Acculturation is the adoption of cultural traits. Dietary acculturation is the process by which a migrating group adopts the dietary patterns and food choices of their new cultural environment. The migrated groups can be individuals who moved from one country to another (immigrants) or groups who moved within the same country from a rural area to an urban area (rural-urban migrants). Dietary acculturation is an important determinant of health in immigrant and rural-urban migrant populations.
Research results show that over several decades, beginning in the late twentieth century, changes in lifestyle behavior patterns (e.g., diet, smoking, alcohol consumption, and physical activity levels) influenced major shifts in the overall health status of populations in developed countries. These behavioral changes are attributed to increases in immigration from developing countries to industrialized countries and, at the same time, increasing rates of urbanization. In 1970, for example, only 36.6% of the world's population lived in urban areas, but by 1994 44.8% were in urban areas. Twenty years later in 2014, World Bank statistics showed that 54% of the population lived in the world's cities. Urban populations are predicted to increase by 2025 to 74% in developing countries and 77% in developed countries.
The movement to urban areas is linked with increases in consumption of energy-rich foods and decreases in the use of body energy associated with declines in physical activity. Rural areas experience these changes just as cities do, because increased use of mechanized agricultural equipment and improvements in rural transportation have also decreased physical activity. In addition, increased availability of processed foods has resulted in dietary changes among both rural and urban populations. However, until the twenty-first century, the process of dietary acculturation of immigrants and rural-urban migrants was not well understood. Evidence from studies was lacking, and no model was available to help understand the effects of dietary acculturation on food and nutrient intake among specific groups.
Increases in immigration to the United States, Canada, and European countries, among others, has called attention to dietary acculturation, emphasizing the importance of investigating the health status of racial and ethnic minorities living in developed countries. Experts say that research attention must increase now that models of dietary acculturation are available to healthcare professionals and policy makers. Acculturation scales have been designed to measure dietary acculturation and to help address related changes in health status, which can facilitate research efforts. Future studies will focus on the independent effects of acculturation on dietary behavior, including the influence of demographic characteristics such as age, country of origin, and family and socioeconomic factors such as education, language, and income.
Dietary acculturation is a complex, multifactorial phenomenon that varies widely because of the merging of so many different cultures and environmental influences in developed countries. When individuals and families from a particular ethnic group move to a new place and adopt the eating habits of the new cultural environment, various consequences arise that affect both the diet and the health of the group. Researchers suggest that a “health immigrant effect” exists that shows immigrants to be in substantially better health when they migrate than the native-born individuals in the host country. This is partly the result of immigration policies that require the good health status of those who wish to qualify for immigration. Yet, new trends during acculturation may include shifts to more sedentary activities, changes in lifestyle behavior such as smoking or alcohol consumption, high rates of dietary excess compared to the groups' native diets, increases in obesity, and increased risk for certain chronic diseases. Evidence has shown that the so-called Western diet, which is high in fat and low in fruits, vegetables, and fiber, is associated with increased risk of chronic diseases among immigrants. Researchers have termed this process “the nutrition transition.” As a result, the healthy immigrant effect declines gradually as the length of residence in the new country or new urban area increases, causing the immigrant populations' health risk to gradually surpass that of the native population.
Dietary acculturation occurs gradually as a result of socioeconomic, demographic, and cultural factors in the immigrants' or rural-urban migrants' host country. Individuals in the immigrant/migrant population may change long-held attitudes and beliefs about food and the purchasing and preparation of food. Even their tastes may change as they become acquainted with new foods and eating patterns. Dietary acculturation may occur more quickly among those with higher education, higher income status, and host-country language fluency. Television, radio, magazines, newspapers, and connections with native populations may also help to speed dietary acculturation by providing greater exposure to the attitudes, beliefs, and values of the host population. The new food supply is also an influence, as well as the lack of availability of foods from the migrants' traditional diets.
Dietary acculturation can be measured in a migrating group or in an immigrant population by collecting dietary recall data. In the United States, using 1999–2010 dietary recall data from thousands of participants in the ongoing National Health and Nutrition Examination Survey (NHANES), researchers developed a flexible indicator that can measure changes in immigrants' eating habits compared to those of individuals born in the United States. Called the “Food Similarity Index,” the index lets researchers compare immigrants' dietary patterns over generations and across groups, increasing the understanding of how dietary acculturation has shaped the overall health of specific immigrants and their risk factors for disease. For instance, one type of change may be moving from a geographic area with a high prevalence of poor sanitation, infectious diseases, and periodic famine to an urban industrial area with Westernized lifestyle and diet, resulting in a high prevalence of chronic disease. The adopted diet may play a significant role in increasing the risk of chronic disease.
