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Background: In Western countries the prevalence of cardiovascular disease (CVD) is often higher in non-Western migrants as compared to the host population. Diet is an important modifiable determinant of CVD. Increasingly, dietary patterns rather than single nutrients are the focus of research in an attempt to account for the complexity of nutrient interactions in foods. Research on dietary patterns in non-Western migrants is limited and may be hampered by a lack of validated instruments that can be used to assess the habitual diet of non-western migrants in large scale epidemiological studies. The ultimate aims of this study are to (1) understand whether differences in dietary patterns explain differences in CVD risk between ethnic groups, by developing and validating ethnic-specific Food Frequency Questionnaires (FFQs), and (2) to investigate the determinants of these dietary patterns. This paper outlines the design and methods used in the HELIUS-Dietary Patterns study and describes a systematic approach to overcome difficulties in the assessment and analysis of dietary intake data in ethnically diverse populations.Methods/design: The HELIUS-Dietary Patterns study is embedded in the HELIUS study, a Dutch multi-ethnic cohort study. After developing ethnic-specific FFQs, we will gather data on the habitual intake of 5000 participants (18-70 years old) of ethnic Dutch, Surinamese of African and of South Asian origin, Turkish or Moroccan origin. Dietary patterns will be derived using factor analysis, but we will also evaluate diet quality using hypothesis-driven approaches. The relation between dietary patterns and CVD risk factors will be analysed using multiple linear regression analysis. Potential underlying determinants of dietary patterns like migration history, acculturation, socio-economic factors and lifestyle, will be considered.Discussion: This study will allow us to investigate the contribution of the dietary patterns on CVD risk factors in a multi-ethnic population. Inclusion of five ethnic groups residing in one setting makes this study highly innovative as confounding by local environment characteristics is limited. Heterogeneity in the study population will provide variance in dietary patterns which is a great advantage when studying the link between diet and disease. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to explore the role of ethnicity and maternal perceived weight status in the association between maternal child feeding practices and childhood Body Mass Index (BMI) at the age of 11-12 years in a multi-ethnic population., Methods: We collected data on child feeding practices by the validated Child Feeding Questionnaire (CFQ) among 2398 mothers of adolescents (M age  = 11.2, SD age  = 0.6). Multivariate linear analyses were used to determine the cross-sectional association between child feeding practices ('Restriction', 'Pressure to eat', and 'Monitoring'), maternal perception of child's weight status, SDS-BMI, and ethnicity., Results: 'Restriction' (β = 0.16; 95% CI [0.11; 0.20]) and 'Pressure to eat' (β = -0.32 [-0.36;-0.28]) were significantly associated with child SDS-BMI. Both associations were strongly influenced by the mother's perception of child's weight status. Besides, non-native Dutch mothers performed significantly higher levels of 'Restriction' (M±SD = 12.17 ± 4.41) and 'Pressure to eat' (10.75 ± 4.03) compared to native Dutch mothers (11.25 ± 4.15 and 9.99 ± 3.83, respectively). Native Dutch mothers performed higher levels of 'Monitoring' (17.15 ± 2.54) compared to non-native Dutch mothers (16.73 ± 3.01). Furthermore, children of non-native Dutch mothers had a 0.15 (0.27; 0.46) higher SDS-BMI. Finally, results showed that the association between 'Pressure to eat' and SDS-BMI was stronger in native Dutch mothers (β = -0.20; 95% CI [-0.24; -0.15]) compared to non-native Dutch mothers (β = -0.11; 95% CI [-0.18; -0.04])., Discussion and Conclusion: Ethnic differences in childhood BMI seemed to be partially attributable to the maternal perception of her child's weight status. Besides, maternal perception of child's weight appeared to play an important role in the association between maternal child feeding practices and childhood SDS-BMI. Hence, our findings contribute to the growing evidence concerning the bi-directional association between child feeding practices and childhood BMI., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Healthier dietary patterns are generally more costly than less healthy patterns, but dietary costs may be more important for dietary quality in lower educated and ethnic minority groups. The aim of this study was to investigate the association between dietary costs and dietary quality and interactions with ethnicity and socioeconomic position (SEP)., Methods: We used cross-sectional data from 4717 Dutch, Surinamese, Turkish and Moroccan origin participants of the multi-ethnic HELIUS study (the Netherlands), who completed an ethnic-specific food frequency questionnaire (FFQ). The primary outcome measure was dietary quality according to adherence to the Dutch Healthy Diet index 2015 (DHD15-index, range 0-130). Individual dietary costs (the monetary value attached to consumed diets in Euros) were estimated by merging a food price variable with the FFQ nutrient composition database. Regression analyses were used to examine main and interaction effects. Analyses were adjusted for age, sex, smoking, energy intake, physical activity, ethnicity and educational level., Results: Having higher dietary costs was associated with higher dietary quality. Analyses stratified by educational level showed that associations were stronger in higher educated (B tertile3  = 8.06, 95%CI = 5.63; 10.48) than in lower educated participants (B tertile3  = 5.09, 95%CI = 2.74; 7.44). Stratification by ethnic origin showed strongest associations in Turkish participants (B tertile2  = 9.31, 95%CI = 5.96; 12.65) and weakest associations in Moroccan participants (B tertile3  = 4.29, 95%CI = 0.58; 8.01). Regardless of their level of education, Turkish and Moroccan individuals consumed higher quality diets at the lowest cost than Dutch participants., Conclusions: The importance of dietary costs for dietary quality differs between socioeconomic and ethnic subgroups. Increasing individual food budgets or decreasing food prices may be effective for the promotion of healthy diets, but differential effects across socioeconomic and ethnic subgroups may be expected.

