Acculturation and Sociocultural Influences on Dietary Intake and Health Status among Puerto Rican Adults in Massachusetts

BACKGROUND: Previous studies have shown the negative consequences of acculturation on lifestyle factors, health status, and dietary intake of Hispanic immigrants in the United States. Despite prevalent type 2 diabetes and low socioeconomic status among Puerto Rican adults living on the US mainland, little is known about acculturation in this group. OBJECTIVE: 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 socioeconomic status. DESIGN: Cross-sectional data from the Boston Puerto Rican Health Study, which included 1,219 Puerto Ricans in the Boston area, aged 45 to 75 years. STATISTICAL ANALYSES: Characteristics were compared using analysis of covariance, linear trend, and Pearson's χ² 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 (version 9.1.3, 2002-2003, SAS Institute, Cary, NC). RESULTS: Levels of acculturation were low, despite young age at first arrival to the US mainland (25.4±12.3 years) and long length of stay (34.2±12.2 years). Greater English language use was associated with higher socioeconomic status, 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 nonstarchy vegetable intake. CONCLUSIONS: 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, nonstarchy vegetables, and whole grains. Interventions to improve access to better quality carbohydrate sources are necessary for this group disproportionately affected by diabetes.