Prevalence of cardiovascular disease risk factors among older Puerto Rican adults living in Massachusetts

The Association Between Acculturation and Diet and Physical Activity Among Pregnant Hispanic Women with Abnormal Glucose Tolerance

Background: Hispanic women are disproportionately affected by gestational diabetes mellitus (GDM), yet few studies have assessed the impact of acculturation on health behaviors that may reduce GDM risk. Materials and Methods: We assessed relationships between acculturation and meeting American Diabetes Association guidelines for macronutrient intake and American College of Obstetricians and Gynecologists guidelines for physical activity (PA) using baseline data from Estudio Project Aiming to Reduce Type twO diabetes, a randomized trial conducted in Massachusetts (2013-2017) among 255 Hispanic pregnant women with hyperglycemia. Acculturation was assessed via the Psychological Acculturation Scale, duration of time and generation in the continental United States, and language preference; diet with 24-hours dietary recalls; and PA with the Pregnancy Physical Activity Questionnaire (PPAQ). Results: The majority of participants who reported low psychological acculturation (74.9%), preferred English (78.4%), were continental U.S. born (58.0%), and lived in the continental United States ≥5 years (91.4%). A total of 44.8%, 81.8%, 22.9%, and 4.6% of women met guidelines for carbohydrate, protein, fat, and fiber intakes, respectively; 31.9% met guidelines for PA. Women with higher acculturation were less likely to meet carbohydrate guidelines (English preference: adjusted risk ratios [aRR] 0.45, 95% confidence intervals [CI] 0.23-0.75; U.S. born: aRR 0.60, 95% CI 0.36-0.91; duration of time in United States: aRR 0.96, 95% CI 0.92-0.99). Women with higher acculturation were more likely to meet PA guidelines (U.S. born: aRR 1.95, 95% CI 1.11-3.44). Conclusions: In summary, higher acculturation was associated with lower likelihood of meeting dietary guidelines but greater likelihood of meeting PA guidelines during pregnancy. Interventions aimed at reducing GDM in Hispanics should be culturally informed and incorporate acculturation. Clinical Trial Registration: clinicaltrials.gov NCT01679210.

Perspectives of Puerto Rican Adults about Heart Health and a Potential Community Program

BACKGROUND

Puerto Ricans are the second largest Hispanic group in the U.S. and older adults have significant health disparities. Educational programs that address heart disease risk for this population have rarely been developed and implemented.

PURPOSE

To address this gap, the Heart Healthy Initiative for Puerto Rican adults is being developed. To develop it as a participatory program, the community members were asked about their perspectives.

METHODS

Five focus groups with 28 participants, aged 45-60, were conducted, transcribed and analyzed using Thematic Analysis. In-depth analysis of meanings of health promoting behaviors, in the context of cultural beliefs and values was carried out.

RESULTS

The following themes were identified: Health as balance and integration; Health as connection of self, connection with others; Cultural meanings of lifestyle choices; Stresses and struggles. Participants suggested that the program should have significant variety and a holistic perspective, be sensitive to different needs and motivations, stimulate mutual understanding and shared cultural meanings.

DISCUSSION

The program needs to support lifestyle changes which maximally preserve traditions and to introduce multi-level changes.

TRANSLATION TO HEALTH EDUCATION PRACTICE

The identified cultural meanings of diet, physical activity and relationships were taken into account to develop the educational curriculum.

Higher adherence to a diet score based on American Heart Association recommendations is associated with lower odds of allostatic load and metabolic syndrome in Puerto Rican adults

A score based on diet and lifestyle recommendations from the AHA has been associated with cardiovascular risk factors. We aimed to assess whether the diet components alone were associated with metabolic syndrome (MetS) and allostatic load (AL; a composite measure of 10 physiologically dysregulated variables). The diet score ranged from 0 to 90 and included intake components for dietary fats, fruits and vegetables, whole grains, salt, added sugars, and alcohol and was tested in a cross-sectional analysis of 1318 Puerto Rican adults (aged 45-75 y; 72% women) living in Boston, MA. The mean ± SD diet score was 28.0 ± 9.9 for men and 30.0 ± 10.1 for women. Replicating findings from a previous study in this cohort that used both the diet and lifestyle components, we observed associations between the diet-only score and insulin, waist circumference, and HDL cholesterol. We found novel significant associations between the continuous diet score and AL components, namely an inverse association with urinary cortisol and a positive association with serum dehydroepiandrosterone sulfate in women as well as an inverse association with urinary norepinephrine in men (all P < 0.05). In multinomial logistic regression, every 10 AHA diet score units were associated with 22% (95% CI: 1, 38; P = 0.043) lower odds of having ≥6 (vs. ≤2) dysregulated AL components in women. In men, every 10 diet score units were associated with lower odds of MetS (OR: 0.69; 95% CI: 0.52, 0.93; P = 0.016). Following AHA recommendations for a healthy diet may protect against the development of components of MetS and AL in Puerto Rican adults.

