Table 1.

Summary of the available evidence and knowledge gaps on nutritional health related issues among Canadian immigrants from the literature review

What we know···	What we don’t know yet···
The healthy immigrant effect (HIE): there is an overall negative effect on the health of immigrants associated with time since migration to Canada	What specifically is the role of diet and acculturation? How does the enculturation (tendency to maintain values and beliefs of the home country)—acculturation dynamic affect the dietary and health transitions among immigrants?
Dietary habits inevitably change after immigration to Canada	How, why and to what extent? How does the exposure to Canadian culture affect the nutrition knowledge, perceptions and beliefs of immigrants? What are their knowledge and perceptions of the host country nutrition discourse?
Some individuals tend to maintain their traditional diet that is often healthier that Western diets	What are the challenges in maintaining a traditional diet? How can maintenance be facilitated while enhancing nutrition knowledge and practice? Can we conciliate and/or simultaneously promote healthy traditional foods and healthy western foods?
South East Asians, Caribbeans, Africans and Latinos are at a high risk for nutrition related chronic conditions including diabetes and cardiovascular disease.	What are the age standardized BMI cut-offs that are appropriate for identifying individuals at risk in these groups? What are the dietary and activity behaviours of these mostly understudied groups underlying an increased or reduced risk of chronic conditions? Is there any role for the diet-gene interactions?
Dietary transition undoubtedly contributes to the health transition among Immigrant, but diet is one risk factor among many	How do social determinants affect the relationships between acculturation, immigrant dietary behaviours, and health? What are the specific role of the different levels of determinants: individual (gender, age); behaviours; social (poverty, religion, social support, education, culture), and physical environment (winter, transportation)? What are the most important driving factors to target in nutrition related health promotion? What is the role of physical activity?
There is an increasing prevalence of childhood obesity and adolescent onset of type II diabetes in Canada	What are the dietary risk factors for type II diabetes and other chronic conditions among immigrant children? How do these risk factors vary across generations, immigrant groups (cultural origin and religion) and types (refugees, skilled workers, and family class), gender, and over time?
Availability and accessibility of traditional foods, financial insecurity, and limited transportation are important barriers to healthy eating	What is the magnitude of food insecurity among immigrants? How do immigrants experience and cope with these issues?
There tends to be a consensus that culturally appropriate interventions including promoting traditional foods for immigrants is important to ensure better health equity	What works: what cost effective interventions related to immigrant dietary behaviours, nutrition and health are available for scaling up? What are the nutritional values and potential safety of traditional foods? What is the best way to include traditional foods in health promotion programmes? Which groups should be prioritized for health promotion: women? Children? Refugees?