https://orcid.org/0000-0001-8378-1612
Figures
Abstract
Background
Migration in Spain has increased in recent decades, leading to a multicultural society. These migrations have brought about a transcendental change in the lifestyles and health of migrants. The aim of these study was to describe the frequency of consumption of sugary drinks, fruit and vegetables in the native and immigrant population residing in the Valencian Community (Spain) and its possible relationship with certain socioeconomic characteristics and lifestyles.
Methods
A representative sample of the population aged 15 years or older, non-institutionalised and resident in the Valencian Community. Descriptive cross-sectional observational study conducted on the basis of the Valencian Community Adult Health Survey, 2016. We analysed the consumption of fruit, vegetables and sugary soft drinks by country of birth and sex, and their possible association with socio-demographic characteristics and lifestyles.
Results
5485 adults aged 15 years and older were analysed, 13.48% of whom were of immigrant origin. Overall, women had a significantly lower adjusted risk of inadequate vegetable consumption and lower than recommended fruit consumption. Men of immigrant origin showed a higher risk of lower than recommended vegetable consumption and a lower risk of inadequate consumption of sugar-sweetened soft drinks than natives. Women of immigrant origin showed a lower risk of lower-than-recommended vegetable consumption but a higher risk of inadequate consumption of sugar-sweetened soft drinks. Differences were also observed in the recommended consumption of these products according to educational level, social class, age, employment status, physical exercise and self-perceived weight.
Citation: Moncho J, Ortega Sarabia LE, Trescastro-López EM, Martínez-García A (2025) Differences in dietary patterns between native and immigrant populations in Spain. PLoS One 20(7): e0328458. https://doi.org/10.1371/journal.pone.0328458
Editor: Francis Xavier Kasujja, Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, UGANDA
Received: February 4, 2025; Accepted: July 1, 2025; Published: July 21, 2025
Copyright: © 2025 Moncho et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: The data provided to the study researchers are public and anonymous. They are available at the following references: Generalitat Valenciana. Conselleria de Sanitat Universal i Salut Pública. (2018). Encuesta de Salud 2016 de la Comunitat Valenciana. Metodología. https://www.sp.san.gva.es/DgspPortal/docs/ES_Metodologia2018.pdf Generalitat Valenciana. Conselleria de Sanitat Universal i Salut Pública. (2022). Dirección General de Salud Pública y Adicciones. Polìticas de salud/Encuestas de Salud. https://www.sp.san.gva.es/sscc/opciones4.jsp?CodPunto=3785&Opcion=SANMS502&MenuSup=SANMS50&Nivel=2.
Funding: The publication costs of this article were funded by ISABIAL (Instituto de Investigación Sanitaria de Alicante) (Group 23). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
Competing interests: The authors have declared that no competing interests exist.
Introduction
In recent decades, there has been a notable increase in migration, which has contributed to the transformation of Spain into a multicultural country [1]. The National Statistics Institute (INE) reports that as of 1 January 2023, 8,204,206 individuals of immigrant origin (born abroad) reside in Spain, representing 17.06% of the total population. The main receiving regions are Catalonia (1,774,487), Madrid (1,535,784) and Valencia (1,091,230) [2].
These migrations entail a major change in the lifestyles of the people involved, who ultimately adopt the norms of the host country (acculturation). This process can have both positive and negative consequences for habits such as diet, physical activity or the consumption of toxic substances (drugs, alcohol, tobacco), among others [3–5].
The diets of migrants can be influenced by numerous socio-demographic factors such as gender, ethnicity, age, income, educational level, social status and geography that determine consumption patterns [4,6,7].
In this sense, consumption patterns refer to the amounts, proportions, combinations or varieties of foods and beverages consumed, as well as the frequency with which they are habitually consumed. Some consumption patterns have been identified as a significant risk factor for population health. According to the World Health Organization (WHO), the nutritional recommendations for a healthy population are 5 servings of fruits and vegetables per day and limiting their intake of foods and beverages with a high sugar content to the greatest extent possible [8]. The Mediterranean Diet is considered a healthy dietary pattern that meets these recommendations [9,10].In this regard, several studies have indicated a correlation between the consumption of sugar-sweetened beverages and an increased risk of developing type II diabetes mellitus, cardiovascular disease, dental caries and certain types of cancer [11–13]. In contrast, the consumption of fruits, vegetables, whole grains and other plant-based foods has been associated with a reduced risk of developing the aforementioned chronic diseases [8,14–17].
