Macronutrient intakes among adult Hispanics: a comparison of Mexican Americans, Cuban Americans, and mainland Puerto Ricans

Developing a Diet and Physical Activity Intervention for Hispanic/Latina Breast Cancer Survivors

Objectives

There is limited guidance on how to effectively educate cancer survivors to adopt and maintain specific diet and physical activity recommendations, especially among underserved and under-resourced populations. Here, the objective is to present the development of a behavioral and theoretically-based multi-modal diet and physical activity intervention program for Hispanic/Latina breast cancer survivors, Mi Vida Saludable (My Healthy Life).

Methods

The development process was based on the 6 steps of the Nutrition Education DESIGN Procedure: (1). Decide behaviors; (2). Explore determinants; (3). Select theory-based model; (4). Indicate objectives; (5). Generate plans; and (6). Nail down evaluation. The theoretical framework for the intervention is Social Cognitive Theory.

Results

The resulting behavioral intervention consists of 2 components. The first component is in-person group education consisting of 4 lessons over 1 month. Each 4-hour group lesson includes a hands-on cooking component, a physical activity component, and facilitator-led nutrition education and discussion, with 2 field trips to a local grocery store and farmers’ market. The second component is an e-Health program that includes weekly text messages, biweekly emailed newsletters, and ongoing website access.

Conclusion

The systematic DESIGN Procedure provided practical guidance for developing a behaviorally-focused, theory-based, and culturally sensitive program that addresses both dietary and physical activity behaviors for delivery both in-person education and through eHealth. The Procedure may be useful for developing other behaviorally focused and theory-based interventions.

Food insecurity and physical functioning in Boston area Puerto Rican older adults

Objective:

Prior studies have found evidence of a relationship between food insecurity and functional limitations among older populations in the USA.

Design:

This is a longitudinal investigation of food security in relation to functional limitations, assessed as Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scores.

Setting:

The Greater Boston, MA area.

Participants:

1461 Boston Puerto Rican Health study participants, predominantly (70·5 %) female and aged 57·1 years (sd ± 7·6) at baseline followed for 6·2 (sd ± 0·98) years.

Results:

In cross-sectional analysis at baseline, participants reporting severe food insecurity had greater functional limitations (higher ADL; β = 2·34; 95 % CI (1·48, 3·19)) and higher IADL (β = 1·17, 95 % CI (0·68, 1·65)) compared with food secure participants. In longitudinal linear mixed models, severely food insecure participants at baseline had greater functional limitations over 5 years, as assessed by ADL (β = 1·74; 95 % CI (0·95, 2·53); P < 0·001) and IADL (β = 0·93, 95 % CI (0·48, 1·38)) compared with food secure participants. However, baseline food security did not significantly alter the 5-year trajectory in ADL (P-interaction between baseline food security and time for ADL and IADL = 0·41 and 0·47, respectively).

Conclusions:

In this cohort of Boston area Puerto Rican adults, those who are food insecure had consistently higher ADL and IADL scores over time, compared with those who are food secure. Baseline food security did not appear to alter the trajectory in ADL or IADL score.

Higher Dairy Intakes Are Associated with Higher Bone Mineral Density among Adults with Sufficient Vitamin D Status: Results from the Boston Puerto Rican Osteoporosis Study

Background

Dairy foods have been shown to improve bone mineral density (BMD) in non-Hispanic whites. Puerto Rican adults have a higher prevalence of osteoporosis and vitamin D deficiency than non-Hispanic whites. However, there is little understanding of lifestyle influences on bone in this population.

Objective

The aim of this study was to examine associations of dairy intakes with BMD among adults from the Boston Puerto Rican Osteoporosis Study with and without adequate serum vitamin D status.

Methods

A total of 904 participants in this cross-sectional analysis provided dietary intakes with a culturally tailored food-frequency questionnaire. Dairy food groups were calculated [total dairy, modified dairy (without cream or dairy desserts), fluid dairy (milk + yogurt), cheese, yogurt, and cream and desserts]. BMD (grams per centimeter squared) was measured using dual-energy X-ray absorptiometry. Vitamin D status was defined as sufficient (serum 25-hydroxyvitamin D [25(OH)D] ≥20 ng/mL) or insufficient (<20 ng/mL). General linear models were used to examine associations between dairy intake and BMD, stratified by vitamin D status.

Results

Of the total sample, 73% were women, of whom 87% were postmenopausal. Mean ± SD age was 60.0 ± 7.6 y and mean ± SD body mass index (kg/m2) was 32.3 ± 6.6. Mean serum 25(OH)D (range: 4-48 ng/mL) was 14.3 ± 3.6 ng/mL in insufficient individuals and 26.0 ± 5.5 ng/mL in sufficient individuals. In the full sample, higher intakes of modified dairy foods (β = 0.0015, P = 0.02) and milk (β = 0.0018, P = 0.04) were associated with higher femoral neck (FN) BMD. Among those who were vitamin D sufficient, higher intakes of total dairy (P = 0.03-0.07), fluid dairy (P = 0.01-0.05), and milk (P = 0.02-0.09) were significantly related to higher FN and lumbar spine BMD, respectively. Among vitamin D-insufficient participants, dairy intakes were not associated with BMD (P-range = 0.11-0.94).

Conclusions

Dairy food intakes were associated with higher BMD among adults, particularly those with sufficient vitamin D status. Future studies should confirm findings longitudinally and assess culturally acceptable lifestyle interventions to improve bone health among Hispanic adults. This trial was registered at clinicaltrials.gov as NCT01231958.

Foods Contributing to Macronutrient Intake of Women Living in Puerto Rico Reflect Both Traditional Puerto Rican and Western-Type Diets

Lack of variability in dietary intake within a population makes identification of relationships between diet and disease difficult. Studies in populations with greater interindividual variation can provide important insights. The Puerto Rican diet is in transition from a traditional to a more Western-type diet, resulting in greater interindividual variability. We identified foods contributing to absolute intake and variability in the intake of macronutrients among Puerto Rican women. One hundred women, aged 30⁻79, residents of San Juan, Puerto Rico, completed three, interviewer-administered, 24-h dietary recalls from which foods contributing to absolute intake and intake variability in intake of energy, fat, protein, carbohydrate and dietary fiber were determined. The overall prevalence of intake of foods was also calculated. Traditional Puerto Rican foods such as legumes, rice, and plantains were important contributors to the intake of calories and macronutrients as were foods more typical of Western diets including white bread and sweetened carbonated beverages. Identification of food sources of nutrients for this population with a diet in transition can contribute to the development of instruments to measure dietary intake and to understand the contribution of diet to the etiology of chronic disease among Puerto Rican women.

Segmented Assimilation: An Approach to Studying Acculturation and Obesity Among Latino Adults in the United States

Segmented assimilation theory posits that immigrants experience distinct paths of assimilation. Using cluster analysis and data from the National Latino and Asian American Survey, this study sought to apply this theory in relation to obesity among Latinos. Four clusters emerged: a "second-generation classic," a "third-generation classic," an "underclass," and a "segmented assimilation" pattern. In analyses controlling for sociodemographic confounders (eg, age), second-generation classic individuals had higher odds of obesity (odds ratio = 2.70, 95% confidence interval = 1.47-4.93) relative to the segmented pattern. Similarly, third-generation classic individuals had higher odds of obesity (odds ratio = 3.23, 95% confidence interval = 1.74-6.01) compared with segmented assimilation individuals.

"We like Fried Things": Negotiating Health and Taste among Hispanic Caribbean Communities in New York City

The study was conducted to understand fried-food (FF) consumption among Hispanic Caribbean (HC) communities in New York City. Data were collected through qualitative interviews with 23 adults self-identified as Cuban, Dominican, or Puerto Rican. Most informants considered FFs an important part of their traditional diet. Potential explanations included taste, cost, convenience, and the emotive values attached to FF. FF consumption was contextualized in local foodscapes. Results include strategies to diminish FF consumption and differences across HC groups and migratory generations. The relevance for future nutrition interventions addressing health disparities in this community is discussed.

