Dietary Transitions and Sustainability Among Asian International Tertiary Education Students in Western Countries: A Scoping Review

Abstract

Western countries host a significant number of international tertiary students from Asia, who often undergo dietary acculturation, impacting their health, well-being, and the sustainability of their diets. This scoping review critically examines dietary transitions among this demographic, focusing on the extent, nature, and drivers of these changes, with a strong emphasis on sustainability implications. We conducted a comprehensive search across five databases from 2014 to 2024, including all review types, primary studies, and theses/dissertations, yielding thirty-eight relevant studies. The results reveal a marked shift from traditional to Western dietary patterns, characterised by increased consumption of processed foods and decreased intake of culturally traditional foods. Despite the challenges of limited access to traditional food stores and unfamiliar food environments, students showed a strong preference for maintaining their traditional dietary habits. Notably, the shift towards higher consumption of meat, dairy, and sugary foods, coupled with lower intake of fruits, vegetables, and fish, underscores the urgent need for policies that support access to culturally appropriate, environmentally sustainable food choices. This review advocates for a reinforced focus on integrating culturally sensitive, sustainable dietary practices into strategies aimed at supporting international students.

1. Introduction

The movement of students around the world is becoming increasingly common, with the global number of international students leaving their home country to pursue tertiary education more than doubling over the past 20 years, reaching 6.4 million in 2021 [1]. The largest origin of international students is from countries in East, South, and Southeast Asia, with over 1 million students from China and half a million from India [1]. Within Australia, 17 of the top 20 most common countries of international student origin belong to these three geographic regions [2]. Western countries of the Organisation for Economic Cooperation and Development (OECD) receive the most international tertiary education students, with the most recent data showing the USA received more than 833,000, the UK nearly 601,000, Australia around 378,000, Germany over 376,000, and Canada nearly 318,000 international students in 2021 [3].

As a result of moving abroad, international students often experience dietary acculturation, a process in which they adopt the dietary habits of the host country while also retaining certain elements of their native diet [4]. Dietary guidelines in Western countries promote a healthy, balanced diet consisting of fruits, vegetables, whole grains, meats, and dairy [5,6,7,8]. These recommendations are generally consistent with the United Nations Food and Agriculture Organisation (UNFAO) and World Health Organisation (WHO) model for sustainable healthy diets. These guidelines emphasise diets that are not only health-promoting but also environmentally sustainable, economically affordable, accessible, and culturally appropriate [9].

Despite the alignment of Western dietary guidelines with these sustainable practices, many Western countries tend towards the ‘Western diet’ pattern, which has been defined as featuring an excess of processed foods, added sugars, refined grains, and red and processed meat, while having insufficient fish, vegetables, and fruit [10]. This is due to the prevalence of ultra-processed and fast foods in these regions, which often leads to non-compliance with healthy eating recommendations [11].

Comparatively, a traditional Asian diet aligns more closely with the sustainable healthy diet recommendations outlined by the UNFAO and WHO. Asian dietary guidelines also promote a healthy, balanced diet incorporating many of the same main food groups as the Western guidelines, all macronutrients (carbohydrates, protein, and fats), and sufficient intakes of vitamins and minerals to support health and well-being [12,13,14]. Traditional Asian diets typically include rice, noodles, and vegetables with either meat or vegetarian alternatives [15,16,17,18,19]. Whilst traditional Asian diets are often plant-based and low in ultra-processed foods (UPFs), adherence to such a diet may vary amongst young adults due to the availability of UPFs in Asian countries.

Documented dietary changes experienced by international students from any country are varied, but a decrease in the consumption of fruit, vegetables, and home country foods is often noted alongside an increased adoption of host country foods, including a ‘Western diet’ pattern for students moving to Western countries. The shift toward Western dietary patterns among Asian students frequently involves a move away from sustainable and culturally traditional diets towards increased consumption of processed and fast foods, influenced by factors such as cost, convenience, and accessibility [4,20]. This occurred despite most students’ preference for their home diet [4]. In studies that found increased intake of convenience food (pre-prepared packaged food) and fast food upon arrival in a host country, weight gain over a relatively short time frame was reported [4,21]. Students further felt concern over impacts on other parameters, such as blood glucose, cholesterol, and digestion [4]. Conversely, weight loss may be of concern due to the stress of change, as well as a dislike of the local diet and limited cooking skills [4]. Despite this, it has also been reported that a subset of international students describe their personal diet in their host country as ‘healthier’ than in their home country due to having more responsibility over their intake [22]. Beyond physical changes, the inability to access desired cultural foods may have a negative impact on students’ mental health [23]. The erosion of dietary diversity and the move away from culturally rooted food practices not only impact individual health but also undermine cultural sustainability, posing challenges to the maintenance of traditional diets and associated cultural identities [24].

Understanding the dynamics of dietary acculturation among Asian international students in Western settings is crucial. This knowledge can guide the development of interventions in host countries that not only promote health and well-being but also support the adoption of culturally appropriate sustainable dietary practices.

Previous studies and reviews have either more broadly focused on the dietary transitions of international university students in any country or, more specifically, on a particular cohort of international students or a particular host country, city, or institution. For these reasons, this scoping review was conducted with the objective of understanding dietary changes experienced by this specific significant international student population. To this end the following research question was developed:

What are the dietary changes experienced by international tertiary education students from Asian countries who move to Western countries, and what factors contribute to these changes?

A scoping review was chosen for its utility in summarising broad findings from a field which is heterogenous in methods [25].

2. Materials and Methods

2.1. Protocol

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR), which is designed to help ensure consistency in the reporting of scoping reviews [25]. Compliance with the PRISMA-ScR checklist can be found in Supplementary Table S1. Recommendations from the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis were also integrated, which is particularly suitable as it contains specific recommendations for the conduct of scoping reviews to ensure research is rigorous, transparent, and trustworthy [26]. The PRISMA-ScR and JBI guidelines were selected due to their robustness in guiding scoping reviews that aim to map the existing literature and identify key themes, which is critical for addressing the broad research questions of this study. The protocol was prospectively registered with the Open Science Framework on 8 August 2024 (osf.io/d5jrt).

2.2. Eligibility Criteria

To accurately target the research aim, any studies investigating and related to the diets of Asian international students who move to Western countries were eligible for inclusion. All review types, primary studies, and grey literature (theses/dissertations) were included in the search to ensure all relevant studies were considered. Studies were considered eligible if the sample size was at least 50% East, South, or Southeast Asian students. Studies were also eligible if the sample size was less than 50% Asian but presented results specific to Asian students from these regions.

Studies were considered ineligible for inclusion if they were published prior to 2014 to capture the current dietary habits of Asian international students, as food environments and migration patterns are rapidly changing. Studies published in a language other than English were also ineligible due to the language limitations of the reviewers.

When considering Western host countries, we were primarily concerned with those receiving the most international students (the USA, the UK, Australia, Germany, and Canada) [3]. We decided to include other OECD countries in the Western Europe [27] and Australasia regions due to social and food environment similarities with the major host countries, as well as the influence of a ‘Western diet’ pattern in many of these countries [10]. We have chosen to use the United Nations geographic region definition of Western European countries, as this excludes Spain and Portugal, which typically follow the ‘Mediterranean diet’ pattern, which is very distinct from the dietary patterns observed in the major host countries. This resulted in the inclusion of the following Western host countries in our search: the USA, Canada, Austria, Belgium, France, Germany, Luxembourg, the Netherlands, Switzerland, England, Northern Ireland, Scotland, Wales, Australia, and New Zealand.

When considering Asian countries, we included East, Southeast, and South Asian countries, as the majority of international students originate from these regions [3].

The full exclusion and inclusion criteria can be found in Supplementary Table S2.

2.3. Search Strategy

To capture all relevant primary and review articles, MEDLINE, CINAHL, Scopus, and Web of Science databases were searched from January 2014 to August 2024, on 23 August 2024. Grey literature was searched for using keywords in ProQuest Dissertations and Theses Global and through citation chaining on included articles. The search strategy was developed and executed by two reviewers (HM and DT) and was refined by an experienced research librarian. An initial limited search was made in Medline and Scopus to identify keywords and indexed terms used in relevant papers. Keywords were adapted from the population (Asian international students), concept (dietary transitions), and context (Western countries). For example, many of the papers used terms such as international students, young adults, feeding behaviour, and diet. Identified terms were then added to develop the full search strategy (Supplementary Table S3), which was carried out across the included databases. Key search terms included Asia*,5, Tab East Asia*, South Asia*, Southeast Asia*, [and individual country names in these regions]; students, international/foreign/Asia* students; nutrition*/food*/diet* chang*/pattern*/acculturation; West* Countr*, West* Europe*, North* America*, United Kingdom, [and individual Western OECD country names]. Once relevant papers that met the eligibility criteria were identified, their reference lists were searched for additional sources to be screened for inclusion. Additionally, forward chaining was also performed on eligible studies using Google Scholar.

