Sage Journals: Discover world-class research

Abstract

Dietary patterns are strongly influenced by cultural background and perspectives. Levels of dietary acculturation need to be considered when talking with immigrants about healthy eating. Lower levels of dietary acculturation are associated with positive health outcomes. Encouraging healthy traditional foods is a positive approach to use with individuals who are at lower levels of dietary acculturation. Questions about languages spoken in different settings and foods most often consumed can help health care practitioners assess levels of dietary acculturation. General intake recommendations of lower saturated fat, more whole grains, more fruits, more vegetables, leaner proteins, and smaller portion sizes (for caloric balance) are general recommendations that can be applied within most cultural food patterns to optimize health outcomes.

Keywords

nutrition multicultural counseling acculturation

Health professionals often need to advise patients from a variety of cultural groups on general healthy eating practices. A cultural group is often identified by similarities in ethnicity, country of origin, religion, ideals, characteristics, or behaviors. Most cultures have unique food-related behaviors that ultimately influence overall health outcomes of the population.

This role of food in culture^1,2 is evidenced by the inclusion of food in cultural celebrations, including weddings, funerals, birthdays, national holidays, and religious holidays. On a less tangible level, many interpersonal relationships are associated with specific feeding behavior. Many in the general American culture may associate a good mother taking care of a sick child with warm chicken noodle soup or mending an emotional hurt with warm cookies and milk. Food is also a part of how individuals express and manage their impression to others, including use as a symbol of socioeconomic status. Knowing how to properly use table settings, eat a lobster, or pass the bread at a formal meal may communicate level of education and economic resource. Food also has connotations associated with age. Pizza and soda are commonly seen as stereotypical adolescent foods, whereas oat bran cereal and prunes might be associated more often with older adults. Food and food patterns also have gender associations. Steak with beer may be associated more with male consumption patterns, whereas salad with wine spritzer may seem to characterize female food consumption patterns. Although the role of culture and food can be seen in many of the different scenarios described above, the most recognized food and culture associations are the traditional foods of broadly defined ethnic or racial and geographic communities.

Although the traditional diets of many cultures around the world are often no longer fully intact, it is useful to examine what is known in general of traditional diet patterns . . .

In advising patients, it is important for health professionals to understand two things: (a) the individual’s current level of acculturation and (b) elements of the individual’s traditional diet pattern.

Acculturation

Acculturation is the process where an immigrant takes on the values, beliefs, practices, customs, and behaviors of a new culture. In general, immigrants are classified as being at a low, moderate, or high level of acculturation. At the lowest levels of acculturation, an immigrant has retained almost all of his or her traditional cultural patterns, whereas at the highest level of acculturation, an immigrant has adopted almost all of the new host country’s cultural patterns. Similar to general acculturation, dietary acculturation is the process by which immigrants adopt the food-related beliefs, values, attitudes, and dietary behaviors of the new culture.³ In general in the United States, individuals at lower levels of acculturation tend to have healthier dietary intake patterns^4,5 and lower rates of obesity and comorbidities than their more acculturated counterparts.^6-8

Traditional Dietary Patterns

To understand dietary acculturation, it is necessary to understand traditional dietary patterns; however, identifying traditional diet patterns of many cultures is becoming increasingly difficult. Many children and adults today have grown up in a time where foods, which previous generations would have considered traditional, have been replaced by more processed, Westernized foods. Those people may not have a full concept of what traditional foods were or how to prepare them.³

Although the traditional diets of many cultures around the world are often no longer fully intact, it is useful to examine what is known in general of traditional diet patterns as many of the traditional taste profiles still influence current food patterns. With this knowledge we can better understand the elements of the traditional diet that immigrants may have retained. The brief, general list of some common foods found in 5 cultures is found in Table 1. The cultural diet patterns of these groups are briefly described below. These descriptions are extremely generalized and do not take into account the wide variations in diet patterns that occur with geographical differences within each cultural group. The food patterns described in this article were researched (unless otherwise referenced) using the book Food and Culture by Kittler and Sucher.⁹

Table 1.

Common traditional foods found in Native American, Latino/Hispanic, Asian, Asian Indian, and African cultures.