Breast Cancer Prevalence and Mortality among Hispanic Subgroups in the United States, 2009-2013

Background. This paper presents data on breast cancer prevalence and mortality among US Hispanics and Hispanic subgroups, including Cuban, Mexican, Puerto Rican, Central American, and South American. Methods. Five-year average annual female breast cancer prevalence and mortality rates for 2009-2013 were examined using data from the National Health Interview Survey (prevalence) and the National Center for Health Statistics and the American Community Survey (mortality rates). Results. Overall breast cancer prevalence among US Hispanic women was 1.03%. Although the estimates varied slightly by Hispanic subgroup, these differences were not statistically significant. The breast cancer mortality rate for Hispanics overall was 17.71 per 100,000 women. Higher rates were observed among Cubans (17.89), Mexicans (18.78), and Puerto Ricans (19.04), and a lower rate was observed among Central and South Americans (10.15). With the exception of the rate for Cubans, all Hispanic subgroup rates were statistically significantly different from the overall Hispanic rate. Additionally, all Hispanic subgroups rates were statistically significantly higher than the Central and South American rate. Conclusion. The data reveal significant differences in mortality across Hispanic subgroups. These data enable public health officials to develop targeted interventions to help lower breast cancer mortality among the highest risk populations.

Nutritional Risk Among Urban, Community-Dwelling Older Hispanics: Influence of Demographic and Cultural Characteristics

This investigation explored nutritional risk and dietary characteristics of older Hispanics (52 years or older) living independently in a large, urban metropolitan area. Fifty-nine participants (93% female) completed a 16-item nutrition assessment questionnaire, and dietary intake data were collected on 49 of these participants. Of participants, 65% were well-nourished, although 35% were at risk of malnutrition or were malnourished. Participants'diets were lacking adequate amounts of dietary fiber, vitamin E, folate, zinc and calcium as well as energy foods, protein, and complex carbohydrates. A culturally sensitive nutrition intervention to meet the needs of older Hispanics should emphasize adequate fluid intake and traditional food sources of fiber, vitamin E, folate, zinc, and calcium. In addition, knowledge of different types of carbohydrates and dietary fats should be incorporated into interventions that also provide opportunities for social interactions among older Hispanics.

How Does Managed Care Improve the Quality of Breast Cancer Care Among Medicare-Insured Minority Women?

PURPOSE

The aim of this study is to investigate if evidence-based clinical guidelines are implemented equitability among ethnic minority breast cancer patients using Medicare Advantage and investigate if presumed advantages of managed care over fee-for-service are greater for minorities than for Whites.

METHODS

Data from the Surveillance, Epidemiology, and End Results and Medicare were used to examine 70,755 women over age 65 diagnosed with early stage breast cancer between 2005 and 2009. Implementation of two clinical guidelines was assessed: receipt of radiation therapy after breast conserving surgery and estrogen receptor status documentation. Multilevel logistic regression and inverse propensity weighting controlled for confounding.

RESULTS

African Americans are still less likely than Whites to receive radiation therapy after breast-conserving surgery, whether they use Medicare fee-for-service (OR 95 % CI) = 0.90 (0.83, 0.98) or managed care (OR 95 % CI) = 0.87 (0.76, 1.00). Differences between receipt of radiation therapy by insurance plan type was nonexistent. Relative to FFS, the use of managed care improved the odds of having estrogen receptor status documented by 44 % in African Americans, (OR 95 % CI) = 1.44 (1.15, 1.83) and by 42 % in Latina patients (OR 95 % CI) = 1.42 (1.17, 1.78).

CONCLUSIONS

Compared to Medicare fee-for-service, ethnic and racial disparities among Medicare Advantage users were reduced. We observed fewer disparities, but not an elimination of disparities, among Medicare Advantage enrollees receiving breast cancer care with an organizational and patient component of care. This suggests managed care may still need to focus on minority patient empowerment and involvement in care.

The Hispanic paradox in cardiovascular disease and total mortality

Health statistics and epidemiologic studies have shown that Hispanics live longer than Non Hispanic Whites, despite a high prevalence of cardiovascular disease (CVD) risk factors and an average low socioeconomic status, both strong predictors of CVD and mortality. This phenomenon has been dubbed "The Hispanic paradox" and has been demonstrated in old and contemporary cohorts. To date, no factor has been identified that could explain this phenomenon, but socio demographic factors, dietary intake and genetic predisposition have been proposed as possible explanations for the Hispanic paradox. As with the French paradox, where French were found to have a lower rate of coronary heart disease (CHD), helped to identify the role of the Mediterranean diet and wine consumption in the prevention of CHD, the Hispanic paradox could help identify protective factors against CHD. This article describes the current evidence supporting the existence of the Hispanic paradox and provides a brief review on the possible explanations.

Misreporting of dietary intake affects estimated nutrient intakes in low-income Spanish-speaking women

Misreporting of dietary intake affects the validity of data collected and conclusions drawn in studies exploring diet and health outcomes. One consequence of misreporting is biological implausibility. Little is known regarding how accounting for biological implausibility of reported intake affects nutrient intake estimates in Hispanics, a rapidly growing demographic in the United States. Our study explores the effect of accounting for plausibility on nutrient intake estimates in a sample of Mexican-American women in northern California in 2008. Nutrient intakes are compared with Dietary Reference Intake recommendations, and intakes of Mexican-American women in a national survey are presented as a reference. Eighty-two women provided three 24-hour recalls. Reported energy intakes were classified as biologically plausible or implausible using the reported energy intakes to total energy expenditure cutoff of <0.76 or >1.24, with low-active physical activity levels used to estimate total energy expenditure. Differences in the means of nutrient intakes between implausible (n=36) and plausible (n=46) reporters of energy intake were examined by bivariate linear regression. Estimated energy, protein, cholesterol, dietary fiber, and vitamin E intakes were significantly higher in plausible reporters than implausible. There was a significant difference between the proportions of plausible vs implausible reporters meeting recommendations for several nutrients, with a larger proportion of plausible reporters meeting recommendations. Further research related to misreporting in Hispanic populations is warranted to explore the causes and effects of misreporting in studies measuring dietary intake, as well as actions to be taken to prevent or account for this issue.

Food-group and nutrient-density intakes by Hispanic and Latino backgrounds in the Hispanic Community Health Study/Study of Latinos

BACKGROUND

Hispanics are a heterogeneous group of individuals with a variation in dietary habits that is reflective of their cultural heritage and country of origin. It is important to identify differences in their dietary habits because it has been well established that nutrition contributes substantially to the burden of preventable diseases and early deaths in the United States.

OBJECTIVE

We estimated the distribution of usual intakes (of both food groups and nutrients) by Hispanic and Latino backgrounds by using National Cancer Institute methodology.

DESIGN

The Hispanic Community Health Study/Study of Latinos is a population-based cohort study that recruited participants who were 18-74 y of age from 4 US cities in 2008-2011 (Miami, Bronx, Chicago, and San Diego). Participants who provided at least one 24-h dietary recall and completed a food propensity questionnaire (n = 13,285) were included in the analyses. Results were adjusted for age, sex, field center, weekend, sequencing, and typical amount of intake.

RESULTS

Overall, Cubans (n = 2128) had higher intakes of total energy, macronutrients (including all subtypes of fat), and alcohol than those of other groups. Mexicans (n = 5371) had higher intakes of vitamin C, calcium, and fiber. Lowest intakes of total energy, macronutrients, folate, iron, and calcium were reported by Dominicans (n = 1217), whereas Puerto Ricans (n = 2176) had lowest intakes of vitamin C and fiber. Food-group servings reflected nutrient intakes, with Cubans having higher intakes of refined grains, vegetables, red meat, and fats and Dominicans having higher intakes of fruit and poultry, whereas Puerto Ricans had lowest intakes of fruit and vegetables. Central and South Americans (n = 1468 and 925, respectively) were characterized by being second in their reported intakes of fruit and poultry and the highest in fish intake in comparison with other groups.