2.4. Selection of Sources

Citations were collated in EndNote 21 (Clarivate, 2013) [28] and then uploaded into Covidence (Veritas Health Innovation, 2024) [29] for removal of duplicates and subsequent screening.

To ensure that the eligibility criteria were consistently applied between the two reviewers (HM and DT), a pilot screening was conducted based on a framework developed by JBI [26]. Reviewers separately applied the eligibility criteria to 100 randomly selected abstracts found during database searching, then met to discuss any disagreements between results and refined the eligibility criteria so that they could be applied with more unanimity. The eligibility criteria were deemed sufficient to begin comprehensive screening when a minimum of 75% agreement between reviewers’ results was achieved [26]. The reviewers exceeded this and reached a 98% agreement. Any subsequent discrepancies were to be resolved by a member of the wider research team (AR or RR).

The screening began with examining titles and abstracts. Following this, full texts were screened for eligibility, with reasons for exclusion noted in Supplementary Table S4.

2.5. Data Charting and Items

Two reviewers created a data charting form that was updated continuously throughout the search. The data items that were considered include the students’ countries of origin, host country, sample characteristics (age, gender, degree status, length of stay in Western country), sample size, study design (study type and data collection methods), relevant information such as the students’ home country and Western host country diets, relevant quotes from students, and factors influencing these changes. The full data charting form can be accessed in Supplementary Table S5.

Qualitative and quantitative findings related to the students’ dietary habits were separated according to their home country and Western host country, allowing changes in diet to be identified and documented. Key themes related to dietary changes were identified and listed in the table and expanded upon in the narrative synthesis, which allowed for comparisons to be drawn between different studies. Factors influencing dietary changes were also explored in the narrative synthesis.

3. Results

3.1. Selection of Sources of Evidence

A total of 5197 studies were identified using the full search strategy and a further 46 using citation searching (Figure 1). After duplicate removal, 4916 studies were screened by title and abstract and then 76 through full-text screening. Thirty-eight studies were included in the scoping review. The reasons for the exclusion of articles during full-text screening are listed in Supplementary Table S4.

3.2. Characteristics of Sources of Evidence

Table 1. Study and participant characteristics for all included studies.

Author (Year)	Study Design	Sample Size	Host Country	Home Country	Participant Characteristics			Length of Stay
					Sex	Age	Degree Status
Alakaam et al. (2015) [31]	Qualitative Cross-sectional Focus groups	n = 32 (56% Asian)	USA	Asia (47%), South Asia (9%)	63% M 38% F	19–38	25% UG 75% G	6 month–4 years
Alakaam et al. (2020) [32]	Qualitative Cross-sectional Focus groups	n = 44 (45% Asian)	USA	Asia (45%)	55% M 45% F	18–32	77% UG 23% G	6 months–5 years
Almohanna et al. (2015) [33]	Quantitative Longitudinal with 3 time periods (V1 beginning of semester, V2 6 weeks later, V3 12 weeks later) Food Frequency Questionnaire, 24 h and multiple-choice questions	n = 35 (74% Asian)	USA	China (40%), India (20%), South Korea (6%), Bangladesh (3%), Nepal (3%), Vietnam (3%)	49% M 51% F	NR	14% UG 86% G	NR
Amos & Lordly (2014) [34]	Qualitative Cross-sectional Focus groups, photographs, and memos	n = 15 (40% Asian)	Canada	China (100%)	13% M 87% F	25–30	67% UG 33% G	NR
Brown (2016) [35]	Qualitative Ethnographic, longitudinal Interviews every 3 months for the 12-month academic year and observations	n = 13 (46% Asian)	UK	Korea (8%), Taiwan (8%), China (8%), Thailand (8%), Indonesia (8%), Malaysia (8%)	15% M 85% F	22–40	100% G	NR
Buell et al. (2021) [36]	Qualitative Single-case study Semi-structured interviews, analysis of housing and dining documents	n = 19 (32% Asian)	USA	South Asia (21%), East Asia (11%)	68% M 32% F	18–25	100% UG	NR
Chai et al. (2019) [21]	Quantitative Cross-sectional Questionnaire	n = 172 (100% Asian)	USA	China (61%), India (22%), South Korea (5%), Taiwan (2%)	49% M 51% F	Mean = 26	100% G	NR
Chen & Brady (2023) [37]	Qualitative Phenomenological EAT-26 Questionnaire and semi-structured interviews	n = 5 (100% Asian)	Canada	China (100%)	100% F	Mean = 23	100% UG	1.5–7 years
Dean et al. (2022) [38]	Quantitative Cross-sectional Questionnaire	n = 173 (50% Asian)	USA	China (19%), India (14%), Korea (6%), Other Asia (11%)	57% M 37% F	Mean = 28	11% UG 89% G	2.5 months–16 years
Dong (2019) * [39]	Mixed-methods Ethnographic Interview, quantitative survey (n = 35), photovoice (n = 12), and observation (n = 6)	n = 35 (100% Asian)	USA	China (100%)	43% M 57% F	Mean = 27	3% UG 97% G	Average of 3.6 years
Du 2023 [40]	Qualitative Longitudinal (data collected at 3 time points—August, December, March), cohort Anthropometric measures, acculturative stressor scale, questionnaires	n = 54 (91% Asian)	USA	China (92%), India, South Korea	43% M 57% F	Mean = 19	100% UG	NR
Ghosh et al. (2022) [41]	Mixed-methods Cross-sectional In-depth, semi-structured interviews, context analysis, and field observations	n = 30 (100% Asian)	Canada	India (100%)	50% M 50% F	21–25	NR	NR
Hanbazaza et al. (2021) [42]	Qualitative Semi-structured, individual interviews	n = 11 (55% Asian)	Canada	NR	73% M 27% F	18–33	55% G	NR
He et al. (2024) [43]	Qualitative Cross-case analysis of 3 independent qualitative research projects Semi-structured, individual interviews	n = 52 (100% Asian)	UK and USA	China (100%)	12% M 88% F	18–24	NR	NR
Hsiung (2018) * [44]	Quantitative Cross-sectional Questionnaire (n = 23), individual interviews, and 24 h recall (n = 20)	n = 23 (100% Asian)	USA	China (22%), Taiwan (48%), Hong Kong (9%), Japan (17%), Korea (4%)	42% M 58% F	18–24	NR	3 months–7 years
Jiang (2015) * [45]	Quantitative Cross-sectional Survey	n = 172 (100% Asian)	USA	China (61%), India (22%), South Korea (5%), Taiwan (2%)	49% M 51% F	Mean = 26	100% G	Average of 29.2 months
Korff & Hunter (2019) [46]	Quantitative Longitudinal—2 groups (A and B) and 2 timepoints for each group (Group A T1 and T3, 19 weeks apart) (Group B T2 and T3, 6 weeks apart) Questionnaire, anthropometric and biochemical measurements, and food sensory testing	n = 33 (61% Asian)	USA	China (27%), Japan (3%), Bangladesh (18%), India (6%), Pakistan (6%).	61% M 39% F	Mean = 23	NR	2–64 weeks
Lam (2023) * [47]	Quantitative Cross-sectional Survey	n = 3 (100% Asian)	USA	India (33%), Korea (67%)	NR	20–28	33% UG 67% G	Average of 24.33 months
Lee (2020) [48]	Quantitative Cross-sectional Survey	n = 511 (100% Asian)	USA	China (56%), Korea (32%), Taiwan (4%), Hong Kong (3%), Japan (2%)	31% M 67% F	18–35	27% UG 67% G	<1 to >10 years
Leu et al. (2015) [22]	Qualitative Cross-sectional Interview	n = 31 (100% Asian)	Australia	Singapore (45%), Malaysia (16%), Vietnam (13%), Indonesia (6.5%), Thailand (6.5%), Other Southeast Asia (13%)	42% M 58% F	18+	100% UG	NR
Liu (2019) * [49]	Qualitative Cross-sectional Participant observation and interview	n = 15 (100% Asian)	Canada	100% from Mainland China, Hong Kong, or Taiwan	40% M 60% F	18+	NR	NR
Liu (2018) * [50]	Mixed-methods Cross-sectional Survey, including food recall	n = 36 (100% Asian)	USA	China (100%)	58% M 42% F	20–37	47% UG 53% G	NR
Liu et al. (2020) [51]	Quantitative Cross-sectional Questionnaire	n = 472 (31% Asian)	Republic of Ireland	China, Hong Kong, India, Japan, Korea, Malaysia, Mongolia, Vietnam	43% M 57% F	18–26	80% tertiary 20% primary and secondary	1 week–7.4 years
Luong et al. (2022) * [52]	Quantitative Cross-sectional Survey, including FFQ	n = 862 (Unknown % Asian)	USA	“Asian”: From China, Indonesia, Japan, Korea, Philippines, Sri-Lanka, Thailand, Vietnam “Asian Indian”: From Bangladesh, India, Nepal, Pakistan	43% M 55% F 2.5% O	23 ± 4.5	63% UG 37% G	NR
Noyongoyo (2018) * [53]	Mixed-methods Cross-sectional Survey and interview Survey sample	n = 273 (54% Asian)	USA	Asian countries not specified	44% M 56% F	18–33+	32% UG 68% G	NR
O’Sullivan et al. (2016) [54]	Qualitative Cross-sectional Interview	n = 10 (30% Asian)	UK	1 from Bangladesh, 1 South Korea, 1 Sri Lanka	20% M 80% F	20–45	NR	NR
Pang (2022) [55]	Qualitative Cross-sectional Interview	n = 10 (100% Asian)	Australia	100% from Mainland China or Hong Kong	20% M 80% F	NR	NR	Up to 10 years
Pilli et al. (2021) [56]	Mixed-methods Cross-sectional Focus group, food records	n = 30 (40% Asian)	Canada	Eastern Asia (27%), Southeast Asia (13%)	33% M 67% F	18–33	NR	4 months–7 years
Prather et al. (2015) * [57]	Quantitative Cross-sectional Questionnaire	n = 97 (100% Asian)	USA	India (100%)	78% M 22% F	18–37	99% G	1 month–9 years
Saccone et al. (2015) [58]	Qualitative Cross-sectional Phenomenological Survey	n = 25 (44% Asian)	USA	China (16%), Japan (12%), South Korea (12%), India (4%)	40% M 60% F	17–39	8% UG 92% G	<1–>5 years
Shi et al. (2024) [23]	Qualitative Cross-sectional Phenomenological Interview	n = 14 (100% Asian)	Australia	China (57%), India (43%)	21% M 79% F	19–27	50% UG 50% G	<3 months–>1 year
Tran (2021) * [59]	Qualitative Cross-sectional Interview	n = 8 (100% Asian)	USA	3 from Vietnam, 2 China, 1 Hong Kong and Philippines, 1 India, 1 Japan	37% M 63% F	20–25	NR	NR
Wang (2017) * [60]	Mixed-methods Cross-sectional Questionnaire and interview	n = 20 (100% Asian)	UK	100% from Mainland China, Hong Kong, or Taiwan	55% M 45% F	19–30	30% UG 70% G	6 months–7 years
Wu et al. (2016) [61]	Mixed-methods Cross-sectional Focus group, 24 h recall	n = 43 (100% Asian)	USA	China (100%)	37% M 63% F	19–31	53% UG 47% G	Average: 20.3 ± 18 months
Yan et al. (2016) [62]	Qualitative Cross-sectional Interview	n = 18 (Unknown % Asian)	USA	China (Unknown %)	33% M 67% F	Mean = 19.2	100% UG	<5 years
Zhang (2017) [63]	Quantitative Prospective observational study Anthropometric measures and questionnaire	n = 93 (100% Asian)	USA	China (100%)	59% M 41% F	NR	NR	1 month
Zhang (2016) * [64]	Quantitative Cross-sectional Anthropometric measures and questionnaire	n = 55 (100% Asian)	USA	China (100%)	51% M 49% F	Mean = 23.8 ± 3.7	62% UG 38% G	34.4 ± 34.4 months
Zhao (2017) * [65]	Qualitative Cross-sectional Interview	n = 19 (100% Asian)	USA	China (100%)	47% M 53% F	18–>28	47% UG 53% G	6 months–>4 years

