Characterizing longitudinal change in accelerometry-based moderate-to-vigorous physical activity in the Hispanic Community Health Study/Study of Latinos and the Framingham Heart Study

BACKGROUND

Physical activity promotes health and is particularly important during middle and older age for decreasing morbidity and mortality. We assessed the correlates of changes over time in moderate-to-vigorous physical activity (MVPA) in Hispanic/Latino adults from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL: mean [SD] age 49.2 y [11.5]) and compared them to a cohort of primarily White adults from the Framingham Heart Study (FHS: mean [SD] 46.9 y [9.2]).

METHODS

Between 2008 and 2019, we assessed accelerometry-based MVPA at two time points with an average follow-up of: 7.6 y, SD 1.3 for HCHS/SOL, and 7.8 y, SD 0.7 for FHS. We used multinomial logistic regression to relate socio-demographic and health behaviors with changes in compliance with 2018 US recommendations for MVPA from time 1 to time 2 (remained active or inactive; became active or inactive) across the two cohorts.

RESULTS

In HCHS/SOL mean MVPA was 22.6 (SD, 23.8) minutes at time 1 and dropped to 16.7 (19.0) minutes at time 2. In FHS Mean MVPA was 21.7 min (SD, 17.7) at time 1 and dropped to 21.3 min (SD, 19.2) at time 2. Across both cohorts, odds of meeting MVPA guidelines over time were about 6% lower in individuals who had lower quality diets vs. higher, about half in older vs. younger adults, about three times lower in women vs. men, and 9% lower in individuals who had a higher vs. lower BMI at baseline. Cohorts differed in how age, gender, income, education, depressive symptoms, marital status and perception of general health and pain associated with changes in physical activity. High income older Hispanics/Latino adults were more likely to become inactive at the follow-up visit as were HCHS/SOL women who were retired and FHS participants who had lower levels of education and income. Higher depressive symptomology was associated with becoming active only in HCHS/SOL women. Being male and married was associated with becoming inactive in both cohorts. Higher perception of general health and lower perception of pain were associated with remaining active only in FHS adults.

CONCLUSIONS

These findings highlight potentially high-risk groups for targeted MVPA intervention.

Predictors of incident diabetes in two populations: framingham heart study and hispanic community health study / study of latinos

BACKGROUND

Non-genetic factors contribute to differences in diabetes risk across race/ethnic and socioeconomic groups, which raises the question of whether effects of predictors of diabetes are similar across populations. We studied diabetes incidence in the primarily non-Hispanic White Framingham Heart Study (FHS, N = 4066) and the urban, largely immigrant Hispanic Community Health Study/Study of Latinos (HCHS/SOL, N = 6891) Please check if the affiliations are captured and presented correctly.

METHODS

Clinical, behavioral, and socioeconomic characteristics were collected at in-person examinations followed by seven-day accelerometry. Among individuals without diabetes, Cox proportional hazards regression models (both age- and sex-adjusted, and then multivariable-adjusted for all candidate predictors) identified predictors of incident diabetes over a decade of follow-up, defined using clinical history or laboratory assessments.

RESULTS

Four independent predictors were shared between FHS and HCHS/SOL. In each cohort, the multivariable-adjusted hazard of diabetes increased by approximately 50% for every ten-year increment of age and every five-unit increment of body mass index (BMI), and was 50-70% higher among hypertensive than among non-hypertensive individuals (all P < 0.01). Compared with full-time employment status, the multivariable-adjusted hazard ratio (HR) and 95% confidence interval (CI) for part-time employment was 0.61 (0.37,1.00) in FHS and 0.62 (0.41,0.95) in HCHS/SOL. Moderate-to-vigorous physical activity (MVPA) was an additional predictor in common observed in age- and sex-adjusted models, which did not persist after adjustment for other covariates (compared with MVPA ≤ 5 min/day, HR for MVPA level ≥ 30 min/day was 0.48 [0.31,0.74] in FHS and 0.74 [0.56,0.97] in HCHS/SOL). Additional predictors found in sex- and age-adjusted analyses among the FHS participants included male gender and lower education, but these predictors were not found to be independent of others in multivariable adjusted models, nor were they associated with diabetes risk among HCHS/SOL adults.