CONCLUSION

Variations in diet noted in this study, with additional analysis, may help explain diet-related differences in health outcomes observed in Hispanics and Latinos.

The Healthy Eating Index and the Alternate Healthy Eating Index as predictors of 10-year CHD risk in Cuban Americans with and without type 2 diabetes

OBJECTIVE

To examine the relationship between dietary patterns, as measured by the Healthy Eating Index (HEI) and the Alternate Healthy Eating Index (AHEI), and 10-year predicted CHD risk in Cuban Americans with and without type 2 diabetes (T2D).

DESIGN

In a cross-sectional study participants were selected from two randomly generated mailing lists of individuals with and without T2D. HEI and AHEI scores were calculated from a self-reported FFQ. CHD risk was determined using the 10-year CHD risk calculator of the Adult Treatment Panel III.

SETTING

Miami Dade and Broward Counties, FL, USA.

SUBJECTS

Cuban Americans (n 358) aged ≥30 years.

RESULTS

Participants with T2D had a higher waist circumference (P = 0·001) and 10-year CHD risk score (P = 0·008) compared with those without T2D. Participants without T2D had a higher energy intake (P = 0·034), total blood cholesterol (P = 0·007), HDL cholesterol (P = 0·001) and HEI score (P = 0·006) compared with participants with T2D. AHEI score was a significant predictor of 10-year CHD risk (F(1,351) = 4·44, P = 0·036). An association between AHEI and 10-year CHD risk was found only for participants with T2D (β = -0·244, se = 0·049, P = 0·001).ConclusionThe present study showed that only participants with T2D with significantly higher AHEI scores had lower scores for 10-year predicted CHD risk. No association was found between HEI score and CHD risk among Cuban Americans. Individuals with T2D are advised to follow the AHEI dietary pattern.

Essential fatty acid intake and coronary heart disease risk factors among college students of 3 ethnic groups

OBJECTIVES

Few studies address gender and ethnic variations in essential fatty acid (EFA) intake and risk factors for coronary heart disease (CHD). The purpose of this study was to estimate EFA intake among college students of 3 ethnic groups and compare the relationship between EFA intake and CHD risk factors.

METHODS

Using a cross-sectional design, 300 subjects from 3 ethnic groups--one-third (n = 100) non-Hispanic white, one-third Hispanic, and one-third non-Hispanic black-completed the Cardiovascular Risk Assessment Instruments and a Food Frequency Questionnaire to determine fatty acid intake. Measured CHD risk factors were quantified as CHD Risk Point Standards (CHDRPS).

RESULTS

Results showed that Hispanic females had a significantly higher mean percent intake of arachidonic acid and ratio of linoleic acid to alpha-linolenic acid than non-Hispanic white females, and Hispanic males had significantly higher mean percent intake of EPA and [EPA plus docosahexaenoic acid (DHA)] than non-Hispanic white males. An inverse correlation was found between CHDRPS and DHA among non-Hispanic blacks. A significant positive correlation was found between CHDRPS and linoleic acid among non-Hispanic white females, as well as serum homocysteine (tHcy) concentrations and the ratio of linoleic acid to alpha-linolenic acid intake among non-Hispanic black females.

CONCLUSION

Gender and ethnic differences play a role in adherence to dietary guidelines, demonstrating relevance for future research in this area.

Dietary glycemic index and load in relation to cardiovascular disease risk factors in Cuban American population

OBJECTIVE

To examine whether dietary glycemic index (GI) or glycemic load (GL) had an effect on the cardiovascular disease (CVD) risk factors and whether the effects were dependent on the diabetes status in the Cuban American population.

DESIGN

A case–control, single-time-point study.

METHODS

A total of 324 middle-aged Cuban American adults had completed data on fasting blood lipids, physical activity level and usual dietary intake using a validated food frequency questionnaire. Published GI values were assigned to food items and average dietary GI and GL were calculated per participant.

RESULTS

Subjects without type 2 diabetes (T2D) were 3.3 times more likely to be in the recommended, highest high-density lipoprotein-cholesterol category if they were in the second dietary GL tertile as compared with those in the first dietary GL tertile (P = 0.042, 95% confidence interval = 1.94, 10.78).

CONCLUSIONS

The results of the present study suggest that in this sample of Cuban Americans a high GI or GL diet do not adversely affects blood lipids, especially among subjects without T2D.

Differences in fruit and vegetable intake among Hispanic subgroups in California: results from the 2005 California Health Interview Survey

OBJECTIVE

To compare total fruit and vegetable intake in cup equivalents and its individual components among Hispanic subgroups in California.

METHODS

Data are from the adult portion of the 2005 California Health Interview Survey. Hispanic/Latino subjects (n=7,954) were grouped into six subcategories (Mexican, Central American, Caribbean, Spanish American, South American, and >1 group). Total fruit and vegetable intake in cup equivalents was estimated from frequency responses about seven food categories. Both t test and chi(2) test were used to assess differences in sociodemographic characteristics across Hispanic subgroups. Multivariate linear regressions using SUDAAN software (Survey Data Analysis, version 9.0.1, 2005, Research Triangle Institute, Research Triangle Park, NC) were conducted to obtain means of total fruit and vegetable intake in cup equivalents and its components by Hispanic subgroups controlling for confounders.

RESULTS

Hispanic subgroups did not differ in their intake of total fruit and vegetable intake in cup equivalents (mean 3.4 c and 2.9 c for men and women, respectively). Small but significant differences (P<0.01) were found across Hispanic subgroups in individual fruit and vegetable components (green salad [women only], cooked dried beans and nonfried white potatoes) after adjusting for potential sociodemographic and acculturation confounders.

CONCLUSIONS

Fruit and vegetable intake by Hispanic respondents did not meet the national recommendation, although their reported intake is higher compared to other race/ethnicity groups. The public health message remains the same: Increase fruit and vegetable intake. Examination of intake for subgroups of Hispanics may enhance the utility of dietary information for surveillance, program and message design, and intervention and evaluation.

Predictors of hypertension awareness, treatment, and control among Mexican American women and men

BACKGROUND

The burden of hypertension and related health care needs among Mexican Americans will likely increase substantially in the near future.

OBJECTIVES

In a nationally representative sample of U.S. Mexican American adults we examined: 1) the full range of blood pressure categories, from normal to severe; 2) predictors of hypertension awareness, treatment and control and; 3) prevalence of comorbidities among those with hypertension.

DESIGN

Cross-sectional analysis of pooled data from the National Health and Nutrition Examination Surveys (NHANES), 1999-2004.

PARTICIPANTS

The group of participants encompassed 1,359 Mexican American women and 1,421 Mexican American men, aged 25-84 years, who underwent a standardized physical examination.

MEASUREMENTS

Physiologic measures of blood pressure, body mass index, and diabetes. Questionnaire assessment of blood pressure awareness and treatment.

RESULTS

Prevalence of Stage 1 hypertension was low and similar between women and men ( approximately 10%). Among hypertensives, awareness and treatment were suboptimal, particularly among younger adults (65% unaware, 71% untreated) and those without health insurance (51% unaware, 62% untreated). Among treated hypertensives, control was suboptimal for 56%; of these, 23% had stage >/=2 hypertension. Clustering of CVD risk factors was common; among hypertensive adults, 51% of women and 55% of men were also overweight or obese; 24% of women and 23% of men had all three chronic conditions-hypertension, overweight/obesity and diabetes.

CONCLUSION

Management of hypertension in Mexican American adults fails at multiple critical points along an optimal treatment pathway. Tailored strategies to improve hypertension awareness, treatment and control rates must be a public health priority.

