Preventive Nutrition Issues in Ethnic & Socioeconomic Groups in the United States

Summary: A comparison of dietary patterns of various ethnic and socioeconomic (SES) groups shows that improvements are needed in the diets of all groups to better align them with current nutrition recommendations for promoting health and reducing disease. Dietary risks related to ethnicity and SES are mediated by a host of complex cultural and economic factors. These issues require careful consideration in efforts to improve the dietary quality of adults in the United States.

Reference: Kumanyika SK, Krebs-Smith SM. Preventive nutrition issues in ethnic and socioeconomic groups in the United States. In: Bendich A, Deckelbaum RJ, eds. Preventive Nutrition, Volume II: Primary and Secondary Prevention. Totowa NJ: Humana Press Inc. 2000.

As consensus has emerged about the specific aspects of dietary patterns that promote health and reduce disease risks, the social epidemiology of dietary risk factors has received increasing attention. This area of research focuses on issues such as the extent to which the diets of specific population groups adhere to dietary guidelines, the factors that influence dietary patterns and changes, and the particular populations or groups that are experiencing improving dietary patterns or patterns that increase risk of diet-related diseases. In the United States, ethnicity and socioeconomic status (SES) are associated with major health disparities.

Using data from the Third National Health and Nutrition Examination Survey (NHANES III), the Hispanic Health and Nutrition Examination Survey (HHANES), and the 1994-1996 Continuing Surveys of Food Intakes by Individuals (CSFII), the authors of this book chapter examined selected aspects of dietary intake patterns of non-Hispanic whites, non-Hispanic blacks, Mexican Americans, American Indians/Alaskan Natives, and Asian/Pacific Islanders. They used the USDA Healthy Eating Index (HEI) to convert the elements of these dietary patterns into a single scale so as to more easily compare the groups. The authors used the HEI to also compare dietary patterns of groups defined by two measures of SES -- income and education. The HEI index, which is composed of 10 components that focus on specific food groups (fruits, vegetables, grains, meat, dairy), nutrient intakes (fat, saturated fat, cholesterol, sodium), and dietary variety, provides a method for assessing the extent to which dietary intakes comply with the Dietary Guidelines for Americans.

According to the HEI criteria, the diets of all five ethnic groups needed improvement, though the groups differed among the various components in the index. For example, compared to whites and Mexican Americans, blacks tended to have fewer servings from the grain and milk groups and more from the meat group. This resulted in higher intakes of cholesterol and lower intakes of fiber, folate, and calcium. Mexican Americans tended to have higher intakes of fruits and vegetables, especially dried beans and peas, than did the other two groups. All three groups had lower than recommended numbers of servings of grains, especially whole grains. Intakes of vegetables were generally in the recommended range, though groups differed in the types of vegetables consumed. For all three groups, intake of discretionary fats and added sweets exceeded recommendations. Asian Americans/Pacific Islanders did particularly well on scores for fat, saturated fat, and variety. None of the five groups met recommendations for intakes of fruits or milks.

When food and nutrient intakes were compared among groups defined by SES, grain, fruit, vegetable, and milk intakes were highest for the highest income and education groups; servings from the meat group tended to be lower. Discretionary fat was similar for all the groups; added sweets were highest among middle income groups and declined with increasing education. Overall HEI scores increased with increasing education and income.

In drawing conclusions from these findings, the authors make several points:

• Describing the difference in dietary patterns among various ethnic and SES groups is relatively easy; characterizing the net effect of these patterns on health status and disease risks is more difficult. Because great diversity exists within ethnic groups, differences in dietary practices and their impacts may be greater within these groups than among them. Sample sizes need to be sufficiently large so that ethnic and SES differences in dietary patterns can be examined in a broad and multivariate context.



• The concept of "epidemiologic transition" is central to understanding how dietary patterns of ethnic or SES groups influence their current and future disease risks and why different approaches to health promotion and disease reduction may be needed for different groups. As groups move from straitened to more comfortable economic circumstances, they tend to adopt dietary patterns characterized by more food, more animal foods, and more processed and refined-carbohydrate foods, and they engage in less obligatory physical activity. Because these patterns are recognized as unhealthful, some individuals in groups who have reached this point have begun to adopt protective lifestyle habits, such as avoiding high-fat foods and exercising. In some ethnic groups, the persistence of lower-risk traditional practices, such as high consumption of dry beans and grains, may offset the effects of adopting more affluent dietary and activity patterns.



• Comparing the dietary patterns of different ethnic and SES groups is politically sensitive, and investigators must be careful to avoid the suggestion of ethnocentrism in stating that certain dietary patterns are superior to others. Although current dietary recommendations bear a striking similarity to the diets of low-income and economically developing nations (emphasizing grains and cereals, fruits and vegetables, and de-emphasizing animal products), encouraging such dietary patterns may be seen as discouraging adoption of mainstream culture by individuals in minority or lower-income groups.



• The analyses by SES consistently demonstrated less favorable dietary profiles among those with less education and income. Whether this holds within each minority population cannot be determined. This disparity is also consistent with the large SES disparities in mortality from chronic diseases, such as cancer and heart disease, and suggests that SES is as, or more, important than ethnicity as a basis for targeting interventions to improve dietary patterns.

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