CONCLUSIONS

The same four independent predictors - age, body mass index, hypertension and employment status - were associated with diabetes risk across two disparate US populations. While the reason for elevated diabetes risk in full-time workers is unclear, the findings suggest that diabetes may be part of the work-related burden of disease. Our findings also support prior evidence that differences by gender and socioeconomic position in diabetes risk are not universally present across populations.

Preconception Diet Quality Is Associated with Birth Weight for Gestational Age Among Women in the Hispanic Community Health Study/Study of Latinos

BACKGROUND

The nutritional status of women in the preconception period is of paramount importance due to its role in reproduction.

OBJECTIVE

Our aim was to assess overall diet quality during the preconception period and its association with infant birth weight adjusted for gestational age (GA).

DESIGN

This is an observational longitudinal cohort of Hispanic people living in the United States.

PARTICIPANTS/SETTING

Data are from the Hispanic Community Health Study/Study of Latinos baseline (2008-2011) and second clinic examinations (2014-2017). Included are the first 497 singleton live-born infants among the 2,556 women (younger than 45 years) who attended the second visit. Field sites were located in Miami, FL; Bronx, NY; Chicago, IL; and San Diego, CA, and represent individuals with heritage from Cuba, Dominican Republic, Mexico, Puerto Rico, and Central and South America.

MAIN EXPOSURE

Diet assessment included two 24-hour recalls from baseline. The 2010 Healthy Eating Index (HEI-2010) was used to measure diet quality, with higher scores indicating better quality.

STATISTICAL ANALYSES PERFORMED

Complex survey linear regression estimated the association between HEI-2010 scores (continuous variable and categorized into tertiles) and birth-weight z score and birth weight for GA percentile.

RESULTS

Mean (standard deviation) age of women was 25.8 (5.2) years and 36.4% were classified as underweight or normal weight, 30.0% were overweight, and 33.6% had obesity at baseline. Mean (standard deviation) HEI-2010 score was 56.5 (13.4), and by weight classifications was 54.4 (14.1) for underweight or normal weight and 57.7 (12.8) for overweight or obesity. Median (interquartile range) birth-weight z score was 0.5 (interquartile range [IQR], -0.2 to 1.3) overall and 0.2 (IQR, -0.5 to 1.0), 0.6 (IQR, -0.2 to 1.3), and 0.5 (IQR, -0.2 to 1.4) for the first, second, and third HEI-2010 tertile, respectively. Median birth weight for GA percentile was 68.2 (IQR, 40.2 to 89.7) overall, and 56.8 (IQR, 29.6 to 85.0), 71.5 (IQR, 42.8 to 90.0), and 70.1 (IQR, 42.9 to 91.2) by HEI-2010 tertile. In adjusted models, the highest tertile of the HEI-2010 score was associated with a higher birth-weight z score and birth weight for GA percentile, and the continuous HEI-2010 score was only associated with birth weight for GA percentile. Preconception body mass index (calculated as kg/m2) did not modify these associations.

CONCLUSIONS

Overall diet quality, as measured by the HEI-2010, in the preconception period is associated with infant birth weight adjusted for GA among US Hispanic and Latina women.

Defining Abdominal Obesity as a Risk Factor for Coronary Heart Disease in the U.S.: Results From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

OBJECTIVE

Various organizations have highlighted the need to examine whether abdominal obesity cut points are appropriate for identification of cardiovascular risk among ethnic minority adults, particularly Hispanic/Latino adults living in Western societies. This study aimed 1) to establish optimal definitions for abdominal obesity among Hispanics/Latinos and 2) to determine the level of agreement between the presence of metabolic syndrome diagnosed by the current Joint Interim Statement (JIS) definition and an updated definition with optimal abdominal obesity cut points.

