Cad. Saúde Pública, Rio de Janei o, 31(2):229-245, e , 2015
The impac o mig a ion on body weigh :
a e iew
O impac o da mig ação no peso co po al:
uma e isão
El impac o de la mig ación sob e el peso co po al:
una e isión
1 Faculdade de Medicina,
Uni e sidade de Lisboa,
Lisboa, Po ugal.
Co espondence
B. Goulão
Ins i u o de Medicina
P e en i a, Faculdade de
Medicina, Uni e sidade de
Lisboa.
Rua Luís Augus o Palmei im
6, 3o esq, Lisboa –
1700-274, Po ugal.
[email p o ec ed]
Bea iz Goulão
1
Os aldo San os
1
Isabel do Ca mo
1
Abs ac
Immig an s may be mo e ulne able o obesi y
as a esul o he immig a ion p ocess. The aim
o his a icle is o summa ize cu en knowledge
abou he impac o immig a ion on body mass
index (BMI). A sys ema ic e iew was pe o med
in acco dance wi h PRISMA guidelines h ough
a da abase sea ch o scien i ic a icles (las up-
da ed in Augus 2014). Thi y-nine a icles we e
included and assessed. Resul s a ied acco d-
ing o e hnic backg ound, coun y o o igin and
hos coun y. A consis en posi i e associa ion
be ween BMI and ime since immig a ion was
ound among Hispanic, Eu opean and A ican
immig an s. Less han hal o he s udies ob-
se ed a posi i e associa ion among Asian im-
mig an s. The quali y o he majo i y o he s ud-
ies assessed was poo , e lec ing a need o im-
p o e me hodology and concep de ini ion. Im-
mig a ion appea s o ha e a de e io a i e e ec
on BMI. Unde lying causes may include changes
in nu i ion and physical ac i i y, psychological
and social ac o s, and gene ic suscep ibili y and
hese aspec s should be included as mode a o
a iables in u u e s udies.
Emig a ion and Immig a ion; Accul u a ion;
Obesi y
Resumo
A obesidade pode se uma das ca ac e ís i-
cas mais al e á eis no p ocesso de mig ação.
P e endeu-se esumi a in o mação sob e o im-
pac o da mig ação no índice de massa co po al
(IMC). Realizou-se uma e isão sis emá ica da
li e a u a de aco do com as di e izes PRISMA,
po meio de pesquisa ele ônica (úl ima a ua-
lização em agos o de 2014). Fo am incluídos e
a aliados quali a i amen e 39 a igos. A asso-
ciação en e mig ação e e olução de IMC a ia
de aco do com o g upo é nico e países de o igem/
acolhimen o. Imig an es hispânicos, eu opeus e
a icanos ap esen am elação consis en e e po-
si i a en e IMC e empo de mig ação. Os imi-
g an es asiá icos ap esen am associação posi i-
a em menos da me ade dos es udos. No ge al, a
qualidade dos es udos é aca e há necessidade
de melho a concei os e mé odos. Pa ece exis i
um e ei o de e io a i o da mig ação no IMC. Al-
e ações nu icionais, de a i idade ísica, a o es
psicossociais e susce ibilidade gené ica podem
se mo i os subjacen es a inclui como a iá eis
mode ado as em es udos u u os.
Mig ação In e nacional; Acul u ação;
Obesidade
229
REVISÃO REVIEW
h p://dx.doi.o g/10.1590/0102-311X00211913
Goulão B e al.
230
Cad. Saúde Pública, Rio de Janei o, 31(2):229-245, e , 2015
In oduc ion
The e is a g owing in e es in he associa ion
be ween immig a ion and ood consump ion.
Food and be e ages play a key ole in main ain-
ing social and cul u al connec ions among im-
mig an s. O e ime, ood consump ion among
immig an s ends o change due o accul u a ion
and lack o a ailabili y o ypical ood p oduc s
om hei home coun y
1,2,3
.
An associa ion has been obse ed be ween
die a y accul u a ion and immig an in eg a ion
in o he hos coun y and a de e io a ion o die
among immig an s
4
. Immig a ion o en leads
o changes in he quali y o ood consumed and
cooking me hods. Immig an s a e suscep ible
o a apid change in emphasis owa ds con e-
nience oods, such as snacks and swee s, while
he consump ion o s aple oods like ice and
co n emains unchanged o e longe pe iods o
ime
5
. S udies show ha he ac o s ha a ec
ea ing habi s among immig an s include ood
a ailabili y, income, belie s ela ing o ood, eli-
gion and “ ood laws”, and he gene a ion and age
o immig an s
5
.
Die a y accul u a ion does no always ha e
nega i e esul s. In a s udy o Mo occan immi-
g an s ca ied ou in Spain, ood choices we e
mo e a ied and nu i ionally-dense among o
he mos accul u a ed immig an s
6
. The au ho s
also concluded ha ecen immig an s wi h poo
luency in Spanish may ha e di icul ies in ac-
cessing a la ge a ie y o oods.