How dietary intake methodology is adapted for use in European immigrant population groups - a review

Immigrants comprise a noteworthy segment of the European population whose numbers are increasing. Research on the dietary habits of immigrants is critical for correctly providing diet counselling and implementing effective interventions. The aim of the present study was to identify the presently used methods and adaptations required for measuring dietary intake in European immigrant groups. A comprehensive review strategy included a structured MEDLINE search, related references and key expert consultations. The review targeted adults from non-European union (European union-15 countries) ethnic groups having the largest populations in Europe. As studies evaluating nutrient intake were scarce, papers evaluating intake at the level of foods were included. Forty-six papers were selected. Although Eastern Europe, Turkey, Africa (North, Sub-Saharan and Afro-Caribbean), Asia and Latin America represented the most numerous immigrant groups, papers on dietary intake were not available for all populations. Interview-administered FFQ and repeated 24 hour recalls were the most frequently applied instruments. Inclusion of ethnic foods and quantification of specific portion sizes of traditional foods and dishes in assessment tools as well as food composition databases were commonly identified problems. For FFQ, food list elaboration required particular consideration to reflect key ethnic foods and relative contribution to nutrient intake. Extra efforts were observed to overcome cultural barriers to study participation. Evaluating dietary intake of immigrant populations requires special attention to various methodological aspects (sampling, recruiting, instruments used, method of administration, food composition database, acculturation, etc.) so as to adequately address the range of socio-cultural factors inherent in these nutritionally at risk target groups.

Are immigrant enclaves healthy places to live? The Multi-ethnic Study of Atherosclerosis

The growing size and changing composition of the foreign-born population in the USA highlights the importance of examining the health consequences of living in neighborhoods with higher proportions of immigrants. Using data from the Multi-ethnic Study of Atherosclerosis in four US cities, we examined whether neighborhood immigrant composition was associated with health behaviors (diet, physical activity) among Hispanic and Chinese Americans (n=1902). Secondarily we tested whether neighborhoods with high proportions of immigrants exhibited better or worse neighborhood quality, and whether these dimensions of neighborhood quality were associated with healthy behaviors. Neighborhood immigrant composition was defined based on the Census 2000 tract percent of foreign-born from Latin-America, and separately, percent foreign-born from China. After adjustment for age, gender, income, education, neighborhood poverty, and acculturation, living in a tract with a higher proportion of immigrants was associated with lower consumption of high-fat foods among Hispanics and Chinese, but with being less physically active among Hispanics. Residents in neighborhoods with higher proportions of immigrants reported better healthy food availability, but also worse walkability, fewer recreational exercise resources, worse safety, lower social cohesion, and lower neighborhood-based civic engagement. Associations of neighborhood immigrant composition with diet persisted after adjustment for reported neighborhood characteristics, and associations with physical activity were attenuated. Respondent-reported neighborhood healthy food availability, walkability, availability of exercise facilities and civic participation remained associated with behaviors after adjusting for immigrant composition and other covariates. Results show that living in an immigrant enclave is not monolithically beneficial and may have different associations with different health behaviors.

Determinants of Latina obesity in the United States: the role of selective acculturation

Obesity has reached epidemic proportions in the United States. Hispanic American women in particular have higher rates of obesity than their non-Hispanic White counterparts. In this article, the authors review the existing literature on acculturation as it relates to obesity and health behaviors among U.S. Hispanic women. In addition, a conceptual framework is proposed to examine factors contributing to obesity through "selective acculturation." This concept challenges traditionally held unilateral assumptions that underscore Hispanic women's unhealthful behavioral patterns by explaining a process whereby Hispanic women both maintain some older health-related behaviors and acquire new ones once they settle in a new culture.

Health and nutrient content claims in food advertisements on Hispanic and mainstream prime-time television

OBJECTIVE

Characterize frequency and type of health and nutrient content claims in prime-time weeknight Spanish- and English-language television advertisements from programs shown in 2003 with a high viewership by women aged 18 to 35 years.

DESIGN

Comparative content analysis design was used to analyze 95 hours of Spanish-language and 72 hours of English-language television programs (netting 269 and 543 food ads, respectively).

MAIN OUTCOME MEASURES

A content analysis instrument was used to gather information on explicit health and nutrient content claims: nutrition information only; diet-disease; structure-function; processed food health outcome; good for one's health; health care provider endorsement.

ANALYSIS

Chi-square statistics detected statistically significant differences between the groups.

RESULTS

Compared to English-language television, Spanish-language television aired significantly more food advertisements containing nutrition information and health, processed food/health, and good for one's health claims. Samples did not differ in the rate of diet/disease, structure/function, or health care provider endorsement claims.

CONCLUSIONS AND IMPLICATIONS

Findings indicate that Spanish-language television advertisements provide viewers with significantly more nutrition information than English-language network advertisements. Potential links between the deteriorating health status of Hispanics acculturating into US mainstream culture and their exposure to the less nutrition-based messaging found in English-language television should be explored.

Diabetes self-management: perspectives of Latino patients and their health care providers

Lifestyle modification programs tailored to experience, culture, psychosocial characteristics, and world-view can improve knowledge, self-care behaviors, and glucose control among Latinos with diabetes. Few data exist, however, on improving diabetes self-management among Latinos. In addition, views and practices of practitioners caring for these patients have received little attention.

OBJECTIVE

This study describes findings from qualitative research to inform the refinement of self-management interventions tailored to Latino patients with type 2 diabetes.

METHODS

Two practitioner focus groups assessed perceptions of patients' knowledge, attitudes, and behaviors. Four patient focus groups examined knowledge, beliefs, practices, barriers, and facilitators. Data were transcribed and subjected to content analysis.

RESULTS

Thirty-seven patients seeking care at a community clinic participated, along with 15 health care practitioners. Important knowledge gaps regarding diabetes causation and self-management were identified. Negative attitudes towards self-management were common among patients. Key facilitators included strong religious faith and support of medical practitioners. Families both facilitated and prevented adoption of self-management practices.

CONCLUSION

This study provides unique insights into the knowledge, attitudes, practices, and perceived barriers facing Latino patients and their providers regarding diabetes self-management.

PRACTICE IMPLICATIONS

Study findings underscore the need to develop tailored programs for this population and to train practitioners on their implementation.

Ethnicity and Nutrient Intake among Arizona WISEWOMAN Participants

BACKGROUND

Diet quality and risks of chronic disease have been identified, yet nutrient intakes from older uninsured populations have been scarcely described.

METHODS

Using the dietary intake profiles of an older, uninsured, and mostly Hispanic sample of Arizona WISEWOMAN participants, two ethnic groups were compared: Mexican American and non-Hispanic white women. Sociodemographic data related to nutrient intakes were identified. Estimated mean nutrient intakes of Mexican Americans (n = 260) and non-Hispanic white (n = 88) women were compared based on ethnicity and acculturation levels. Using linear regression models, associations of individual characteristics were made on nutrients for which reported intakes were less than the estimated average requirement (EAR).

RESULTS

Mexican Americans had energy, vitamin E, and niacin intakes that were significantly lower than those of non-Hispanic whites, whereas vitamin A intake was significantly higher among Mexican Americans. Less acculturated Mexican American women had significantly higher intakes of vitamin E and folate than their more acculturated counterparts. For both ethnic and acculturation groups, intakes of vitamin E, calcium, and potassium were lower than the established standards in more than 70% of this population. Having a high body mass index (BMI) was associated with lower reported energy intake and higher protein and potassium intakes, and smoking was associated with lower intakes of vitamin E and folate.

CONCLUSIONS

Mexican American women had overall lower micronutrient intakes compared with uninsured non-Hispanic white older women; this difference may be attributed to their underreporting intake.

Prevalence and clinical correlates of mitral annulus calcification in Hispanics and non-Hispanic whites

BACKGROUND

Data about mitral annulus calcification (MAC) are sparse in Hispanics. We compare prevalence and clinical correlates of MAC in Hispanics and non-Hispanic whites.

