontinent. With the increasing immigration of Indians to Australia, a potential rise in oral cancer cases can be expected if they continue engaging in oral cancer risk practices. Unfortunately, little is known on this topic in the Australian context. This study aimed to generate new insights into this area by examining Indian immigrants’ knowledge, attitudes and practices regarding oral cancer in Australia and their perceived role of general practitioners in raising oral cancer awareness. Exploring these aspects could determine the oral cancer risk behaviours of Indians in Australia along with any contributing factors which could help identify potential preventative strategies. A cross-sectional survey was undertaken of 164 Indians across Australia. Data were analysed using SPSS software with descriptive statistics. Respondents had varying levels of knowledge about oral cancer (mean total score 61%), particularly around risk factors such as alcohol and areca nut use as well as oral cancer-related signs/symptoms. The majority (87.7%) had not received any information about oral cancer in a health care setting but were receptive (71–90%) to general practitioners playing a more active role in this area. Respondents were engaging in positive preventative oral health care though few were currently (6.7%) or previously (14.7%) chewing tobacco preparations. Further research is needed through larger studies to confirm the study findings and inform the development of culturally tailored strategies particularly involving general practitioners, to raise oral cancer awareness and provide early screening for Indian immigrants.

Integrative oncology: Addressing the global challenges of cancer prevention and treatment

The increase in cancer incidence and mortality is challenging current cancer care delivery globally, disproportionally affecting low- and middle-income countries (LMICs) when it comes to receiving evidence-based cancer prevention, treatment, and palliative and survivorship care. Patients in LMICs often rely on traditional, complementary, and integrative medicine (TCIM) that is more familiar, less costly, and widely available. However, spheres of influence and tensions between conventional medicine and TCIM can further disrupt efforts in evidence-based cancer care. Integrative oncology provides a framework to research and integrate safe, effective TCIM alongside conventional cancer treatment and can help bridge health care gaps in delivering evidence-informed, patient-centered care. This growing field uses lifestyle modifications, mind and body therapies (eg, acupuncture, massage, meditation, and yoga), and natural products to improve symptom management and quality of life among patients with cancer. On the basis of this review of the global challenges of cancer control and the current status of integrative oncology, the authors recommend: 1) educating and integrating TCIM providers into the cancer control workforce to promote risk reduction and culturally salient healthy life styles; 2) developing and testing TCIM interventions to address cancer symptoms or treatment-related adverse effects (eg, pain, insomnia, fatigue); and 3) disseminating and implementing evidence-based TCIM interventions as part of comprehensive palliative and survivorship care so patients from all cultures can live with or beyond cancer with respect, dignity, and vitality. With conventional medicine and TCIM united under a cohesive framework, integrative oncology may provide citizens of the world with access to safe, effective, evidence-informed, and culturally sensitive cancer care.

Prevalence of Overweight and Obesity in Children of Immigrant Origin in Spain: A Cross-Sectional Study

Social determinants of health are a major contributing factor to health inequalities and have important effects on the health of the population. The aim of the study was to estimate the prevalence of overweight/obesity in native and immigrant children aged 2-14 years residing in Spain, and to explore its relationship with socioeconomic factors, habits, and living and health conditions. This study used data from the 2017 Spanish National Health Survey, which collects health information on the population residing in Spain. Multivariate logistic regression models were fitted to estimate the risk of overweight/obesity controlling for the variables of interest. The final sample consisted of 2351 households. Children of immigrant origin had a significantly higher overall prevalence of overweight and/or obesity than natives, both in boys (40.5% vs. 29.5%) and girls (44.8% vs. 30.3%), and a higher adjusted risk of overweight/obesity (OR = 1.67). In addition, it has been observed that children of immigrant origin were at higher risk of consuming sugary soft drinks, exercising less, and using screens more. In conclusion, the increased risk of having different habits that may contribute to developing excess weight and of having overweight/obesity in children with a migrant background should guide public health policies and interventions, emphasizing those groups at higher risk and incorporating considerations of socioeconomic inequalities.