Many factors are subject to change when individuals move from their native country to a new cultural environment and try to become accustomed and fit in. While not all sociocultural factors are directly related to diet and food intake, they may still influence diet and lifestyle choices. The sociocultural factors that have been found to influence dietary acculturation include:
The benefits to acculturation depend on the immigrants' country of origin. Those who come from drought-stricken areas or from areas with limited food supplies will benefit from the wide availability of fresh food. Immigrants from these areas may have been malnourished and will regain their health.
Studies have shown that adopting a Western diet high in fat and sugar and low in fruits, vegetables, and high fiber/wholegrain foods increases the risk for obesity and chronic disease, depending on the extent to which immigrants follow the traditional dietary patterns of their own culture. For instance, individuals in Peru who moved from rural areas to cities fell into a lower socioeconomic status that was shown to be directly associated with risk of overweight/obesity in migrants of all ages. Immigrants who live below the official poverty threshold often have suboptimal diets. In Peru, however, although acculturation was greater among rural/urban migrants and lower income resulted in changes in dietary patterns, the increase in obesity was not associated with changes in physical activity. In contrast, the age at which Jamaican immigrants migrated to the United States influenced whether migrants adhered to their traditional dietary pattern. Among the Jamaican immigrants, demographic and lifestyle characteristics, such as having less education and less physical activity, appeared to have greater influence on health status than diet.
Specific changes in dietary patterns vary extensively depending on differences between the traditional diet of the immigrant culture and the prevailing dietary habits of the host culture. The shift in dietary habits may be gradual in the process of acculturation. For example, in a 2014 study of dietary intake and habits of South Asian immigrants in Western countries, total energy intake tended to decrease as time spent in the host country increased. Overall, the immigrants had lower protein intake and lower mon-unsaturated fat intake than the diets of the Western host countries, but intake of carbohydrates, total fat, saturated fats, and micronutrients varied between individual immigrant families.
Dietary acculturation success stories are found among some migrating groups, including evidence of improvements in dietary patterns. For instance, in one study, about 60% of South Asian immigrants to Canada reported making healthier food choices at home and when dining out. Consumption of fruits and vegetables increased, whereas consumption of high fat and/or fried foods decreased. Stir-frying and baking or grilling foods increased, and many South Asians decreased the amount of frying altogether after moving to Canada; however, the immigrants reported consuming more convenience foods, soft drinks, desserts, and eating out more often than in their native Asia. The main health parameter measured in this group of immigrants was body mass index (BMI; a ratio of weight to height), which decreased as duration of residence increased. A lower BMI indicates loss of excess weight. The South Asian immigrants also reported higher nutrition awareness as a result of food labeling and media promotion of good nutrition, which they had not seen as often in their own country.
From a public health perspective, understanding the dietary patterns of immigrants is important in order to understand their health risks as well as the influence of those risks on trends of overall health in the host country. For rural-urban migrants, health risks include a more sedentary lifestyle, availability of convenience and junk foods, and greater exposure to unhealthy eating patterns.
Immigrants, regardless of how long they have spent transitioning to the culture of their host country, will have greater difficulty with acculturation if they have already been diagnosed with diabetes or another chronic disease. For example, South Asians who migrate to the United States have a high prevalence (from 17% to 29%) of type 2 diabetes and, when evaluated, a strong association was shown between dietary acculturation and diabetes risk factors, suggesting the importance of assessing diabetes risk factors in other immigrant or nonnative groups. Existing chronic illness may be an even greater challenge for immigrants whose populations have higher prevalence rates of type 2 diabetes or cardiovascular disease. Immigrants in the process of dietary acculturation may benefit from culture-specific nutrition education and support.
Education programs for immigrants are sometimes helpful in encouraging the adoption of healthy food choices in their new living situations. For instance, Mongolian immigrants in South Korea were found to have three possible dietary patterns: the traditional Mongolian diet among 26% of immigrants; a transitional diet among 43% of immigrants, and a Korean diet adopted by 31% of the Mongolian immigrants. Interestingly, the Korean diet was actually the most healthful because of the availability of more foods, whereas the traditional and transitional diets lacked essential nutrients and were associated with chronic disease. Researchers concluded that nutrition and dietary education was needed to instruct Mongolian immigrants on making healthy food choices in their new cultural environment. As research continues and more is learned about the influence of dietary acculturation on the health of both immigrant and native populations, public health approaches and nutrition education interventions are expected to increase.
See also Hispanic and Latino diet .
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L. Lee Culvert