Native American
Milk	No milk products common in the traditional diet
Protein	Meats including bear, dear, moose, buffalo, rabbit, elk, raccoon; poultry including duck, pheasant, grouse, turkey, goose; catfish, cod, crab, halibut, shrimp, trout; beans; nuts and seeds including acorns, walnuts, chestnuts, hazelnuts, pumpkin seeds, sunflower seeds, squash seeds, and peanuts
Grains	Wild rice; corn products including cornbread, tortillas, hominy; and toasted corn
Fruits	Chokeberries, buffalo berries, cranberries, grapes, elderberries, rhubarb, strawberries, blackberries, blueberries, apples, salmonberries, and persimmons
Vegetables	Wild greens (including creases, cattail, dandelion, milkweed, watercress, clover), nettles, onions, squash, potatoes, turnips, tomatoes, pumpkin, chilies, cacti, and mushrooms
Fats	Rendered fat from land mammals or seals/whales
Beverages	Teas made using mint, rose hips, buffalo berries, and sassafras
Seasonings	Honey and tree saps (including maple syrup)

Latino/Hispanic
Milk	Cow and goat milk; aged and unaged cheeses (including Queso Blanco and Queso Fresca); and evaporated milk
Protein	Meats including goat, beef, pork, deer; poultry including chicken, duck, and turkey; eggs; fish including shrimp and a variety of firm fleshed fish; legumes including black beans, pinto beans, chickpeas, fava, white and kidney beans
Grains	A variety of corn products (including tortillas), wheat breads, and rice
Fruits	Coconut, avocados, guava, bananas, passion fruit, limes, lemons, strawberries, cactus fruit, oranges, mangoes, papaya, melons, and pineapple
Vegetables	Chilies, onions, potatoes, cactus, squashes, tomatoes, peas, tomatillos, asparagus, beets, cabbage, carrots, leeks, watercress, yams, and yucca
Fats	Butter and lard
Beverages	Coffee, chocolate, beer, fruit-flavored water drinks (Aqua Frescas), and fermented beverages (including rum, beer, and tequila)
Seasonings	Cilantro, garlic, anise, annatto, cinnamon, cumin, mace, nutmeg, and vanilla

Asian
Milk	Buffalo and cow milk
Protein	Meat including beef, lamb, pork, bear, moose; poultry including duck, chicken, squab, quail; eggs; and fish
Grains	Corn, rice, wheat, sorghum, millet, and buckwheat
Fruits	Coconuts, apples, dates, grapes, kumquats, dragon eyes, persimmons, plums, watermelon, orange, litchi, lime, figs, mango, papaya, pineapples, passion fruit, pomegranates, tangerines, and pomelos
Vegetables	Bamboo shoots, bean sprouts, broccoli, celery, long beans, eggplant, cabbage (including napa and bok choy), mushrooms (including oyster, straw, black, and shitake), burdock root, lotus root, peas, spinach, yams, watercress, tomatoes, seaweed, parsnips, water chestnuts, and okra
Fats	Oils (including corn, sesame, peanut, and soybean), suet, butter, lard, and bacon fat
Beverages	Teas, broth, beer, and distilled spirits
Seasonings	Five-spice (anise, clove, star anise, cassia, cinnamon, and Szechuan pepper), fish sauce, ginger, garlic, hot mustard, cilantro, cumin, oyster sauce, green onions, hoisin, sesame seed, peppers, soy sauce, turmeric, cloves, and vinegar

Asian Indian
Milk	Buffalo, donkey, or cow’s milk; yogurts; fresh curds; and milk-based desserts
Protein	Meats including pork, goat, or beef; poultry including duck and chicken; fish including herring, mullet, carp, pomfret, shrimp, clams, sardines, and crab; nuts/seeds including almonds, cashews, walnuts, sunflower seeds, peanuts, pistachios, and betel nuts
Grains	Rice, wheat, millet, and buckwheat
Fruits	Avocados, dates, guava, apples, mangoes, bananas, oranges, coconut, peaches, pineapples, raisins, tangerines, strawberries, loquata, limes, pomegranate, litchis, pomelos, starfruit, and persimmons
Vegetables	Bamboo shoots, beets, carrots, corn, tapioca, mushrooms, artichokes, bitter melon, cabbage, parsnips, squash, water chestnuts, tomatoes, spinach, turnips, radishes, brussels sprouts, cauliflower, cucumbers, eggplant, okra, collard greens, mustard greens, rhubarb, and yams
Fats	Clarified butter (ghee), peanut oil, coconut oil, mustard oil, and sesame seed oil
Beverages	Tea, coffee, flavored water (flavored with fruit syrup, spice, or herbs), and alcoholic beverages (including rice wines, beer, and fermented fruit syrups)
Seasonings	Bay leaf, cardamom, cinnamon, garlic, pepper, saffron, turmeric, chilies, cloves, coriander, cumin, fennel, limes, mint, nutmeg, dill, fenugreek, tamarind, poppy seed, asafetida, and lemons