METHODS

We reviewed echocardiograms and clinical data of 337 Hispanics and 279 non-Hispanic whites, age 45 to 75 years. In cross-sectional data, prevalence and interrelationships of MAC, coronary heart disease (CHD), and risk factors were compared using multivariable logistic regression.

RESULTS

In Hispanics, MAC was significantly associated with CHD (odds ratio [OR] = 2.06, confidence interval [CI] = 1.09-3.87), age (OR = 1.73, CI = 1.21-2.49), female sex (OR = 1.87, CI = 1.01-3.47), smoking (OR = 1.80, CI = 1.01-3.24), and having multiple (>2) risk factors (OR = 3.43, CI = 2.66-4.43). In non-Hispanic whites, MAC was associated with CHD (OR = 4.24, CI = 2.00-8.98), age (OR = 2.87, CI = 1.82-4.50), and having multiple risk factors (OR = 3.59, CI = 2.7-4.77). There were no significant ethnic differences in prevalence of MAC.

CONCLUSIONS

Among Hispanics referred for echocardiography, MAC is associated with CHD and risk factors.

Correlates of fat intake behaviors in participants in the eating for a healthy life study

OBJECTIVE

This study identified socioeconomic correlates of total dietary fat intake in the Eating for a Healthy Life Study, a community-based dietary intervention study involving religious organizations.

SUBJECTS/DESIGN

To create our sampling frame for the Eating for a Healthy Life Study, a pool of religious organizations was identified from a list of religious faith organizations provided by the Church Council of Greater Seattle. Individual members were randomly selected from recruited religious organizations to complete a telephone-administered, baseline, cross-sectional survey. There were 2,507 respondents who were eligible, consenting participants. Dietary behavior was assessed using a modified version of the Fat- and Fiber-Related Diet Behavior Questionnaire. Socioeconomic status was assessed using individual demographic variables.

MAIN OUTCOME MEASURES

Fat-related behaviors indicated by fat summary score and stage of change.

STATISTICAL ANALYSES

A multivariable linear regression model was used to examine the association of individual demographic variables with the Fat- and Fiber-Related Diet Behavior Questionnaire-derived measure of dietary fat intake. The same individual variables were used in a multivariable logistic regression model of dietary stage of change.

RESULTS

Age, race, sex, education, and self-assessed health status were found to be statistically significant correlates of fat intake. Variables associated with stage of dietary fat change included sex, education, and religious organization cohesion.

CONCLUSIONS

Demographic variance is an important factor in understanding dietary fat intake.

Fat-Related Dietary Behaviors of Adult Puerto Ricans, with and without Diabetes, in New York City

OBJECTIVE

To assess the fat-related dietary behaviors of adult Puerto Ricans with and without diagnosed diabetes, living in New York City.

DESIGN

A random-digit-dialing telephone survey was conducted following Behavioral Risk Factor Surveillance System procedures. Dietary behavior was assessed using a brief Fat-Related Diet Habits Questionnaire, in which higher scores indicated higher fat intake.

SUBJECTS/SETTING

A total of 1,304 adult Puerto Ricans living in New York City were interviewed. Diabetes status was assessed using standard Behavioral Risk Factor Surveillance System questions.

STATISTICAL ANALYSES PERFORMED

Weighted analyses using SUDAAN software for complex surveys were done, and t tests were used to assess differences in mean fat-related dietary score by sociodemographic and health characteristics. Age-adjusted least-squared means were used to compare scores between those with and without diabetes. Linear regression was used to model characteristics associated with fat-related dietary score.

RESULTS

Fat-related dietary score was lower among those with diabetes and varied by population and health characteristics. Age-adjusted scores were significantly lower for those with diabetes who were younger, less educated, obese, or physically active. In the regression model, family history, weight, and exercise interacted with diabetes status. Those with diabetes were significantly more likely to modify meat consumption practices (eg, remove skin or trim fat) to reduce fat compared with those without diabetes.

CONCLUSIONS

New York City Puerto Ricans with diabetes are somewhat more likely to engage in behaviors to reduce fat compared with those without diabetes. Targeted, culturally sensitive nutrition education and counseling emphasizing lower-fat food choices and other fat-reducing behaviors can help reduce risk and control diabetes. Education messages should be tailored to the individual's diabetes status and other health and sociodemographic characteristics.

Frequency of attendance at religious services, cardiovascular disease, metabolic risk factors and dietary intake in Americans: an age-stratified exploratory analysis

BACKGROUND

Few data have been published on the association of attendance at religious services with cardiovascular morbidity and dietary and metabolic risk factors in representative samples of populations despite a known inverse association with mortality and smoking.

OBJECTIVE

To test the null hypothesis that frequency of attendance at religious services is unrelated to prevalence or levels of cardiovascular disease, dietary and metabolic risk factors.

DESIGN

Cross-sectional survey of a large national sample.

PARTICIPANTS

American men and women aged 20 years and over with complete data in the Third National Health and Nutrition Examination Survey (N = 14,192).

MEASUREMENTS

Self-reported frequency of attendance at religious services, history of doctor-diagnosed diseases, food intake frequency, 24-hour dietary intake, health status, socio-demographic variables and measured serum lipids and body mass index.

RESULTS

Weekly attenders were significantly less likely to report stroke, even after adjusting for multiple variables only in African American women OR = 0.35, 95% CI 0.19-0.66, p < 0.01. No association was seen for heart attack or diabetes. Fish intake at least weekly was more common in weekly attenders, significantly so only in African American women (odds ratio 1.24, 95% CI 1.01-1.58, p < 0.05) and in older Mexican American men (odds ratio 2.57, 95% CI 1.45-2.57, p < 0.01). In linear regression analyses, no significant independent associations were seen between attendance frequency and serum lipid levels or dietary intake of energy, or fat in g and % of kcal.

CONCLUSION

Hypotheses generated by these analyses are that in African American women stroke is less prevalent and weekly fish intake more prevalent among weekly attenders than others and that there are no significant independent associations of serum lipids, dietary intake, prevalent CHD, or diabetes with frequency of attendance of religious services. Independent testing of these hypotheses in other samples is needed.

Cancer screening among Latino subgroups in the United States

BACKGROUND

Relying upon the Health Belief Model and a behavioral model of health care utilization, the purpose of this study was to examine current adherence to cancer screening among Latino subgroups.

METHODS

Using data from the 2000 National Health Interview Survey, 5377 Latinos were surveyed for their use of Pap smear, mammogram, breast self-examination and the clinical breast exam among women, prostate specific antigen test among men, and the fecal occult blood test, sigmoidoscopy, colonoscopy, and proctoscopy among both men and women. Using sampling weights, multivariate logistic regression models were used to assess screening use.

RESULTS

Dominican women had 2.4 times greater likelihood of having had mammography than other Latinos. In addition, Latinas aged 50-69, who had more years of education, a personal history of cancer, who were not current smokers, had health insurance, had visited a primary care provider over the past 12 months, and had at least one other screening test had greater use of mammography. Younger age, marriage, greater acculturation, visits to a primary care provider, health insurance, and the use of other cancer screening tests predicted the uptake of the Pap smear. Latinas were more likely to use a CBE if they were younger, had a Bachelor's degree, a personal history of cancer, were more acculturated, had visits to a primary care provider over the past 12 months, and used other cancer screening tests. Puerto Ricans, Central or South Americans had half the likelihood of having colorectal cancer screening than other groups. Ages between 50 and 69, male sex, marriage, history of visiting a health care provider, and use of other screening tests predicted use of the FOBT. Older age, greater education, male sex, history of visiting a health care provider in the previous year, use of other screening tests, and better health status influenced the uptake of endoscopy for colorectal cancer screening. Cuban males had fivefold greater utilization of PSA testing. Additionally, PSA use among Latinos was predicted by older age, history of visiting a primary care provider in the past 12 months, and use of other screening tests.