RESEARCH DESIGN AND METHODS

The sample included 16,289 adults who self-identified as Hispanic/Latino ages 18-74 years enrolled in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Receiver operating characteristic curves were used to derive sensitivity and specificity values. The largest sum of sensitivity plus specificity was used to determine appropriate cut points.

RESULTS

Among U.S. Hispanic/Latino adults, waist circumference cut points of >102 cm in men (in line with current JIS criteria) and >97 cm (9 points higher than JIS criteria) in women provide optimal discrimination for cardiovascular risk as judged by the presence of coronary heart disease. When using these cut points to create an updated metabolic syndrome definition among women, we found disagreement between our updated definition and the current JIS criteria. The prevalence of the metabolic syndrome was overestimated by ∼5 percentage points among women based on JIS criteria in comparison with our definition.

CONCLUSIONS

Our results suggest that the current recommendations for waist circumference cut points may not be appropriate for U.S. Hispanic/Latino women.

Associations Between Dietary Fat Quality and Cognitive Function Among Adults: The Hispanic Community Health Study/Study of Latinos

Objectives

Individual fatty acids (FA) within dietary fat classes [saturated (SFA), monounsaturated (MUFA), polyunsaturated (PUFA), and trans FA (TFA)] may differentially affect risk of cognitive impairment. This has received little attention by most previous studies of diet and cognitive function, and few studies are available among Hispanic/Latinos. Our objective was to quantify associations of dietary FA (DFA) patterns with cognitive function among Hispanic/Latinos residing in the US.

Methods

This is a cross-sectional analysis of participants of the Hispanic Community Health Study/Study of Latinos, a diverse cohort recruited from 2008–11 (n = 7842, mean age 55 y, 62% female). Dietary data are from two 24-hr recalls; the National Cancer Institute method was used to estimate usual nutrient intake. Total animal and plant MUFA variables and 26 FA were used to derive DFA patterns by principal components analysis. Global cognitive function was calculated as the average z-score from 3 cognitive tests [Word Fluency (WF), Spanish English Verbal Learning Test (B-SEVLT) sum, and Digit Symbol Substitution (DSS)]. Survey linear regression models, were adjusted for a number of confounders including, but not limited to education, depressive symptoms, ethnicity, study site, physical activity, and total energy.

Results

DFA patterns were characterized by greater consumption of long-chain SFA, animal MUFA, and TFA (Factor 1); short to medium-chain SFA (Factor 2); very-long-chain PUFA (Factor 3); very-long-chain SFA, plant MUFA and essential PUFA (Factor 4). Each 1-SD increase in only Factor 2 or 4 was associated with a 0.03 ± 0.01 SD or 0.02 ± 0.01 SD higher global cognitive function score, respectively (P &lt; 0.05). Factor 2 was positiviely associated with DSS and B-SEVLT scores (P &lt; 0.05). Factors 1 and 4 were positively associated with DSS scores (P &lt; 0.05). Factor 3 was not significantly associated with any cognitive function measure.

Conclusions

Our findings suggest that intake of short to medium-chain SFA, and of plant based MUFA, SFA, and PUFA, may be associated with a small benefit on global cognitive function among Hispanic/Latino adults. Null associations were observed with a very-long-chain PUFA pattern, which may be partly due to low fish consumption. Prospective studies conducted in similar and other populations are needed to confirm our results.

Funding Sources

None.

Relation of Diabetes to Cognitive Function in Hispanics/Latinos of Diverse Backgrounds in the United States