First call, home: perception and practice around health among South Asian migrants in Melbourne, Australia

The socio-cultural context of populations has a significant effect on health outcomes across every stage of life. In Australia, South Asian migrants have a comparatively higher incidence of chronic disease and less use of health services. Often overlooked are community views of health, cultural traits and belief systems. This study aimed to explore the factors that influence health perception and practice of South Asian migrants. The study used a mixed method approach with both a survey and interviews. A total of 62 participants between the age of 18 and 64 years were surveyed and 14 participants completed interviews. Data were analysed descriptively and thematically. South Asians share a common perception and practice around health and illness. This paper highlights two key findings. First, these groups take a broad view of health encompassing physical, mental, emotional, social and economic aspects of life. Second, these cultural groups do not seek medical help as their first choice, but have a high level of trust in family for providing health advice and share a belief in the effectiveness of home remedies for managing health conditions. Participants shared their expectation that the Australian health system should consider their socio-cultural construct to make services culturally safe and engaging to enhance service utilisation.

Strategies and interventions for healthy adolescent growth, nutrition, and development

Adolescence is a pivotal point in the life course, characterised by transformative physical, cognitive, and emotional growth, an openness to change, and a drive to reshape the social environment. It offers unique opportunities to adopt changes in diet and physical activity that can persist into later life. Yet pre-existing nutritional problems, including micronutrient deficiencies, food insecurity, and poor-quality diets, persist at the same time as adolescents face the rapid emergence of an obesity epidemic. Adolescent growth and nutrition has been largely overlooked in intervention and policy research. Most intervention studies have emphasised micronutrient supplementation, with few taking into account the multiple drivers of adolescent diets. This Series paper highlights that effective interventions and policies will need to cut across sectors; be supported by multifaceted and multilevel policy; and extend across education, health, food systems, social protection, and digital media. Better data standardisation and systems will be essential in coordinating and monitoring these responses. In a context of shifts in planetary ecosystems and commercial drivers, resilient food systems will need to both ensure access to healthy and affordable foods and provide the infrastructure and incentives for continuing physical activity. Intergenerational partnerships with young people will be essential in bringing about transformative change and ensuring that food policies reflect their needs and aspirations.

Food environment interactions after migration: a scoping review on low- and middle-income country immigrants in high-income countries

OBJECTIVE

To map and characterise the interactions between the food environment and immigrant populations from low- and middle-income countries living in high-income countries.

DESIGN

A scoping review was carried out following the framework outlined by Arksey and O’Malley, as well as Levac et al. Peer-reviewed studies in English published between 2007 and 2021 were included. Two reviewers screened and selected the papers according to predefined inclusion criteria and reporting of results follows the PRISMA-ScR guidelines. A ‘Best fit’ framework synthesis was carried out using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework.

SETTING

High-income countries.

PARTICIPANTS

Immigrants from low- and middle-income countries.

RESULTS

A total of sixty-eight articles were included, primarily based in the USA, as well as Canada, Australia and Europe, with immigrants originating from five regions of the globe. The analysis identified three overarching themes that interconnected different aspects of the food environment in addition to the four themes of the ANGELO framework. They demonstrate that in valuing fresh, healthy and traditional foods, immigrants were compelled to surpass barriers in order to acquire these, though children’s demands, low incomes, time scarcity and mobility influenced the healthiness of the foods acquired.

CONCLUSION

This study brought together evidence on interactions between immigrant populations and the food environment. Immigrants attempted to access fresh, traditional, healthier food, though they faced structural and family-level barriers that impacted the healthiness of the food they acquired. Understanding the food environment and interactions therein is key to proposing interventions and policies that can potentially impact the most vulnerable.