CONCLUSIONS

Cancer screening programs must take into account differences among Latinos in age, gender, educational levels, marital status, cancer history, risk behaviors, insurance, health status and health services utilization.

Eating Patterns and Cardiovascular Disease Risk in a Detroit Mexican American Population

The purpose of this study was to examine dietary patterns and cardiovascular risk factors in Hispanic adults living in Southwest Detroit. A descriptive design was used. Self-report baseline data were collected using The Rate Your Plate and Personal Health Risk Assessment questionnaires. A nonrandom sample of 32 Mexican American adults was recruited from a large Roman Catholic Church in Southwest Detroit. Participants were selected if they were enrolled in the larger parent research study to test the effects of a lay health educator intervention and planned to participate in the nutrition education portion of the intervention. Unhealthy eating patterns outnumbered heart healthy eating practices. The majority used higher fat salad dressings; ate fried foods, sweets, and high fat snacks; consumed greater than the desired amounts of regular cheese; drank whole milk; and ate few fruits and vegetables. Lack of physical activity, being overweight, and exposure to second-hand smoke were the most prevalent cardiovascular risk factors. The data suggest that effective community-based heart disease prevention programs that emphasize risk factor screening and cardiovascular risk reduction through heart healthy eating are needed.

Higher fat intake and lower fruit and vegetables intakes are associated with greater acculturation among Mexicans living in Washington State

OBJECTIVE

To examine associations of diet with acculturation among Hispanic immigrants from Mexico to Washington state and to compare dietary patterns of Hispanic with non-Hispanic white residents.

DESIGN

Data are part of the baseline assessment for a community-randomized cancer prevention trial. The Fat-Related Diet Habits questionnaire and the National 5-A-Day for Better Health program dietary assessment instruments were used to collect data on fat and fruit and vegetable intake, respectively. Data were also collected on demographic characteristics and acculturation status.

SUBJECTS/SETTING

A total of 1,689 adult Hispanic and non-Hispanic white residents of 20 communities in the Yakima Valley, WA, completed in-person interviews.

STATISTICAL ANALYSES PERFORMED

Mixed model regression analyses tested associations of acculturation with diet. These models compared the fat and the fruit and vegetable intake of Hispanics vs non-Hispanic white residents. Additional analyses compared the diets of highly acculturated Hispanics with low-acculturated Hispanics. All models included age, sex, income, and education and were also adjusted for the random effect of community.

RESULTS

Dietary patterns varied by ethnicity and acculturation status. On average, compared with non-Hispanic white residents, Hispanics consumed one more serving of fruits and vegetables per day (P<.001). Dietary habits changed as Hispanics acculturated to the United States. Highly acculturated Hispanics ate fewer servings of fruits and vegetables per day compared with those not highly acculturated (P<.05). Highly acculturated Hispanics had slightly higher, but not statistically significant, scores on the Fat-Related Diet Habits questionnaire, which corresponds to a higher fat intake, compared with low-acculturated Hispanics. The early dietary changes made on acculturation included adding fat at the table to breads and potatoes.

APPLICATIONS/CONCLUSIONS

Nutrition professionals should encourage their Hispanic clients to maintain their traditional dietary practices, such as a high intake of fruits and vegetables and eating bread and potatoes without added fat.

Correlation of dietary intake and colorectal cancer incidence among Mexican-American migrants: the multiethnic cohort study

Studies of migrants, along with geographic and temporal variations in incidence, indicate that colorectal cancer is especially sensitive to changes in environmental factors, including, most importantly, diet. The goal of this research was to examine the changes in dietary practices that may be consistent with the changing incidence of colorectal cancer in the Los Angeles Mexican-American population. Cancer incidence and dietary intake data were available for over 35,000 Latinos of Mexican national origin currently participating in the prospective Multiethnic Cohort Study, representing the largest sample of Mexican-origin Latinos of any such study in the United States. The dataset is unique in that changes in cancer rates and in dietary behaviors across three generations could be examined. Most of the change in colorectal cancer rates occurred between the first and second generations, and, correspondingly, nearly all the dietary change also occurred between the first and second generations. Although some food traditions were retained by Mexican Americans, the dietary changes due to acculturation were significant and support an association between colorectal cancer risk and certain dietary components, notably, alcohol as a risk factor and nonstarch polysaccharides and vegetables as protective factors.

Baseline fat-related dietary behaviors of white, Hispanic, and black participants in a cholesterol screening and education project in New England

OBJECTIVE

To examine baseline fat-related dietary behaviors of white, Hispanic, and black participants in Minimal Contact Education for Cholesterol Change, a National Institutes for Health-funded cholesterol screening and education project conducted in New England.

SUBJECTS

A sample of 9,803 participants who joined the study at baseline (n=7,817 white; n=1,425 Hispanic; and n=561 black).

METHODS

Participants completed baseline questionnaires that included demographic and psychosocial items as well as the Food Habits Questionnaire, a dietary assessment tool measuring fat-related dietary behaviors. They also had their blood cholesterol level and height and weight measured.

STATISTICAL ANALYSES

Analysis of variance (ANOVA) was used to compare racial/ethnic groups on continuous demographic variables, and the chi(2) test of association was used to compare groups on demographic categorical variables. Multivariate analysis of variance (MANOVA) was used to compare mean differences between racial/ethnic groups on six behavioral subscales (Fat Factors) differentiating domains of behavior related to fat intake and to compare 27 individual fat-related dietary behaviors.

RESULTS

After adjusting for sex, age, marital status, education, employment status, and percent time lived in the United States, white participants had the lowest Food Habits Questionnaire summary score (2.44) (indicating a lower fat diet), followed by Hispanic (2.61) and black (2.68) participants. The three ethnic groups also differed on the prevalence of Fat Factors and specific fat-related dietary behaviors. White participants were more likely to use lower-fat alternatives, to avoid frying, to replace meat, and to modify meat to make it lower in fat. However, they were least likely to eat fruits and vegetables for snacks and desserts. Hispanic participants were more likely to engage in fat-avoidance behaviors and to eat fruits and vegetables for snacks and desserts. Black participants were less likely to eat meatless meals and modify meats to make them lower in fat. Black and Hispanic participants were more likely than white participants to fry foods. Hispanics were less likely to read food labels for nutrition information. The most and least prevalent fat-related behaviors also differed by each ethnic group, showing that different behaviors were more and less easily implemented by each ethnic group.

CONCLUSIONS/APPLICATIONS

The results of this study suggest that there is a need for improvement in dietary behaviors related to fat intake, especially for blacks and Hispanics, and that the specific dietary behavior issues differ widely by ethnicity. These results can be used by nutrition educators and researchers to help them decide what messages to emphasize in dietary counseling, nutrition education programs, and materials. The results can also be used to help design better dietary assessment tools and more effective interventions for culturally diverse populations.

Dietary and plasma lipid, lipoprotein, and apolipoprotein profiles among elderly Hispanics and non-Hispanics and their association with diabetes

BACKGROUND

There are limited data about dietary intakes and plasma lipids of elderly US Hispanics.

OBJECTIVE

The disparity in prevalence of type 2 diabetes among population groups underscored our need to assess dietary and plasma risk factors for cardiovascular disease.

DESIGN

Plasma lipids and apolipoproteins and dietary intakes of macronutrients were measured in elderly subjects (60-98 y): 490 Hispanics of Caribbean origin (Puerto Ricans and Dominicans) and 163 non-Hispanic whites. Plasma values were related to ethnicity and to macronutrient intake. Differences in plasma lipids due to diabetes were assessed among the Hispanics.

