Diabetes in the Hispanic or Latino population: genes, environment, culture, and more

Associations of adiponectin with body fat distribution and insulin sensitivity in nondiabetic Hispanics and African-Americans

CONTEXT

Hypoadiponectinemia has emerged as an independent risk factor for type 2 diabetes and cardiovascular disease. Although associations of adiponectin with central obesity and insulin resistance have been reported, very little data are available from studies using detailed measures of insulin sensitivity (S(I)) and/or body fat distribution in ethnic groups at high risk for metabolic disease.

OBJECTIVE

The aim of the study was to identify the correlates of adiponectin in 1636 nondiabetic Hispanics and African-Americans.

DESIGN

A cross-sectional analysis of participants in the Insulin Resistance Atherosclerosis Family Study was conducted. S(I) was determined from frequently sampled iv glucose tolerance tests with minimal model analysis. Subcutaneous and visceral adipose tissues (SAT, VAT, respectively) were determined with computed tomography. Triglyceride, high-density lipoprotein, C-reactive protein, and adiponectin were measured in fasting samples. Generalized estimating equation (GEE) models were used to identify factors associated with adiponectin concentration.

SETTING

A multicenter study using a family-based design was conducted.

PARTICIPANTS

A total of 1636 nondiabetic Hispanic and African-American subjects participated.

MAIN OUTCOME MEASURES

Circulating adiponectin concentration was measured.

RESULTS

Age, female gender, high-density lipoprotein, SAT, and S(I) were positive independent correlates of adiponectin, whereas glucose, CRP, and VAT were negative independent correlates (all P < 0.05). Ethnicity was not an independent correlate of adiponectin in this model (P = 0.27); however, an ethnicity by VAT interaction term was retained, indicating a stronger negative association of VAT with adiponectin in African-Americans compared with Hispanics.

CONCLUSION

Directly measured S(I), VAT, and SAT were independently correlated with adiponectin in Hispanic and African-American subjects. The inverse association of VAT with adiponectin was stronger in African-Americans compared with Hispanics, a finding that suggests possible ethnic differences in the effects of visceral obesity.

Weight regain in U.S. adults who experienced substantial weight loss, 1999-2002

BACKGROUND

Relatively few studies have focused on who is at risk for weight regain after weight loss and how to prevent it. The objectives of this study were to determine the prevalence and predictors of weight regain in U.S. adults who had experienced substantial weight loss.

METHODS

Data were analyzed from the 1999-2002 National Health and Nutrition Examination Survey (NHANES). This study examined U.S. adults aged 20-84 years who were overweight or obese at their maximum weight (body mass index >/=25) and had experienced substantial weight loss (weighed 10% less than their maximum weight 1 year before they were surveyed) (n=1310).

RESULTS

Compared to their weight 1 year ago, 7.6% had continued to lose weight (>5%), 58.9% had maintained their weight (within 5%), and 33.5% had regained weight (>5%). Factors associated with weight regain (vs weight maintenance or loss) included Mexican American ethnicity (versus non-Hispanic white) (odds ratio [OR]=2.0; 95% confidence interval [CI]=1.3-3.1), losing a greater percentage of maximum weight (>/=20% vs 10% to <15%) (OR=2.8; 95% CI=2.0-4.1), having fewer years since reaching maximum weight (2-5 years vs >10 years) (OR=2.1; 95% CI=1.2-3.7), reporting greater daily screen time (>/=4 hours vs 0-1 hour) (OR=2.0; 95% CI=1.3-3.2), and attempting to control weight (OR=1.8; 95% CI=1.1-3.0). Finally, weight regain was higher in those who were sedentary (OR=1.8; 95% CI=1.0-3.0) or not meeting public health recommendations for physical activity (OR=2.0; 95% CI=1.2-3.5).

CONCLUSIONS

How to achieve the skills necessary for long-term maintenance of weight loss in the context of an obesogenic environment remains a challenge.

Type 2 diabetes in the Hispanic or Latino population: challenges and opportunities

PURPOSE OF REVIEW

To describe how type 2 diabetes affects the Latino or Hispanic population in the United States, and identify the multiple challenges and opportunities to improve diabetes care in this rapidly growing group.

RECENT FINDINGS

Three compelling reasons justify the work in this area. First, this group has become the largest minority in the country, representing 13.7% of the total population. Based on current growth rates, one in four individuals will be of Hispanic origin by the year 2050. Second, this population suffers from very high rates of type 2 diabetes, obesity, the metabolic syndrome and their multiple vascular complications. A genetic tendency to develop insulin resistance and abdominal obesity, along with multiple nutritional, lifestyle, socio-economic and cultural factors, influence the development and course of type 2 diabetes among Latinos. Third, Hispanics have lagged behind in their diabetes care when compared with the predominant non-Hispanic White population.

SUMMARY

Understanding the challenges and opportunities in Latinos with diabetes is necessary to develop and implement comprehensive culturally oriented diabetes care, education, outreach and research programs. Some of these strategies may also be beneficial for other groups and can contribute to better integrate our societies.