Objectives:To examine the association between diabetes and cognitive function within U.S. Hispanics/Latinos of Central American, Cuban, Dominican, Mexican, Puerto Rican, and South American background. Method: This cross-sectional study included 9,609 men and women (mean age = 56.5 years), who are members of the Hispanic Community Health Study/Study of Latinos. We classified participants as having diabetes, prediabetes, or normal glucose regulation. Participants underwent a neurocognitive battery consisting of tests of verbal fluency, delayed recall, and processing speed. Analyses were stratified by Hispanic/Latino subgroup. Results: From fully adjusted linear regression models, compared with having normal glucose regulation, having diabetes was associated with worse processing speed among Cubans (β = -1.99; 95% CI [confidence interval] = [-3.80, -0.19]) and Mexicans (β = -2.26; 95% CI = [-4.02, -0.51]). Compared with having normal glucose regulation, having prediabetes or diabetes was associated with worse delayed recall only among Mexicans (prediabetes: β = -0.34; 95% CI = [-0.63, -0.05] and diabetes: β = -0.41; 95% CI = [-0.79, -0.04]). No associations with verbal fluency. Discussion: The relationship between diabetes and cognitive function varied across Hispanic/Latino subgroup.

Moderate-vigorous physical activity and health-related quality of life among Hispanic/Latino adults in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Background

Physical activity is a modifiable healthy behavior that has been shown to positively influence health-related quality of life. However, research examining the link between physical activity and health-related quality of life among Hispanic/Latino adults is limited and inconsistent. The purpose of this study is to assess whether accelerometer-measured moderate-vigorous physical activity (MVPA) is associated with self-reported (a) mental health-related quality of life, and (b) physical health-related quality of life among diverse Hispanic/Latino adults in the US.

Methods

Cross-sectional data from 12,379 adults ages 18–74 years in 2008–2011, who participated in HCHS/SOL and had complete data were analyzed using complex survey design methods. Accelerometer data were categorized into no MVPA, low, moderate, and high MVPA. Health-related quality of life was assessed with the Short-Form 12 and we used the mental and physical component subscales where higher scores indicate better health-related quality of life. Multivariate linear regression models were used to derive adjusted means with 95% confidence intervals and linear trends.

Results

We observed no significant linear trend between accelerometer-measured MVPA and mental health-related quality of life (p_trend = 0.73). There was a significant positive association between MVPA and physical health-related quality of life (p_trend < 0.001) where higher MVPA corresponded with higher scores in physical health-related quality of life. The adjusted means were 46.67 (44.85–48.48) for no MVPA, 49.33 (49.03–49.63) for low MVPA, 50.61 (50.09–51.13) for moderate MVPA, and 51.36 (50.86–51.86) for high MVPA.

Conclusions

Among diverse Hispanic/Latino adults in the US, accelerometer-measured MVPA was associated with physical health-related quality of life, but not mental health-related quality of life. Future interventions should evaluate if increases in MVPA lead to improvements in health-related quality of life.

Electronic supplementary material

The online version of this article (10.1186/s41687-019-0129-y) contains supplementary material, which is available to authorized users.

Associations of Sodium and Potassium with Obesity Measures Among Diverse US Hispanic/Latino Adults: Results from the Hispanic Community Health Study/Study of Latinos

OBJECTIVE

The objective of this study was to evaluate cross-sectional associations of sodium and potassium with BMI, waist circumference (WC), and body fat and to determine whether the nativity and/or duration of United States (US) residence modified these associations.

METHODS

Sodium and potassium were derived from 24-hour diet recalls from 16,156 US participants of the 2008 to 2011 Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and from 24-hour urine in 447 HCHS/SOL participants. BMI, WC, and body fat were measured.

RESULTS

Dietary sodium that was 500 mg/d higher was cross-sectionally associated with a 0.07-kg/m² higher BMI (P < 0.05) and a 0.18-cm larger WC (P = 0.04). Dietary potassium that was 500 mg/d higher was only associated with lower BMI and smaller WC among those who were foreign-born with 10 + years in the US (-0.13 kg/m² , P < 0.01 and -0.36 cm, P = 0.01, respectively) and among those who were US-born (-0.62 kg/m² , P < 0.01 and -1.42 cm, P < 0.01, respectively). Urinary sodium that was 500 mg/d higher was associated with a 0.27-kg/m² higher BMI (P < 0.01) and 0.54 kg more body fat (P < 0.01).

CONCLUSIONS

Sodium intake was associated with higher BMI, WC, and body fat. Potassium intake was associated with lower BMI and smaller WC among US-born participants and participants with a longer duration of US residence.