Carbohydrate nutrition differs by diabetes status and is associated with dyslipidemia in Boston Puerto Rican adults without diabetes

Puerto Rican adults have a greater prevalence of type 2 diabetes (T2D) and lower HDL-cholesterol (HDL-C) than the general U.S. population. Carbohydrate nutrition may play a role in this disparity. Cross-sectional analyses included data from 1219 Puerto Ricans aged 45-75 y enrolled in the Boston Puerto Rican Health Study. Using the Pearson chi-square test and ANCOVA, lifestyle characteristics and dietary intake, as assessed by semiquantitative FFQ, were compared by T2D status based on fasting plasma glucose concentration and medication use. Food source rankings for carbohydrate, dietary glycemic load (GL), and fiber were obtained using the SAS procedure PROC RANK. Geometric mean plasma HDL-C and TG concentrations were compared across quintiles of dietary carbohydrate, glycemic index (GI), GL, and fiber by using ANCOVA and tests for linear trend. In multivariable analyses, individuals with T2D (39.5%) had lower dietary carbohydrate, GL, and total sugar intake from lower intake of sugar, fruit drinks, and soda compared with those without T2D. In individuals without T2D, dietary carbohydrate and GL were inversely associated with HDL-C (P < 0.0001). Associations between dietary fiber and HDL-C were confounded by carbohydrate intake, apparently from concurrent consumption of legumes with white rice, a refined carbohydrate food. No associations were observed between carbohydrate, dietary GI, GL, or fiber and TG. In conclusion, individuals with T2D showed evidence of dietary modification. Among those without diabetes, a high intake of refined carbohydrates was associated with decreased HDL-C. Longitudinal research on carbohydrate nutrition in relation to diabetes risk factors and blood lipids in Puerto Ricans is warranted.

Distribution and correlates of the metabolic syndrome in adults living in the San Juan Metropolitan Area of Puerto Rico

OBJECTIVE

This study evaluated correlates of the metabolic syndrome among adults living in Puerto Rico, a Hispanic subpopulation disproportionately affected by diabetes.

METHODS

A probability cluster design was used to select a sample of households of the San Juan Metropolitan Area in Puerto Rico. A total of 858 persons aged 21-79 years completed a face-to-face interview, blood pressure and anthropometric measurements, blood sampling and spot urine. Logistic regression was employed to assess correlates of the metabolic syndrome.

RESULTS

Of 368 (42.9%) of adults who met the criteria for metabolic syndrome, elevated fasting glucose (49.8%), abdominal obesity (48.6%), and reduced HDL cholesterol (45.8%) were the most prevalent diagnostic criteria. In a multivariable logistic model that simultaneously adjusted for sociodemographic characteristics and health behaviors, older age, high school educational attainment or less, no alcohol intake, and lack of moderate-to-vigorous physical activity remained significantly (p < 0.05) associated to the metabolic syndrome. However, the associations for male gender, some college education, and current smoking > or = 20 cigarettes/day had borderline significance. Further controlling for inflammatory markers slightly attenuated the strength of most of these associations but remained significantly (p < 0.05) associated to the metabolic syndrome with only a few exceptions. Middle and upper tertiles of hs-CRP, fibrinogen, and PLl-1 and an elevated albumin-to-creatinine ratio were also associated (p < 0.05) with the metabolic syndrome.

CONCLUSION

Enhancing public education regarding modifiable risk factors for the metabolic syndrome and providing optimal medical management of individual metabolic disturbances among those at risk through preventive lifestyle changes should be placed as a public health priority for Puerto Rico.

Acculturation and sociocultural influences on dietary intake and health status among Puerto Rican adults in Massachusetts

BACKGROUND

Previous studies have shown negative consequences of acculturation on lifestyle factors, health status, and dietary intake of Hispanic immigrants in the US. Despite prevalent type 2 diabetes and low socioeconomic status (SES) among Puerto Rican adults living on the US mainland, little is known about acculturation in this group.

OBJECTIVE

We investigated associations among acculturation, lifestyle characteristics, health status, and carbohydrate nutrition in Puerto Rican adults. A secondary objective was to investigate possible confounding and/or effect modification on these associations by SES.

DESIGN

Cross-sectional data from the Boston Puerto Rican Health Study, which included 1219 Puerto Ricans in the Boston area, aged 45-75 years.

STATISTICAL ANALYSES

Characteristics were compared using ANCOVA, linear trend and Pearson's chi-square tests across quartiles of acculturation. Tests for interaction by poverty status were conducted. Proportional contributions of foods to intake of total carbohydrate and fiber were assessed using SAS RANK.

RESULTS

Levels of acculturation were low, despite young age at first arrival to the US mainland (25.4 ± 12.3 y) and long length of stay (34.2 ± 12.2 y). Greater English language use was associated with higher SES, alcohol consumption, physical activity, better perceived health, and less central obesity. Acculturation was associated with lower legume fiber and greater cereal fiber intake. Among those above the poverty threshold, acculturation was associated with lower dietary glycemic index and starch intake, and greater fruit and non-starchy vegetable intake.

CONCLUSIONS

In contrast to studies with Mexican Americans, the association of acculturation with dietary quality in these Puerto Rican adults was mixed, but tended toward better carbohydrate quality. Dietary recommendations should include maintenance of traditional, healthful dietary practices including consumption of legumes, but also reduction in refined grains, and greater inclusion of fruit, non-starchy vegetables, and whole grains. Interventions to improve access to better quality carbohydrate sources are necessary for this group disproportionately affected by diabetes.