Title:

Associations between dietary quality and inflammation among Bhutanese refugee adults eligible for the Supplemental Nutrition Assistance Program

Objectives: To quantify the associations between adherence to U.S. dietary guidelines and inflammation among Bhutanese refugee adults who are eligible to receive SNAP (Supplemental Nutrition Assistance Program) benefits. Methods: A convenience sample of Bhutanese refugee adults (n=53, mean age=47±2 years, 83% female) residing in New Hampshire was recruited. We estimated diet using the average of three 24-hour recalls. Adherence to U.S. dietary guidelines was defined using the 2015 Healthy Eating Index (HEI). A fasting blood sample was analyzed for inflammatory biomarkers, IL-6 and TNF-α. The HEI score and score components were expressed in tertiles, and related to biomarkers using ANCOVA. Food rankings were conducted to identify contributors to HEI components. Results: On average, participants lived in the U.S. for 7.8±0.5 years. The prevalence of overweight/obesity and type 2 diabetes was 82% and 41%, respectively. In multivariate adjusted models, individuals with higher HEI scores had significantly lower IL-6 concentrations (3.1±0.5 pg/mL, 2.4±0.4 pg/mL, and 2.0±0.5 pg/mL by increasing HEI tertile, P-trend=0.05). In examining HEI components, greater consumption of total and whole fruit (P-trend=0.03, P-trend=0.05) was related to lower IL-6 concentrations. We observed null associations with TNF-α. The top 3 contributors to fruit consumption were bananas (21.5%), apples (15.5%), mangos (15%). Conclusions: In this cross-sectional study of low-income Bhutanese refugee adults, greater adherence to U.S. Dietary Guidelines, particularly for fruit consumption, was associated with lower IL-6 concentrations. Over 50% of fruit was represented by only a few foods, which can inform cultural tailoring of SNAP Education interventions in this understudied population. Funding: The New Hampshire Agricultural Experiment Station

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