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Advancing Health Equity Through Culture-Centered Dietary Interventions to Address Chronic Diseases

September 28 - 29 , 2023
Virtual Workshop


The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH), in collaboration with multiple NIH Institutes and Offices as well as other federal partners (Centers for Disease Control and Prevention (CDC), the Indian Health Service (IHS), Health and Human Services Office of the Assistant Secretary for Health (OASH), and the U.S. Department of Agriculture (USDA)), hosted a two-day virtual workshop titled "Advancing Health Equity Through Culture-Centered Dietary Interventions to Address Chronic Diseases" on September 28th-29th, 2023. This workshop convened researchers, healthcare providers, community representatives, and government officials to discuss the pivotal role of culture in dietary interventions aimed at diverse populations underrepresented in health research.

Key Objectives:

  • To review how cultural foodways and sociocultural factors could be leveraged to improve the effectiveness of dietary interventions among diverse populations, including immigrant groups, racial/ethnic minorities, and rural communities.
  • To identify gaps and opportunities for research on the cultural tailoring and adaptation of evidence-based dietary approaches and for research on heritage foodways to prevent, manage, and treat diet-related diseases in culturally-diverse populations and under-resourced communities.
  • To examine the influence of culture-related factors on the biological mechanisms, such as changes in the gut microbiome, underlying responses to traditional and evidence-based dietary patterns.


Adherence to evidence-based dietary approaches, such as the Dietary Guidelines for Americans, and dietary patterns such as the Dietary Approaches to Stop Hypertension (DASH) diet and Mediterranean diet, is associated with a multitude of health benefits. These include lowered blood pressure, improved lipid profiles, reduced cardiovascular disease (CVD) incidence, decreased risk of type 2 diabetes, and decreased risk for several cancers and cancer mortality. Yet, the strength of these associations varies by race and ethnicity. There are also racial and ethnic differences in adherence to these dietary patterns. This is critically important in our increasingly culturally diverse nation, in which immigrants and their descendants are expected to account for nearly 90% of the increase in the U.S. population over the next four decades. There is research evidence that immigrants who move away from their traditional foods to adopt U.S. dietary practices (dietary acculturation) may experience losses of healthy gut bacteria and an increased risk for diet-related chronic diseases (Peters, 2020; Satia-Abouta, 2002). Notably, such evidence underscore the notion of diet as a cultural element that is influenced by, among other things, food access, environmental factors, belief systems, history, racial/ethnic identity, and migration. Culture-centered approaches that integrate traditional foodways and sociocultural factors are critical for improving adherence to healthy dietary patterns, and can therefore reduce diet-related diseases across diverse populations, including immigrant groups, racial/ethnic minorities, and rural communities.

Workshop Areas of Focus

The workshop addressed the following topics and provided research opportunities for each:

Cultural Aspects of Food and Diet and Implications for Dietary Interventions


The session provided an examination of the relationship between chronic diseases, socioeconomic and racial/ethnic disparities, and dietary choices. It broadened the definition of culture to include a diverse array of shared values, knowledge, and practices, each significantly influencing perceptions regarding health and food. This session focused on the challenges inherent in applying uniform dietary guidelines across varied cultural contexts, collaborating with community representatives to create culturally informed dietary interventions, and addressing structural barriers that limit access to healthy foods in disadvantaged communities.

Research Opportunities:

  • Develop dietary guidelines that are culturally adaptive, with a focus on traditional foods and eating patterns across diverse communities.
  • Collaborate with community representatives to co-design culturally sensitive dietary interventions.
  • Investigate structural barriers that impede access to healthy foods in socioeconomically disadvantaged areas.
  • Conduct policy-level interventions to enhance affordability and accessibility of healthy foods.
  • Study the impact of acculturation on diet quality.
  • Enhance methodologies for accurately capturing dietary data across diverse cultural groups.

