Associations Between Dietary Quality and Inflammation Among Bhutanese Refugee Adults Eligible for the Supplemental Nutrition Assistance Program

OBJECTIVES: To quantify the associations between adherence to U.S. dietary guidelines and inflammation among Bhutanese refugee adults who are eligible to receive SNAP (Supplemental Nutrition Assistance Program) benefits. METHODS: A convenience sample of Bhutanese refugee adults (n = 53, mean age = 47 ± 2 years, 83% female) residing in New Hampshire was recruited. A bilingual community health worker conducted study visits. We estimated diet using the average of three 24-hour recalls. Adherence to U.S. dietary guidelines was defined using the 2015 Healthy Eating Index (HEI), where a higher score indicates greater adherence to guidelines. A fasting blood sample was analyzed for inflammatory biomarkers, IL-6 and TNF-α. The HEI score and score components were expressed in tertiles, and related to biomarkers using ANCOVA. Food rankings were conducted to identify contributors to HEI components. RESULTS: On average, participants lived in the U.S. for 7.8 ± 0.5 years, with a household size of 3.8 ± 0.2 members. The prevalence of overweight/obesity and type 2 diabetes was 82% and 41%, respectively. In multivariate adjusted models, individuals with higher HEI scores had significantly lower IL-6 concentrations (3.1 ± 0.5 pg/mL, 2.5 ± 0.4 pg/mL, and 2.0 ± 0.5 pg/mL by increasing HEI tertile, P-trend = 0.019). In examining the individual HEI components, greater consumption of total fruit (P-trend = 0.02) and whole fruit (P-trend = 0.017) was related to lower IL-6 concentrations, whereas refined grains was associated with higher values (P-trend = 0.036). We observed null associations with TNF-α. The top 5 contributors to fruit consumption were bananas (21.5%), apples (15.5%), mangos (15%), avocados (9.6%), and kiwis (8.8%); those for refined grains included parboiled rice (78.8%), white rice (6.1%), pasta (4.6%), crackers (1.3%), and white bread (1.3%). CONCLUSIONS: In this cross-sectional study of low-income Bhutanese refugee adults, greater adherence to U.S. Dietary Guidelines, particularly for fruit and refined grain consumption, was associated with lower IL-6 concentrations. Over 70% of fruit and 90% of refined grains were represented by only a few foods, which can inform cultural tailoring of SNAP Education interventions in this understudied population. FUNDING SOURCES: The New Hampshire Agricultural Experiment Station.