O he s udies sugges ha he ini ial heal h
s a us o immig an s is be e han ha o he
popula ion o he hos coun y. This phenome-
non is known as he “heal hy immig an e ec ”
7
.
Howe e , his e ec o en disappea s as leng h
o esidence inc eases
7,8
. On he o he hand,
compa a i e s udies show ha a e immig a ion
he isk o diseases associa ed wi h obesi y, such
as ca dio ascula disease, diabe es, and cance ,
may change o e ime
7
. Suscep ibili y o obesi y
[de ined as body mass index (BMI) ≥ 30 kg/m
2
]
9
inc eases wi h immig a ion and leng h o esi-
dence in he hos coun y. E idence om s ud-
ies ca ied ou in he Uni ed S a es sugges s ha
ecen immig an s gene ally ha e a lowe BMI
han he Ame ican popula ion. Howe e , BMI
ends o inc ease as he leng h o esidence in he
hos coun y inc eases, p og essi ely con e ging
owa ds he le els o he Ame ican popula ion
7
.
The same phenomenon has been obse ed by
s udies in Canada, Aus alia and Eu ope
8
.
S udies o his phenomenon in o he coun-
ies a e sca ce. Fou o he i e sys ema ic e-
iews o his issue concen a e exclusi ely on
obesi y among he US immig an popula ion.
Mis a & Ganda
10
analyzed his issue om a glob-
al pe spec i e. Howe e , he s udy was published
in 2007 and lacks a quali a i e assessmen o he
pape s included. The p esen a icle is he esul
o an upda ed sys ema ic e iew o s udies o
analyze he associa ion be ween leng h o ime
since immig a ion and body weigh among i s
gene a ion immig an s.
The e iew was wo ldwide, including coun-
ies o which da a was a ailable, and ocused
on wo app oaches o esea ch which add ess
he links be ween immig a ion, accul u a ion
and weigh gain among i s gene a ion immi-
g an s. The i s uses leng h o esidence in he
hos coun y as a p oxy measu e o accul u a ion.
Al hough a e y common app oach, he alid-
i y o his assump ion has ye o be ully dem-
ons a ed in he li e a u e
9
. The second a ea o
esea ch compa es immig an s li ing in he hos
coun y wi h hei coun e pa s li ing in hei
home coun y.
Me hods
A sys ema ic e iew was conduc ed in acco dance
wi h PRISMA guidelines
11
h ough a sea ch o
published s udies con ained in he PubMed, JS-
TOR and EBSCO da abases, wi h no publica ion
da e es ic ions. The sea ch was conduc ed ini-
ially on July 27
h
2011 and upda ed on Augus
8
h
2014. The ollowing combined keywo ds we e
used as al e na i es in o de o ob ain as many
s udies as possible: “immig an ”; “mig an ”, “ o -
eign-bo n”; “coun y o bi h”, “coun y o o igin”;
“ egion o bi h”, “ egion o o igin”; “BMI”, “body
mass index”; “o e weigh ”, “obesi y”; “body
weigh ” and “du a ion”, “leng h o s ay”; “ ime”;
“accul u a ion”.
The i les and abs ac s o he iden i ied pa-
pe s we e independen ly sc eened by he i s
wo au ho s who a i ed a a consensus on eligi-
bili y and con en . The ull ex s o po en ially el-
e an pape s we e assessed o eligibili y based
on he ollowing c i e ia: (i) pape s mus desc ibe
o iginal wo k; (ii) s udies include adul s bo n in
o eign coun ies ( i s gene a ion immig an s)
and espec i e speci ic da a abou he a iables
o in e es ; (iii) measu e o o e weigh o BMI (o
change in hese a iables) is a key/endpoin a i-
able – whe he sel - epo ed o no ; (i ) s udies
include leng h o esidence in he hos coun y
o amoun o ime spen in he hos coun y as
a key/independen a iable; ( ) s udies include
da a ha allows compa ison o immig an s
g oups and nonimmig an coun e pa s om he
immig an ’s coun y o o igin; ( i) ull ex s a e
in English, Spanish o Po uguese. S udies ha
IMPACT OF MIGRATION ON BODY WEIGHT
231
Cad. Saúde Pública, Rio de Janei o, 31(2):229-245, e , 2015
ocused only on child en o eenage s, ega d-
less o whe he hey we e i s gene a ion immi-
g an s, we e excluded. Gene ally his g oup is no
en i ely independen in hei ood and leisu e
physical ac i i y choices, and choice o whe e o
li e, and he e o e he ac o s ha in luence he
a iables in his g oup a e di e en o hose in-
luencing adul immig an s.
Da a was ex ac ed in o a s anda dized ma-
ix ha included he i le o he a icle, name o
he scien i ic jou nal and publica ion, hos coun-
y, popula ion and compa ison g oups (i appli-
cable), main ou come (BMI, o e weigh /obesi y,
change in BMI), s a is ical analysis, co a ia es
used, and main esul s.