Sociocultural Factors Influencing Foodways and Food Sovereignty in Native American Communities


This session offered an in-depth exploration of the multi-layered challenges and opportunities related to food sovereignty and health equity in Native American communities. Various culturally sensitive, community-driven initiatives like the Choctaw Nation's Growing Hope and the Elders Mentoring Elders program in Alaska and the community-based participatory research with the Cree community in Northern Quebec were presented as effective strategies for combatting these challenges through the use of traditional food systems. Such community-based participatory research methods, guided by the principle of reflexivity, become imperative to avoid perpetuating systemic biases and to ensure actionable, beneficial results.

Research Opportunities:

  • Examine the efficacy of grassroots food sovereignty initiatives, based on traditional practices and foods in promoting health equity among indigenous populations.
  • Evaluate lifestyle modifications and the prevalence of chronic diseases like obesity and diabetes among Native Americans.
  • Investigate the role of community engagement and intergenerational transfer of knowledge on food security, community resilience, and overall well-being.
  • Examine how culturally grounded interventions impact health metrics in indigenous communities.
  • Explore the structural impediments faced by indigenous communities in attaining food sovereignty and security.
  • Through natural experiment research, investigate the impacts of policy alternatives that could support the dual objectives of food sovereignty and health equity.

Dietary Interventions Tailored to Black Communities of Diverse Sociocultural Experiences in the U.S.


The session examined culturally tailored dietary interventions aimed at diverse Black communities in the U.S., highlighting innovative approaches grounded in community-based and health disparities research. Interventions were conducted with a variety of Black communities, such as those living in rural Georgia adopting a plant-based diet, East African and Sub-Saharan communities using culturally specific spices and herbs to reduce hypertension, and those living in southeastern U.S adapting the Mediterranean diet. Collectively, these interventions emphasized the need for culturally sensitive strategies to achieve meaningful health outcomes among Black communities.

Research Opportunities:

  • Assess the sustainability and effectiveness of plant-based dietary interventions tailored for rural Black communities in the Deep South, focusing on various age groups and health conditions.
  • Explore the influence of dietary acculturation among East African immigrants and evaluate the efficacy of community-based interventions designed to maintain healthy traditional diets.
  • Investigate the adaptability of the Mediterranean diet in the Southeastern U.S.
  • Investigate the effectiveness of health messages, including social media, that are both culturally and linguistically tailored in promoting healthier dietary choices and mitigating chronic diseases within specific cultural groups within the U.S. Black population.

Migration, Acculturation and Dietary Interventions among Diverse Hispanic/Latino Communities in the U.S.


The session provided a comprehensive, interdisciplinary overview of the complex interplay between migration, cultural diversity, and dietary habits among U.S. Hispanic and Latino communities. It focused on a variety of subgroups in the diverse Hispanic/Latino population and interventions in a variety of settings. These included Puerto Ricans, Latin Americans in NYC, and Hispanic immigrants in border states like Arizona. Various delivery mechanisms, ranging from in-person sessions to virtual platforms, were explored to ensure effective engagement in these diverse communities.

Research Opportunities:

  • Examine how social determinants of health influence health outcomes and dietary choices in Hispanic Caribbean communities, particularly Puerto Ricans.
  • Explore the integration of educational and dietary intervention programs that are sensitive to the socio-economic and cultural factors affecting Hispanic families in border states, such as Arizona.
  • Investigate the efficacy of various technological platforms in engaging different segments of the Hispanic and Latino population in dietary interventions, focusing on age groups and levels of acculturation.
  • Explore the potential of Latin American restaurants to act as agents for public health.
  • Examine the feasibility and effectiveness of integrating culturally sensitive and positive nutrition education into healthcare settings, focusing on the role of registered dietitians, and into various technological platforms, focusing on age groups and levels of acculturation.
  • Investigate the underutilization of existing dietary guidelines in Hispanic and Latino communities, and propose strategies for improvement.

Cultural Considerations for Dietary Interventions for the Diverse Asian and Pacific Islander Populations in the U.S.