Objective: To examine differences in overweight and obesity of second-generation Turkish, Moroccan and Surinamese migrants v. first-generation migrants and the ethnic Dutch. We also studied the influence of sociodemographic factors on this association., Design: Data were collected in 2008 in a cross-sectional postal and online health survey., Setting: Four major Dutch cities., Subjects: In the survey 42 686 residents aged 16 years and over participated. Data from Dutch (n 3615) and second/first-generation Surinamese (n 230/139), Turkish (n 203/241) and Moroccan (n 172/187) participants aged 16-34 years were analysed using logistic regression with overweight (BMI ≥ 25·0 kg/m²) and obesity (BMI ≥ 30·0 kg/m²) as dependent variables. BMI was calculated from self-reported body height and weight. Sociodemographic variables included sex, age, marital status, educational level, employment status and financial situation., Results: After controlling for age, overweight (including obesity) was more prevalent in most second-generation migrant subgroups compared with the Dutch population, except for Moroccan men. Obesity rates among second-generation migrant men were similar to those among the Dutch. Second-generation migrant women were more often obese than Dutch women. Ethnic differences were partly explained by the lower educational level of second-generation migrants. Differences in overweight between second- and first-generation migrants were only found among Moroccan and Surinamese men., Conclusions: We did not find a converging trend for the overweight and obesity prevalence from second-generation migrants towards the Dutch host population. Therefore, preventive interventions should also focus on second-generation migrants to stop the obesity epidemic.

Background: The prevalence of overweight appears to vary in people of first and second generation ethnic minority groups. Insight into the factors that underlie these weight differences might help in understanding the health transition that is taking place across generations following migration. We studied the role of social and cultural factors associated with generational differences in overweight among young Turkish and Moroccan men and women in the Netherlands., Methods: Cross-sectional data were derived from the LASER-study in which information on health-related behaviour and socio-demographic factors, level of education, occupational status, acculturation (cultural orientation and social contacts), religious and migration-related factors was gathered among Turkish and Moroccan men (n = 334) and women (n = 339) aged 15-30 years. Participants were interviewed during a home visit. Overweight was defined as a Body Mass Index ≥ 25 kg/m2. Using logistic regression analyses, we tested whether the measured social and cultural factors could explain differences in overweight between first and second generation ethnic groups., Results: Second generation women were less often overweight than first generation women (21.8% and 45.0% respectively), but this association was no longer significant when adjusting for the socioeconomic position (i.e. higher level of education) of second generation women (Odds Ratio (OR) = 0.77, 95%, Confidence Interval (CI) 0.40-1.46). In men, we observed a reversed pattern: second generation men were more often overweight than first generation men (32.7% and 27.8%). This association (OR = 1.89, 95% CI 1.09-3.24) could not be explained by the social and cultural factors because none of these factors were associated with overweight among men., Conclusions: The higher socio-economic position of second generation Turkish and Moroccan women may partly account for the lower prevalence of overweight in this group compared to first generation women. Further research is necessary to elucidate whether any postulated socio-biological or other processes are relevant to the opposite pattern of overweight among men.

Objectives: To evaluate body size preference, body weight perception and their relationship with actual weight in two migrant groups of non-Western origin, Turks and Moroccans; additionally, to study the association between body size preference and acculturation., Design: Cross-sectional study., Setting: Amsterdam, The Netherlands., Subjects and Methods: Males and females (18-30 years) were randomly selected from the population registry (n 451); participants, or at least one of their parents, were born in Turkey or Morocco. Body size preference was assessed using seven silhouette drawings and body weight perception was assessed by asking participants' opinion of own weight. Acculturation variables were generation status and two scale measures, cultural orientation and social contacts., Results: Participants showed preference for a thin body size. The discrepancy between ideal and current size was significant in women but not men (P < 0.001). Perceived current body size was correlated with BMI (Spearman's correlation coefficient 0.60, P < 0.001 (men) and 0.73, P < 0.001 (women)). Among overweight participants (BMI = 25.0-29.9 kg/m2), 63-82 % of men and 35 % of women perceived themselves as 'average'. Paying attention to own body weight was associated with a discrepancy between ideal and current size among women and with perceiving oneself as 'overweight' among men. Body size preference was not significantly associated with the three acculturation variables., Conclusion: We did not observe a preference for large body sizes in these two non-Western migrant groups. Similar to Western populations, most women wished to be thinner than they were. This was not the case among men, the majority of whom were also unaware of being overweight.

Migrant mortality does not conform to a single pattern of convergence towards prevalence rates in the host population. To understand better how migrant mortality develops, it is necessary to further investigate how the underlying behavioural determinants change following migration. We studied whether the prevalence of behavioural risk factors over two generations of Turkish and Moroccan migrants converge towards the prevalence rates in the Dutch population. From a random sample from the population register of Amsterdam, 291 Moroccan and 505 Turkish migrants, aged 15-30, participated in a structured interview that included questions on smoking, alcohol consumption, physical inactivity and weight/height. Data from the Dutch population were available from Statistics Netherlands. By calculating age-adjusted Odds Ratio's, prevalence rates among both generations were compared with prevalence rates in the host population for men and women separately. We found indications of convergence across generations towards the prevalence rates in the host population for smoking in Turkish men, for overweight in Turkish and Moroccan women and for physical inactivity in Turkish women. Alcohol consumption, however, remained low in all subgroups and did not converge towards the higher rates in the host population. In addition, we found a reversed trend among Turkish women regarding smoking: the second generation smoked significantly more, while the first generation did not differ from ethnic Dutch. In general, behavioural risk factors in two generations of non-Western migrants in the Netherlands seem to converge towards the prevalence rates in the Dutch population. However, some subgroups and risk factors showed a different pattern.