The i s wo au ho s independen ly ap-
p aised he quali y o he e idence p oduced by
s udies ocussing on he impac o immig a ion
on obesi y based on he ollowing c i e ia: (a) e-
c ui men s a egy; (b) sample size; (c) whe he
pa icipa ion a e was epo ed; (d) pa icipa ion
a e; (e) well de ined eligibili y c i e ia; and ( )
o e all adequacy o me hods. The esul s o each
c i e ia we e used o gene a e a inal sco e, ang-
ing om 0 (low ele ance) o 7 (high ele ance).
Resul s
The s udy selec ion p ocess is shown in Figu e 1.
A o al o 39 a icles om an ini ial lis o 365 ci-
a ions we e conside ed eligible o his e iew.
These a icles we e published be ween 2000 and
2014 and based on s udies in he ollowing coun-
ies: he Uni ed S a es (25), Canada (4), he Ne h-
e lands (1), Spain (1), I aly (1), Is ael (1), F ance
(1), No way (2), Luxembou g (1), Sweden (1) and
he Uni ed Kingdom (1).
Sample sizes a ied be ween 53
12
and
478,276 indi iduals
13
. Table 1 shows ha a num-
be o pape s included in his e iew did no in-
clude ele an de ails abou me hodology, pa -
icula ly sampling and ec ui men echniques
and pa icipa ion a es, hus comp omising he
quali y o he e idence.
Leng h o esidence in he hos coun y
as a de e minan o inc eases in BMI
Signi ican dispa i ies we e obse ed be ween
immig an sub-g oups wi h ega d o he asso-
cia ion be ween leng h o ime since immig a ion
and BMI
13
. Resul s a e he e o e p esen ed by
immig an g oup (Table 2) showing he esul s
o speci ic coun ies o o igin whe e a ailable.
Some s udies he e o e appea mo e han once.
We show he mos p e alen eligion among im-
mig an s and i s language based on he egion
Figu e 1
PRISMA luxog am.
o bi h o acili a e he g ouping o immig an s
and he in e p e a ion o po en ial accul u a-
ion ba ie s. Fou o he s udies
12,14,15,16
used
only emale samples. All bu one o he s udies
17
sampled only adul s. All bu one o he s udies
18
we e c oss-sec ional. One s udy consis ed o
a epea ed c oss-sec ional su ey o e alua e
changes in he p e alence o obesi y among
immig an s and US-bo n indi iduals
19
. BMI
was sel - epo ed in he majo i y o he s udies.
Ten o he s udies measu ed weigh and heigh
14,16,18,20,21,22,23,24
, while one s udy measu ed only
heigh and weigh was sel - epo ed
25
. In ano h-
e s udy, weigh and heigh we e measu ed bu
change in BMI (ou come a iable) was calcula ed
based on sel - epo ed pas weigh and heigh
26
.
Only one s udy epo ed o ha e impu ed miss-
ing da a
27
. The a iable leng h o esidence in
he hos coun y was always de ined using an
in e al scale, gene ally di ided in o ecen (< 5
yea s) and long- e m (> 15 yea s). Ele en
13,17,20,
28,29,30,31,32,33,34,35
s udies included all immig an
g oups esiden in he hos coun y. Fi e s ud-
ies
17,28,32,36,37
showed he inc ease in leng h o
esidence in he hos coun y bu did no s a i y
he esul s by immig an g oup. Ano he s udy
28
p esen ed esul s by egion o o igin, concluding
Goulão B e al.
232
Cad. Saúde Pública, Rio de Janei o, 31(2):229-245, e , 2015
Table 1
Quali y assessmen o he s udies e iewed.
Au ho s Hos coun y Rec ui men
s a egy *
Sample
size **
Pa icipa ion
a e
( epo ed
o no ) ***
Pa icipa ion
a e >
75% ***
Eligibili y
c i e ia well
de ined ***
O e all
app ecia ion
o ele ance
o he a icle #
Koya & Egede 28 Uni ed S a es 22101↑↑↑
Pa k e al. 20 Uni ed S a es 0 2 0 0 1 ↑
Gu ié ez-Fisac e al. 32 Spain 2 2 0 0 1 ↑↑
I e sen e al. 26 No way 1 2 1 0 1 ↑↑
Rege -Tobias e al. 12 Is ael 1 0 0 0 1 ↑
No o ny e al. 80 Uni ed S a es 2 2 0 0 1 ↑↑
Laude dale & Ra houz 39 Uni ed S a es 2 2 1 1 1 ↑↑↑
Dijkshoo n e al. 42 Ne he lands 02101↑↑
McDonald & Kennedy 30 Canada 2 2 0 0 1 ↑↑
