Intergenerational Transmission of Regional Cuisine Preferences and Adult Health Outcomes
- Design
- Longitudinal cohort with FFQ sub-study
- Sample
- n = 3,148 (sub-sample of Upper Midwest Cohort)
- Measurement
- Regional Cuisine Retention Index (RCRI)
- Outcomes
- BMI, HbA1c, lipid panel, self-reported CVD events
- Wave window
- Wave 4 (2016) → Wave 6 (2025)
Drawing on a sub-sample of the Halverson Institute's Upper Midwest Cohort Study (n = 3,148), we examine the association between intergenerational retention of regional cuisine preferences and adult health outcomes. We construct a Regional Cuisine Retention Index (RCRI) from a 56-item food frequency questionnaire administered at Wave 4 (2016) and Wave 6 (2025), and relate the index to body mass index, hemoglobin A1c, lipid panel measurements, and self-reported cardiovascular events.
After adjustment for parental education, household income, and physical activity, a one-standard-deviation increase in RCRI was associated with a 0.86 kg/m² higher BMI (95% CI [0.61, 1.11]), a 0.18 percentage-point higher HbA1c (95% CI [0.11, 0.25]), and a 12.4% relative increase in the probability of a self-reported cardiovascular event during the follow-up window. We discuss the implications of these associations for the design of culturally informed public-health communication.
1. Introduction
Regional cuisines — durable, geographically anchored patterns of food preparation and consumption — represent one of the most observable forms of cultural transmission in the United States. The Upper Midwest, the geographic focus of the broader Halverson cohort, is associated with a distinctive cuisine characterized by heavy reliance on cured meats, processed cheese, hot-dish casseroles, fried freshwater fish, and high-fat dairy preparations.
Although the nutritional epidemiology literature has documented strong associations between individual dietary components and a range of cardiometabolic outcomes, comparatively little work has examined the role of intergenerationally transmitted cuisine preferences as a coherent construct.
2. Measurement
Our central methodological contribution is the Regional Cuisine Retention Index (RCRI), a continuous measure derived from a 56-item food frequency questionnaire developed in consultation with nutritional scientists at the University of Illinois Urbana–Champaign. The instrument was administered at Wave 4 (2016) and Wave 6 (2025) to the sub-sample of cohort respondents who consented to biospecimen collection.
The RCRI is constructed as a weighted average of item-level frequencies, with weights estimated from a principal-components analysis of cuisine-defining items identified by an expert panel. Cronbach's α across the 56-item scale was 0.84.
3. Results
After adjustment for parental education, household income, physical activity, and county fixed effects, a one-standard-deviation increase in RCRI was associated with a 0.86 kg/m² higher BMI, a 0.18 percentage-point higher HbA1c, and a 14.2 mg/dL higher LDL cholesterol concentration (Table 2).
These associations were robust to the inclusion of indicators of household food-purchase patterns and to a battery of sensitivity analyses using alternative weighting schemes for the RCRI.
4. Discussion
Our findings extend a substantial body of nutritional-epidemiological work by treating regional cuisine preferences as a coherent and intergenerationally transmitted construct, rather than as an aggregation of individually optimized food choices. The magnitudes we estimate are clinically meaningful and consistent in direction across all examined outcomes.
Limitations include the geographically narrow recruitment area, the reliance on self-reported food frequency, and the relatively short follow-up window for cardiovascular outcomes. We do not interpret our findings as evidence of a direct causal pathway from cuisine to disease, but rather as motivation for further research into culturally informed interventions.
All protocols received approval under Halverson Institute IRB Protocol #2003-0418 (sub-study amendment, approved 2021).
References
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Suggested Citation
Funding & Disclosures
This research was supported by program-restricted grants administered through the Halverson Institute. The author(s) declare no competing interests. Views expressed are those of the author(s) and do not necessarily reflect those of the institute or its funders.