Africa
Milk	Milk (often consumed in desserts), buttermilk, and cheese
Protein	Meats including pork, raccoon, squirrel, opossum and beef; poultry including chicken and turkey; fish/shellfish including crab, perch, crab, tuna, shrimp, red snapper, salmon, sardines, and crawfish; eggs; legumes including kidney beans, black-eyed peas, red beans, peanuts, and pinto beans; nuts/seeds including pecans, walnuts, and sesame seeds
Grains	Corn (including breads, hominy, and grits), wheat (breads and pastas), and rice
Fruits	Bananas, peaches, apples, watermelon, and berries
Vegetables	Greens (including collard, mustard, chard, turnip, and kale), okra, yams, tomatoes, potatoes, squash, spinach, and green peas
Fats	Meat renderings and butter
Beverages	Coffee, fruit (juice and wine), tea
Seasonings	Garlic, sassafras powder, lemon juice, onions, salted meat (including ham hocks, bacon, and pork fat), peppers

Native American Diet Patterns

Traditional Native American diet patterns are an excellent example of dietary diversity related to geographic location. In the Northern Plains region, Elders have primarily identified prairie turnips, fruits (chokecherries, June berries, plums, blueberries, cranberries, strawberries, buffalo berries, gooseberries), potatoes, squash, dried meats (venison, buffalo, jack rabbit, pheasant, and prairie chicken), corn, teas (spearmint, peppermint, bergamot), and wild rice as traditional foods.¹⁰ Acorns are commonly used in traditional Native American dishes in California.¹¹ The traditional diet pattern of Pima Indians is higher in complex carbohydrates (often from beans and corn) and lower in fat than the current Westernized diet pattern.¹² Alaskan Native diets traditionally consisted largely of sea animals, and traditional harvesting activities commonly included smoking fish or meats, picking berries, fishing, and picking greens.¹³

The traditional diet of Native Americans has many elements that are known to protect against disease. Many wild berries are rich in phytochemicals and are strong antioxidants that are antidiabetic, cardioprotective, antiviral, anti-inflammatory, anticancer, antibacterial, gastroprotective, radioprotective, and immunomodulatory.^14,15 The observed high intakes of fat from sea animals (primarily seals and whales) and lower cardiovascular disease incidence was one of the initial findings that identified the role of omega-3 fatty acids in heart disease prevention.^16,17

Latino/Hispanic Diet Patterns

The traditional Latino/Hispanic diet can been characterized as being high in fresh meats (eg, turkey, pork, beef), fish, vegetables (eg, squash, greens, cactus, chayote, tomatoes, onions, chili peppers, and cilantro), fruits (eg, avocados, bananas, coconut, guava, limes, mangoes, papaya), beans, rice, corn, and spices (eg, cinnamon, cocoa, garlic, anise, cumin, mace, and vanilla).¹⁸ Some but not all traditional dishes are hot and spicy, with chili peppers commonly used. Beans, corn, and tomatoes form the basis for much of the cuisine. Spanish explorers brought many items to the Mexican diet that are now often considered quintessential Mexican flavors and foods, including onions, garlic, cinnamon, rice, sugarcane, and hogs.

An analysis of the national data from the National Health and Examination Survey (1999-2004) revealed that foreign-born Latino/Hispanic adults living in the United States reported consuming more fruits, vegetables, fruit and vegetable juices, and high-fiber/low-fat breads and less snacks, desserts, soda, fruit drinks, and fast foods than their US-born counterparts.^19,20 Less acculturated Mexican Americans consume less fat and more fiber, protein, vitamins (A, C, E, and B₆), folic acid, calcium, potassium, and magnesium than Mexican Americans born in the United States.^21,22 These differences in nutrient intake are probably because of foreign-born Mexican Americans’ greater consumption of fruits, vegetables, whole grains, legumes, and traditional Mexican foods such as cornbread, corn tortillas, beans, and rice and less consumption of desserts and added fats.^20,21 High intakes of legumes are associated with many health benefits, including helping prevent diabetes, obesity, some cancers, and cardiovascular disease.²³

