Diet Quality, Metabolic Syndrome, and Nativity Status: Elucidating Metabolic Advantage and Disadvantage Among Non-US-Native and US-Native Populations Using NHANES Data (2013–2018)

BACKGROUND/OBJECTIVES: Nutrient-poor diet quality is a major driver of the global burden of metabolic syndrome (MetS). The US ranks among the lowest in diet quality and has the highest rate of immigration, which may present unique challenges for non-US-native populations who experience changes in access to health-promoting resources. This study examined associations among MetS, nativity status, diet quality, and interaction effects of race-ethnicity among Hispanic, Asian, Black, and White US-native and non-US-native adults. METHODS: We examined data from 5482 adult participants (≥20 years of age) in the National Health and Nutrition Examination Survey (2013-2018). MetS (per the ATP III panel guidelines) was assessed continuously (MetS z-score) and dichotomously. Dietary recalls were used to compute HEI-2015 scores. Nativity status and sociodemographic variables were assessed. Age-adjusted and multivariate-adjusted logistic regressions were conducted to examine the associations between nativity status and MetS and interaction effects by race-ethnicity. RESULTS: < 0.001) compared to their US-native counterparts-even when stratified by racial-ethnic groups. US-native participants had larger waist circumferences and elevated triglyceride levels. Non-US-native Black Americans had a 60% lower risk of having MetS even after adjusting for diet quality (OR: 0.39, 95% CI: 0.17, 0.88) compared to their US-native counterparts. For MetS components, non-US-native Asian participants reported a lower risk for dyslipidemia, while non-US-native multiracial participants had higher triglycerides. CONCLUSIONS: Non-US-native groups display better diet quality compared to their US-native counterparts. However, the findings suggest that diet quality alone does not account for nativity-related cardiometabolic disparities, particularly in US-native Black Americans, thus necessitating interventions targeting the social determinants of health.