Goel e al. 34 Uni ed S a es 2 2 1 0 1 ↑↑↑
Roshania e al. 17 Uni ed S a es 2 2 0 0 1 ↑↑
Fu & Vanlandingham 21 Uni ed S a es 2 1 1 0 1 ↑↑
Yeh e al. 63 Uni ed S a es 1 2 0 0 1 ↑↑
Ba cenas e al. 38 Uni ed S a es 0 2 1 1 1 ↑↑
Sanchez-Vaznaugh e al. 81 Uni ed S a es 2200 1↑↑
Linds öm & Sundquis 49 Sweden 2 2 1 0 1 ↑↑↑
Alb ech e al. 18 Uni ed S a es 02001 ↑
Choi e al. 41 Uni ed S a es 1 0 1 0 1 ↑
T emblay e al. 33 Canada 0 2 1 1 1 ↑↑
Fuen es-A lick & Hessol 25 Uni ed S a es 0 0 1 1 1 ↑
Wolin e al. 14 Uni ed S a es 0 1 0 0 1 ↑
Toselli e al. 53 I aly 0 0 0 0 1 ↑
Dey & Lucas 82 Uni ed S a es 2 0 0 0 1 ↑
Kaplan e al. 83 Uni ed S a es 2 2 1 0 1 ↑↑↑
Oza-F ank & Na ayan 31 Uni ed S a es 2 2 0 0 1 ↑↑
Sanchez-Vaznaugh e al. 29 Uni ed S a es 2 2 0 0 1 ↑↑
Cai ney & Os bye 36 Canada 2 2 0 0 1 ↑↑
Mille e al. 16 Uni ed S a es 00001 ↑
Chiu e al. 35 Canada 2 2 1 0 1 ↑↑↑
C eigh on e al. 27 Uni ed S a es 2 2 1 1 1 ↑↑↑
Ullmann e al. 84 Uni ed S a es 21001↑↑
Ma in-Fe nandez e al. 37 F ance 22101↑↑↑
Gele & Mbalilaki 23 No way 0 0 0 0 1 ↑
Ba hmal e al. 40 Uni ed S a es 2 2 1 1 1 ↑↑↑
Riosmena e al. 85 Uni ed S a es 22001↑↑
Pa ikh e al. 86 Uni ed S a es 11101↑↑
Ga duño-Diaz & Khokha 24 Uni ed Kingdom 0 0 0 0 1 ↑
Pa k e al. 19 Uni ed S a es 2 2 0 0 1 ↑↑
Bha naga e al. 45 Uni ed Kingdom 0 1 1 1 1 ↑↑
Mahajan & Be mingham 43 Aus alia 0 0 0 0 1 ↑
Tennakoon e al. 46 No way 2 2 1 0 1 ↑↑↑
Kou is-Blazos e al. 50 Aus alia 2 0 1 1 1 ↑↑
Zahid e al. 44 No way 22101↑↑↑
* 0: non- andomized/con enience sampling; 1: andomized sampling (no na ional-based); 2: andomized sampling (na ional-based);
** 0: < 385 cases; 1: 385-1,000 cases; 2: > 1,000 cases;
*** 0: C i e ia no me (e.g. pa icipa ion a e no epo ed, pa icipa ion a e < 75% and eligibili y c i e ia no well de ined); 1: C i e ia me (e.g. pa icipa ion
a e epo ed, pa icipa ion a e > 75% and eligibili y c i e ia well de ined);
# Compu ed as he sum o sco es gi en o each o he i e indica o s (p e ious columns). This o e all sum was subsequen ly ecoded in o in he ollowing
ca ego ies: ↑ Poo (less han 4 poin s); ↑↑ Accep able (4 o 5 poin s); ↑↑↑ Good (> 5 poin s).
IMPACT OF MIGRATION ON BODY WEIGHT
233
Cad. Saúde Pública, Rio de Janei o, 31(2):229-245, e , 2015
Table 2
E ec o leng h o esidence on body mass index/o e weigh p e alence, by immig an g oup.
Immig an g oup Sample
size
Hos coun y Coun y o o igin O icial language/s (Mos p e alen )
eligion/s
Re e ence Associa ion
wi h BMI/
o e weigh
p e alence
Hispanics 7,503 Uni ed S a es Mexico Spanish Roman Ca holicism Ba cenas e al. 38 ↑
313 Uni ed S a es Cen al and Sou h
Ame ica, Mexico
Spanish and
Po uguese
Roman Ca holicism Fuen es-A lick &
Hessol 25
↑
32 374 Uni ed S a es * * * Goel e al. 34 ↑
174 Uni ed S a es Pue o Rico women Spanish Roman Ca holicism Himmelg een e
al. 15
↑
2,420 Uni ed S a es Mexico, Cen al and
Sou h Ame ica o
Ca ibbean
Spanish and
Po uguese
Roman Ca holicism
o Ch is iani y
Kaplan e al. 83 ↑
33,299 Uni ed S a es Mexico, Cen al
and Sou h Ame ica,
Ca ibbean Islands
Spanish and
Po uguese
Roman Ca holicism
o Ch is iani y
Oza-F ank &
Na ayan 31
↑
13,011 Uni ed S a es * * * Pa k e al. 20 ↑
37,350 Uni ed S a es Mexico, Cen al and
Sou h Ame ica, Pue o
Rico
Spanish and
Po uguese
Roman Ca holicism
o Ch is iani y
Sanchez-Vaznaugh
e al. 29
↑
154,649 Uni ed S a es *Spanish and
Po uguese
Roman Ca holicism Singh e al. 13 ↑
Cuba Spanish Roman Ca holicism ↔
Mexico Spanish Roman Ca holicism ↑
Pue o Rico Spanish Roman Ca holicism ↔
388 Mexico Spanish Roman Ca holicism Wolin e al. 14 ↑
126,796 Canada * * * McDonald &
Kennedy 30
↑
1,486 Uni ed S a es Mexico and Non-Mexico Spanish Roman Ca holicism Alb ech e al.