According to previous research in other countries [18–25], knowing the differences in the consumption patterns of sugary drinks, fruit and vegetables among migrant population compared to those born in the host country may facilitate the design of effective strategies to promote healthy eating habits in specific populations, taking cultural differences into account. This study is therefore necessary for several reasons. Spain is one of the countries with the largest immigrant population globally [26] comprising individuals from a multitude of nationalities and cultural backgrounds [1]. It is therefore evident that an understanding of the dietary patterns of the immigrant community is essential for the development of effective interventions and policies aimed at improving public health. Furthermore, there is a lack of research on this topic in Spain. For this reason, the present study is proposed.
The aim of the present study was to describe the frequency of consumption of sugar-sweetened beverages, fruit and vegetables among the native and immigrant population residing in the Valencian Community aged 15 years and older, and its possible relationship with certain socioeconomic characteristics and lifestyles.
Methods
Data sources
Descriptive cross-sectional observational study based on the Health Survey of the Valencian Community, corresponding to the year 2016, which included a representative sample of the population aged 15 years or older, non-institutionalised and resident in the said Community. The survey was carried out by the health authorities within the scope of the health policies of the Regional Ministry of Health of the Valencian Community [25]. The data collection was conducted by a company that had been awarded the contract between the months of May and December 2016.
Given the structure of the sample design used to collect the sample (complex sample design that assigned each subject a weighting factor according to its representativeness), all the analyses carried out took into account the corresponding weighting factors included in the databases provided by the Health Plans Service of the Regional Ministry of Health of the Generalitat Valenciana. Details on the survey methodology (sample design, sampling procedure, consent, ethics, etc.) have been published previously [27]. According to national regulations, the data from the National or Autonomous Health Surveys are public in Spain and the Valencian Health Authorities are responsible and guarantors of confidentiality and anonymity, so the approval of an ethical committee is not necessary [28]. The data provided to the study investigators are publicly available and anonymized, so this research does not raise ethical issues.
Dependent variables
The dependent variables were consumption of fruit, vegetables and sugar-sweetened soft drinks. Initially, fruit and vegetable consumption were considered at three levels (less than one serving per day, one to two servings per day and three or more times per day). Consumption of sugary soft drinks was considered at five levels (one or more times a day, 4–6 times a week, 1–3 times a week, less than once a week and never). These variables were subsequently recoded twice in order to analyse, on the one hand, inadequate consumption of these products and, on the other hand, non-compliance with the recommendations on their consumption. The following were considered inadequate consumption of the different products analysed: not consuming fruit, not consuming vegetables or consuming them less than once a week, and consuming sugary drinks one or more times a day. Recommended consumption was considered to be consuming two or more fruits per day, three or more servings of vegetables per day and never consuming sugar-sweetened beverages, in line with the latest recommendations made for healthy populations [8,29,30].
Explanatory variables
The main explanatory variables were: country of birth (Spain vs. others), sex (male, female) and age (age in years was considered as a continuous quantitative variable and categorized into 5 age groups: 15−24, 25−44, 45−64, 65−74 and 75 or more years), educational level (classified into four categories: University, Secondary, Primary and No studies), perception of weight (two classifications were considered: the first recoding included three categories: thin, normal and overweight/obesity; the second recoding included two categories: thin/normal and overweight/obesity), cohabitation in couples (Yes/No), employment status (was classified into three categories; working, unemployed, other), physical exercise (two classifications were considered: the first recoding included four categories: not at all, sometimes, regularly and several times a week; the second recoding included two categories: none vs. the rest) and social class based on the occupation. The social class categories considered were based on the classification proposed in 2012 by the Working Group on Determinants of the Spanish Society of Epidemiology (SEE), adapted for the ENSE [31]. These are obtained from the occupation, current or past, and coded to three digits according to the National Classification of Occupations that came into force in 2011 (CNO-11) [32]. The 6 categories proposed were: I. directors and managers of establishments with 10 or more employees and professionals traditionally associated with university degrees; II. directors and managers of establishments with less than 10 employees, professionals traditionally associated with university degrees, and other technical support professionals. Sportsmen and artists; III. intermediate occupations and self-employed workers; IV. supervisors and workers in skilled technical occupations; V. skilled primary sector workers and other semi-skilled workers; and VI. unskilled workers. For the analysis, these 6 categories were regrouped into 3 categories as follows: (1) Class I–II; (2) Class III–IV; and (3) Class V–VI.
Data analysis
First, a descriptive analysis of the main study variables was carried out, disaggregating by country of birth (native/foreign) and sex (male/female). For categorical variables, frequency distribution tables were constructed. For the study of the associations between the variables related to the daily consumption of fruits and vegetables and sugar-sweetened beverages and the characteristics of physical condition, sociodemographic, socioeconomic, family and living habits, the Pearson chi-squared test, Fisher’s exact test or the Monte Carlo method were used, depending on the fulfilment of the conditions for the application of each of them for each of the population subgroups considered (natives or foreigners). Finally, multivariate logistic regression models were adjusted. The dependent variables in each case were: inadequate fruit consumption, inadequate vegetable consumption, inadequate consumption of sugar-sweetened beverages, and failure to comply with the recommendations for vegetables, fruits and sugar-sweetened beverages. The explanatory or independent variables included were, in addition to country of birth, sex, age, educational level, social class, cohabitation, self-perceived weight, employment status and leisure time physical exercise. Possible interaction and collinearity were taken into account in the adjustment of all models. The analysis was performed with the IBM SPSS Statistics v.25 statistical analysis program and a p value of less than 0.05 was considered significant.
