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Association between birthplace and time in the US with diet quality in US adolescents: Findings from the National Health and Nutrition Examination Survey, 2007 to 2018.

BACKGROUND
During adolescence, diet quality reaches its lowest point compared to other childhood life stages. Acculturation is associated with decreased diet quality among many groups of United States (US) immigrant adults, but research is limited among adolescents.


OBJECTIVE
To investigate the associations between birthplace and length of time living in the US, two proxy measures of acculturation, with diet quality among adolescents (12-19 years old).


METHODS
Data were from the National Health and Nutrition Examination Survey (2007-2018), which included two 24-hour dietary recalls (n = 6,113) to estimate Healthy Eating Index-2015 (HEI-2015) total scores and component scores. Multivariate linear regression and generalized linear models were performed to compare HEI-2015 total scores and component scores between US-born adolescents (n = 5342) and foreign-born adolescents with <5 years (n = 244), 5 - <10 years (n = 201), and ≥10 years (n = 290) of US residency.


RESULTS
Foreign-born adolescents with <5 years (53.3±1.2), 5 - <10 years (51.4±1.5), and ≥10 years of US residency (49.9±0.8) had higher HEI-2015 total scores than US-born adolescents (47.0±0.3, p<0.0001) and higher total vegetables, seafood and plant proteins, and added sugars scores (Ps≤0.0001). Foreign-born adolescents with more years of US residency had higher total fruits, whole fruits, and saturated fats scores than those with fewer years of US residency. Sensitivity analysis revealed this pattern held for Mexican American/other Hispanic adolescents.


CONCLUSIONS
Being born outside the US and living in the US for less time (among foreign-born adolescents) is associated with higher diet quality. Culturally informed health promotion programs may help to reduce diet-related disparities related to acculturation among adolescents.