18 **
↔
399 Uni ed S a es “Mainly Mexican” Spanish Roman Ca holicism Ulmann e al. 84 ↑
1,610 Uni ed S a es Mexico Spanish Roman Ca holicism C eigh on e al. 27 ↑
273,188 Uni ed S a es * * * Pa k e al. 19 ↑
43,042 Uni ed S a es Mexico Spanish Roman Ca holicism Riosmena e al. 85 ↔
Numbe o men ions inding posi i e associa ion/To al numbe o men ions 15/19
(con inues)
ha his a iable had a signi ican e ec on he
p e alence o ca dio ascula isk ac o s (includ-
ing o e weigh ) among immig an s. A s udy by
Ma in-Fe nandez e al.
37
o immig an s li ing in
F ance ound ha he associa ion be ween leng h
o ime spen in he hos coun y and BMI/o e -
weigh was only e iden among olde men.
• Hispanics
Nine een men ions o he Hispanic subg oup in-
ol ing di e en coun ies o o igin we e made in
17 s udies, o which 15 showed a posi i e associa-
ion be ween leng h o esidence and BMI/ a e
o o e weigh 79%). All excep one o he s ud-
ies ( om Canada) we e om he Uni ed S a es.
Sample sizes a ied be ween 32 and 273,188 im-
mig an s.
A c oss-sec ional popula ion based s udy ca -
ied ou by Sanchez-Vaznaugh e al.
29
in Cali o -
nia showed ha inc eases in BMI wi h leng h o
esidence and gene al mean BMI we e g ea es
among Hispanic immig an s. This associa ion
a ies wi hin he Hispanic subg oup, wi h Mexi-
can immig an s expe iencing he g ea es inc ease
in BMI and wais ci cum e ence o e ime
18
.

Goulão B e al.
234
Cad. Saúde Pública, Rio de Janei o, 31(2):229-245, e , 2015
Table 2 (con inued)
Immig an g oup Sample
size
Hos coun y Coun y o o igin O icial language/s (Mos p e alen )
eligion/s
Re e ence Associa ion
wi h BMI/
o e weigh
p e alence
Asia ics 37,350 Uni ed S a es China, Philippines,
Ko ea, Vie nam, Paci ic
Islands
Chinese, Filipino/
English, Ko ean,
Vie namese,
Nau uan/English
Taoism, Roman
Ca holic,
Buddhism,
Con ucianism
Sanchez-Vaznaugh
e al. 29
↔
63,030 Uni ed S a es China, Vie nam, Ko ea Chinese,
Vie namese, Ko ean
Non- eligious,
Ca holic,
Buddhism,
Con ucianism
Wang e al. 87 ↑
254,153 Uni ed S a es Japan, China,
Philippines, India, Ko ea,
Vie nam
Japanese, Chinese,
Filipino/English,
Hindi, Ko ean,
Vie namese
Buddhism, Taoism,
Roman Ca holic,
Hinduism
Laude dale &
Ra houz 39
↑
2,537 Uni ed S a es China Chinese Taoism Yeh e al. 63 ↑
33,299 Uni ed S a es Sou heas Asia Vie namese, Thai,
Khme , ...
