Dietary Guidelines for Latino in the U.S.
The United States Department of Agriculture (USDA) 2015-2020 Dietary Guidelines provides guidance and recommendations to help Americans make healthy choices in the areas of nutrition focused on preventing diet-related chronic diseases. However, culturally relevant recommendations specific to Latino/Hispanics’ health and nutritional habits are often lacking. About half of all American adults have one or more preventable, diet-related chronic diseases, including cardiovascular disease, Type-2 diabetes, and being overweight/obesity. Latinos in the US experience higher rates of these conditions compared to non-Hispanic whites. In 2015, 18 percent of the U.S. population was of Latino/Hispanic origin; making it the nation’s largest minority group and it is predicted to rise to 30 percent by 2050. Among them, 63 percent were Mexican Americans; 16 percent from the Caribbean, 5.6 percent South American and 8.5 percent were non-Mexicans from Central America (1,2).
When we refer to the eating patterns of the Latino/Hispanics in the US, it is important to consider the diversity within, their different food preferences, cultural definitions of foods, dietary patterns, and the use of many different names for the same food. Therefore, the assumption that all Latinos follow the same food patterns is inaccurate (3). Studies confirm that universal dietary guidelines have limited utility for different ethnic groups with particular diet-related health needs and food preferences, and that, efficacious dietary guidelines need to include the unique and particular dietary characteristics of the specific group in question (4).
Through out my tenured years as a professor teaching a nutrition course at CUNY-Hostos Community College, I accumulated data from the students, who were mostly Latinos (58%), Africans and African Americans (22%). The students were asked to keep a four-day food journal and sort their food intake into groups using the USDA Dietary Guidelines for Americans, Food Guide- “Choose My Plate” as the nutritional guide that relates the nutrition theory to food groups. After twelve years of reviewing the students’ food journals (> 3,000), common practices were noticed regarding how they sorted food into groups. The students with Latino backgrounds more often included starchy vegetables, legumes, beans, roots, and tubers in the vegetable group, as designated by USDA “Choose My Plate” Food Guide. In their final term paper assessment of their food intake, the majority of the students stated having an adequate intake of vegetables, since they had a high intake of the starchy ones–in particular beans, corn, potatoes, yucca, and plantains. Also, it was noticed that they had a frequent intake of rice, usually eaten together with the starchy vegetables, resulting in a high intake of starch, but not much of the dark green, orange and “other” vegetables. An example of a common mixture of food in one meal was rice, beans, plantains (either green or yellow), and meat. The USDA Choose My Plate Food Guide assignment of the starchy vegetables in the same group as the non-starchy ones apparently created a confusion or a false belief of eating an appropriate amount of vegetables. Furthermore, a study by Davis (2013) showed that the Latino participants’ from New York City followed a Caribbean starch pattern diet with a significantly high intake of pinto beans, plantain, and yucca as well as other starchy vegetables (5). The classification of these items high in starch and calories as vegetables by the USDA 2015 Dietary Guidelines Food Guide may not be of importance for a population that has a low intake of them, but it may be inappropriate for Latinos, due to their high and frequent intake and their high prevalence of diabetes and obesity.
The eating patterns of Latinos in the US are different from those of the general non-Hispanic US population and they are also different among themselves. Mexican Americans eat more tortillas and taco shells than non-Mexican Latinos (twice as many) while the latter group eats three times more rice (6). In general, Latinos eat similar foods but prepare them in different ways and give them different names. Consider beans, for example: Mexican Americans often prepare pinto beans as a paste, eat them with tortillas, and call them frijoles refritos, while individuals from the Caribbean prepare them with sofrito as a stew (calling them habichuelas quisá), and eating them either with rice or cooking them together with the rice, (calling it moro in the Dominican Republic, congri in Cuba, manpostiao in Puerto Rico), and consuming them almost daily, sometimes twice a day. Furthermore, Latinos from the Dominican Republic prepare kidney beans with sugar and coconut milk (calling it habichuelas dulces), and eat them for dessert. Adding to the diversity, Central Americans boil the beans and eat them daily with cheese or cream sauce either for breakfast or lunch. When it comes to food names, Latinos hold many different names for the same food item. For example, sweet potatoes are known as batata dulce, batata mameya (Puerto Rico), boniato (Cuba), camote (Honduras, Perú, Ecuador), chaco; and corn is known as maíz (Caribe), choclo (Argentina, Ecuador, Perú), chicha, elote (Mex.), jojota, and marlo (7).