Cigarette and alcohol consumption among Colombian migrants and Chileans living in Northern and Central Chile

INTRODUCTION

In Chile, the migrant population generally reports lower rates of cigarette and alcohol consumption. However, the migratory process and assimilation of behaviors after extended exposure to the host country could increase the consumption of these substances. The aim of this study was to compare cigarette and alcohol consumption among Colombian migrants and Chileans residing in Chile.

METHODS

In 2019, data were collected from 963 Colombian migrants and 909 Chileans in three cities in Chile. The chi-squared test was used to analyze significant differences in cigarette and alcohol consumption between the groups. Subsequently, the relative risk (RR) and corresponding p-values were obtained.

RESULTS

Colombian migrants had a significantly lower consumption of cigarettes than Chileans (16.6% and 25.1%, respectively). Regarding alcohol consumption, Colombian migrants reported lower consumption than Chileans (43.3% and 48.4 %, respectively ).

CONCLUSIONS

The lower consumption of cigarettes and alcohol by Colombian migrants compared to Chileans is positive for the health of migrants. However, it is advisable to promote health interventions to avoid an increase in the consumption of these substances, especially considering that migrants could assimilate the consumption habits of Chileans.

The Incidence and Determinants of Metabolic Syndrome Amongst a Group of Migrants to Qatar: A Prospective Longitudinal Observational Cohort Study 24-Months Post-Migration

While there is some evidence that migration to Western countries increases metabolic syndrome (MetS) risk, there is a lack of data pertaining to migration to the Middle East. This study aimed to investigate the relationship between migration and MetS incidence following 24-months of residency in Qatar and identify possible MetS determinants. Migrants to Qatar employed at Hamad Medical Corporation (the national health service) aged 18–65 years were invited to participate. Baseline and follow-up screening for MetS included HbA1c, triglycerides, HDL-cholesterol, blood pressure, and waist circumference. MetS-free migrants were rescreened 24-months post-migration, and the World Health Organization STEPwise questionnaire was administered, assessing changes in lifestyle from baseline. Of 1095 migrants contacted, 472 consented to participate, 205 of whom had normal metabolic parameters at baseline; 160 completed follow-up screening. Most participants were males (74.6%, n = 153) and Asian (81.0%, n = 166/205), and two thirds (66.3%, n = 136/205) were nurses. The incidence of new-onset MetS was 17.0% (n = 27/160, 95%CI; 11.0–23.0%), with 81.0% (n = 129/160, 95%CI; 73.8–86.0%) having at least one MetS element 24-months post-residency in Qatar. Male gender was a risk factor for MetS (adjusted odds ratio (AOR) = 3, p = 0.116), as was consuming medication that could induce MetS (AOR = 6.3, p < 0.001). There is merit in further research targeting these groups.

The Relationship between Macronutrient Distribution and Type 2 Diabetes in Asian Indians

Asian Indians (AIs) are at increased risk for type 2 diabetes mellitus than other ethnic groups. AIs also have lower body mass index (BMI) values than other populations, so can benefit from strategies other than weight reduction. Macronutrient distributions are associated with improved glycemic control; however, no specific distribution is generally recommended. This study looks at whether a macronutrient distribution of 50:30:20 (percent of total calories from carbohydrates, fats, and protein) is related to diabetes status in AIs. Diet and Hemoglobin A1c (HbA1c) were assessed from convenience sample of AI adults in Maryland. A ratio of actual to needed calories using the 50:30:20 macronutrient distribution was then tested against diabetes status to identify associations. All groups except non-diabetic females, were in negative energy balance. The non-diabetic group consumed larger actual to needed ratios of protein than pre-diabetics and diabetics. However, all groups consumed protein at the lower end of the Acceptable Macronutrient Distribution Range (AMDR), and the quality of all macronutrients consumed was low. Therefore, weight loss may not be the recommendation for diabetes management for AIs. Increasing protein and insoluble fiber consumption, could play a critical role.