Results
The sample analysed included a total of 5485 individuals aged 15 years and over, resident in the Valencian Community, of whom 48.6% were men and 51.4% women, with percentages of people of immigrant origin of 14.2% and 12.8% respectively.
Significant differences (Table 1) were observed between the native population and those of immigrant origin by age (younger in the case of immigrants, p < 0.001), level of studies (higher level of studies in immigrants, p < 0.001), cohabitation as a couple (higher percentage of cohabitation in native and in immigrant women with p < 0.001 and p = 0.006, respectively), employment status (higher percentage of unemployed population in the case of immigrants, p < 0.001) and leisure time physical activity (higher physical activity in men of immigrant origin, p < 0.001 and lower in the case of women, p = 0.018) for both sexes. In addition, in men, significant differences were observed between natives and immigrants according to social class (higher in the case of the native population, p < 0.001) and weight perception (higher percentage of perceived weight higher than normal in natives, p < 0.001).
Table 2 shows the frequencies of fruit and vegetable consumption. The most frequent consumption category for both fruit and vegetables were between 1–2 servings per day with total percentages of 44.9% and 60.6% respectively. This was also the case when disaggregated by country of birth. Significant differences in the frequency of daily fruit consumption were detected between natives and immigrants, both in men and women, especially in the categories of consumption of three or more servings and less than one serving per day. Native men had lower fruit consumption than immigrants (p < 0.001). In the case of women, it was the natives who had the highest fruit consumption (p < 0.001). In terms of vegetable consumption, native-born men had, overall, significantly lower vegetable consumption than those of immigrant origin with consumption percentages of less than one serving per day of 40% and 28.6% respectively (p < 0.001). In women, no significant differences in vegetable consumption were detected (p = 0.838).
Table 3 shows the frequency of consumption of sugary soft drinks. In general, natives showed a significantly lower consumption of these products (p < 0.001) than those of immigrant origin, both in men and in women. Forty per cent of natives never consumed this type of beverage compared to 34.1% of those of immigrant origin, while in women these percentages were 41.8% and 34.1% respectively. On the other hand, 23.7% of men and 24.1% of women of immigrant origin consumed sugary soft drinks 4 or more times a week, compared to 16.6% and 13.5% respectively in the case of natives. The daily consumption of these products was particularly high among women of immigrant origin compared to native women (21.6% vs. 8%).
Table 4 shows the frequency of fruit consumption according to socio-demographic characteristics and physical activity by sex and country of birth. The number of daily fruit servings was significantly associated with age (higher consumption in older adults), level of education (lower consumption the higher the level of education in natives and higher consumption the higher the level of education in immigrants), living with a partner (higher consumption if natives and women of immigrant origin live together and lower consumption if they live together in immigrant men), social class (higher consumption in social class I-II), employment status (higher consumption in social class I-II), employment status (higher consumption in immigrants) and the number of fruit servings per day (higher consumption in immigrants), social class (higher consumption in social class I-II), employment status (higher consumption in those who work or belong to the category of others, except in women of immigrant origin where there were no significant differences), physical activity (higher consumption if they exercise several times a week) and weight perception (higher consumption if they perceived themselves to be of normal weight. Lower consumption if they perceived themselves as overweight or obese in natives and men of immigrant origin or perceived themselves as thin in immigrant women), in both men and women.
In general, adults of immigrant origin consumed more servings of fruit than natives in age groups under 64 years, in those with at least primary education (in men), in those who do not live with a partner, in those belonging to social classes III-IV and V-VI, in those who work (in men), in those who do physical activity at least once a week and in those who perceive themselves to be slim or of normal weight in men and overweight or obese in women.
Table 5 shows the frequency of vegetable consumption according to socio-demographic characteristics and physical activity by sex and country of birth. The number of servings of vegetables per day was significantly associated with age (higher consumption in older adults), level of education (lower consumption in natives and women of immigrant origin with secondary education and with primary education in immigrant men), living with a partner (higher consumption if they live together in immigrant men), social class (higher consumption in social class I-II), employment status (lower consumption in immigrant men), social class (higher consumption in social class I-II), employment status (lower consumption in unemployed natives and in those who work in immigrants), physical activity (lower consumption the less physical activity), and weight perception (higher consumption if they perceived themselves to be of normal weight, except in men of immigrant origin where they had lower consumption).