This session examined the nuanced healthcare and dietary challenges facing diverse Asian and Pacific Islander communities in the U.S., set against a backdrop of significant health disparities. The panel spotlighted interventions in a variety of contexts and represented the diversity in these groups, including the Marshallese community, Southeast Asians, Chinese Americans, and indigenous Hawaiian communities.  Culturally and linguistically appropriate adaptations of interventions that include variables like spirituality, and sociopolitical context were discussed.

Research Opportunities:

  • Investigate how historical events like nuclear testing have impacted dietary practices and health outcomes in Marshallese populations.
  • Evaluate the effectiveness of culturally tailored dietary interventions within diverse South Asian communities, considering cultural, religious, social networks, and regional variations.
  • Conduct research to understand how social networks and religious beliefs influence dietary choices and health outcomes in diverse Asian and Pacific Islander communities.
  • Examine the potential for integrating traditional views and practices related to food and nutrition into modern health interventions among indigenous Hawaiian populations.
  • Assess the effectiveness of web-based interventions that are tailored for specific Asian and Pacific Islander ethnic groups in terms of cultural and linguistic adaptations.

Developing Evidenced Based Dietary Guidance for Diverse Populations


This session provided a review of federal efforts for developing dietary guidance for the diverse U.S. population, including existing challenges and opportunities for fostering greater equity in the U.S. Dietary Guidelines, the USDA's Food and Nutrition Services emphasis on the importance of culturally sensitive nutrition interventions and equity in federal nutrition assistance programs, and the CDC's initiatives in promoting healthy food environments through cultural considerations. The session delved into evidence review methodologies and the Food and Nutrient Database for Dietary Studies (FNDDS), acknowledging the limitations of current data collection methods, particularly their lack of cultural sensitivity, and the underrepresentation of specific ethnicities in large cohort studies.

Research Opportunities:

  • Assess the effectiveness of the 2025 U.S. Dietary Guidelines in addressing health disparities across different racial, ethnic, and socioeconomic groups, focusing on its impact on federal programs.
  • Examine how inclusion of a broader range of ethnic foods in the USDA’s Food and Nutrient Database for Dietary Studies could improve dietary assessments among various ethnic groups.
  • Design and validate culturally sensitive dietary surveys and recall methodologies that capture nuances in food consumption across different ethnic groups.
  • Examine the various factors that influence food choices in different ethnic and cultural communities (e.g., company during meals, food presentation).
  • Evaluate the adaptability and accuracy across of innovative technologies like photograph-based dietary recall in capturing accurate food intake data.
  • Investigate the potential for collaborations across academia, healthcare, and communities in the development of more inclusive and culturally sensitive dietary guidelines.

Precision Nutrition, Culture, and Diet


The session explored the complexities of the gut microbiome, metabolomics, and their implications for chronic diseases across diverse demographic groups. The session highlighted microbiome research in a variety of diverse communities, including the Strong Heart Study involving American Indians, a New Hampshire-based study in a Bhutanese refugee adult population, and Hispanic and Latino populations. The session wrapped up with a critical dialogue on methodological questions, including how to differentiate between host and microbial-derived metabolites, the role of specific foods in traditional diets, and the promising future avenues for microbiome research.

Research Opportunities:

  • Investigate the specific dietary-related mechanisms by which microbial-derived metabolites interact with host cells to regulate inflammation.
  • Extend the findings from existing studies to explore the relationship between lipidomic markers and cardiometabolic diseases in high-risk groups.
  • Research the consequences of low dietary fiber intake on the gut microbiome in Hispanic communities, focusing on potential health outcomes such as cardiometabolic risk.
  • Examine how individual gut microbiome profiles may predict responses to dietary interventions, aiming to advance the field of personalized nutrition.
  • Investigate the causal relationships between identified lipidomic markers and specific health outcomes, focusing on the potential for these markers to serve as predictive or diagnostic tools.
  • Assess the feasibility and impact of incorporating microbiome research findings into clinical practice, particularly in the context of precision nutrition and culturally sensitive interventions.

