Relationships among acculturation using 2 different language variables, diet quality, and accuracy of diet quality assessment in non-Hispanic Asians residing in the United States

Authors: Thomson, Jessica; LANDRY, ALICIA - University Of Central Arkansas; Walls, Tameka

Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/21/2023
Publication Date: 5/3/2023
Citation: Thomson, J.L., Landry, A.S., Walls, T.I. 2023. Relationships among acculturation using 2 different language variables, diet quality, and accuracy of diet quality assessment in non-Hispanic Asians residing in the United States. Journal of Nutrition. 153(5):1577-1586. https://doi.org/10.1016/j.tjnut.2023.03.030.
DOI: https://doi.org/10.1016/j.tjnut.2023.03.030

Interpretive Summary: The Asian population is the fastest growing racial/ethnic group in the United States, and they tend to succeed when considering economic measures. However, immigration may adversely affect health as higher acculturation can increase risks for poor diet, obesity, and other chronic diseases. To mitigate the potential negative effects of acculturation on diets of Asian Americans, questions regarding use of language variables as proxy measures of acculturation and links to dietary intake and accuracy of diet quality assessment need to be addressed. Using data from the National Health and Nutrition Examination Survey (NHANES) 2015-2018, two proxy measures of acculturation based on language spoken in the household and language of dietary recalls were created for Asian American participants. Diet quality was assessed by applying the Healthy Eating Index (HEI) to dietary recalls for which higher scores indicate more healthful dietary intake. Accuracy of diet quality assessment was determined by matching HEI scores to perceived diet quality ratings. Statistical methods for complex survey designs were used for analysis. Diet quality differences were remarkably similar among acculturation levels using either household or dietary recall language. Higher scores in the low and/or moderate acculturation groups were observed for vegetables, fruit, whole grains, seafood and plant protein, fats, added sugars, and total diet quality as compared to the high acculturation group. However, lower refined grains scores were observed in the low as compared to high acculturation group. Likewise, variables explaining differences in diet quality were similar between the two acculturation measures. Inaccurate diet quality assessment and less education were associated with lower diet quality scores for all three acculturation groups, while low/very low household food security and non-awareness of dietary guidelines were associated with lower scores only for the high acculturation group. No relationship was apparent between acculturation and accuracy of diet quality assessment suggesting perception of diet quality is poor in Asian Americans regardless of acculturation level. Although acculturation classification differences existed between two proxy measures based on differing language variables, few diet quality and explanatory variable differences were observed. Hence, the use of either language variable may yield similar results regarding relationships between acculturation and diet in Asian Americans, although there may be theoretical or practical reasons why researchers may choose one language variable over another.

Technical Abstract: Background: Evidence suggests acculturation can increase risks of poor diet, obesity, and chronic diseases. Yet questions remain regarding acculturation proxy measures and associations with diet quality in Asian Americans. Objective: Primary objectives included estimating percentages of Asian Americans with low, moderate, and high acculturation using two proxy measures of acculturation based on different language variables and determining if diet quality differences existed among acculturation levels using the two proxy acculturation measures. Methods: Study sample included 1,275 Asian participants =16 years of age from National Health and Nutrition Examination Survey 2015-2018. Nativity/length of US residence, immigration age, language spoken at home (home), and language of dietary recall (recall) were used as proxy measures for two acculturation scales. Replicate 24-hour dietary recalls were conducted and diet quality was assessed using 2015 Healthy Eating Index (HEI-2015). Statistical methods for complex survey designs were used for analysis. Results: Using home and recall language, 26% vs 9% of participants were classified with low, 50% vs 63% with moderate, and 24% vs 28% with high acculturation. On the home language scale, participants with low and/or moderate acculturation had higher scores (0.5-5.5 points) for vegetables, fruits, whole grains, seafood and plant protein, saturated fats, added sugars, and total HEI-2015 than participants with high acculturation; participants with low acculturation had lower refined grains score (1.2 points) than participants with high acculturation. Results were similar for the recall language scale except differences between participants with moderate and high acculturation also were observed for fatty acids. Conclusions: Although percentages of Asian Americans classified with low, moderate, and high acculturation differed between two proxy measures for acculturation, diet quality differences among acculturation groups were remarkably similar between the two proxy measures. Hence, use of either language variable may yield comparable results regarding relationships between acculturation and diet in Asian Americans.