* Thesis/dissertation; USA = United States of America; UK = United Kingdom; UG = undergraduate; G = graduate; NR = no result.

describes the study and population characteristics for each paper. Twenty-five studies were published papers, and thirteen were theses/dissertations. Eighteen qualitative, thirteen quantitative, and seven mixed-methods studies were included. Twenty-four studies were conducted in the USA, three in the UK, one jointly in the USA and UK, six in Canada, three in Australia, and one in the Republic of Ireland. Asian international students came from a diverse range of countries in East, Southeast, and South Asia; however, 20 studies had China, Taiwan, and Hong Kong as the countries of origin for the most Asian students.

3.3. Results of Individual Sources of Evidence

Table 2. Summary of dietary changes and factors influencing change from all included studies.

Author (Year)	Home Country Diet	Western Host Country Diet	Summary of Changes	Factors Influencing Changes
Alakaam et al. (2015) [31]	Eating Patterns Mainly traditional foods Fresh, simple, and basic Regular meal times Breakfast daily and 3 courses Small food portions No late-night meal available Varied and filling	Eating Patterns Mainly American food Skipping/light breakfast Late-night meal available Easy to prepare Large portions Unstructured/irregular Consumed more meals Less varied Convenience food	Eating Patterns Frequency of traditional food consumption Meal irregularity Meal pattern Portion size Convenience foods	Access: Easy to access fast and convenience foods, hard to access traditional foods Cost: Fast and convenience foods are cheaper; traditional is more expensive Transport: Traditional stores in big cities, but fast and convenience stores in walking distance Availability: Few traditional foods available Less fresh produce than home country Individual preference: Some students try to cook traditional foods; others adapt to the USA Religion: Lack of halal foods means Muslim students consume less meat and eat less in restaurants/on campus Time: A busy schedule increases convenience food instead of cooking and eating healthier food Living environment: Campus cafeteria food and buffet-style increases consumption Food is more expensive and less varied Family structure: Students with a spouse had fewer changes in their dietary habits Students with children in the USA had more changes
	Food/Eating Environment Home-cooked Commensal eating	Food/Eating Environment Not cooking often Mainly eating alone	Food/Eating Environment Frequency of home-cooked meals Eating alone
	Food/Nutrient Intake Fresh fruit and vegetables Limited snacking and dessert Drinking traditional tea	Food/Nutrient Intake More fast food, meat, sugar, salt, convenience foods, cereals, bread, dairy, and soda beverages Snacks and desserts Drinking coffee	Food/Nutrient Intake Fruits and vegetables Snacks and desserts Tea/coffee Fast food Meat Sugar Salt Convenience foods Cereals Bread Dairy Soda
Alakaam et al. (2020) [32]		Food/Eating Environment Indian student expressed the limited choices available in the USA for vegetarians and had to start eating eggs	Food/Eating Environment Availability of vegetarian products	NR
	Food/Nutrient Intake Indian student reports starting the day with tea or milk Did not eat eggs due to vegetarian diet Vegetarian burger patties were available	Food/Nutrient Intake Korean student eats hamburgers, pizza, and pasta	Food/Nutrient Intake Hamburgers Pizza Pasta Eggs
Almohanna et al. (2015) [33]	NR	Eating Pattern 78% were cooking a native diet at V1 but only 60% at V3 88% ate at FF restaurants at V3, 42% 3 or more days a week	Eating Pattern Frequency of traditional food consumption Eating out frequency	NR
		Food/Eating Environment Almost 1/3 of students believed food-buying and cooking patterns were very influenced by the American diet	Food/Eating Environment American influence
		Food/Nutrient Intake Consuming typical American foods: burgers, pizza, ice cream, mashed potatoes, french fries, and carbonated drinks Significant increase in burger consumption from V1 to V3 Average consumption of 1742 kcal at V1 and 1773 kcal at V3	Food/Nutrient Intake Burgers
Amos & Lordly (2014) [34]	NR	Food/Nutrient Intake Canadian organic food is frequently accessed due to greater availability	NR	NR
Brown (2016) [35]	NR	Attitude Towards Eating Some found local food bland and tasteless. Largely intolerant of local food	Attitude Towards Eating Negative perception of host country foods Cultural identity	Cost—Free range chicken was unaffordable, reported by a Taiwanese participant Living Environment—Living with host families forced students to eat local food
		Eating Pattern All Southeast Asian students ate home food as a way to maintain ethnic identity, and additionally, they associated a home culture diet with health
		Food/Eating Environment The Korean and Thai students moved out of English host family homes to improve their diet Southeast Asian students found communal eating important and noted confusion that English host families do not always eat together All Southeast Asian students dedicated significant time each day to cook traditional food, sometimes up to 2 h	Food/Eating Environment Cooking frequency Living environment/ residency
Buell et al. (2021) [36]	Eating Pattern Fresh, homemade food	Food/Eating Environment All described how different the food on campus was from the food they grew up with in their communities—some moved off campus to avoid eating and paying for meal plans Others moved to different residence halls so they could cook for themselves. They saw campus food as poor quality and wanted to connect their experience with food to their culture	Food/Eating Environment Residency Food availability on campus	Cost—Dining halls and meal plans prevent access to cultural/desired food and can be too expensive
Chai et al. (2019) [21]	NR	Dietary Acculturation Indian students had significantly higher adoption of USA food compared to students from the other countries (China, South Korea, and Taiwan)	Dietary Acculturation Adoption of Western foods/food habits	NR
		Food/Nutrient Intake Small increase in the consumption of added sugar and whole grains Higher calcium and dairy consumption by Indian students than Chinese and Korean students Added sugar was the only nutrient group negatively associated with length of residence Increasing acculturation to USA culture was associated with a small increase in added sugar consumption; however, this decreased with maintenance of one’s own culture	Food/Nutrient Intake Added sugar Whole grains Calcium and dairy
Chen & Brady (2023) [37]		Attitude Towards Eating More functional, no longer serving other purposes, e.g., pleasure, comfort, social connection	Attitude Towards Eating Functional	NR
	Eating Patterns 3 meals a day	Eating Patterns Do not usually have 3 meals per day Lunch is the main meal Skipping meals, late-night binge eating	Eating Patterns Meal irregularity Meal pattern
		Food/Eating Environment Limited access to traditional foods	Food/Eating Environment Traditional food availability
	Food/Nutrient Intake Meat/animal products consumed
Dean et al. (2022) [38]	Attitude Towards Eating 63% considered a traditional diet healthy, balanced, and sufficient in fruit and vegetables	Attitude Towards Eating 68% considered an American diet unhealthy	Attitude Towards Eating Negative perception of host country foods	Access: Traditional foods are difficult to access Cost: Traditional foods are expensive Food Insecurity: Influenced dietary acculturation Living environment: Having local family members affected dietary acculturation
		Dietary Acculturation 62% considered themselves ‘more’ dietary acculturated 55% felt an American diet influenced buying and cooking patterns Undergraduates are more likely to be dietary acculturated	Dietary Acculturation Shopping and cooking
		Eating Pattern Many East and Southeast Asian students considered themselves loyal to their native diet
		Food/Nutrient intake Increased prepackaged meals/pizza/mac and cheese (46%/35%/35%) Increased fast food Decreased fish Slight decrease in whole foods and increase in processed food	Food/Nutrient Intake Prepackaged meals Pizza Mac and cheese Fast food Fish Whole foods Processed foods
Dong (2019) * [39]		Attitudes Towards Eating Majority thought the USA food environment was ‘bad’ Participants felt foods served in the USA have too much meat, fat, oil, sugar, processed food, and junk food Some participants saw eating American food as important in the acculturation process Many believed Chinese and pan-Asian diets could help maintain nutritional health	Attitudes Towards Eating Negative perceptions of host country foods	Availability—Fried and high-energy foods were widely available on campus, making it difficult to eat a healthy diet Cost—UPFs were more affordable than fresh fruit and vegetables Some participants cooked together with roommates to save money