Translating Research into the Community


This session highlighted diverse community-based efforts aimed at mitigating disparities in healthy and culturally appropriate food access and disease management across various U.S. communities—from interventions among American Indians and Alaska Natives with type 2 diabetes, and culturally inclusive emergency food systems in Arkansas to food systems work among Marshallese communities, and adaptations of the CDC's Diabetes Prevention Program for Caribbean communities in New York City. Additionally, a food insecurity intervention (e.g., expanded market access and increased Community Supported Agriculture memberships) among multicultural immigrant and refugee populations in Lowell, Massachusetts and the emerging concept of teaching kitchens were also discussed.

Research Opportunities:

  • Assess the long-term impact and scalability of culturally tailored educational resources, such as diabetes nutrition education, especially when delivered through peer-educator models and incorporating traditional food practices.
  • Examine the effectiveness of cultural food preference lists and toolkits in charitable food distribution systems, focusing on their impact on health outcomes across various communities.
  • Investigate how barriers like safety concerns, time constraints, and social norms can be effectively addressed when adapting national programs like the CDC's Diabetes Prevention Program to specific communities, such as Caribbean populations in urban settings.
  • Conduct research to evaluate the impact of community food assessments and their subsequent strategies, like the expansion of markets or adoption of acres for urban agriculture, on health outcomes in multicultural immigrant and refugee communities.
  • Explore the effectiveness of teaching kitchens as learning laboratories in diverse cultural settings, taking into account variables such as cultural and dietary flexibility.
  • Investigate the impact of the COVID-19 pandemic on healthcare delivery in online settings, focusing on best practices for maintaining community engagement and managing health disparities during crises.

Cross-Cutting Themes

Cross cutting themes included the importance and need for more inclusivity, interdisciplinary collaboration, community-centered approaches, technological innovations, sociocultural nuances, and considerations for structural and economic factors.  Below are examples of potential research opportunities to advance health equity through culture-centered dietary interventions that were identified through the workshop:

  • The importance of planning and translating research into the community such as the scalability of culturally tailored educational resources, cultural food preference lists and toolkits in charitable food distribution systems, community food assessments, community teaching kitchens, and knowing best practices for maintaining community engagement.
  • The need for more inclusive, equitable dietary and health guidelines, which considers both sociocultural and biological factors.
  • The necessity for multi-disciplinary research that integrates diet, metabolomics, community psychology, and public health.
  • The need for utilization of emerging technologies and methods—like food pattern modeling, lipidomics, and virtual classrooms.
  • The role of cultural specificity, traditional diets, and the sociocultural aspects of food for culturally tailored dietary guidelines.
  • To address structural barriers to healthy foods, income inequality, and other socioeconomic factors that significantly impact dietary choices.

The findings, knowledge gaps, and opportunities described here represent a summary of individual opinions and ideas expressed during the workshop. The summary does not represent a consensus opinion or directive made to or by NHLBI or NIH.

Workshop Organizing Committee and Leadership

Workshop Chairs

  • Josiemer Mattei, PhD, MPH
  • Brie Turner-McGrievy, PhD, MS, RDN

Workshop Program Leads

  • Alison Brown, MS, PhD, RDN
  • Tanya Agurs-Collins, PhD, MS, RDN

Workshop Organizing Committee

  • Kibbe Brown, MS, RDN - IHS, HHS
  • Juliana Camargo, PhD, MPH - NHLBI, NIH
  • Fungai Chanetsa, PhD, MPH - NHLBI, NIH
  • Janet de Jesus, MS, RD - OASH, HHS
  • Laurie Donze, PhD - NHLBI, NIH
  • Regine Douthard, MD, MPH - ORWH, OD, NIH
  • Rachel Fisher, MS, MPH, RD - OASH, HHS
  • Sheila Fleischhacker, PhD, JD, RDN - NIFA, USDA
  • Roberto Flores, PhD, MPH - OD, NIH
  • Carlos Garrido, PhD, MS, MPH - NIMHD, NIH
  • Meagan Grant, PhD - NHLBI, NIH
  • Diane M. Harris, PhD, MPH, CHES - CDC
  • Bramaramba Kowtha MS, RDN - ODP/OD, NIH
  • Gabriel Lai, PhD - NIMHD, NIH
  • Phuong-Tu Le, BS, CEP - NIMHD, NIH
  • TusaRebecca Pannucci PhD, MPH, RD - CNPP, FNS, USDA
  • Charlotte Pratt, PhD, MS, RD, FAHA - NHLBI, NIH
  • Candice Price, PhD - NHLBI, NIH
  • Marissa Shams-White, PhD, MSTOM, MS, MPH - NCI, NIH
  • Jennifer Seymour, PhD - CDC
  • Eve Stoody, PhD - CNPP, FNS, USDA
  • Debbie Vitalis PhD, MPH - NHLBI, NIH

