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Acculturation and Associations with Ultra-processed Food Consumption among Asian Americans: NHANES, 2011-2018.

  • Pachipala, Krithi1
  • Shankar, Vishal1
  • Rezler, Zachary1
  • Vittal, Ranjana1
  • Ali, Shahmir H2
  • Srinivasan, Malathi S1
  • Palaniappan, Latha1
  • Yang, Eugene1, 3
  • Juul, Filippa4
  • Elfassy, Tali1, 5
  • 1 Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, CA, USA.
  • 2 Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA.
  • 3 Department of Medicine, Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA.
  • 4 Department of Public Health Policy and Management, New York University School of Global Public Health, New York, NY, USA.
  • 5 Department of Medicine, Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL, USA.
Published Article
Journal of Nutrition
Oxford University Press
Publication Date
Jul 06, 2022
DOI: 10.1093/jn/nxac082
PMID: 35389482


Ultra-processed food (UPF) consumption is linked to adverse health outcomes, including cardiovascular disease and all-cause mortality. Asian Americans (AAs) are the fastest growing ethnic group in the United States, yet their dietary patterns have seldom been described. The aim was to characterize UPF consumption among AAs and determine whether acculturation is associated with increased UPF consumption. The NHANES is an annual, cross-sectional survey representative of the US population. We examined 2011-2018 NHANES data, which included 2404 AAs ≥18 y old with valid 24-h dietary recall. Using day 1 dietary recall data, we characterized UPF consumption as the percentage of caloric intake from UPFs, using the NOVA classification system. Acculturation was characterized by nativity status, nativity status and years in the United States combined, home language, and an acculturation index. We assessed the association between acculturation and UPF consumption using linear regression analyses adjusted for age, sex, marital status, education, income, self-reported health, and self-reported diet quality. UPFs provided, on average, 39.3% (95% CI: 38.1%, 40.5%) of total energy intake among AAs. In adjusted regression analyses, UPF consumption was 14% (95% CI: 9.5%, 17.5%; P < 0.05) greater among those with the highest compared with the lowest acculturation index score, 12% (95% CI: 8.5%, 14.7%: P < 0.05) greater among those who speak English only compared with non-English only in the home, 12% (95% CI: 8.6%, 14.7%: P < 0.05) greater among US-born compared with foreign-born AAs, and 15% (95% CI: 10.7%, 18.3%: P < 0.05) greater among US-born compared with foreign-born AAs with <10 y in the United States. UPF consumption was common among AAs, and acculturation was strongly associated with greater proportional UPF intake. As the US-born AA population continues to grow, UPF consumption in this group is likely to increase. Further research on disaggregated AA subgroups is warranted to inform culturally tailored dietary interventions. © The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.

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