[Global food quality in the migrant population residing in Chile]

Introduction

Introduction: the migration process involves change, modification, or acquisition of new eating patterns and ways of eating, which do not always positively impact the health of migrants, being frequently associated with a higher risk of metabolic diseases and excess malnutrition when the quality of food is not adequate. Objective: to analyze the global food quality index (GQI) in the Colombian migrant population in Chile, comparing it with the Chilean population and non-migrant Colombians. Methods: the total sample consisted of 834 individuals over 18 years of age - 206 Colombian migrants residing in Chile, 266 Colombians residing in Colombia, and 362 Chileans. A global food quality index survey was applied to categorize the healthiness of the participants' dietary patterns. Results: there were significant differences in all the ICGA scores analyzed regarding healthy foods, unhealthy foods, and mealtimes. It was observed that Colombians residing in Colombia have the highest score in the healthy classification, while Colombian migrants have the highest figures in the unhealthy condition. Regarding meal times, Chileans are the least compliant with meal times. However, other influences related to food groups stand out. Conclusion: it is necessary to delve deeper into variables linked to the sociodemographic context, analyze potential changes over time, and replicate in migrants of other nationalities to have more information on the relationship between food quality and the migration process.

Eritrean Refugees' and Asylum-Seekers' Attitude towards and Access to Oral Healthcare in Heidelberg, Germany: A Qualitative Study

Oral health concerns in Eritrean refugees have been an overlooked subject. This qualitative study explored the access of Eritrean refugees and asylum-seekers (ERNRAS) to oral health care services in Heidelberg, Germany, as well as their perceptions and attitudes towards oral health care. It involved 25 participants. We employed online semi-structured interviews (n = 15) and focus group discussions (n = 2). The data was recorded, transcribed, and analysed, using thematic analysis. The study found out that most of the participants have a relatively realistic perception and understanding of oral health. However, they have poor dental care practices, whilst a few have certain misconceptions of the conventional oral hygiene tools. Along with the majority's concerns regarding psychosocial attributes of poor oral health, some participants are routinely consuming Berbere (a traditional spice-blended pepper) to prevent bad breath. Structural or supply-side barriers to oral healthcare services included: communication hurdles; difficulty in identifying and navigating the German health system; gaps in transculturally, professionally, and communicationally competent oral health professionals; cost of dental treatment; entitlement issues (asylum-seekers); and appointment mechanisms. Individual or demand-side barriers comprised: lack of self-sufficiency; issue related to dental care beliefs, trust, and expectation from dentists; negligence and lack of adherence to dental treatment follow-up; and fear or apprehension of dental treatment. To address the oral health burdens of ERNRAS, it is advised to consider oral health education, language-specific, inclusive, and culturally and professionally appropriate healthcare services.

Socio-cultural beliefs about an ideal body size and implications for risk of excess weight gain after immigration: a study of Australian residents of sub-Saharan African ancestry

Objectives: Though several studies have focused on risk factors associated with excess weight gain, little is known about the extent to which socio-cultural beliefs about body sizes may contribute to risk of excess weight gain, especially in non-Western migrant communities. Drawing on socio-cultural and attribution theories, this study mainly explored socio-cultural beliefs about an ideal body size among Australian residents who were born in sub-Saharan Africa (SSA).  Implications of body size beliefs for risk of excess weight gain after immigration have also been discussed.Design: Employing a qualitative design, 24 in-depth interviews were conducted with Australian residents who were born in SSA. Thematic content analysis was undertaken to ensure that participants' experiences and views were clearly captured.Results: According to the participants, a moderately large body size is idealised in the SSA community and post-migration weight gain is commonly regarded as evidence of well-being. While desirability of a moderately large body size was noted by some participants, others were concerned about health risks (e.g. high blood pressure) associated with excess weight gain. Moreover, body size ideals seemed to be different for men and women in the SSA community and these ideals were mainly promoted by family and friends. Participants reported that women with very slim (skinny) body sizes are often regarded as persons suffering from health problems, whereas those with 'plumpy' body types are often considered beautiful. Participants also noted that men are expected to look well-built and muscular while those with big bellies are often seen as financially rich.Conclusions: Participants' interpretation of post-migration weight gain as evidence of well-being calls for urgent intervention as risk of excess weight gain appear to be high in this immigrant group.