Workshop Speakers and Moderators

  • Halide Aydin, MS
  • Loneke Blackman Carr, PhD, RDN
  • Kibbe Brown, MS, RDN
  • Dale C. Brunelle, PhD
  • Maria Carlota Dao, PhD, MA
  • Ambria Crusan, PhD, MS, RDN/LD
  • Maria Carlota Dao, PhD, MA
  • Nicole Farmer, MD
  • Sheila Fleischhacker, PhD, JD, RDN
  • Amanda Fretts, PhD, MPH
  • Teresa Fung, MS, RDN, ScD
  • Melissa Fuster, PhD, MS
  • Joel Gittelsohn, PhD
  • David Goff, MD, PhD
  • Jeanmerli Gonzalez, MPH
  • Heather Greenlee, ND, PhD, MPH
  • Christine Ha, PhD
  • Diane Harris, PhD, MPH
  • Margrethe Horlyck-Romanovsky, DrPH
  • Valarie Blue Bird Jernigan, DrPH, MPH
  • Janet de Jesus, MS, RDN
  • Donna Johnson-Bailey, MPH, RDN
  • Nicole Karongo, MPH, RDN
  • Namratha Kandula, MD, MPH
  • Robert Kaplan, PhD
  • Karina R. Lora, PhD, RDN
  • Miguel Angel Lopez, PhD, MPH, RDN, LDN
  • Josiemer Mattei, PhD, MPH, MS
  • Philmar Medoza Kabua, RN, MSN
  • Brandy Moser, MS
  • Alanna Moshfegh, MS, RDN
  • Brett Otis, ALM
  • Sharon Ka'iulani Odom, MPH, RDN
  • TusaRebecca Pannucci, PhD, MPH, RDN
  • Eliseo J. Pérez-Stable, MD
  • Selina Mae Quibrantar, BSc(H), MSc
  • Minakshi Raj, PhD, MPH
  • Sudha Raj, PhD, RDN, FAND
  • Elektra Robinson, PhD
  • Lisa Goldman Rosas, PhD, MPH
  • Carmen Samuel-Hodge, PhD, RDN
  • Jennifer Seymour, PhD
  • Marissa Spear, CPA
  • Samara Sterling, PhD, RDN
  • Sarah Stotz, PhD, MS, RDN, CDCES
  • Katherine Tucker, PhD
  • Jenni Vaughan, RDN, LD
  • Sonia Vega-Lopez, PhD, MS
  • Roniece Weaver, MS, RDN, LD
  • Xiaoxiao Wen, MS, PhD
  • Marissa Shams White, PhD, MSTOM, MS, MPH
  • Stella Yi, MPH, PhD
  • Ming-Chin Yeh, PhD, MEd, MS
  • Jinying Zhao, MD, PhD

Workshop Agenda

Workshop Recording

Continuing Education Credits

This workshop has been approved by the Commission on Dietetic Registration (CDR) for up to 8.5 CPEU credits. Registered Dietitian Nutritionists (and other health care professionals) who would like to claim Continuing Professional Education Units (CPEU) for attending the workshop can download the Continuing Professional Education Certificate of Attendance using this link. If you have any questions and/or concerns, please email Tanya Agurs-Collins and Alison Brown.