Dietary disparities of urban immigrant schoolchildren in New York City: Results from a mixed-methods pilot study

Background Obesity has been identified as an emerging health concern for Chinese American children; however, very little is known about diets in Asian American children. Objective To assess the feasibility of assessing diet of urban Chinese American children in an applied (school) setting and to gain insight on diet and drivers of dietary intakes from community nutrition experts. Design Data were from the Food Journal Project 2017, a school-based pilot study conducted by a multi-sector collaboration, and qualitative data from nutrition and community experts. Participants/Setting Children aged 8-12 (n=83) completed two dietary assessments using a food diary from January-June 2017. Children were then interviewed using the food diary as a guide; dietary data were entered into the ASA24 system by study staff. Chinese American children were compared to non-Chinese peers with respect to nutrient intake and the Healthy Eating Index 2010 (HEI-2010). Six semi-structured interviews and one panel discussion including two registered dietitians and community leaders with working knowledge of the Chinese American community were conducted from January-June 2018. Main Outcome Measures Nutrient intake and HEI-2010 scores. Statistical Analyses Performed Chi-squared and t-test comparisons, with statistical significance set at α=0.05. Results Adjusted for caloric intake, Chinese American children consumed 20% more sodium, 21% more protein but 27% less sugar compared to non-Chinese children. With regards to the HEI-2010, Chinese American children had less favorable whole grains and sodium scores; and more favorable seafood protein and empty calories scores compared to non-Chinese children. Qualitative data underscored the current burden of diet-related health disparities among Chinese American children and suggested Chinese American receptivity to family-based nutritional and cooking education interventions. Conclusions Sodium reduction and increasing whole grain intakes may be warranted in Chinese American children but should be verified with additional studies. Interventions to improve nutrition in this understudied population are critical. Research Question What are typical dietary intakes and current community and family-based challenges related to healthy eating in Chinese American children – an understudied disparity group? Key Findings Chinese American schoolchildren have high sodium and low whole grain intakes compared to non-Chinese peers. These specific dietary disparities work in concert with low physical activity levels and cultural norms in contributing to diet-related health disparities in this group. Family-based nutrition education and potential focus of dietetic counseling on sodium and whole grain intake areas are indicated to address these disparities. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the Walmart Foundation. This research was supported in part by NIH/National Institute on Minority Health and Health Disparities (U54MD000538), and National Heart, Lung, and Blood Institute (R01HL141427). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the NIH and CDC. ### Author Declarations All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript. Yes All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Data may be requested by establishing a Data Use Agreement with the lead author/lead author organization.