		Dietary Acculturation 12 participants felt their diet had not changed, 12 that they had somewhat changed, and 11 that they had changed a lot
		Eating Patterns 22 participants preferred to eat Chinese food, 13 other Asian food (Pan-Asian food), and none preferred non-Asian food	Eating Patterns Frequency of traditional food consumption
	Food/Eating Environment Eat with family	Food/Eating Environment Some participants regularly share food with others Dining in Asian restaurants provided some students with familiar food and social support Average cooking frequency was 4.6 days per week Participants prefer to cook by stir-frying, steaming, and water boiling	Food/Eating Environment Eating with others Cooking frequency and methods
	Food/Nutrient Intake Vegetable and carbohydrate heavy, low in meat, and cooked with steaming, water boiling, and stir-frying Rice is the foundation of meals	Food/Nutrient Intake For those who experienced changes, there was a shift from a vegetable and carbohydrate-heavy diet to greater consumption of UPFs, e.g., instant noodles, burgers, and sandwiches	Food/Nutrient Intake Vegetables Carbohydrates UPFs, e.g., instant noodles, burgers, and sandwiches
Du 2023 [40]	NR	Eating Patterns On average, females experienced an increase in emotional and uncontrolled eating behaviours	Eating Patterns Emotional eating	NR
Ghosh et al. (2022) [41]		Eating Patterns Some participants regularly ordered dinner-tiffins (catering service where home-cooked meals are prepared and delivered by community members) The majority of students had no breakfast, and many did not often have lunch or dinner	Eating Patterns Meal irregularity Meal delivery service	Food insecurity Time—Limited due to working multiple jobs and late-night shifts, resulting in skipping breakfast and other meals. Limited time to cook Living Environment—Some students compromised on dietary habits to find accommodation and were prevented from renting based on diet preferences, e.g., not allowed to cook beef, eggs, or curry
		Food/Nutrient Intake Male participant reported living mostly off coffee and tea due to food insecurity	Food/Nutrient Intake Tea/coffee Food insecurity
	Food/Eating Environment Indian college cafeterias also have Western foods available, such as burgers
Hanbazaza et al. (2021) [42]	Food/Eating Environment Some report family support in shopping and cooking	Eating Pattern When time was limited, some students chose quick, convenient food rather than cultural and familiar foods	Eating Pattern Convenience Foods Frequency of traditional food consumption	Time: Full-time university made it challenging to prepare healthy cultural meals Family structure: Lack of family support for shopping and meal preparation Unemployment/underemployment: Finding a job was a challenge to attaining food security Lack of availability of culturally appropriate foods Limited accessibility to sources of cultural foods: Cold weather during the winter was a barrier to purchasing food, as well as physical inaccessibility to grocery stores and restaurants that sell cultural foods due to the distance and time taken Lack of affordability of culturally appropriate foods: Nine students reported even if they found culturally appropriate foods, they were unable to afford them
He et al. (2024) [43]		Attitudes Towards Eating Some students did not like UK or USA food, describing it as bland, fattening, and uninviting Enjoying Chinese food (home-cooked or restaurant) together with Chinese peers became a coping strategy for acculturative stress Described Western food such as fish and chips, fried chicken, sandwiches, or salads as “cold”, “unhealthy”, and “uninviting”	Attitudes Towards Eating Negative perception of host country foods	Cost: Cost of Chinese food affected accessibility
	Food/Eating Environment Food was easily accessible for students, e.g., living with parents, easy access to campus canteens, well-developed food delivery service	Food/Eating Environment Chinese food in restaurants is expensive, so less likely to consume Most learnt cooking skills.	Food/Eating Environment Traditional food affordability Cooking skills
		Food/Nutrient Intake One participant reported having to find cheaper alternatives to Chinese food, such as KFC or McDonald’s	Food/Nutrient Intake KFC McDonald’s
Hsiung (2018) * [44]		Dietary Acculturation 57% felt they shifted to an American diet	Dietary Acculturation American diet	Cost Availability of native food in USA supermarkets Supermarket location Time (main reason for skipping meals) Nutrition facts Religion Availability of specific cooking equipment—To prepare traditional meals
	Eating Patterns 65% have 3 meals per day 65% skipped breakfast	Eating Patterns 52% skipped breakfast. 65–70% have 2 meals per day and eat more Asian cuisine than American About half eat native food several times a week About half eat at an American restaurant several times a month Majority cook more Asian than American food	Eating Patterns Meal irregularity Meal pattern Eating out frequency
		Food/Eating Environment Majority usually buy groceries from American supermarkets	Food/Eating Environment Shopping locations
	Food/Nutrient Intake Fruit, vegetables, rice/noodles, hot food/dish more than 3 times per week	Food/Nutrient Intake Average consumption of 335 g of grains, 3.2 cups of vegetables, 1.2 cups of fruit, almost 1 cup of dairy, and 264 g of protein Lower intake of fruits, vegetables, rice/noodles, hot food/dish Greater consumption of processed foods—instant noodles, bread, soda, coffee, cereal, oats, cheese, cold food/dish, and bubble tea	Food/Nutrient Intake Fruits Vegetables Rice/noodles Hot food/dish Processed foods—instant noodles, bread, soda, coffee, cereal, oats, cheese, cold food/dish, and bubble tea
Korff & Hunter (2019) [46]	NR	Dietary Acculturation 38% reported increased USA food adoption between two time points; the rest had no change	NR	NR
Lam (2023) * [47]	NR	Attitudes Towards Eating All craved their cultural food within 30 days prior to survey		Transportation, Cost—Forced students to rely on campus food pantries
		Food/Eating Environment 1 participant experienced very low food security and utilised a food pantry on campus	Food/Eating Environment Food insecurity
Lee (2020) [48]	NR	Dietary Acculturation Private university students, students who had stayed in the USA longer, and more acculturated students ate more processed foods		Convenience, availability, taste, price, and stress reduction—Resulted in more processed foods being eaten Health and weight concerns, taste, cost, and poor quality—Resulted in fewer processed foods being eaten Time, cost, taste, and quality—Resulted in fewer whole foods being eaten Availability, convenience, taste, and health concerns—Resulted in more whole foods being eaten Food safety concerns—Concerns about how food was made, the quality being worse than foods in their home country, and feeling sick after eating Religion Environmental sustainability—Throwing away bottles/packages, energy and water used to produce foods, and pollution
		Food/Nutrient Intake Ate/drank more processed food, water, raw vegetables, meat, dairy, and other Asian foods Ate fewer cooked vegetables and foods from home countries Consumed more meat and dairy products than home country foods Students from mainland China consumed more whole foods than students from Korea Processed foods were consumed 1.6 times per day On average, baked foods, processed meat, and sugar-sweetened beverages were consumed around 1x per week	Food/Nutrient Intake Water Raw and cooked vegetables Meat Dairy Asian (home country) foods Baked foods Processed meats Sugar-sweetened beverages
Leu et al. (2015) [22]		Attitude Towards Eating Some students ate in ‘survival mode’ rather than for taste/pleasure	Attitude Towards Eating Perceived healthiness Functional	Availability: Culturally valued food could be accessed but was difficult due to transportation and was limited Cost: Cost prioritised when shopping Cost affected the palatability of the food Budget range $20–200/week. Average expenditure was $82 (males) and $85 (females). $5/meal was considered reasonable Quality: Prioritised when shopping Socialising: Reason for cooking with friends Individual preferences: Locally bought traditional foods taste inauthentic Time: Affected the palatability of the food cooked Reason for cooking with friends
		Dietary Acculturation Many students adapted to the Australian food environment and made Western food	Dietary Acculturation Adoption of Western food habits