RESULTS

Intakes of carbohydrate and polyunsaturated fatty acids were higher and intakes of cholesterol and saturated and monounsaturated fatty acids were lower in Hispanics than in non-Hispanic whites. Concentrations of total cholesterol, HDL cholesterol, and apolipoprotein A-I were significantly lower among Hispanic women than among non-Hispanic white women; a similar trend was seen in men. Dyslipidemia (high triacylglycerols and low HDL cholesterol) was more prevalent among Hispanics with than without diabetes.

CONCLUSIONS

Ethnic differences in serum lipids exist and appear to be associated with differences in dietary intakes. However, both Hispanics and non-Hispanic whites had lipid profiles indicating a high risk of cardiovascular disease. Hispanics with diabetes were at higher risk of dyslipidemia than were those without diabetes. Our data suggest that lifestyle changes, including diet modification and exercise, could be of significant benefit to both ethnic groups.

Socioeconomic, cultural, and behavioral factors affecting Hispanic health outcomes

Evidence suggests that social and economic factors are important determinants of health. Yet, despite higher porverty rates, less education, and worse access to health care, health outcomes of many Hispanics living in the United States today are equal to, or better than, those of non-Hispanic whites. This paradox is described in the literature as the epidemiological paradox or Hispanic health paradox. In this paper, the authors selectively review data and research supporting the existence of the epidemiological paradox. They find substantial support for the existence of the epidemiological paradox, particularly among Mexican Americans. Census undercounts of Hispanics, misclassification of Hispanic deaths, and emigration of Hispanics do not fully account for the epidemiological paradox. Identifying protective factors underlying the epidemiological paradox, while improving access to care and the economic conditions among Hispanics, are important research and policy implications of this review.

Recent dietary guidelines to prevent and treat cardiovascular disease, diabetes, and obesity

Nutrition guidelines are emphasizing dietary patterns as primary and secondary prevention trials provide increasing evidence of the importance of lifestyle changes to prevent/control cardiovascular disease (CVD) risk factors such as diabetes and hypertension. Despite the increasing evidence that weight loss and modified dietary patterns are effective, there is considerable debate about the level of carbohydrate that will be most beneficial. Epidemiologic studies indicate that certain ethnic and racial minority groups have increased CVD risk with higher rates of obesity, hypertension, diabetes, and stroke. Immigrant and Native American populations have had a dramatic rise in obesity, diabetes, and ultimately CVD with acculturation, accompanied by a higher fat intake and decreased physical activity. Culturally tailored intervention approaches are being used to reduce risk. The lack of third-party payment still limits the availability of nutrition services. However, medical nutrition therapy is covered by Medicare for diabetes and pending legislation will extend coverage to CVD. Medical education researchers have developed tools such as the WAVE (Weight, Activity, Variety and Excess) pocket guide as a quick method to facilitate addressing referral for medical nutrition therapy that can be readily incorporated into practice settings.

Genetic factors play an important role in the pathogenesis of hyperlipidemia post-transplantation

BACKGROUND

Our purpose was to identify factors associated with hyperlipidemia post-transplantation in a Hispanic population.

METHODS

From 1985 to 1999, a kidney graft survival longer than 3 months occurred in 293 cases at the Instituto Nacional de la Nutrición. Most of the patients living in Mexico City were included (n = 83). The evaluation included a questionnaire, blood samples, and assessment of body composition and dietary habits. As many as possible first-degree relatives were studied.

RESULTS

Women had higher values of cholesterol (236 +/- 51 versus 215 +/-41; P < 0.05), low-density lipoprotein cholesterol (147 +/- 42 versus 131 +/- 34; P = 0.05), high-density lipoprotein cholesterol (57.3 +/- 14 versus 47.9 +/- 14; P = 0.002) and high-density lipoprotein-2 cholesterol. Isolated hypercholesterolemia was the most common lipid abnormality (40.9%), followed by mixed hyperlipidemia. Lipoprotein (a) greater than 30 mg/dL was found in 13 cases. Familial combined hyperlipidemia (FCHL) in the patient's relatives was a marker for dyslipidemia (odds ratio, 7.04; 95% confidence interval, 1.2 to 59.7). These cases had a worse lipid profile. Cyclosporine-treated FCHL patients had higher lipid levels compared with the non-FCHL, cyclosporine-treated patients. The effects of cyclosporine on the lipid levels were lower, but significant, after the exclusion of the FCHL cases.

CONCLUSION

Post-transplant dyslipidemia is determined by genetic and environmental factors. FCHL in the patient's relatives was associated with post-transplant hyperlipidemia; an additive effect with cyclosporine was found. The evaluation of the lipid profile of relatives may be useful for the assessment of the risk of post-transplant dyslipidemia.

Comparison of baseline fat-related eating behaviors of Puerto Rican, Dominican, Colombian, and Guatemalan participants who joined a cholesterol education project

OBJECTIVE

The objective is to compare baseline fat-related eating behaviors among Hispanic subgroups who joined a cholesterol education research project in New England.

DESIGN

Participants attended baseline screenings as part of the study. They had their height, weight, and blood cholesterol measured and completed baseline surveys with demographic, risk factor, dietary, and psychosocial questions.

PARTICIPANTS

A total of 370 Puerto Rican, 210 Colombian, 357 Dominican, and 102 Guatemalan subjects participated in the baseline.

MAIN OUTCOME MEASURES

Dietary behavior was measured using the Food Habits Questionnaire (FHQ), which was originally developed to assess food choices and preparation patterns related to adopting a low-fat diet. Measures include FHQ fat summary scores (a reflection of total fat intake), fat behavior subscales, and individual fat-related behaviors.

ANALYSIS

Analysis of variance was used to compare FHQ fat summary scores and multivariate analysis of variance was used to compare fat behavior scores and individual food item scores for the 4 Hispanic subgroups. Age and gender were covariates in the models.

RESULTS

Puerto Rican participants had a significantly higher mean FHQ fat summary score than Dominicans and Guatemalans and a higher prevalence of many fat-related eating behaviors. Although there were some differences by subgroup, the 4 most prevalent fat-related behaviors were similar: cooking with fat/oil, eating higher-fat sweets, eating higher-fat snacks, and eating dinners with meat.

CONCLUSIONS AND IMPLICATIONS

Future educational programs and materials for diverse Hispanic audiences in the northeastern United States should include the above issues; however, educational materials and programs ought to be tailored to individuals whenever possible. Efforts may need to focus on Puerto Ricans, who had a higher prevalence of many fat-related behaviors in this study.

Intake and food sources of macronutrients among older Hispanic adults: association with ethnicity, acculturation, and length of residence in the United States

OBJECTIVE

To describe the food intake and food sources of macronutrients in diets of older Hispanic adults in the Northeastern United States and to explore relationships between acculturation, years in the United States, and macronutrient intake.

DESIGN

Cross-sectional study using a representative sample of older Hispanic adults and a comparison group of non-Hispanic whites.

SUBJECTS/SETTING

Hispanic (n = 711) and non-Hispanic white (n = 226) persons, aged 60 years and older, residing in Massachusetts.

STATISTICAL ANALYSIS

Macronutrient intakes, collected by 24-hour dietary recall, were compared across ethnic groups by means of the general linear models procedure (with Bonferroni adjustments). Associations between macronutrient intake and predictor variables were tested with Pearson correlations and linear regression. The contribution of foods to total intake of macronutrients was determined by use of a rank procedure.

RESULTS

Hispanic elderly subjects consumed significantly less saturated fat and simple sugars and more complex carbohydrates than did non-Hispanic whites. Hispanics residing in the United States for a longer time tended to have macronutrient profiles more similar to those of the non-Hispanic whites. Rice for Hispanic and bread for non-Hispanics were the major contributors of energy. More acculturated Hispanic elders consumed fewer ethnic foods and more foods related to the non-Hispanic-white eating patterns than those less acculturated.