In general, adults of immigrant origin consumed more vegetable servings than natives in age groups below 64 years, in those with at least secondary education, in those not living with a partner (in men), in all social classes, in those who were working (in men) or unemployed, in those who were physically active at least regularly (in men) and in all categories of weight perception in men.
Table 6 shows the frequency of consumption of sugar-sweetened soft drinks according to socio-demographic characteristics and physical activity by sex and country of birth. In general, higher consumption of this product was significantly associated with younger age, higher level of education, not living with a partner, lower social class, being unemployed, lower frequency of physical exercise (except for women of immigrant origin with higher consumption among those who exercised regularly), and an overweight/obese weight perception, both in men and women. Significant differences in the frequencies of consumption of sugary soft drinks between natives and immigrants were detected in almost all categories of each of the characteristics analysed, in both men and women. In general, adults of immigrant origin consumed more sugary soft drinks than natives in those under 24 years of age, in those with secondary or lower education in men and secondary or university education in women, in all categories of cohabitation, in all social classes except I-II, in all categories of employment status except those who were unemployed in men, in all levels of physical activity in women and in all categories of weight perception in women.
Multivariate analysis
Table 7 presents the results of the multivariate analysis. Higher educational attainment was significantly associated with a lower risk of inadequate vegetable consumption (OR=0.20 in university students, p < 0.001; OR=0.32, p < 0.001 in high school vs. no education) and sugary soft drinks (OR=0.55, p = 0.017 in university students), a lower risk of lower than recommended fruit consumption (OR=0.69 in university students, p = 0.007; OR=0.68, p = 0.002 in high school students) and a higher risk of higher than recommended consumption of sugary drinks (OR=1.44, p = 0.009 in university students). A lower level of social class was significantly associated with a lower risk of inadequate vegetable consumption (OR=0.43, p < 0.001 social class III-IV vs I-II) and a higher risk of inadequate consumption of sugar-sweetened soft drinks (OR=1.86, p < 0.001 social class V-IV vs I-II), lower than recommended fruit (OR=1.34, p < 0.001 social class III-IV vs I-II) and vegetable (OR=1.91, p < 0.001) consumption. Being unemployed was significantly associated with a higher risk of inadequate (OR=2.18, p < 0.001) and higher than recommended (OR=1.34, p = 0.002) consumption of soft drinks with sugar. Similarly, not living with a partner was significantly associated with an increased risk of inadequate (OR=1.29, p = 0.027) and higher than recommended (OR=1.38, p < 0.001) consumption of soft drinks with sugar (OR=1.38, p < 0.001).
Age was significantly associated with the consumption of all products, so that the older the age, the lower the risk of inadequate consumption or of not reaching the consumption recommendations for the different products analysed. Being overweight or obese was significantly associated with a higher risk of inadequate consumption of soft drinks with sugar (OR=1.89, p < 0.001), lower than recommended consumption of fruit (OR=1.40, p < 0.001) and higher than recommended consumption of soft drinks with sugar (OR=1.30, p < 0.001). Vegetable consumption was associated with a lower risk of lower than recommended consumption (OR=0.78, p = 0.041). Not exercising at all was significantly associated with a higher risk of inadequate intake or not reaching the consumption recommendations for all the products analysed.
Being female was significantly associated with a lower risk of inadequate vegetable consumption (OR=0.53, p < 0.001) and lower than recommended fruit consumption (OR=0.85, p = 0.007). A significant interaction was detected between sex and country of birth for inadequate consumption of soft drinks with sugar (p < 0.001) and recommended vegetable consumption (p = 0.045). Thus, while men of immigrant origin had a higher risk of lower than recommended vegetable consumption (OR=2.75) and a lower risk of inadequate consumption of sugar-sweetened soft drinks (OR=0.64) than natives, women of immigrant origin showed a lower risk of lower than recommended vegetable consumption (OR=1.04 x 0.44 = 0.464) but a higher risk of inadequate consumption of sugar-sweetened soft drinks (OR=0.80 x 4.58 = 3.66).
