The impact of migration on body weight : a review

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 Goulão B e al. 244 Cad. Saúde Pública, Rio de Janei o, 31(2):229-245, e , 2015 31. Oza-F ank R, Na ayan KMV. 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