Associations Between Dietary Quality and Inflammation Among Bhutanese Refugee Adults Eligible for the Supplemental Nutrition Assistance Program

Abstract

ObjectivesTo quantify the associations between adherence to U.S. dietary guidelines and inflammation among Bhutanese refugee adults who are eligible to receive SNAP (Supplemental Nutrition Assistance Program) benefits. MethodsA convenience sample of Bhutanese refugee adults (n = 53, mean age = 47 ± 2 years, 83% female) residing in New Hampshire was recruited. A bilingual community health worker conducted study visits. We estimated diet using the average of three 24-hour recalls. Adherence to U.S. dietary guidelines was defined using the 2015 Healthy Eating Index (HEI), where a higher score indicates greater adherence to guidelines. A fasting blood sample was analyzed for inflammatory biomarkers, IL-6 and TNF-α. The HEI score and score components were expressed in tertiles, and related to biomarkers using ANCOVA. Food rankings were conducted to identify contributors to HEI components. ResultsOn average, participants lived in the U.S. for 7.8 ± 0.5 years, with a household size of 3.8 ± 0.2 members. The prevalence of overweight/obesity and type 2 diabetes was 82% and 41%, respectively. In multivariate adjusted models, individuals with higher HEI scores had significantly lower IL-6 concentrations (3.1 ± 0.5 pg/mL, 2.5 ± 0.4 pg/mL, and 2.0 ± 0.5 pg/mL by increasing HEI tertile, P-trend = 0.019). In examining the individual HEI components, greater consumption of total fruit (P-trend = 0.02) and whole fruit (P-trend = 0.017) was related to lower IL-6 concentrations, whereas refined grains was associated with higher values (P-trend = 0.036). We observed null associations with TNF-α. The top 5 contributors to fruit consumption were bananas (21.5%), apples (15.5%), mangos (15%), avocados (9.6%), and kiwis (8.8%); those for refined grains included parboiled rice (78.8%), white rice (6.1%), pasta (4.6%), crackers (1.3%), and white bread (1.3%). ConclusionsIn this cross-sectional study of low-income Bhutanese refugee adults, greater adherence to U.S. Dietary Guidelines, particularly for fruit and refined grain consumption, was associated with lower IL-6 concentrations. Over 70% of fruit and 90% of refined grains were represented by only a few foods, which can inform cultural tailoring of SNAP Education interventions in this understudied population. Funding SourcesThe New Hampshire Agricultural Experiment Station.