Discussion
The results obtained show differences in the consumption patterns of fruit, vegetables and soft drinks with sugar between the native and immigrant populations. A higher consumption of fruit was observed in adults of immigrant origin than in natives for both sexes, as well as a higher risk of not reaching the recommended daily intake of vegetables. These results partially coincide with those obtained in a similar study in Portugal [18], where immigrants consumed a higher proportion of fruit and vegetables than natives. Other studies have found a higher risk of inadequate fruit and vegetable consumption in immigrants of different nationalities compared with the native population [5,25,33]. The scarcity or unavailability of certain types of vegetables that are part of the immigrants’ traditional diet, as well as lack of knowledge about the new foods of the host country and how to prepare them, could be some of the reasons for this trend [21]. Additionally, men had lower fruit and vegetable consumption than women, regardless of country of birth, as shown in other studies [5,18,34,35]. This finding may reflect gender differences in health consciousness and awareness of the need for a healthy diet. In previous research, masculine roles were associated with men’s preferences for meat, energy-dense foods and alcohol consumption (such as beef burgers, fries, pizza and beer) [36]. This finding suggests that gender can be used as a strategic factor in FV promotion for both sexes, promoting vegetables and plant proteins that appeal to men by linking the benefits of these foods to masculinity goals [35].
Likewise, consumption of sugar-sweetened soft drinks was higher in immigrants compared to natives, both men and women, a finding shared by several studies where migrant were more likely to consume sugary drinks [21,37]. In this sense, the inappropriate consumption of sugar-sweetened soft drinks was more frequent in younger age groups, independent of the other study variables. Considering that adults of immigrant origin were predominantly young in this research, it is possible that this tendency is one of the explanations for the higher consumption of sugar-sweetened soft drinks by this population. Several studies show similar results, with younger adults being more likely to consume these beverages, and young adults being four times more likely to consume them regularly [12,38]., One explanation for this could be that adolescents and young adults may be more susceptible to media advertising of sugar-sweetened soft drinks, as well as their low market prices, making them a more attractive and affordable option for them. On the other hand, it is important to note that women of immigrant origin were found to be the highest consumers of sugar-sweetened beverages and to be at the highest risk of inappropriate consumption of sugar-sweetened beverages, which is interesting because in other studies it was immigrant men who were the highest consumers [22,37]. Therefore, it would be interesting to study this fact in this context if there is a gender issue involved, such as aspects of differentiated social integration.
In addition, it was also found that the higher the age (regardless of country of birth), the lower the risk of under-consuming or not meeting the recommended intake of fruit, vegetables and sugar-sweetened soft drinks. These results are in line with previous studies [18,38]. This may be because older people tend to have healthier eating habits, better cooking skills and more time to cook.
Higher levels of education were associated with a lower adjusted risk of inadequate vegetable consumption and lower than recommended fruit consumption, regardless of country of birth. These results are consistent with those obtained in other studies in Europe [5,18,34] and Thailand [35], where people with secondary and university education had better fruit and vegetable intake [39]. This could be explained by the fact that educational level may be associated with a higher level of nutritional knowledge [35], which in turn tends to be associated with favourable attitudes, greater interest and concern towards healthy eating habits. Furthermore, higher levels of education are often associated with higher levels of income, which may make it easier for this group to access healthy food.
Besides, higher risks of underconsumption of vegetables and inadequate consumption of sugar-sweetened soft drinks were found in adults from lower social classes. The association between social class and diet is similar to that observed in other studies [40,41], as lower economic status makes it more difficult to maintain access to healthy foods and may increase consumption of more affordable food options, such as fast food and sugary soft drinks, which are often low in essential nutrients and high in calories [37]. Furthermore, not living with a partner was associated with a higher adjusted risk of inadequate consumption of sugar-sweetened soft drinks [42], which may increase the risk of several diseases, such as type 2 diabetes or various types of cancer [43,44]. In this case, native-born men and foreign-born women living alone reported inadequate diet more frequently than their counterparts from different countries of birth. According to previous research [40], men tend to adopt the style of eating that is considered best for the family and the fact of living with a woman, who is traditionally associated with preparing meals at home, would be associated with better eating habits. Foreign women living alone may be more likely to neglect healthy food choices on a daily basis due to a lack of motivation to take care of the family’s diet, as well as factors related to adapting to a new country.
In terms of employment status, being unemployed was associated with twice the adjusted risk of inadequate consumption of sugar-sweetened soft drinks and a higher risk of not meeting vegetable consumption recommendations compared with those who were employed; also being retired, studying or doing housework was also associated with twice the risk of eating fewer vegetables than recommended. These results are in line with other studies [18], which suggest that those who work have a higher consumption of vegetables and fruit. This could be due to the fact that not working is associated with limited purchasing power, which may lead individuals to opt for cheap and unhealthy diets [40,45]. This finding is important because policies and/or strategies aimed at improving the nutritional status of specific groups should take these issues into account and not just focus on the food issue itself.
Interestingly, self-perceived weight also plays an important role in dietary food choices. In this case, it was observed that those who perceived themselves as overweight or obese had a lower risk of under-consumption of vegetables. This may be due to the fact that as the perception of being overweight influences the dietary pattern by increasing the intake of vegetables. This observation of the influence of self-perceived weight on dietary patterns has been described in other studies [46].