Asian Diet Patterns

In many Asian cultures, traditionally there have been high intakes of tea, fish, and soybeans products (including tofu, soy milk, and soy flour). The traditional diet is also generally higher in rice, fresh vegetables, and fresh fruit and is lower in meat, sugar, and saturated fats than the typical American diet pattern. In addition to the well-documented benefits of consuming a diet lower in added sugar, saturated fat, and higher in fruits and vegetables, many of the elements of this traditional diet pattern have been found to have positive health effects (eg, omega-3 fatty acids in fish, polyphenols in tea, and isoflavones in soybeans).^24-26

Asian Indian Diet Patterns

In general, the Asian Indian diet contains rice, wheat, legumes, fermented dairy products, clarified butter, and many characteristic spices. Although there are some common foods throughout India (including rice, chutneys, pickles, yogurts, coffee, coconut milk, and fresh fruits and vegetables), there are some unique differences between Northern and Southern Indian cuisines. The spices in the South tend to be hotter, whereas the spices in the North tend to be aromatic. Vegetarian diets are very common throughout India because of religious reasons. Many of these vegetarians also consume milk, eggs, and fish (lacto-ovo-peso-vegetarian). Many of the spices commonly used in Asian Indian cooking (eg, ginger, saffron, turmeric, cloves, and cinnamon) have been associated with the prevention of cancer, diabetes, and cardiovascular disease.²⁷

African Diet Patterns

Traditional diets in both West and Central Africa contain many starches (including plantains and root vegetables such as cassava), grilled meats with sauce, and stews. Many dishes may contain greens, spinach, tomatoes, chilies, peppers, peanuts, and onions. Although most meats are beef or chicken, other local animals such as monkey, crocodile, warthog, and antelope are sometimes consumed. Less meat is consumed in East Africa, where many animals are used as a form of currency. Corn and bananas are common starches used in East Africa. East African cuisine was influenced by many different populations that settled in the region. The influence of Arab settlers can be seen in the rice with spices (eg, saffron, cloves, and cinnamon) often served on the coast. British and Asian Indian settlers brought curries, pickled vegetables, and lentil soups. The Portuguese brought their own spices, cooking techniques (eg, roasting and marinating), vegetables (eg, chilies, peppers, tomatoes, and corn), and citrus fruits (eg, lime, lemons, pineapples, and oranges). North African cuisine was also influenced by the arrival of settlers and travelers including the Phoenicians (sausages), Carthaginians (wheat and semolina), Berbers (couscous), Romans (olives), Arabs (spices including nutmeg, cinnamon, ginger, saffron, and cloves), and the Ottoman Turks (pastries). Although some areas in Africa have a very limited consumption of milk products, the diet patterns in Southern Africa include milk and fermented milk products (including buttermilk, yogurt, and sour cream). Many of the traditional foods of Black Southern African Americans can be traced to the traditional foods of Southern Africa, including barbecued, roasted, and dried meats.

Many of the common ingredients in the traditional African diet pattern (including greens, spinach, tomatoes, chilies, peppers, peanuts, and onions) have each been found to have individual disease prevention capabilities.

These are only a small sample of the potential traditional food patterns in each of these cultures. Within each culture there are countless variations, specialties, and patterns. There are also many different cultures in the world not addressed in this article. It is impossible for any health provider to become proficient in the foods of all cultures. An excellent way for health providers to become more familiar with other cultures’ foods is to not only talk to patients about their traditional food and read about traditional food but also to try new unfamiliar food whenever possible. Explore local restaurants that serve “authentic” diverse cuisines (be aware that many ethnic restaurants serve an “Americanized” version of their traditional food) and visit small ethnic food outlets. At every grocery store trip, select one new unfamiliar food to try. The Internet serves as an excellent resource to learn to prepare a virtually unlimited number of unique ethnically diverse foods.

In addition to the vast quantity of different types of food consumed in each culture, there are an equally vast number of medicinal uses for foods and herbs in each culture. The ability to even begin to catalogue the potential medicinal uses of these foods and herbs is beyond the scope of this article.

Assessing Level of Acculturation

In addition to understanding some general concepts about an individual’s traditional diet pattern, tailoring dietary advice to an individual’s level of acculturation is very important. A short series of questions that can be used to assess an individual’s level of acculturation is provided in Table 2. However, it is essential that health providers do not try to use this approach to stereotype people. Cultural commonalties can be recognized without making assumptions about individuals. Health providers must also become aware of and eradicate any preconceptions or judgments they may hold against a culture before effective communication and counseling can occur. An initial essential step when working with any patient is to develop rapport. Establishing a climate where the patient feels he or she is being valued, listened to, and respected often is adequate to achieve essential baseline rapport. Only after this has been achieved should a health provider seek to understand the patient’s level of acculturation and provide advice on healthy choices within that acculturation level and context of traditional food pattern.