Islam, Budhism Oza-F ank &
Na ayan 31
↔
Cen al Asia Russian, Manda in
Chinese
Islam ↑
Middle Eas A abic, Pea sian,
Tu kish, Be be ,
Ku dish
Islam ↔
802 Uni ed S a es Chinese Chinese Taoism Alb ech e al.
18 **
↔
32,374 Uni ed S a es * * * Goel e al. 34 ↔
86,687 Canada China, Philippines,
Ko ea, Japan, Vie nam,
Cambodia, Laos,
Indonesia
Chinese, Japanese,
Ko ean, Vie namese
Taoism, Islam,
Buddhism
T emblay e al. 33 ↑
I an, A ghanis an Pe sian Islam, Muslim ↔
India, Pakis an, S i Lanka Hindu, English,
U du, Sinhala
Hinduism,
Buddhism, Muslim
↑
13,011 Uni ed S a es * * * Pa k e al. 20 ↔
154,649 Uni ed S a es China Chinese Budhism Singh e al. 13 ↔
Philippines Filipino, English Roman Ca holic ↔
India Hindu Hinduism ↔
O he Asian coun ies
and Paci ic Islands
* * ↑
126,796 Canada Sou h Asian Hindu, English,
U du, Sinhala
Hinduism,
Buddhism, Muslim
McDonald &
Kennedy 30
↑
Sou heas Asian Vie namese, Thai,
Khme
Islam, Budhism ↑
Wes Asia Pe sian Islam, Muslim ↑
China, Japan, Ko ea Chinese, Japanese,
Ko ean
Taoism, Buddhism ↔
703 Uni ed S a es Vie nam Budhism Vie namese Fu &
Vanlandingham 21
↑
261 Uni ed S a es Vie nam Budhism Vie namese Choi e al. 41 ↑
16,316 No way Vie nam Budhism Vie namese I e sen e al. 26 ↔
S i Lanka Sinhala Budhism ↑
Pakis an English, U du Muslim ↔
I an Pe sian Islam ↔
Tu key Tu kish Islam ↔
(con inues)
IMPACT OF MIGRATION ON BODY WEIGHT
235
Cad. Saúde Pública, Rio de Janei o, 31(2):229-245, e , 2015
Table 2 (con inued)
Immig an g oup Sample
size
Hos coun y Coun y o o igin O icial language/s (Mos p e alen )
eligion/s
Re e ence Associa ion
wi h BMI/
o e weigh
p e alence
Asia ics 1,384 Ne he lands Tu key Tu kish Islam Dijkshoo n e
al. 42
↔
3,228 Uni ed S a es India Hindu Hinduism Bha mal e al. 40 ↔
163,797 Canada Sou h Asian Vie namese, Thai,
Khme , Hindu, ...
Islam, Budhism,
Hinduism
Chiu e al. 35 ↔
China Chinese Budhism ↔
517 Uni ed S a es China Chinese Budhism Pa ikh e al. 86 ↔
100 Uni ed
Kingdom
Sou h Asian Vie namese, Thai,
Khme , Hindu, ...
Islam, Budhism,
Hinduism
Ga duño-Diaz &
Khokha 24
↔ ***
Numbe o men ions inding posi i e associa ion/To al numbe o men ions 13/34
Eu opeans 37,350 Uni ed S a es * * * Sanchez-Vaznaugh
e al. 29
↓
33,299 Uni ed S a es * * Ch is ian Oza-F ank &
Na ayan 31
↑
Russia Russian O hodox
Ch is iani y
↑
126,796 Canada * * * McDonald &
Kennedy 30
↑
32,374 Uni ed S a es * * * Goel e al. 34 ↑
86,687 Canada * * * T emblay e al. 33 ↑
13,011 Uni ed S a es * * * Pa k e al. 20 ↑
154,649 Uni ed S a es * * * Singh e al. 13 ↑
843 Luxembou g Po ugal Po uguese Roman Ca holic Alke wi e al. 22 ↔
218 Uni ed S a es Fo me So ie Union Russian O hodox
Ch is iani y
Mille e al. 16 ↔
163,797 Canada * * * Chiu e al. 35 ↑
Numbe o men ions inding posi i e associa ion/To al numbe o men ions 8/11
No h A icans 1,384 Ne he lands Mo occo A abic, Be be Muslim Dijkshoo n e
al. 42
↑
339 I aly Mo occo A abic, Be be Muslim Toselli e al. 53 ↑
Numbe o men ions inding posi i e associa ion/To al numbe o men ions 2/2
Sub-Saha ian
A icans
37,350 Uni ed S a es * * * Sanchez-Vaznaugh
e al. 29
↑
33,299 Uni ed S a es * * * Oza-F ank e al. 31 ↑
126,796 Canada * * * McDonald &
Kennedy 30
↑
32,374 Uni ed S a es * * * Goel e al. 34 ↔
13,011 Uni ed S a es * * * Pa k e al. 20 ↔
154,649 Uni ed S a es * * * Singh e al. 13 ↔
53 Is ael E hiopia Amha ic Ch is iani y Rege -Tobias e
al. 12
↑
208 No way Somalia Somali, A abic Muslim Gele & Mbalilaki
23
↑
163,797 Uni ed S a es * * * Chiu e al. 35 ↔
Numbe o men ions inding posi i e associa ion/To al numbe o men ions 5/9
* No indica ion (i.e., no possible o iden i y, om he o iginal a icle/ e e ence);
** Alb ech e al. 18 is he only longi udinal s udy included in his e iew;
*** The e is no indica ion o he s a is ical signi icance o he inc eased BMI mean in long- e m immig an s compa ed wi h sho - e m immig an s.
↑ Signi ican s a is ical posi i e associa ion be ween he wo a iables o in e es ; ↔ No signi ican associa ion ound be ween he wo a iables o in e es ;
↓ S a is ical endency ( hough no signi ican ) o a nega i e associa ion be ween he wo a iables o in e es .
Goulão B e al.
236
Cad. Saúde Pública, Rio de Janei o, 31(2):229-245, e , 2015
Alb e ch e al.
18
conduc ed he only longi udi-
nal s udy on his ma e in ol ing Asian and His-
panic immig an s li ing in six di e en egions o
he Uni ed S a es. Mean annual changes in BMI
we e s a is ically signi ican among Mexican im-
mig an s, bu no in o he Hispanic subg oups.