Regarding exercise, lack of physical activity was associated with a lower quality diet, with a higher risk of inadequate consumption of fruit, vegetables and sugary soft drinks and of not meeting the respective consumption recommendations, as seen in other studies [18,25,47]. This could be explained by the fact that, in general, people who are physically active are more likely to be interested in a healthy diet as part of a healthy lifestyle.
Limitations
The present study has some limitations that should be considered when interpreting its results. Firstly, it should be noted that, as is well known, the observational and cross-sectional design of the study does not allow us to establish causal relationships, and is limited to identifying significant associations between the variables of interest.
On the other hand, given that some years have passed since the data used in the study were collected, the results obtained may not reflect the reality of current dietary patterns in the population. In addition, although the data collection was carried out by trained interviewers, the difficulty of respondents to accurately recall the amounts and types of food, as well as the influence of emotional and social factors, could affect the accuracy of the information collected.
Finally, the variables fruit portions consumed per day and vegetable portions consumed per day have been treated separately in this study, which has made it difficult to compare with the majority of studies, in which fruit and vegetables are grouped together to study their consumption. However, we believe that this distinction provided a more detailed study of the consumption of each food group, setting a recommended threshold for each and facilitating future recommendations.
Conclusions
There are differences in the consumption patterns of fruit, vegetables and sugary drinks between the native and immigrant population of the Valencian Community. Knowing the socio-demographic variables that can lead to unhealthy eating patterns, such as being unemployed, not living with a partner, having a low level of education, belonging to a lower level of social class or not taking physical exercise, allows us to implement appropriate actions to intervene and improve the diet of the immigrant population by adapting strategies and policies to each population group and their needs. Therefore, public health policies and interventions aimed at the general population should incorporate an approach that takes into account the origin of the population and addresses social and economic inequalities, with an emphasis on these higher-risk groups.
Acknowledgments
The authors would like to thank the Regional Ministry of Health of the Valencian Community (Spain) for carrying out the surveys to find out the health status of the population, as well as all the participants.
References
- 1.
McAuliffe M, Triandafyllidou A. Informe sobre las migraciones en el mundo 2021. Geneva: Organización Internacional para las Migraciones; 2021.
- 2. Instituto Nacional de Estadística. Porcentaje de población extranjera por comunidad autónoma y provincia, sexo, comunitarios/no comunitarios y tamaño de municipio. INE. 2022. https://www.ine.es/jaxi/Datos.htm?path=/t20/e245/p04/provi/l0/&file=0tamu004.px
- 3. Fadlallah MA, Pal I, Chatterjee JS. Health disparities: a perspective on internal migration and health behavior in Sudan. Ann Glob Health. 2020;86(1):48. pmid:32405462
- 4. Ngongalah L, Rankin J, Rapley T, Odeniyi A, Akhter Z, Heslehurst N. Dietary and physical activity behaviours in african migrant women living in high income countries: a systematic review and framework synthesis. Nutrients. 2018;10(8):1017. pmid:30081522
- 5. Volken T, Rüesch P, Guggisberg J. Fruit and vegetable consumption among migrants in Switzerland. Public Health Nutr. 2013;16(1):156–63. pmid:22583693
- 6. Ojo AS, Nnyanzi LA, Giles EL, Ells LJ, Awolaran O, Okeke SR, et al. Perceptions of dietary intake amongst Black, Asian and other minority ethnic groups in high-income countries: a systematic review of qualitative literature. BMC Nutr. 2023;9(1):85. pmid:37443077
- 7. Siddiqui F, Winther V, Kurbasic A, Sonestedt E, Lundgren KB, Lindeberg S, et al. Changes in dietary intake following a culturally adapted lifestyle intervention among Iraqi immigrants to Sweden at high risk of type 2 diabetes: a randomised trial. Public Health Nutr. 2017;20(15):2827–38. pmid:28738912
- 8.
World Health Organization. Alimentación sana. Geneva: WHO; 2020 [Accessed 2025 January 28. ]. https://www.who.int/es/news-room/fact-sheets/detail/healthy-diet
- 9. Karam J, Bibiloni MDM, Serhan M, Tur JA. Adherence to mediterranean diet among Lebanese University Students. Nutrients. 2021;13(4):1264. pmid:33921397
- 10. Laffond A, Rivera-Picón C, Rodríguez-Muñoz PM, Juárez-Vela R, Ruiz de Viñaspre-Hernández R, Navas-Echazarreta N, et al. Mediterranean diet for primary and secondary prevention of cardiovascular disease and mortality: an updated systematic review. Nutrients. 2023;15(15):3356. pmid:37571293
- 11. Malik VS, Hu FB. The role of sugar-sweetened beverages in the global epidemics of obesity and chronic diseases. Nat Rev Endocrinol. 2022;18(4):205–18. pmid:35064240
- 12. Miller C, Ettridge K, Wakefield M, Pettigrew S, Coveney J, Roder D, et al. Consumption of sugar-sweetened beverages, juice, artificially-sweetened soda and bottled water: an Australian population study. Nutrients. 2020;12(3):817. pmid:32204487
- 13.