Table 2.

Questions to Assess Level of Acculturation and Corresponding Recommendation for Dietary Counseling.

	Level of Acculturation
	Low	Moderate	High
What language do you mostly speak at home?	Speaks mostly or only Spanish	Speaks Spanish and English equally at home	Speaks mostly or only English only
Do you watch mostly/only TV in a different language?	Watches TV mostly or only in Spanish	Watches TV in both English and Spanish	Watches TV mostly or only in English
What language do you usually speak with your friends?	Friends mostly or only speak Spanish	Friends speak English and Spanish equally	Friends speak mostly or only Spanish
What kinds of foods do you most often eat?	Eats mostly or only Mexican foods	Eats Mexican and American foods equally	Eats mostly or only American foods
Dietary counseling recommendation	Encourage healthy traditional foods and discuss risks associated with the American diet	Encourage healthy traditional foods and healthy American diet and discuss which foods out of both diet patterns the individual is most likely going to want to incorporate into his or her diet	Encourage healthy American diet and discuss traditional foods the individual wants to incorporate into his or her diet

After rapport is established, a series of questions can be used to better understand the individual’s cultural perspectives and level of acculturation (see Table 2).

The acculturation process is very complex and unique to each individual. The questions should be used as general guidelines and not as absolute measures of level of acculturation. These questions should not be used in isolation, but when time is limited, the question “What kinds of foods do you most often eat?” would provide the best single indicator of level of dietary acculturation. Individuals will likely have more success achieving their goals if the discussion about food is tailored to meet their acculturation level. If individuals are asked to make healthy choices within a diet pattern outside of their current pattern, they are being asked to make two difficult changes. This would decrease the likelihood of successful behavior change. Additionally, by discussing the positive health benefits of a traditional diet with a patient who is at a lower level of acculturation, the health provider is using an empowering message. Using this positive, empowering approach may result in the patient being more likely to make successful healthy adjustments within his or her current diet pattern.

Summary

Overall, it is important to understand that each individual has his or her own unique cultural food background. Although it shows respect for different cultures by understanding some basic principles of their traditional food practices, it is impractical to try and understand all of the potential different cultural food backgrounds in detail. What is most important is to not make assumptions (or try to stereotype an individual) but instead to ask questions and listen to that individual. Based on the foods the individual currently consumes, you can help him or her set personal goals and modify his or her current diet as needed. These modifications and goals can be framed in a set of recommendations appropriate for most individuals. These common nutritional recommendations (based on the US Dietary Guidelines for Americans²⁸) can be incorporated in all cultural food patterns and include encouraging lower saturated fat, more whole grains, more fruits, more vegetables, leaner proteins, and smaller portion sizes to allow for caloric balance. Allowing an individual to set goals within these recommendations without suggesting changes in the basic structure of his or her cultural diet pattern is a simple, positive approach health providers can take when working with individuals from diverse cultural backgrounds.

References

Colby

. The Ecological Model of Food Behavior. Dubuque, IA: Kendall/Hunt Publishing; 2009.

Colby

. Food Behavior: Why We Eat What We Eat. Dubuque, IA: Kendall/Hunt Publishing; 2010.

Satia

. Dietary acculturation and the nutrition transition: an overview. Appl Physiol Nutr Metab. 2010;35:219-223.

Lara

Gamboa

Kahramanian

Morales

Bautista

. Acculturation and Latino health in the United States: a review of the literature and its sociopolitical context. Annu Rev Public Health. 2005;26:367-397.

Ayala

Baquero

Klinger

. A systematic review of the relationship between acculturation and diet among Latinos in the United States: implications for future research. J Am Diet Assoc. 2008;108:1330-1344.

Koya

Egede

. Association between length of residence and cardiovascular disease risk factors among an ethnically diverse group of United States immigrants. J Gen Intern Med. 2007;22:841-846.

Fitzgerald

Himmelgreen

Damio

Segura-Perez

Peng

Perez-Escamilla

. Acculturation, socioeconomic status, obesity and lifestyle factors among low-income Puerto Rican women in Connecticut, U.S., 1998-1999. Rev Panam Salud Publica. 2006;19:306-313.