Howe e , hese changes a e no signi ican ly
di e en om hose obse ed among US-bo n
Mexican-Ame icans.
The indings sugges di e ences be ween
gende s. Ba cenas e al.
38
epo ed ha among
males BMI was signi ican ly in long- e m immi-
g an s ( esiden o ≥ 15 yea s) han among sho -
e m immig an s (< 5 yea s), while among e-
males BMI was signi ican ly highe in all leng h o
esidence ca ego ies (5 o 9 yea s; 10 o 14 yea s;
≥ 15 yea s) han in he sho - e m ca ego y
32
.
• Asians
Resul s we e less consis en , showing di e ences
acco ding o egion o bi h. Sample sizes a ied
om 261 o 254,153 indi iduals. S udies co e ed
he ollowing hos coun ies: Uni ed S a es (13),
Canada (3), No way (1), and he Ne he lands (1).
O he 34 men ions made o he Asian subg oup
(co esponding o 18 di e en s udies abou
Asian immig an s), 13 (38.2%) ound a posi i e
and signi ican associa ion be ween leng h o
esidence and BMI/ a e o o e weigh . McDon-
ald e al.
30
ound ha he e was li le change in
weigh wi h inc easing leng h o esidence in he
hos coun y among Chinese immig an s li -
ing in Canada. The only longi udinal s udy in-
cluded in his e iew showed ha he e was no
inc ease in BMI o wais ci cum e ence among
Chinese immig an s a e a i e-yea ollow-up
1
,
while h ee s udies
1,13,39
ound a low p e alence
o o e weigh in his g oup. E idence om wo
s udies
30,31
shows a posi i e o null associa ion
be ween he wo main a iables among immi-
g an s om he Middle Eas and Wes Asia. While
no inc ease in BMI wi h inc easing leng h o esi-
dence in he hos coun y was shown o Indians
li ing in Cali o nia
40
, BMI and insulin- esis ance
ends o be g ea e in his g oup han in hei
coun e pa s li ing in India
10
. A posi i e asso-
cia ion be ween inc ease in BMI and inc easing
leng h o esidence in he hos coun y was ound
among Vie namese immig an s li ing in Uni ed
S a es
21,41
and his g oup was mo e likely o be
o e weigh han e u nees o coun e pa s who
ne e le he coun y
21
. This e ec was no con-
i med in No way
26
. Dijkshoo n e al.
42
ound a
high p e alence o obesi y in Tu kish immig an s
li ing in he Ne he lands, bu he e was no e i-
dence o an associa ion wi h leng h o esidence
in he hos coun y.
• Eu opeans
Sample sizes a ied be ween 218 and 163,797.
Only wo s udies included he immig an s’ coun-
y o o igin
16,22
. Ele en men ions we e made o
he Eu opean subg oup in 10 di e en s udies, o
which eigh epo ed a posi i e associa ion be-
ween he wo a iables o in e es (72.7%).
A c oss-sec ional popula ion-based s udy
in he Uni ed S a es ca ied ou by Sanchez-
Vaznaugh e al.
29
epo ed ha he BMI o im-
mig an s li ing in he hos coun y o less han
5 yea s was 1.6% highe han ha o immig an s
who had been li ing in he coun y o 15 yea s o
mo e. Howe e , he au ho s also ound ha he
BMI o whi e immig an s li ing in Uni ed S a es
o 15 yea s was highe han he BMI o hose who
had li ed in he coun y o 10 o 14 yea s. These
esul s con adic he indings o a c oss-sec-
ional popula ion-based s udy ca ied ou in he
Uni ed S a es by Oza-F ank e al.
31
which shows
ha long- e m Caucasian immig an s ( esiden
o ≥ 15 yea s) a e h ee- imes mo e likely o be
o e weigh han ecen immig an s ( esiden
o < 5 yea s) om he same e hnic backg ound.
Newly-a i ed Caucasian immig an s in Canada
a e 15% less likely o be o e weigh bu he a e
o o e weigh p og essi ely inc eases each-
ing hos coun y le els a e a ound 30 yea s o
esidence
30
.
• A icans
Two s udies included No h A icans (Mo oc-
cans). The hos coun ies we e he Ne he lands
and I aly and sample sizes we e 339 and 1,384.
Bo h s udies ound a signi ican posi i e associa-
ion be ween he wo a iables o in e es . How-
e e , he s udy in he Ne he lands, ca ied ou by
Dijkshoo n e al.
42
, ound ha his associa ion
was only s a is ically signi ican among women
(c oss-sec ional s udy wi h da a de i ed om a
sample aken om he Ams e dam popula ion
egis e ).
The sample sizes o Sub-Saha an A ican im-
mig an s a ied be ween 208 and 163,797 and
co e ed he ollowing hos coun ies: Uni ed
S a es (6), Canada (1), Is ael (1); and No way (1).