		Eating Pattern Traditional foods were saved for special occasions	Eating Pattern Frequency of traditional food consumption
	Food/Eating Environment Lived at home	Food/Eating Environment Some students learnt to cook from other students	Food/Eating Environment Cooking skills
	Food/Nutrient Intake Rice with most meals.	Food/Nutrient Intake 26% ate fewer fruits and vegetables and more meat and carbs 36% indicated minimal dietary change 39% indicated a healthier diet, with more fruits and vegetables and less meat and carbs Increased use of meat and frozen vegetables Rice with most meals Simple stir-fries, pan-fried meats, soups, rice, and noodles	Food/Nutrient Intake Meat Carbohydrates Fruit Vegetables Frozen vegetables
Liu (2019) * [49]	NR	Attitude Towards Eating Sharing cultural meals to strengthen friendship with other Chinese students and maintain cultural identity	Attitude Towards Eating Friendship and cultural identity	Culture: Attending Chinese night markets and consuming traditional foods was done to strengthen Chinese identity Socialising: Reason for cooking and sharing traditional meals with friends Individual preferences: Much locally bought Chinese food is considered inauthentic Time: Reason for cooking with friends
		Dietary Acculturation Some inclusion of Western food habits daily	Dietary Acculturation Western food habits
		Eating Pattern Increased consumption of other Chinese regional cuisines and Asian cuisines Local ingredients modified with traditional methods Home cooking of traditional foods, e.g., noodles, soups, and vegetables	Eating Pattern Other cuisines eaten Ingredient substitution/cooking method modification
		Food/Eating Environment Everyday ingredients purchased from Canadian food stores Cultural foods purchased from Chinese food stores	Food/Eating Environment Shopping locations
		Food/Nutrient Intake Pasta, sandwiches, and salads were the most popular Western dishes to cook Chinese seasonings, frozen foods, meat cuts, vegetables, snacks, and soft drinks were procured from Chinese food stores
Liu (2018) * [50]		Attitude Towards Eating 53% not satisfied with the current diet: too much fast food, deep-fried food, irregular meals, and limited choices	Attitude Towards Eating Diet satisfaction	Availability Cooking Convenience Cost Nutrition Individual preferences Time
	Eating Pattern 3 meals a day	Eating Pattern 53% increase in irregularity: skipping meals (particularly breakfast) and eating at irregular times 50% cook 7 or more times/week 81% chose Chinese restaurants when eating out	Eating Pattern Meal irregularity
	Food/Nutrient Intake Frequently consume rice, traditional Chinese noodles, dumplings, wontons, and steamed buns	Food/Nutrient Intake 44%/36% increased fast food/soda 94% purchase traditional Chinese food, e.g., vegetables, tofu, frozen dumplings, noodles, and seasonings 75% regularly consume rice and Chinese noodles Nutrients: 97% consume above recommended (R) protein; 47% below R carbohydrate; 61% below R fat; 50% below R calcium. Food groups: 61% consume above R meat and beans; 53% below R grains; 69% below R vegetables; 64% below R fruit; 89% below R milk	Food/Nutrient Intake Fast food Soft drink
Liu et al. (2020) [51]	NR	Dietary Acculturation 39% of Asian students reported no dietary change, 50% reported change, and 11% were unsure if change had occurred	Dietary Acculturation Present or absent	NR
		Food/Nutrient Intake 42% of Asian students consumed functional foods, which was more than students from other countries
Luong et al. (2022) * [52]	NR	Food/Nutrient Intake 51%/29% of Asian/Asian-Indian students eat plant-based meat alternatives less than once a month 10%/39% of Asian/Asian Indian students eat plant-based meat alternatives once a month or more	NR	NR
Noyongoyo (2018) * [53]	NR	Food/Nutrient Intake 50–60% consumed more packaged cakes and cookies, fried foods, frozen dinners, confectionery, and soft drinks. 40–50% consumed more canned food, sweet snacks, salty snacks, bread, tea and coffee 46% consumed more chicken 40–50% consumed a similar amount of eggs, dairy, potatoes, rice, and vegetables 69%/49%/42%/38% consumed less cassava/fish/sweet potato/leafy greens Increased fruit and vegetables associated with decreased convenience meals Increased protein associated with increased fruit and vegetables	Food/Nutrient Intake Packaged cakes and cookies Fried foodsFrozen dinnersConfectionery Soft drink Canned food Sweet and salty snacks Bread Tea and coffee Chicken Cassava Fish Sweet potato Leafy greens Rice	Availability Convenience Cost
O’Sullivan et al. (2016) [54]	Attitude Towards Eating Participants considered eating practices healthy	Attitude Towards Eating A South Korean student stopped eating ‘unhealthy food’ (pizza and chips) as they attributed this to prior weight gain A Sri Lankan student was concerned about long-term health consequences of a UK diet	Attitude Towards Eating Perceived healthiness Food/nutrient intake: Sugar	Stress reduced consumption for a Bangladeshi student Individual preferences: Sri Lankan student reported fruit and vegetables taste different and were less palatable
	Eating Pattern Regular meals
	Food/Eating Environment Food prepared by family members	Food/Nutrient Intake A Sri Lankan student increased sugary food intake
Pang (2022) [55]		Attitude Towards Eating Students had different opinions on what made a ‘healthy diet’, e.g., organic, low fat and sugar, balanced One student felt she now eats healthier	Attitude Towards Eating Perceived healthiness	Cost: Cost is factored into shopping Food safety concerns: One student consumed more food as she believed there was more food safety. Health: One student favoured organic foods for health reasons Individual preference: A student suggested Chinese people have stronger taste buds, so they need more flavour Socialising: Alcohol is used to navigate social situations
		Eating Pattern A few students said hot pot was their favourite food and pastime
	Food/Eating Environment Food is cheap, accessible, and varied Fast food is more expensive One student commented that food safety is poor	Food/Eating Environment A student noted restaurants are expensive and low quality
		Food/Nutrient Intake A student reported consuming more meat and fewer vegetables Some students started drinking alcohol	Food/Nutrient Intake Meat Vegetables Alcohol
Pilli et al. (2021) [56]	NR	Food/Eating Environment An East Asian student bought groceries from a Western supermarket but also visited a Chinese supermarket for cultural foods	Food/Eating Environment Shopping locations	Cooking skills Cost and Time: Often limited but reported by a Southeast Asian student as important for healthy eating
Prather et al. (2015) * [57]		Attitude Towards Eating Majority neutral/satisfied with food served on campus		Access: Limited access to Indian food sources caused increased dietary acculturation Living environment: Eating more on campus caused increased dietary acculturation
		Dietary Acculturation Peaked after being in the USA for 2 years and then decreased 75% acculturated to American breakfast >70% acculturated to American snacks	Dietary Acculturation Increases then decreases American breakfast adoption American snack adoption
		Eating Pattern 51% had to substitute with local foods to follow traditional eating patterns. Commonly substituted items were spices, herbs, grain, beans, pulses, fish, vegetables, milk, meat, and fruit Little change in rates of vegetarianism 87%/88% ate traditional Indian lunch/dinner Women and those who rarely consumed campus food ate more traditional food	Eating Pattern Ingredient substitution Breakfast characteristics
	Food/Eating Environment Most rarely/never cooked	Food/Eating Environment 57% rarely ate on campus 80% cooked often in the USA	Food/Eating Environment Cooking frequency
		Food/Nutrient Intake 60–75% ate more packaged food, meat, fast food, snacks, and soft drinks	Food/Nutrient Intake Packaged food Meat Fast food Snacks Soft drink
Saccone et al. (2015) [58]		Attitude Towards Eating A Korean student felt they had more responsibility over their diet	Attitude Towards Eating Responsibility	Independence: Responsibility over diet
		Dietary Acculturation A Japanese student was resistant to diet change	Dietary Acculturation Resistance to change
	Food/Nutrient Intake A student reported in China they had lots of fresh vegetables, soups, and foods made from flour	Food/Nutrient Intake A Chinese student had more dairy, sweet snacks and drinks, and fewer Chinese soups	Food/Nutrient Intake Dairy Sweet snacks and drinks Chinese soups
