Patterns of US citizenship status vs. diet quality among adults of African descent.

Introduction: With the substantial growth rate of the Black immigrant population in the US, the impact of colonization on the diets of Black Americans and disproportionately high rates of chronic diseases among individuals with African descent, studies should place more emphasis on ethnicity when investigating nutrition-related risk factors. This study examined the relationship between variations in citizenship level and diet quality among adult subjects with African descent.

Methods: We analyzed data from 1,198 adults with African descent in NHANES 2015-2016. A 'citizenship level' scale was developed using principal component analysis, incorporating years lived in the US, country of birth, and citizenship status. Diet quality was assessed using HEI scores. Associations between citizenship level, sex, age, income, and diet quality (poor, moderate, or good) were examined using a Monte Carlo simulation of Fisher's exact tests. Linear regression models were employed to examine the relationship between citizenship level and continuous HEI scores, adjusting for sex, age, and income, with stratified analyses conducted for each demographic subgroup.

Results: Fisher's exact tests revealed that the level of US citizenship, sex, age, and income level were all significantly associated with the categorical level of diet quality (HEI). Linear regression analysis demonstrated that a lower level of US citizenship was significantly associated with higher HEI scores, indicative of better diet quality (p < 0.001), even after adjusting for sex, age, and income. This relationship persisted across most demographic subgroups but appeared stronger among males and those in the lowest income bracket. The relationship was also significant for younger adults but not for adults aged 65 and older.

Conclusions: Studies suggest a need for more inclusive and culturally tailored nutrition interventions. To minimize the negative impact of colonization and US assimilation on diet quality, future studies should consider stratifying groups based on the heterogeneity of this population and interventions that utilize traditional dietary patterns of the African diaspora as tools to improve the quality of life among people of African descent.