Educational materials are available for the Latino population in the US, but their use might be limited because many of these materials are not relevant to the Latino cultural preferences and dietary patterns. Health and nutrition education programs and educational materials that are made available in Spanish may not be sensitive to cultural differences and most of them were translated into Spanish without considering their vast cultural and linguistic diversity and often they are not comprehended or utilized effectively. The Dietary Guidelines Food Guide used by most Latin-American countries classify starchy vegetables, roots, and tubers with the grain/starch group and the beans and legumes within the protein group, according to their calorie density and the key nutrients they provide. Thus, the writer considered all mentioned criteria within the USDA Food Guide and created The Latino Food Group Guide along with the Latino Plate. Ecological data was used from Latinos in New York on traditional foods and dishes and on how they classified food into the food groups. In addition, focus groups compromised of Latinos were formed to clarify the information obtained previously and an image of the Latino Plate was discussed and updated.
The Latino Food Group Guide divides the Latino foods into more detailed subdivisions, according to their nutrient, calorie, starch, and fat content. It also provides instructions for appropriate food portion sizes, just as the USDA Food Guide does (11). The main differences between the two guidelines are the inclusion of traditional foods (spices and organ meats), classifying cheese, beans, and legumes exclusively in the Protein Group, and the tubers, roots, and starchy vegetables in the Grain/Starch Group instead of the Vegetable Group. Also provided in the Latino Food Group Guide are separate categories for water, spices and condiments, good and bad oils, sweets (with and without added oil), and alcoholic beverages. In addition, the Latino Food Group Guide includes different names used in Spanish for the same food item and considers the meal patterns of the diverse Latino groups in the US. The USDA Food Guide shown in My Plate (Figure 2) includes the five food groups using the familiar image of a plate as the setting to help consumers make better choices and remind them to eat healthier. The Latino Food Group Guide also uses a plate image (Figure 1), similar to the USDA Food Guide My Plate, but it includes a image of a glass of water instead of milk; (b) allocates half of the plate for vegetables, excluding the fruits; (c) contains an image of fruit outside the plate together with milk/yogurt as a snack or dessert option; (d) adds the image of a small bottle of what is considered a good oil, and (e) add depicts two plate sizes—8” and 10”—and recommends the use of the smaller plate to reduce food portion size.
|Latino Food Groups and Latino Plate (11)||The USDA Food Guide and My Plate|
|Grains and Starch||Grain Group|
|Divided into three subgroups: whole grains, enriched/refined grains and roots/tubers and starchy vegetables (sweet potatoes, green bananas, green and yellow plantain, yautía, yam, yucca). They are recommended to eat as part of their grain and starch intake for the day and not in addition to it (avoid rice, tostones, bread, and corn in one meal).||Divided into two subgroups: whole grains and enriched/refined grains. It does not consider roots, tubers, and starchy vegetables as part of this group even though they contribute complex -carbohydrates starch as much as grains do.|
|Protein Foods||Protein Foods|
|Divided into two groups: Protein from animal sources (meat, poultry, eggs, cheese, seafood and animal organs) and protein from vegetable sources-(beans and legumes, soy products, nuts and seeds). Subdivided by fat content: very low fat, low fat, medium fat and high in fat.||Divided into three groups: Seafood; meat, poultry and eggs; and nuts, seeds, legumes and soy products. Subdivided by fat content: very low fat, low fat, medium fat and high in fat.|
|Divide into 3 subgroups: dark green, red and orange vegetables, and other colorful vegetables. The Latino Plate presents the vegetables as half of the plate.||Divided into 5 subgroups: dark green, red and orange, and other vegetables, legumes and starchy vegetables. Choose My Plate has vegetables as about as approximately half of the plate together with fruit.|
|Plate Size||Plate Size|
|Plate sizes (10” and 8”) and recommends the use of the smaller plate.||No plate size indicated|
|Includes all other foods, beverages and edible ingredients that do not fit the definitions of the major food groups but are consume in significant amounts by Latinos. Flavors: condiments, herbs, spices, salsa, sofrito; Water: plain water and flavor water; Sweets: candies and desserts with or without fat, and soft drinks (jarritos, orchatas); Alcoholic Beverages: plain and mixed drinks; Oil/Fat: good (unsaturated) and bad (saturated).||In addition to the food groups, there are recommendations to limit the intake of other components such as added sugars, saturated fats, and sodium mentioned.|
1- William A. Vega, Michael A. Rodriguez, Elisabeth Gruskin; Health Disparities in the Latino Population. Epidemiol Rev 2009; 31 (1): 99-112. doi: 10.1093/epirev/mxp008.