Shi et al. (2024) [23]		Attitude Towards Eating Many students paid more attention to nutritional value 28%/14%/36% felt diet was less healthy/healthier/mixed	Attitude Towards Eating Nutritional value considered Perceived healthiness	Access: Large Western supermarkets are easily accessible. Chinese stores were easier to access than Indian stores Availability: Fewer vegetables and different fruit options Convenience: Important during busy times Cost: Food prices were higher (particularly vegetables and traditional foods), except milk, meat, and processed foods Prioritised by some students. Weekly food budget of $30–100 Food insecurity: Resulted in reduced meal size, cheaper foods, using food pantries, and budgeting Independence: Responsibility over diet Living environment: Influenced cooking (e.g., if the kitchen had no ventilation to flash-fry, limited fridge space) Quality: Prioritised by some students Time: Main barrier to cooking
	Eating Pattern Traditional meals have multiple dishes and are time-consuming Traditional breakfast, lunch, and dinner Three regular meals	Eating Pattern Some Chinese students cooked with less oil and salt Quicker cooking methods, ready-to-eat meals, and takeaways increased during busy times Many changed breakfast to coffee or cereal and milk Students cooked both traditional and Western dinners Many changed to a simple lunch and a larger dinner Meal regularity decreased to only 2 meals Most reduced eating out When eating out, Asian restaurants and fast food were most popular	Eating Pattern Cooking method modification Breakfast characteristics Dinner characteristics Meal pattern Eating out frequency
	Food/Eating Environment Most lived at home Food shopping in India is easy because of street vendors Canteens are cheap and varied Meals prepared by families or procured from the canteen	Food/Eating Environment Traditional foods were purchased less frequently Chinese students had a more positive impression than Indian students of Australian restaurants serving their traditional cuisine 71% cooked frequently for the first time	Food/Eating Environment Traditional food availability Cooking frequency
		Food/Nutrient Intake Less vegetables More dairy, protein sources, and international foods Similar fruit consumption Many purchased more frozen foods	Food/Nutrient Intake Vegetables Dairy Protein sources International foods Frozen foods
Tran (2021) * [59]	Attitude Towards Eating Most did not consider nutrition Most are only familiar with Asian cuisine	Attitude Towards Eating More conscious of nutritional value	Attitude Towards Eating Nutritional value considered	Access: Location and proximity to shops Cooking skills: Changed frequency of eating out Cost Individual preferences: Locally bought traditional foods taste inauthentic Time: Busy schedule
	Eating Pattern Indian students are primarily vegetarian: curries, rice, and bread	Eating Pattern 63% ate out/got takeaway frequently 50% avoided locally bought traditional foods Some tried other cuisines more often A student reported consuming less spice Consumed larger portions	Eating Pattern Other cuisines eaten Portion size
	Food/Eating Environment Meals shared with family Meals prepared by family daily with fresh produce	Food/Eating Environment 63% said USA portion sizes were larger More exposure to nutrition education	Food/Eating Environment Portion sizes Nutrition education
	Food/Nutrient Intake Ate lots of rice	Food/Nutrient Intake Consume more fatty foods and carbohydrates	Food/Nutrient Intake Fatty Foods Carbohydrates
Wang (2017) * [60]	Attitude Towards Eating Balance through hot/cold foods (yin and yang)	Attitude Towards Eating Some used diet to manage health symptoms Majority think Chinese food is healthier than Western food		Cost: Cost prevented some students from purchasing vegetables Stress: Influenced intake of sweet and fast foods for some
		Eating Pattern Some adopted UK breakfast, e.g., milk and cereal	Eating Pattern Breakfast characteristics
		Food/Nutrient Intake Several males ate more fast food Several females ate more sweet food	Food/Nutrient Intake Fast food Sweet food
	Food/Eating Environment Fruit and vegetables are more varied and affordable in Taiwan Parents cooked food at home
Wu et al. (2016) [61]	Attitude Towards Eating Balance through hot/cold foods (yin and yang)	Attitude Towards Eating Most defined American food as fast and convenient food		Culture: Philosophy of yin and yang Cooking skills: Some had not cooked before Cost: Important influence on what was eaten Living environment: Dining halls limited food options Cooking equipment limited food options Socialising: American friends played a role in food exposure Time: Class schedules and heavy workload
		Dietary Acculturation Most believe their diet has changed Moderate adoption of American food For males, breakfast was the first meal to be acculturated, followed by lunch, cooking at home, snacks, eating out, and dinner For females, lunch was the first meal to be acculturated, followed by breakfast, snacks, cooking at home, dinner, and eating out	Dietary Acculturation American food adoption Meals were acculturated at different times for males and females
	Eating Pattern Traditional meals take 1–2 h to cook	Eating Pattern Hot pot and spicy food were favourite Chinese foods Snacks are mostly Western Cook mostly Chinese food
	Food/Eating Environment Some learnt to cook from family prior to moving	Food/Eating Environment Most shop at both American and Chinese stores Males grocery shop more than in their home country	Food/Eating Environment Shopping locations Shopping frequency
	Food/Nutrient Intake Many had tried Western foods, e.g., pizza, bread, and ice cream	Food/Nutrient Intake Both males and females on average eat below the dairy, fruit, and vegetable recommendations Burgers and pizza were the most popular American foods Foods purchased from Asian stores: bulk rice, special sauces, Asian veg, premade frozen Chinese food, e.g., dumplings Foods purchased from American stores: fruit, meat, some vegetables, and bread
Yan et al. (2016) [62]	NR	Food/Eating Environment Some students commute to nearby cities to get Chinese food Some Chinese students move off campus so they can cook their own food	NR	NR
Zhang (2017) [63]	NR	Dietary Acculturation Acculturation to USA culture is associated with less fibre, fruit, vegetables, and more sugar		Stress: Acculturative stress impacted vegetable, takeaway and breakfast consumption
		Eating Pattern Decrease in frequency of eating out Increase in convenience food consumption Overall less healthy eating/dietary intake	Eating Pattern Eating out frequency. Convenience food consumption Healthiness
		Food/Nutrient Intake Decrease in dietary fibre, whole grains, and vegetables Increase in sugar, sugar-sweetened beverages, dairy, and calcium	Food/Nutrient Intake Dietary fibre Whole grains Vegetables Sugar Sugar-sweetened beverages Dairy Calcium
Zhang (2016) * [64]	NR	Dietary Acculturation >80% had a decrease in Chinese dietary habits/items 80% increased Western dietary habits/items	Dietary Acculturation Change in Chinese and Western dietary habits	Access: Both healthy and unhealthy food were more accessible Cost: Unhealthy food was more affordable
		Eating Pattern >70% had a decrease in Chinese breakfast 55% decreased breakfast size, and those in the USA for 2 years or longer were more likely to decrease breakfast size 35% increased dinner size Total portion size increased with length of stay 70% ate more at fast food restaurants 50% decreased balancing yin/yang foods	Eating Pattern Breakfast characteristics Portion size Fast food restaurants Balance of yin/yang foods
		Food/Nutrient Intake >50% decreased intake of traditional preserved foods 50% decreased tofu 60% increased bread, dairy, ground beef, hamburgers, pizza, and spaghetti 50% increased sweets, cakes, and pies 40% increased packaged/pre-prepared food	Food/Nutrient Intake Traditional preserved foods Tofu Bread Dairy Gound beef Hamburgers Pizza Spaghetti Sweets, cakes, pies Packaged/pre-prepared food
Zhao (2017) * [65]	Attitude Towards Eating Diet perceived as healthy			Access: Some found limited access to traditional Chinese restaurants Cost Living environment: Unfamiliar environment and limited food knowledge Time: New schedule changed eating behaviours
		Eating Pattern When at home, most prepared Chinese meals Multiple participants used premade foods When eating out, they mainly chose Chinese or other Asian restaurants When eating at American restaurants, many chose fast food When eating on campus, many chose Americanised Chinese food
	Food/Eating Environment Parents always cooked	Food/Eating Environment Most shop at both American and Chinese stores	Food/Eating Environment Shopping locations
		Food/Nutrient Intake Varied intake of dairy; some increased, some decreased >50% ate fewer vegetables	Food/Nutrient Intake Dairy Vegetables