Himmelgreen

Perez-Escamilla

Martinez

. The longer you stay, the bigger you get: length of time and language use in the U.S. are associated with obesity in Puerto Rican women. Am J Phys Anthropol. 2004;125:90-96.

Kittler

Sucher

. Food and Culture. 5th ed. Belmont, CA: Wadsworth/Thomas Learning.

10.

Colby

McDonald

Adkison

. Traditional Native American foods: stories from elders. J Ecol Anthropol. 2012;15(1). http://shell.cas.usf.edu/jea/PDFs/JEA15-Colby.pdf. Accessed September 8, 2012.

11.

Meyers

Swiecki

Mitchell

. Understanding the native Californian diet: identification of condensed and hydrolyzable tannins in tanoak acorns (Lithocarpus densiflorus). J Agric Food Chem. 2006;54:7686-7691.

12.

Williams

Knowler

Smith

. The effect of Indian or Anglo dietary preference on the incidence of diabetes in Pima Indians. Diabetes Care. 2001;24:811-816.

13.

Redwood

Ferucci

Schumacher

. Traditional foods and physical activity patterns and associations with cultural factors in a diverse Alaska Native population. Int J Circumpolar Health. 2008;67:335-348.

14.

Kokotkiewicz

Jaremicz

Luczkiewicz

. Aronia Plants: a review of traditional use, biological activities, and perspectives for modern medicine. J Med Food. 2010;12:255-269.

15.

Burns Kraft

Dey

Rogers

. Phytochemical composition and metabolic performance-enhancing activity of dietary berries traditionally used by Native North Americans. J Agric Food Chem. 2008;56:654-660.

16.

Middaugh

. Cardiovascular deaths among Alaskan Natives, 1980-86. Am J Public Health. 1990;80:282-285.

17.

Parkinson

Cruz

Heyward

. Elevated concentrations of plasma omega-3 polyunsaturated fatty acids among Alaskan Eskimos. Am J Clin Nutr. 1994;59:384-388.

18.

Colby

Morrison

Haldeman

. What changes when we move? A transnational exploration of dietary acculturation. Ecol Food Nutr. 2009;48:327-343.

19.

Duffey

Gordon-Larsen

Ayala

Popkin

. Birthplace is associated with more adverse dietary profiles for US-born than for foreign-born Latino adults. J Nutr. 2008;138: 2428-2435.

20.

Neuhouser

Thompson

Coronado

Solomon

. Higher fat intake and lower fruit and vegetables intakes are associated with greater acculturation among Mexicans living in Washington State. J Am Diet Assoc. 2004;104:51-57.

21.

Dixon

Sundquist

Winkleby

. Differences in energy, nutrient, and food intakes in a US sample of Mexican-American women and men: findings from the Third National Health and Nutrition Examination Survey, 1988-1994. Am J Epidemiol. 2000;152:548-557.

22.

Guendelman

Abrams

. Dietary intake among Mexican-American women: generational differences and a comparison with white non-Hispanic women. Am J Public Health. 1995;85:20-25.

23.

Geil

Anderson

. Nutrition and health implications of dry beans: a review. J Am Coll Nutr. 1994;13:549-558.

24.

Zhang

Shu

Gao

. Soy food consumption is associated with lower risk of coronary heart disease in Chinese women. J Nutr. 2003;133: 2874-2878.

25.

Henning

Niu

Liu

. Bioavailability and antioxidant effect of epigallocatechin gallate administered in purified form versus as green tea extract in healthy individuals. J Nutr Biochem. 2005;16:610-616.

26.

Tur

Bibiloni

Sureda

Pons

. Dietary sources of omega 3 fatty acids: public health risks and benefits. Br J Nutr. 2012;107(suppl 2):S23-S52.

27.

Vasanthi

Parameswari

. Indian spices for healthy heart—an overview. Curr Cardiol Rev. 2010;6:274-279.

28.

US Department of Agriculture & US Department of Health and Human Services. Dietary Guidelines for Americans 2010. Washington, DC: Government Printing Office; 2010.

Multicultural Food Perspectives

Abstract

Keywords

Acculturation

Traditional Dietary Patterns

Native American Diet Patterns

Latino/Hispanic Diet Patterns

Asian Diet Patterns

Asian Indian Diet Patterns

African Diet Patterns

Assessing Level of Acculturation

Summary

References