Energy Metabolism in Relation to Diet and Physical Activity: A South Asian Perspective

The prevalence of overweight and obesity is on the rise around the world, not only in the West, but also in Asian countries. South Asian countries in particular are experiencing a rapid increase in overweight and obesity, that coexists with the rapid increase in non-communicable diseases linked to obesity such as diabetes and cardiovascular disease than any other country in Asia. The phenomena observed in South Asian countries are due to the size of the population, the ageing of the population, the high degree of urbanization and the lifestyle changes in favor of increased energy consumption and reduced physical activity. The imbalance between energy consumption and energy expenditure results in the development of a positive energy balance that, over time, accumulates in higher body fat. South Asians were reported to have a more unfavorable body composition with a higher percentage of body fat than Caucasians with an equivalent BMI. Body composition is a major determinant of resting energy expenditure. It has been reported that South Asians have a lower resting energy expenditure than Caucasians with the same BMI. Resting energy expenditure accounts for the majority of total daily energy expenditure and, therefore, plays a crucial role in achieving the balance between energy intake and expenditure.

Using an IT-Based Algorithm for Health Promotion in Temporary Settlements to Improve Migrant and Refugee Health

The application of the electronic algorithm developed by the Mig-Healthcare project was pilot tested in a sample of migrants and refugees in 2 Reception and Identification Centres (RICs), temporary settlements, in Greece using portable devices. The questions relate to health literacy issues, to mental health, to vaccination history, to lifestyle habits such as smoking, alcohol intake, diet, to the presence of diseases such as heart disease or diabetes, to the use of prevention services and to dental care. A total of 82 adults, 50 women and 32 men, participated. Data analysis showed that 67.1% (55) of the respondents had difficulty in understanding medical information and 57.3% (47) did not know where to seek medical help for a specific health problem. Four main areas of health problems were identified and further action is required: (A) mental health concerns, (B) vaccinations, (C) obesity, and (D) dental hygiene. Direct linkage with the "Roadmap and Toolbox" section of the project's website gave the respondents access to many sources and tools, while through the use of the interactive map, specific referral points of healthcare delivery in their area were identified. IT-based intervention in migrant and refugee populations in Greece are effective in increasing health literacy levels and identifying areas for health promotion interventions in these groups. Through linkage with the project's database, access to healthcare provision points and action to seek appropriate healthcare when necessary are encouraged. Given the attenuated vulnerability profile of people living in temporary settlements, this algorithm can be easily used in primary care settings to improve migrant and refugee health.

Maternal body mass index and country of birth in relation to the adverse outcomes of large for gestational age and gestational diabetes mellitus in a retrospective cohort of Australian pregnant women

BACKGROUND

The prevalence of gestational diabetes mellitus in Australia has been rising in line with the increased incidence of maternal overweight and obesity. Women with gestational diabetes mellitus, high body mass index or both are at an elevated risk of birthing a large for gestational age infant. The aim was to explore the relationship between country of birth, maternal body mass index with large for gestational age, and gestational diabetes mellitus. In addition to provide additional information for clinicians when making a risk assessment for large for gestational age babies.

METHOD

A retrospective cohort study of 27,814 women residing in Australia but born in other countries, who gave birth to a singleton infant between 2008 and 2017 was undertaken. Logistic regression analysis was used to examine the association between the aforementioned variables.