* Thesis/dissertation; USA = United States of America; NR = no result; UPF = ultra-processed food; UK = United Kingdom.

outlines the results found in each paper regarding home country diet, host country diet, dietary changes, and factors influencing these changes.

3.4. Synthesis of Results

3.4.1. Attitudes Towards Eating

Of the 38 studies, 17 reported the participants’ attitudes towards eating, with multiple studies finding that the perceived healthiness and nutritional value of the food was one of the most important factors for Asian international students when choosing foods to consume in Western countries [22,23,54,55,59].

Most international students viewed host country foods negatively [35,38,39,43]. Asian international students were largely intolerant of Western food, finding it to be bland and tasteless. Furthermore, the majority of students were dissatisfied with the ‘Western diet’ containing too many fast and fried foods, irregular meals, and limited choices [50].

One study also found that students reported a more functional approach to eating in Western countries, with students eating for survival, as food no longer fulfilled other purposes such as pleasure, comfort, and social connection [37]. One student reported, “I feel like here I eat because I need it, because I am hungry. So, the difference would be like in China, I live to eat, in here, I eat to live. That is a difference.” [37].

3.4.2. Dietary Acculturation

Participants across multiple studies experienced dietary acculturation, reportedly increasing consumption of Western foods in their diets and decreasing traditional foods [21,37,44,58,61]. Such changes are demonstrated by a Korean student who stated, “In Korea, I used to eat healthy food, but when I came to America, I always eat hamburgers, pizza, and pasta.” [32].

Whilst most students considered themselves to be acculturated to a ‘Western diet’, others were still resistant to change and remained loyal to their native diet. In Liu et al.’s study [51], almost half the students reported no change in their diet. Similarly, other students made minimal changes to their diet, citing their dislike of foods available in Western supermarkets, as well as gaining responsibility for their diet by cooking their own traditional meals [58].

In some studies, the adoption of Western foods increased as the length of stay in the host country increased [46,48]. One study reported that the adoption of Western dietary habits peaked after being in the host country for two years and then decreased after that point [57].

3.4.3. Eating Pattern

Multiple studies found students decreased the regularity of meals [31,37,50] and changed meal patterns [23,31,37,44,50]. This concept is illustrated by the following quote from a Chinese student [50]:

“I had three meals a day in China. Now I switched three meals to two meals a day and have adopted irregular mealtimes due to my class schedule.”

In the host country, breakfast was the meal skipped most often [31,41,50], and there was significant adoption of a Western-style breakfast [23,57,60].

For many students, the frequency of traditional food consumption decreased [22,31,33,42]. However, preference for traditional food [39] and loyalty to a traditional diet [38] were also demonstrated, including when eating out [50,55,65], getting food delivered [41], or cooking [44,57,61,65].

Furthermore, many students reported an increase in fast food consumption and eating out while living in the host country [33,38,43,44,57,60,64].

3.4.4. Food/Eating Environment

Most students have moved from an environment where access to food was easy due to living at home [22,23,43] and rarely or never having to cook [23,54,56,57,59,60,65]. Eating together was common and considered important [31,35,39,59], and some students maintained this in the host country as a way of strengthening friendships, finding social support, and maintaining cultural identity [39,43,49], while others did not [31]. Within the host country, many students developed their cooking skills [22,43] and began cooking more frequently [23,35,39,57]. Students with limited cooking skills found their food choices were restricted [56]. Lack of skills, compounded by having limited time to cook or develop skills, resulted in the prioritisation of convenience foods and increased frequency of eating out [56,59,61].

Food served on campus was generally perceived to be of poor quality and lacking in traditional options [36,39,65], leading some students to change accommodation so they could cook their own food [35,36,62].

When shopping, many students visited both Western and traditional food stores [49,56,61,65]. A decrease in the accessibility of traditional foods due to access to stores [22,23,31,42] as well as higher prices [23,31,38,43] was noted. This led to less frequent purchasing of traditional foods [23] and contributed to students’ stress in being unable to access these foods [37].

3.4.5. Food/Nutrient Intake

Out of 38 studies, 23 reported a change in food and nutrient intake. Many studies reported decreased vegetable intake [23,31,39,44,55,63,65]. When considering bread and cereals, the intake of bread increased [31,44,53,64] while rice intake remained similar [22,50,53]. For many students, meat consumption increased in the host country [31,48,55,57]; however, the intake of fish decreased [38,53]. Students generally consumed more dairy in the host country [23,31,44,48,58,63,64] but, despite this, did not meet dairy and calcium recommendations [50,61].

An increase in convenience food (i.e., packaged food requiring minimal preparation) [23,31,38,49,53,57,64], processed food [38,39,44,48], and fast food [31,38,50,57,60] was noted. An increase in the intake of fatty foods [59], salt [31], and sugar/sugary foods [21,31,44,50,53,54,57,58,60,63] was also reported. Some of these significant broad trends are captured in this quote from a Chinese student [58]:

“In China I ate lots of fresh vegetables... (now) I eat more dairy, meat, sweets snacks and drinks in the USA.”

3.4.6. Factors Influencing Dietary Transitions

Out of 38 studies, 27 reported on the different factors influencing dietary transitions amongst Asian international students. Several key factors consistently emerged, including the cost/affordability of food (n = 21), the access and availability of traditional foods and cooking facilities (n = 14), time constraints to prepare food (n = 13), and the living environment (n = 8). For example, many students reported difficulty accessing affordable traditional ingredients, leading them to consume more processed or fast foods [31,38,42]. Time constraints, particularly for students juggling study and work, also contributed to a shift towards convenience foods and a decrease in cooking [23,31,41,42,61,65]. While these factors were consistently reported, several other factors, such as cultural preferences, religion, food quality and safety concerns, and environmental sustainability, were mentioned in a few studies and are detailed in Table 2.

4. Discussion

Asian international students experienced various aspects of dietary acculturation when moving to Western host countries. These students tended to increase their consumption of Western foods while decreasing traditional food consumption despite maintaining a strong preference for the latter. For many students, their traditional vegetable, rice, and noodle-rich diet moved towards a diet lower in vegetables and higher in bread, meats, dairy products, convenience and processed foods, and high-sugar foods, which not only affects the student’s health and well-being but also has a larger environmental impact. These changes were largely driven by a food environment that did not promote the affordability and accessibility of traditional foods, which, coupled with limited time, led to a decreased use of traditional ingredients and an increased use of convenience foods.

The length of stay may also have an impact on the extent of dietary acculturation experienced by Asian international students. There is some evidence to suggest that residing in the host country for longer results in greater adoption of host country foods, with some participants reportedly consuming more processed and Western-style foods the longer they remained in the host country [46,48]. This finding is consistent with another study investigating dietary changes across immigrants, which also found that a greater length of stay increased the adoption of host country foods [66]. However, it is important to note that this trend was only observed in a few studies [46,48,57], and, therefore, further research may need to be conducted to determine the time frame in which dietary acculturation becomes more prevalent.

Cost was a significant factor reported to influence dietary transitions, and it was often prioritised when shopping and eating [22,55,61]. This is consistent with results from an Australian study that reported that most Asian international students felt they had limited financial resources and consciously moderated expenses on food [67]. In host countries, vegetables [23,31,39] and traditional foods [23,31,38,42,43] tended to be more expensive, while processed foods [23,31,48], meat [23,50,55], and milk [23] were reported to be cheaper than in Asian countries. Food intake was dependent on the price of each of these food groups; for example, decreased vegetable intake due to higher costs and increased meat intake due to lower costs. Increased meat intake has not always been observed in Asian international student populations, with studies conducted in 1999 [68] and 2000 [69] finding a reduction in meat consumption, which they suggested was due to cost. This discrepancy with the current study is likely due to a change in the cost of meat over time and in different food environments, which supports the idea that students’ consumption is influenced by affordability. These concepts are illustrated by the following participant quote: “Fruit and vegetables are more expensive in the U.S. but meat is cheaper. The price of food does affect me in purchasing. I buy more meat because is cheaper compared to fruit and vegetables.” [50]. This is further supported by findings from an Australian food insecurity study in similar populations, where financial pressure drove students to increase consumption of cheaper food options that were generally more Western and less nutritious [70].

Additionally, the availability and accessibility of foods are factors known to be important in determining intake [71], which is consistent with the results from this review. On some campuses and in the wider food environment, fast food and convenience foods were easy to access, which led to a higher consumption of these foods [31,39,48]. This trend was also observed for whole foods, where intake increased for some students when they were available and accessible [22]. While most students were able to access traditional foods, the stores that sold them were generally further away [23,31,38,42,57,65] and had fewer options [22,31,42]. The availability and accessibility of Western foods were much greater, with large Western supermarkets often being near student accommodations [23]. The disparity in access to foods meant that some students were forced to adapt by using local ingredients in traditional meals [49,57], a phenomenon also reported in the general Chinese immigrant population in Australia [72].