APPLICATIONS/CONCLUSIONS

Efforts to promote better diets among Hispanic elders need to emphasize maintenance or adoption of healthful dietary patterns based on ethnic and modern foods that will satisfy their biological, emotional, and social needs. Dietitians and other dietetics practitioners can use the information presented here in studying nutrition-related chronic diseases, in public health planning, and in nutrition education and promotion efforts directed to ethnic-specific, elderly Hispanic groups.

Knowledge, skills, and behavior improvements on peer educators and low-income Hispanic participants after a stage of change-based bilingual nutrition education program

A nutrition education program, entitled La Cocina Saludable, was designed according to the Stage of Change Model and implemented in ten southern Colorado counties. The objectives were to improve the nutrition related knowledge, skills, and behaviors that lead to healthy lifestyles in a low-income Hispanic population. The content of the program included nutrition information designed to help mothers of preschool children provide for their children's nutritional needs. Previous studies suggest that low-income Hispanics often demonstrate low intakes of vitamins A and C, calcium, iron, and protein, and high rates of diabetes, obesity, and infections. Additionally, this population presents many obstacles for nutrition educators including limited resources, child care, transportation, time, language, culture, literacy, health beliefs, and, in some cases, the transient nature of the population. The program attempted to overcome these barriers by incorporating a flexible program format carried out by abuela (Hispanic grandmother) educators using the processes described in the Stage of Change Model. The program was evaluated using a knowledge, skills and behavior pre-test, post-test, and six-month follow-up survey on both the abuela educators as well as the actual class participants. Results of the peer education training sessions suggest that this type of training program can be effective in increasing the knowledge, skills, and behavior of peer educators as well as reduce need for retraining for educators who continuously teach classes. Additionally, the results suggest that this type of program can be effective in changing selected nutrition related knowledge, skills, and behaviors leading to healthy lifestyles for low-income Hispanic mothers of preschool children.

Differences in fat-related dietary patterns between black, Hispanic and White women: results from the Women's Health Trial Feasibility Study in Minority Populations

OBJECTIVE

This report examines how sources of fat and patterns of fat-related dietary habits differed between black, Hispanic and white women participating in a randomized trial of a low-fat diet intervention.

DESIGN

The intervention consisted of group sessions, which met weekly for 6 weeks, biweekly for 6 weeks and monthly for 9 months, and included didactic nutrition education and activities to provide motivation for sustained dietary change. Outcomes included total fat and fat from nine food groups from a food frequency questionnaire (FFQ), and a summary scale and five subscales that measure fat-related dietary habits.

SETTING/SUBJECTS

Data are from 1702 post-menopausal women, recruited from clinical centres in Atlanta, Birmingham and Miami, with dietary assessments at baseline and 6 months post-randomization.

RESULTS

Total fat intake was similar across race/ethnic groups at baseline, yet there were many differences in sources of fat and fat-related dietary habits. For example, blacks consumed less fat from dairy foods and more fat from meats than whites. Effects of the intervention on total fat intake or the summary fat-related dietary habits scale did not differ across race/ethnicity groups. There were, however, many differences in how the intervention affected sources of fat and fat-related dietary habits. For example, the intervention effect for added fats (e.g. butter and salad dressings) was -8.9 g for blacks and -12.0 g for whites (P<0.05). The intervention effect for adopting low-fat meat purchasing and preparation methods was larger for blacks than whites, and the intervention effect for replacing high-fat foods with fruits and vegetables was larger for Hispanics than whites.

CONCLUSIONS

This study demonstrates that, if properly designed, a single nutrition intervention programme can work well even in groups with culturally diverse dietary patterns.

Comparison of energy and nutrient sources of elderly Hispanics and non-Hispanic whites in New Mexico

OBJECTIVE

Identification and comparison of frequently consumed foods and important food sources of energy, protein, total fat, vitamin A, vitamin C, vitamin E, vitamin B-6, folate, and calcium of elderly Hispanics and non-Hispanic whites.

DESIGN

Dietary intake data were collected using a modified Health Habits and History Questionnaire (a food frequency questionnaire) for 735 subjects who participated in the New Mexico Elder Health Survey.

SUBJECTS

The sample consisted of 330 Hispanics (176 men and 154 women) and 405 non-Hispanic whites (214 men and 191 women) between the ages of 65 and 96 years. Subjects were those with food frequency data among 883 participants who completed the clinical visit of the New Mexico Elder Health Survey.

RESULTS

Results show the top-ranked frequently consumed foods by gender and ethnicity and top-ranked food sources of energy and 8 nutrients. Regional foods were important sources of nutrients in the diets of both Hispanics and non-Hispanic whites, however, more so for the Hispanics. Chile sauces were notable sources of vitamin A, vitamin C, and folate among both groups. Both ethnic groups demonstrated selection of low-fat and skim milk and moderation in consumption of red meat.

APPLICATIONS

These data will be useful for designing nutrition education programs, for studying the relationship between diet and disease among elderly Hispanics and non-Hispanic whites, and for designing assessment instruments for the elderly and other ethnic populations.

Food intake and food consumption patterns of hospital workers in the dominican republic

Coronary heart disease (CHD) is the leading cause of death according to official mortality statistics in the Dominican Republic. The purpose of this study was to assess food intake and food consumption patterns of Dominicans and to discuss CHD risks related to nutrient intake. The subjects were 22 men and 81 women voluntarily recruited among 230 hospital workers in Santo Domingo. The mean nutrient intake and food consumption were estimated from a single 24-hour recall method administered by trained persons who elicited each subject's previous day's intake from midnight to midnight. The mean energy intake was 2030 kcal. The mean intake of total protein, total fat and carbohydrates were 66.3g, 89.1 g and 248g, respectively. Percentage of energy from total fat was 39.5%, which was higher than WHO recommendations. But, the percentage of animal fat per total fat was 46.8%. Especially, the value in the low income group was 31.7%. Moreover, we analyzed the food consumption structure in order to understand the Dominican dietary pattern, and three factors were found to explain the characteristics on the basis of factor analysis.The low percentage of animal fat was due to the diets rich in vegetable oil. Our results suggested that it was difficult to assume that CHD risks increased as a result of the Dominican dietary pattern. This was consistent with our previous findings that the average serum cholesterol level of Dominicans was generally low.

The development and application of a scale of acculturation

As Australia is one of the most multicultural societies in the world, acculturation of migrants and changes in migrants' health status should be an important focus of public health research. The absence of an accepted measure of acculturation is one barrier to exploring the relationship between acculturation and health. This paper presents data from a study of 851 Arabic-speaking adults attending 20 Arabic-speaking general practitioners in Canterbury, Sydney. An eight-item scale assessing acculturation was developed with a structural equation modelling program (LISREL). This acculturation scale was based on similar scales used with Hispanic populations, was theoretically grounded and had high internal consistency and criterion-related validity. To show the application of a scale of acculturation, patients' preferences for participation in medical decision making, according to level of acculturation, were examined. After adjustment for age, sex and highest level of formal education, significant inverse associations between acculturation and preferences for patient (versus family) involvement in medical decision making were found. Mechanisms for how acculturation affects health need to be explored.

Use of selected high-fat foods by Hispanic adults in the northeastern US

OBJECTIVE

To add to the limited information of dietary fat intake of US Hispanic adults, in particular for subgroups other than Mexican Americans.

METHODS

The frequency of eating 13 high-fat food items commonly consumed in the US was examined in 665 Hispanic adults 20-74 years old in Connecticut and Long Island, New York, sampled from Spanish-surname telephone listings and surveyed by telephone in 1992.

RESULTS

Mean estimated fat intake from the 13 items was significantly greater for the 357 men than the 308 women; the largest gender differences were for hamburgers/cheeseburgers and french fries. Whole milk was an important contributor to the fat intake of persons with the highest fat intakes. In multiple linear regression analyses, age (negative association) and gender, but not education and acculturation (based on language spoken, read and written), were statistically significant predictors of fat intake from the 13 items.

CONCLUSIONS

Longitudinal studies using diet diaries are needed in these Hispanic populations.