RESULTS

A significantly higher proportion of large for gestational age infants was born to overweight and obese women compared to those who were classified as underweight and healthy weight. Asian-born women residing in Australia, with a body mass index of ≥40 kg/m2, had an adjusted odds ratio of 9.926 (3.859-25.535) for birthing a large for gestational age infant. Conversely, Australian-born women with a body mass index of ≥40 kg/m2 had an adjusted odds ratio of 2.661 (2.256-3.139) for the same outcome. Women born in Australia were at high risk of birthing a large for gestational age infant in the presence of insulin-requiring gestational diabetes mellitus, but this risk was not significant for those with the diet-controlled type. Asian-born women did not present an elevated risk of birthing a large for gestational age infant, in either the diet controlled, or insulin requiring gestational diabetes mellitus groups.

CONCLUSIONS

Women who are overweight or obese, and considering a pregnancy, are encouraged to seek culturally appropriate nutrition and weight management advice during the periconception period to reduce their risk of adverse outcomes.

[Food and migration: a descriptive-comparative analysis of food behavior between Chileans and Colombians residing in the north and center of Chile]

Introduction

Introduction: migration has been associated with the development of chronic noncommunicable diseases such as obesity, diabetes, hypertension, and cardiovascular disorders. Similarly, the food transition during migration has been related to a high consumption of foods high in refined sugars and saturated fats. There are specific characteristics of the eating behavior that may influence quality in the migrant population's diet. Objective: to compare feeding behavior between the Colombian and Chilean populations residing in the north and center of Chile. Method: the structured interview E-TONA, focused on assessing the behavioral components of daily and anomalous eating habits, was administered to 1,872 individuals, both Chileans and Colombians. Descriptive analyses of frequency distribution and logistic regressions were performed, and odds ratios were calculated. Results: there are significant differences in the majority of eating behaviors, both daily and anomalous, between Chileans and Colombian migrants. Chileans tend to follow more regular schedules and "snack" more between meals than migrants. Migrants have twice the risk of eating alone because they feel ashamed of their eating amount and speed, tend to show fewer behaviors related to better quality in their diet, and tend to be less worried about their diet than Chileans; however, Chileans are almost twice as likely to binge on food and use food as a method to calm anxiety. Conclusion: there are significant differences in most of the evaluated eating behaviors that must be addressed in depth considering cultural differences.

Gestational diabetes mellitus by maternal country of birth and length of residence in immigrant women in Norway

AIMS

Immigrant women are at higher risk for gestational diabetes mellitus (GDM) than non-immigrant women. This study described the prevalence of GDM in immigrant women by maternal country of birth and examined the associations between immigrants' length of residence in Norway and GDM.

METHODS

This Norwegian national population-based study included 192,892 pregnancies to immigrant and 1,116,954 pregnancies to non-immigrant women giving birth during the period 1990-2013. Associations were reported as odds ratios (ORs) with 95% confidence intervals (CIs) using logistic regression models, adjusted for year of delivery, maternal age, marital status, health region, parity, education and income.

RESULTS

The prevalence and adjusted OR [CI] for GDM were substantially higher in immigrant women from Bangladesh (7.4%, OR 8.38 [5.41, 12.97]), Sri Lanka (6.3%, OR 7.60 [6.71, 8.60]), Pakistan (4.3%, OR 5.47 [4.90, 6.11]), India (4.4%, OR 5.18 [4.30, 6.24]) and Morocco (4.3%, OR 4.35 [3.63, 5.20]) compared to non-immigrants (prevalence 0.8%). Overall, GDM prevalence increased from 1.3% (OR 1.25 [1.14, 1.36]) to 3.3% (OR 2.55 [2.39, 2.71]) after 9 years of residence in immigrants compared to non-immigrant women. This association was particularly strong for women from South Asia.

CONCLUSIONS

Gestational diabetes mellitus prevalence varied substantially between countries of maternal birth and was particularly high in immigrants from Asian countries. GDM appeared to increase with longer length of residence in certain immigrant groups.