World Health Organization, Guidelines Review Committee. Guideline: sugars intake for adults and children. Geneva: WHO; 2015. https://www.who.int/publications/i/item/9789241549028
- 14. Liu RH. Health-promoting components of fruits and vegetables in the diet. Adv Nutr. 2013;4(3):384S–92S. pmid:23674808
- 15. Locke A, Schneiderhan J, Zick SM. Diets for health: goals and guidelines. Am Fam Physician. 2018;97(11):721–8. pmid:30215930
- 16. Navratilova HF, Lanham-New S, Whetton AD, Geifman N. Associations of diet with health outcomes in the UK Biobank: a systematic review. Nutrients. 2024;16(4):523. pmid:38398847
- 17.
World Health Organization. Global strategy on diet, physical activity and health. Geneva: WHO; 2019.
- 18. Costa L, Dias S, Martins M do RO. Fruit and vegetable consumption among immigrants in portugal: a nationwide cross-sectional study. Int J Environ Res Public Health. 2018;15(10):2299. pmid:30347692
- 19. Di Noia J, Monica D, Cullen KW, Pérez-Escamilla R, Gray HL, Sikorskii A. Differences in fruit and vegetable intake by race/ethnicity and by hispanic origin and nativity among women in the special supplemental nutrition program for women, infants, and children, 2015. Prev Chronic Dis. 2016;13:E115. pmid:27560723
- 20. Park H, Tserendejid Z, Song K-H, Lee J, Lee Y. Dietary patterns and the association with dietary quality among Mongolian immigrants in South Korea. J Immigr Minor Health. 2015;17(2):422–31. pmid:24894430
- 21. Hun Gamboa N, Urzúa Morales A, López-Espinoza A. Food and migration: a descriptive-comparative analysis of food behavior between Chileans and Colombians residing in the north and center of Chile. Nutr Hosp. 2020;37(4):823–9. pmid:32698595
- 22. Rabiee Khan F, Alzeidan R, Tharkar S, Ullah A, Hersi AS. Food and migration: dietary acculturation among migrants to the kingdom of Saudi Arabia. J Prim Care Community Health. 2020;11:2150132720949771. pmid:32783583
- 23. Popovic-Lipovac A, Strasser B. A review on changes in food habits among immigrant women and implications for health. J Immigr Minor Health. 2015;17(2):582–90. pmid:23892613
- 24. Sanou D, O’Reilly E, Ngnie-Teta I, Batal M, Mondain N, Andrew C, et al. Acculturation and nutritional health of immigrants in Canada: a scoping review. J Immigr Minor Health. 2014;16(1):24–34. pmid:23595263
- 25. Taylor AW, Grande ED, Fateh-Moghadam P, Montgomerie A, Battisti L, Barrie H, et al. Comparison of health and risk factors of older, working-age Australians, Italians and Italian-born Migrants to Australia, with Data from an Italian (PASSI), and an Australian (SAMSS) risk factor surveillance system. J Immigr Minor Health. 2018;20(5):1190–6. pmid:28952005
- 26. United Nations D of E and SAffairsPD. International Migration 2017. 2017. https://www.un.org/en/development/desa/population/migration/publications/wallchart/docs/MigrationWallChart2017.pdf
- 27. Generalitat Valenciana. Encuesta de Salud 2016 de la Comunitat Valenciana. Metodología. 2018. https://www.sp.san.gva.es/DgspPortal/docs/ES_Metodologia2018.pdf
- 28. Generalitat Valenciana, Conselleria de Sanitat Universal i Salut Pública, Dirección General de Salud Pública y Adicciones. Polìticas de salud/Encuestas de salud. 2022 [Accessed 2025 January 28. ]. https://www.sp.san.gva.es/sscc/opciones4.jsp?CodPunto=3785&Opcion=SANMS502&MenuSup=SANMS50&Nivel=2
- 29. Wang DD, Li Y, Bhupathiraju SN, Rosner BA, Sun Q, Giovannucci EL, et al. Fruit and vegetable intake and mortality: results from 2 prospective cohort studies of US men and women and a meta-analysis of 26 cohort studies. Circulation. 2021;143(17):1642–54. pmid:33641343
- 30.