2- Profile America Facts for Features: CB16-FF.16 OCT. 12, 2016. Hispanic Heritage Month 2016.
3- Nangel M. Lindberg, Victor J. Stevens, and Ruben O. Halperin, “Weight-Loss Interventions for Hispanic Populations: The Role of Culture,” Journal of Obesity, doi: 10.1155/2013/542736. Epub (Feb 26, 2013).
4- Painter, J., Rah, J.,Lee, Y. Comparison of International Food Guide Pictorial Representations. Journal of the American Dietetic Association. April 2002. 102 (4): 483-89.
5- Davis, N., C. Schechter, F. Ortega, R. Rosen, J, Wylie-Rosett, and E. Walker. “Dietary Patterns in Blacks and Hispanics with Diagnosed Diabetes in New York City’s South Bronx.” Am J Clin Nutr 97, no. 4 (2013): 878-885.
6- Mercado, F., and Pozo Fileti, C. “Health Implications of Dairy Intake in U.S. Hispanics: Opportunities for Nutrition Intervention and Education,” National Hispanic Medical Association (2010), http://www.dairyfoods.com/ext/resources/Digital_Brochures/DF-Hispanic-White-Paper-FinalProof.pdf.
7- U.S. Department of Agriculture. Agricultural Research Service. 2013. Food Patterns Equivalent Intakes from Food: Consumed per Individual, by Race/Ethnicity and Age, What We Eat in America, NHANES 2009-2010.
8- Profile America Facts for Features: CB16-FF.16 OCT. 12, 2016. Hispanic Heritage Month 2016.
9- Mier, Nelda, Marcia G. Ory, and Alvaro A. Medina. “Anatomy of Culturally Sensitive Interventions Promoting Nutrition and Exercise in Hispanics: A Critical Examination of Existing Literature.” Health Promotion Practice 11, no. 4 (2010); 541-554.
10- Mercado, I. “The Latino Way Food Groups and the Latino Plate-Food Guidelines for Latinos in the U.S.” Journal of Health Psychology Vol.2. No1 2014.
Born and raised in P.R. where she received a BA in Nutrition and Dietetics from the University of Puerto Rico and a MS in Public Health and Nutrition from UPR Medical Science Campus. After working as a Sport Nutritionist for the Olympic Committee in Puerto Rico she decided to move to NYC to pursue a doctoral degree at Columbia University in Health Education. Prof. Mercado worked as a Dietitian in NYC for years with HIV/AIDS clients and later as a bilingual clinical nutrition consultant providing nutrition assessment and counseling for conditions such as diabetes, obesity and hypertension. Starting her 14 years as an Associate Tenured Professor, she teaches health courses at the Education Department-Health Education Unit. Iris Mercado’s real passion are in the area of exercise,behavior modifications, and weight control as she is a certified weight control specialist. At the present moment her goal is to finish her book on weight control for Latinos.