The living environment further impacted the students’ dietary habits, particularly for students living in campus accommodation, where there was limited or no access to cooking facilities, restricting students from cooking their own meals [23,61]. As a result, students living on campus were more likely to consume unhealthy foods and less traditional foods. Another study supports this finding, revealing that students living on campus were unlikely to prepare their own foods, which was associated with lower intakes of fruits and vegetables [73]. These findings also apply to international students from other backgrounds, who also consumed fewer fruits and more processed snack foods after moving abroad to study [74]. Due to the lack of traditional foods on campus, many students moved out of their campus accommodations and moved in with friends or host families or lived alone so that they could cook [36,62].

Being time-poor is another factor that can influence dietary patterns and has previously been reported to decrease home cooking and increase convenience food consumption [71]. In this review, many students reported having limited time to cook food at home [23,31,41], particularly time-consuming traditional meals [42]. This led some students to cook simple meals [22,23,31] or cook with roommates and friends [22]. For many, being time-poor was a reason for the observed increase in convenience food consumption. This is expected given the time-saving nature of these foods, although it has been suggested that a lack of cooking skills may be a stronger driver for convenience food consumption [75]. Indeed, results from this review showed that limited cooking skills resulted in increased convenience food intake and were associated with being time-poor [56,59,61]. Studies in college and young adult populations have shown that having the time and skills to prepare meals is associated with healthier eating habits, including reduced UPF and fast food consumption [76,77,78]. This review also found that increased irregularity of the timing of meals and the skipping of meals was attributed to busy university and work schedules [41,44,50]. Breakfast was the meal skipped most often, more so than in the home country, which may be of concern due to evidence suggesting skipping breakfast is associated with poorer diet quality and lower micronutrient intake [79]. The impact of being time-poor on dietary patterns is by no means unique to Asian international students and has also been reported amongst local students in Western countries [80,81], suggesting that addressing this issue may be important for the wider student community.

The general dietary transitions observed in this study are concerning, considering that consuming traditional foods is important for preserving an individual’s sense of cultural identity as well as their physical and mental health [24]. A recent study conducted with Indian, Chinese, and Malaysian migrants in Singapore found that cultural food practices, including social interactions around food, were significant to the participants’ identities and were also seen as health-promoting [82]. Similarly, in this review, traditional foods were a way of sustaining cultural identity, both individually [35,36,49] and with others [39,43,49], and were considered good for health [35,38,39,54,60,65]. Indeed, home country diets were generally reported to include traditional home-cooked meals with sufficient vegetables and fruit, small amounts of meat, and low amounts of UPFs [31,38,39,44,58,59]. Sufficient fruit and vegetable intake has been widely shown to be beneficial for health [83], and limiting the intake of UPFs and red meat is also beneficial, given the strong burden of evidence showing the negative health impacts of these foods [84,85]. In contrast, Western dietary patterns were often perceived as unappealing and unhealthy, to the point of causing distress and anxiety around developing poor health [35,38,39,43,60]. The general trend in food group intake observed in this review is consistent with a shift towards the ‘Western diet’ pattern that is high in processed foods, added sugars, refined grains, and red and processed meat and lacking in fish, vegetables, and fruit [10]. Many studies have linked this diet pattern with an increased risk of cardiovascular disease, diabetes, obesity, and the possibility of poor mental health and certain types of cancer [10,11]. It has been suggested that this shift may eventually contribute to increased cardiometabolic risk for Chinese immigrants in Australia [72], which may also apply to an Asian international student population. Furthermore, the observed shift towards a ‘Western diet’ is also of concern from an environmental sustainability perspective, given the characteristic decrease in fruits and vegetables alongside an increase in animal products. Extensive research has shown that meat production, especially red meat, is particularly damaging to the environment due to high land use, water use, and greenhouse gas emissions, and dairy production is also of concern for the same reasons [86,87,88]. Plant-based foods generally have a much lower environmental impact across all these factors, and so diets calculated to be more environmentally sustainable typically involve reducing animal-based foods and increasing plant-based foods [86,87,88]. Concerningly, the opposite trend was observed in this review, as students moved from a more plant-based traditional diet to a ‘Western diet’ higher in meat, dairy, and processed foods. The negative impact of forgoing traditional foods and increasing Western foods on emotional, cultural, physical, mental, and planetary well-being is clear. This must be addressed to facilitate health and cultural and environmental sustainability within this population.

4.1. Strengths and Limitations

The strengths of this review are the inclusion of grey literature, which allowed for a broader range of student experiences to be explored, as many of the included theses and dissertations presented a greater variety and volume of results than published articles. Similarly, the inclusion of both quantitative and qualitative data allowed different aspects of dietary acculturation to be captured. Data extraction was performed in duplicate on all included studies by two reviewers, ensuring maximum accuracy and inclusion of relevant results.

The limitations included not conducting a quality assessment, as the purpose was to capture all the data available on Asian international students’ dietary transitions. However, this may have resulted in the inclusion of inaccurate or biased data. Furthermore, the use of different data collection methods across studies means different definitions and measurements may have been used for the same outcome, which may have resulted in the inconsistent reporting of results. The accuracy of some dietary acculturation data may also be compromised by the inclusion of 29 cross-sectional studies. Cross-sectional studies have previously been accused of failing to capture the full breadth of dietary transition [20], making it difficult to draw causal relationships [89]. For all these reasons, future studies aiming to inform specific interventions would benefit from including a quality assessment to ensure that the data are reliable, valid, and generalisable, allowing them to be applied with confidence to an Asian international student population. Additionally, the exclusion of non-English language articles may have resulted in the omission of some relevant studies, particularly those conducted in Western Europe. The applicability of the findings may also be limited in some Western country settings, as most of the studies were conducted in North America. Therefore, it may be beneficial to conduct further research on this topic in other Western countries.

4.2. Generalisability and Applicability

The findings of this study demonstrate the need for interventions that make healthy and traditional foods a more convenient option for Asian international students. Universities should consider developing and implementing policies that support the availability of culturally appropriate, sustainable, and healthy foods on campus. Strategies could include offering affordable traditional dishes from common countries of international student origin in campus food outlets, as in the home country, many students were used to acquiring food from such outlets [23,43]. Additionally, food pantries are accessed by some Asian international students but are underutilised for numerous reasons, including inaccessibility due to location and opening times and a lack of culturally diverse foods [90]. Therefore, campuses could consider making food pantries more accessible and stocking them with popular traditional ingredients from common countries of origin. This could also help to address financial pressures experienced by students while promoting the adoption of culturally appropriate, sustainable, healthy diets amongst students. Additionally, to promote sustainability, campuses could reduce processed and animal-based foods, which have a higher impact on the environment, and provide foods that have lesser impacts, such as minimally processed plant-based foods.

Furthermore, within this review, there were three studies that reported a subset of students who felt that their diet increased in healthfulness, largely due to paying more attention to nutrition now that they have to cook for themselves [22,23,55]. This is supported by findings from another study by Shi et al. [91], which showed that university students with more cooking skills and cooking frequency achieved better diet quality. As suggested in a similar review [4], it could be beneficial for campuses to run culturally appropriate cooking classes for international students, who are often learning to cook for the first time. It is crucial that any interventions are informed by research and co-designed with Asian international students, who are the experts on their own needs and priorities.

Lastly, it is important to note that the majority of these studies were conducted across the USA and the UK, with very limited research coming from Australia. It would be beneficial to conduct further studies in Australia, as it is also one of the largest receivers of international students [3], and the availability of food may differ. Australia is a multicultural country, with a wide variety of Asian foods available, particularly in the larger cities. Therefore, it is possible that Asian international students experience different dietary transitions in Australia compared to those seen in the USA and the UK.

5. Conclusions

Dietary acculturation significantly influences the cultural, physical, and mental well-being of Asian international tertiary education students in Western countries. This scoping review has identified prevalent dietary shifts from traditional to Western patterns, driven by challenges such as cost, limited access to culturally appropriate foods, and time constraints. These dietary changes not only risk degrading students’ health but also threaten the sustainability of cultural food practices in their host countries. The findings highlight the importance of creating supportive physical and cultural environments that facilitate access to sustainable, health-promoting traditional foods. This approach aids in preserving cultural diversity in dietary habits and contributes to the broader sustainability of food systems. Further research, particularly outside the USA, is crucial to develop informed interventions that can integrate cultural awareness into the promotion of sustainable dietary behaviours among international student populations. This could have significant implications for enhancing food policy, supporting local economies, and promoting community engagement in culturally diverse settings.