Associations between immigrant status and dietary patterns in ENCLAVE, a pooled, observational study of women diagnosed with breast cancer

Candyce H Kroenke; Rhonda Aoki; Lawrence H Kushi; Jacqueline M Torres; Brittany N Morey; Scarlett Gomez; Bette Caan; Alison J Canchola; Stacey Alexeeff

doi:10.1016/j.tjnut.2025.06.014

Associations between immigrant status and dietary patterns in ENCLAVE, a pooled, observational study of women diagnosed with breast cancer

J Nutr. 2025 Jun 30:S0022-3166(25)00399-2. doi: 10.1016/j.tjnut.2025.06.014. Online ahead of print.

Authors

Candyce H Kroenke¹, Rhonda Aoki², Lawrence H Kushi², Jacqueline M Torres³, Brittany N Morey⁴, Scarlett Gomez⁵, Bette Caan², Alison J Canchola³, Stacey Alexeeff²

Affiliations

¹ Kaiser Permanente Northern California Division of Research, Pleasanton, CA; Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA. Electronic address: Candyce.H.Kroenke@kp.org.
² Kaiser Permanente Northern California Division of Research, Pleasanton, CA.
³ Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA.
⁴ Department of Health, Society, & Behavior, Program in Public Health, University of California Irvine, Irvine, CA.
⁵ Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA.

PMID: 40602722
DOI: 10.1016/j.tjnut.2025.06.014

Abstract

Background: Diet, critical to breast cancer (BC) survivorship, may change with immigration. We examined associations between immigration factors and diet in a large, diverse population of BC survivors.

Methods: The Exploring Networks in a Cohort of Latina and Asian Emigrants, lifestyle, and Vital status (ENCLAVE) Study included harmonized, pooled data from 4,882 Asian, Hispanic, and non-Hispanic White (NHW) women from three Northern California cohorts of women diagnosed from 1996-2013 with invasive BC, and who provided data on immigrant status and diet. We conducted principal components analysis of data from food frequency questionnaires, which produced "prudent" and "Western" dietary patterns. Outcomes were tertiles characterizing the most healthful (i.e., highest prudent, lowest Western) patterns. Secondary outcomes included high intakes of fruits and vegetables (F&V) and soy, and low intakes of red meat, high-fat dairy, and sweets. We fit log-binomial regression models to examine self-reported nativity and immigration-related variables (language preference, age at immigration, years in the US, second-generation status) and relative prevalence of dietary outcomes, overall and by race and ethnicity.

Results: The correlation between the prudent and Western patterns was r=-0.08, p<0.001. Foreign-born women consumed higher prudent (prevalence ratio [PR])=1.52, 95% confidence interval [CI]:1.38-1.67) and lower Western (PR=1.51, 95% CI:1.37-1.67) diets, as well as higher F&V, and lower butter and red meat intake, compared with US-born women. Associations were similar by race and ethnicity though we noted dietary heterogeneity for certain foods and by other immigration related variables.

Conclusion: Foreign-born Asian, Hispanic, and NHW women with BC had healthier dietary patterns than US-born women, overall and within same-race groups.

Keywords: breast cancer; diet; dietary acculturation; dietary patterns; ethnicity; immigrant; nativity; observational cohort; pooled study; race; women.