Agencia Española de Seguridad Alimentaria y Nutrición AESAN. Recomendaciones dietéticas saludables y sostenibles complementadas con recomendaciones de actividad física para la población española. Ministerio de Consumo. Gobierno de España; 2022. https://www.aesan.gob.es/AECOSAN/docs/documentos/nutricion/RECOMENDACIONES_DIETETICAS.pdf
- 31. Domingo-Salvany A, Bacigalupe A, Carrasco JM, Espelt A, Ferrando J, Borrell C, et al. Proposals for social class classification based on the Spanish National Classification of Occupations 2011 using neo-Weberian and neo-Marxist approaches. Gac Sanit. 2013;27(3):263–72. pmid:23394892
- 32.
Instituto Nacional de Estadística. Clasificación nacional de ocupaciones 2011 (CNO2011). Madrid: Instituto Nacional de Estadística; 2011.
- 33. Rodriguez-Alvarez E, Lanborena N, Borrell LN. Cardiovascular disease risk factors in Spain: a comparison of native and immigrant populations. PLoS One. 2020;15(11):e0242740. pmid:33253252
- 34. Adebayo FA, Itkonen ST, Koponen P, Prättälä R, Härkänen T, Lamberg-Allardt C, et al. Consumption of healthy foods and associated socio-demographic factors among Russian, Somali and Kurdish immigrants in Finland. Scand J Public Health. 2017;45(3):277–87. pmid:28443492
- 35. Phulkerd S, Thapsuwan S, Thongcharoenchupong N, Soottipong Gray R, Chamratrithirong A. Sociodemographic differences affecting insufficient fruit and vegetable intake: a population-based household survey of Thai people. J Health Res. 2020;34(5):419–29.
- 36. Schösler H, de Boer J, Boersema JJ, Aiking H. Meat and masculinity among young Chinese, Turkish and Dutch adults in the Netherlands. Appetite. 2015;89:152–9. pmid:25681291
- 37. Benazizi I, Blasco-Blasco M, Sanz-Valero J. ¿Cómo es la alimentación de la población inmigrante residente en España? Resultados a partir de una revisión sistemática. An sist sanit nav. 2019;4:55–68.
- 38. AlTamimi JZ, Alshwaiyat NM, Alkhalidy H, AlKehayez NM, Alagal RI, Alsaikan RA, et al. Sugar-sweetened beverages consumption in a multi-ethnic population of young men and association with Sociodemographic Characteristics and Obesity. Int J Environ Res Public Health. 2023;20(6):4861. pmid:36981770
- 39. Livingstone KM, Olstad DL, Leech RM, Ball K, Meertens B, Potter J, et al. Socioeconomic inequities in diet quality and nutrient intakes among Australian adults: findings from a nationally representative cross-sectional study. Nutrients. 2017;9(10):1092. pmid:28976927
- 40. Berggreen-Clausen A, Hseing Pha S, Mölsted Alvesson H, Andersson A, Daivadanam M. Food environment interactions after migration: a scoping review on low- and middle-income country immigrants in high-income countries. Public Health Nutr. 2022;25(1):136–58. pmid:34509180
- 41. Dekker LH, Nicolaou M, van Dam RM, de Vries JHM, de Boer EJ, Brants HAM, et al. Socio-economic status and ethnicity are independently associated with dietary patterns: the HELIUS-Dietary Patterns study. Food Nutr Res. 2015;59:26317. pmid:26041009
- 42. Henriksen RE, Torsheim T, Thuen F. Loneliness, social integration and consumption of sugar-containing beverages: testing the social baseline theory. PLoS One. 2023;42(1):1–10.
- 43. Mullee A, Romaguera D, Pearson-Stuttard J, Viallon V, Stepien M, Freisling H, et al. Association between soft drink consumption and mortality in 10 European Countries. JAMA Intern Med. 2019;179(11):1479–90. pmid:31479109
- 44. World Cancer Research Fund, American Institute for Cancer Research. Diet, nutrition and physical activity and cancer: a global perspective. 2018. https://www.wcrf.org/sites/default/files/Summary-of-Third-Expert-Report-2018.pdf
- 45. Colman G, Dave D. Unemployment and health behaviors over the business cycle: a longitudinal view. Southern Econ J. 2018;85(1):93–120.
- 46. Fehrman-Rosas P, Delgado-Sánchez C, Fuentes-Fuentes J, Hidalgo-Fernández A, Quintana-Muñoz C, Yunge-Hidalgo W, et al. Asociación entre autopercepción de imagen corporal y patrones alimentarios en estudiantes de Nutrición y Dietética. Nutr Hosp. 2016;33(3):274. pmid:27513501
- 47. Tassitano RM, Martins de CML, Cabral PC, Mota J, Tenório MCM, Silva da GAP. Psychosocial factors and physical activity as predictors of fruit and vegetable intake in college students. Rev Nutr. 2016;29(2):173–83.