The Mediating Role of Total Fruit and Vegetables Intake in the Association Between Acculturation and Obesity in Hispanic Adults from NHANES 2009–2016

Abstract

Abstract Objectives As Hispanic immigrants to the U.S. become acculturated, they are experiencing many adverse health outcomes such as obesity. However, the association between social determinants and obesity has not been well investigated. This study aimed at examining the association between acculturation and obesity, and whether the association was mediated by the intake of fruit and vegetables in Hispanic adults in the U.S. Methods Based on National Health and Nutrition Examination Surveys (NHANES) between 2009–2016, the study included 5197 Hispanic adults aged ≥20 years. Obesity status was measured by waist circumference and body mass index (BMI). According to participants’ responses to the country of birth, length of stay in the U.S., and language spoken at home, a composite score was calculated to measure acculturation, ranging from 2 to 14 points. The mediators including total intake of fruit, and vegetables were obtained from 24-hour dietary recalls. Multi-variable adjusted logistic structural equation model with bootstrapping method was applied for mediation analysis in overall study population, as well as in subpopulations stratified by gender, ethnicity origin, and poverty income ratio (PIR). All analyses were adjusted for sampling weights to account for the complex sampling design. Results During 2009–2016, 80.1% and 61.5% of Hispanic adults were overweight/obese and central obese, respectively. Acculturation was not significantly associated with obesity measured by BMI but was associated with increased odds of central obesity. Mediation analysis found that total fruit intake fully mediated the association between acculturation and central obesity in Hispanic adults, particularly in Hispanic males. Total vegetables intake was not a mediator in the association between acculturation and central obesity. Conclusions Our findings suggested that increasing fruit consumption may reduce the impact of acculturation on central obesity in Hispanic adults. Further studies are needed to confirm these findings. Funding Sources NIMHD.