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Title: Acculturation and sociocultural influences on dietary intake and health status among Puerto Rican adults in Massachusetts

item VAN ROMPAY, MARIA I. - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item MCKEOWN, NICOLA M. - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item CASTENEDA-SCEPPA, CARMEN - Northeastern University
item FALCON, LUIS M. - Northeastern University
item ORDOVAS, JOSE M. - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item TUCKER, KATHERINE L. - Northeastern University

Submitted to: Journal of the Academy of Nutrition and Dietetics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/26/2011
Publication Date: 1/1/2012
Citation: Van Rompay, M., Mckeown, N., Casteneda-Sceppa, C., Falcon, L., Ordovas, J., Tucker, K. 2012. Acculturation and sociocultural influences on dietary intake and health status among Puerto Rican adults in Massachusetts. Journal of the Academy of Nutrition and Dietetics. 112(1):64-74.

Interpretive Summary: Immigrants to the US vary in the extent to which they retain aspects of their original culture vs. the extent to which they adopt US cultural practices, in a phenomenon referred to as “acculturation”. The degree of acculturation may have implications for the quality of the diet and its impact on overall health, but these relationships are not well understood in Puerto Ricans living in the US. In the current study, we investigated relationships between acculturation, lifestyle, health status and consumption of carbohydrates in a population of older Puerto Ricans living in the Boston, MA area. We determined that the degree of acculturation was low, even though the average length of time lived in the US was more than thirty years. Individuals who used the English language to a greater extent (e.g., higher language acculturation) were more likely to have a greater income, more likely to be physically active, less likely to carry extra weight around the abdomen, and more likely to believe that their health was better. Acculturation was also associated with lower consumption of legumes such as dried beans, which confer health benefits, but also with lower consumption of refined carbohydrates such as white bread, which are considered less healthy than whole grain breads and cereals. The quality of carbohydrates may be particularly relevant in this group of people, in whom diabetes is common. In summary, the role of acculturation in the quality of the diet and overall lifestyle was mixed, including positive and negative associations with healthy diet and behaviors. These results contrast with those obtained in Mexican Americans, emphasizing the differences among sub-groups of Hispanic Americans, and the importance of studies dedicated to Puerto Ricans. Based on this study, recommendations to improve the diet in Boston Puerto Ricans would include maintenance of traditional healthy foods (such as beans) and greater intake of fruits and non-starchy vegetables.

Technical Abstract: Previous studies have shown negative consequences of acculturation on lifestyle factors, health status, and dietary intake of Hispanic immigrants in the US. Despite prevalent type 2 diabetes and low socioeconomic status (SES) among Puerto Rican adults living on the US mainland, little is known about acculturation in this group. We investigated associations among acculturation, lifestyle characteristics, health status, and carbohydrate nutrition in Puerto Rican adults. A secondary objective was to investigate possible confounding and/or effect modification on these associations by SES. Cross-sectional data from the Boston Puerto Rican Health Study, which included 1219 Puerto Ricans in the Boston area, aged 45-75 years. Characteristics were compared using ANCOVA, linear trend and Pearson's chi-square tests across quartiles of acculturation. Tests for interaction by poverty status were conducted. Proportional contributions of foods to intake of total carbohydrate and fiber were assessed using SAS RANK. Levels of acculturation were low, despite young age at first arrival to the US mainland (25.4 +/- 12.3 y) and long length of stay (34.2 +/- 12.2 y). Greater English language use was associated with higher SES, alcohol consumption, physical activity, better perceived health, and less central obesity. Acculturation was associated with lower legume fiber and greater cereal fiber intake. Among those above the poverty threshold, acculturation was associated with lower dietary glycemic index and starch intake, and greater fruit and non-starchy vegetable intake. In contrast to studies with Mexican Americans, the association of acculturation with dietary quality in these Puerto Rican adults was mixed, but tended toward better carbohydrate quality. Dietary recommendations should include maintenance of traditional, healthful dietary practices including consumption of legumes, but also reduction in refined grains, and greater inclusion of fruit, non-starchy vegetables, and whole grains. Interventions to improve access to better quality carbohydrate sources are necessary for this group disproportionately affected by diabetes.