Nine men ions we e made in nine di e en s ud-
ies, i e o which epo ed a posi i e and signi i-
can associa ion be ween leng h o esidence and
BMI/ a e o o e weigh (55.6%). Only wo s udies
epo ed he na ionali y o immig an s (E hiopia
and Somalia). A signi ican inc ease in he a e o
o e weigh wi h inc easing leng h o esidence
was ound among Somali immig an s li ing in
Oslo (No way)
23
.
IMPACT OF MIGRATION ON BODY WEIGHT
237
Cad. Saúde Pública, Rio de Janei o, 31(2):229-245, e , 2015
Compa ison o immig an s wi h espec i e
home-coun y esiden s
O he six s udies ound in his ca ego y, ou we e
om Eu opean coun ies and wo om Aus a-
lia (Table 3). Sample sizes anged om 250
43
o
2,000
44
and he pape s we e published be ween
1995
45
and 2011
44
. All samples included bo h
gende s. Two s udies
43,45
used ela i es as con-
ols. Fi e o he s udies
45,46,47,48,49
epo ed ha
immig an s had a highe BMI han he con ol
g oup. A s udy o Indian immig an s li ing in
Aus alia
43
showed no signi ican di e ence in
BMI among men. Howe e , he g oup li ing in In-
dia had highe wais -hip a ios. Two s udies
43,46
showed ha he ca dio ascula isk p o ile was
be e in immig an s han in he con ol g oup.
Fi e ou o he six s udies included Asian
samples. Two s udies
43,46
o Indian and S i Lank-
an immig an s epo ed ha he ca dio ascula
isk p o ile was wo se in nonimmig an s, despi e
he ac ha BMI was lowe o equal in his g oup.
Mahajan & Be mingham
43
ound ha he le el
o abdominal obesi y was lowe (wais -hip a io)
among Indian immig an s han among men and
women li ing in he coun y o o igin. Tennakoon
e al.
46
ound ha emale S i Lankan immig an s
had highe BMI and highe wais ci cum e ence,
bu lowe iglyce ide and blood p essu e le els
han women li ing in S i Lanka, while Bha naga
e al.
45
epo ed wo se ca dio ascula p o iles,
highe BMI alues, and highe o al choles e ol
le els among Indians li ing in England when
compa ed o hei coun e pa s li ing in India.
Kou is-Blazo e al.
50
epo ed ha he a e
o obesi y among elde ly G eek immig an s li -
ing in Aus alia was highe han among hei
coun e pa s in G eece. These immig an s ap-
pa en ly had heal hie ood habi s bu a wo se
heal h s a us.
Discussion
The associa ion be ween leng h o esidence in
he hos coun y and inc ease in BMI seems o
a y acco ding o he e hnic backg ound o im-
mig an s. This sec ion he e o e akes a mo e de-
ailed look a he associa ion by e hnic g oup.
Hispanics
The isk o de eloping obesi y is g ea e among
Hispanic immig an s han among people om
o he e hnic g oups li ing in he Uni ed S a es
29
.
The esul s o linea eg ession show a clea in-
c ease in mean BMI ac oss gene a ions o His-
panic immig an s
10
. This inc ease is g ea e
among emale immig an s
38
, showing ha
women a e mo e ulne able o he accul u a ion
p ocess
28
.
High a es o p e alence o obesi y and ype
2 diabe es among Hispanics may be explained
by he gene ic he i age ecei ed om Ame ican
Indians
10
. Sanchez-Vaznaugh e al.
29
explain
ha newly-a i ed Hispanic immig an s ha e
lowe educa ional a ainmen and a e less likely
o speak English, s alling upwa d social mobil-
i y and cons aining li e choices and oppo u-
ni ies. Fu he mo e, highe BMI may be due o
cumula i e exposu e o social and physical en-
i onmen s and neighbo hoods ha lack access
Table 3
Body mass index (BMI) o o e weigh p e alence compa isons be ween immig an and non-immig an communi ies, by hos coun y.
Immig an
g oup
Hos coun y Yea o publica ion Re e ence Signi ican di e ences (immig an g oup s. hei coun e pa s)
Pakis ani No way 201144 Men: immig an s had signi ican ly highe BMI (4.5kg/m2 highe in immig an
g oup); Women: immig an s had signi ican ly highe BMI (3.3kg/m2 highe in
immig an g oup)
Indians No way 2011 44 Men: BMI wi hou signi ican di e ences be ween g oups;
Women: immig an s had signi ican ly highe BMI (2.6kg/m2)
Uni ed Kingdom 2006 47 Men: immig an s had signi ican ly highe BMI (4.9kg/m2);
Women: immig an s had signi ican ly highe BMI (5.8kg/m2)
Uni ed Kingdom 1995 45 Men: immig an s had signi ican ly highe BMI (3.9kg/m2);
Women: immig an s had signi ican ly highe BMI (4.7kg/m2)
S i Lankans No way 2010 46 Men: immig an s had signi ican ly highe BMI (3.2kg/m2);
Women: immig an s had signi ican ly highe BMI (2.1kg/m2)
G eeksAus alia 1996 48
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Submi ed on 15/Dec/2013
Final e sion esubmi ed on 25/Sep/2014
App o ed on 31/Oc /2014