Neighbourhood socioeconomic status and cross-sectional associations with obesity and urinary biomarkers of diet among New York City adults: the heart follow-up study

OBJECTIVE

To determine whether neighbourhood socioeconomic status (SES) is associated with body mass index (BMI), waist circumference (WC) and biomarkers of diet (urinary sodium and potassium excretion).

DESIGN

A cross-sectional study.

SETTING

The data reported were from the 2010 Heart Follow-up Study, a population-based representative survey of 1645 adults.

PARTICIPANTS

Community-dwelling diverse residents of New York City nested within 128 neighbourhoods (zip codes).

PRIMARY AND SECONDARY OUTCOME MEASURES

BMI (kg/m2) and WC (inches) were measured during in-home visits, and 24-hour urine sample was collected to measure biomarkers of diet: sodium (mg/day) and potassium (mg/day), with high sodium and low potassium indicative of worse diet quality.

RESULTS

After adjusting for individual-level characteristics using multilevel linear regressions, low versus high neighbourhood SES tertile was associated with 1.83 kg/m2 higher BMI (95% CI 0.41 to 3.98) and 251 mg/day lower potassium excretion (95% CI -409 to 93) among women only, with no associations among men (P values for neighbourhood SES by sex interactions <0.05).

CONCLUSION

Our results suggest that women may be particularly vulnerable to the effects of a socioeconomically disadvantaged neighbourhood. Future neighbourhood research should explore sex differences, as these can inform tailored interventions.

TRIAL REGISTRATION NUMBER

NCT01889589; Results.

Diet Quality and Its Association with Cardiometabolic Risk Factors Vary by Hispanic and Latino Ethnic Background in the Hispanic Community Health Study/Study of Latinos

BACKGROUND

Healthful diet quality has been associated with a lower risk of metabolic syndrome (MetS) in several populations, but reports on Hispanic and Latino cohorts, grouped or by ethnic background, have been limited and inconsistent.

OBJECTIVE

We aimed to examine diet quality by using the 2010 Alternate Healthy Eating Index [(AHEI) range: 0-110, lowest to highest quality] and its cross-sectional association with MetS and its cardiometabolic components across 6 Hispanic and Latino backgrounds.

METHODS

We studied 12,406 US Hispanics and Latinos, aged 18-74 y and free of diabetes, from the multicenter, population-based Hispanic Community Health Study/Study of Latinos cohort. Food and nutrients were assessed from two 24-h recalls. MetS was defined by using the 2009 harmonized guidelines. Complex survey procedures were used in multivariable-adjusted linear regression models to test the association of the AHEI with continuous markers and in logistic regression models with MetS as an outcome.

RESULTS

The prevalence of MetS was 24.2%. Overall, Hispanics and Latinos had low scores for intakes of sugar-sweetened beverages and fruit juices, whole grains, and fruit and favorable scores for trans fats and nuts and legumes, according to AHEI criteria. Adjusted mean AHEI and its individual components differed by ethnic background (P < 0.001), ranging from 43.0 for Puerto Ricans to 52.6 for Mexicans. Overall, adjusted odds (95% CIs) of having MetS were 22% (9%, 33%) lower for each 10-unit increase in AHEI. This association was modified by ethnic background (P-interaction = 0.03), with significantly lower odds observed only for Mexicans (30%; 95% CIs: 13%, 44%) and Central Americans (42%; 95% CIs: 9%, 64%) for each 10-unit increase in AHEI. AHEI was inversely associated with waist circumference, blood pressure, and glucose among Mexicans and Puerto Ricans and with triglycerides among Mexicans only, and positively associated with HDL cholesterol among Puerto Ricans and Central Americans (all P < 0.05).

CONCLUSIONS

Diet quality differed by Hispanic or Latino background. Although healthier diet quality was associated with lower odds of MetS in the overall Hispanic and Latino cohort, the association of AHEI and cardiometabolic factors varied by ethnic background. Nutrition-related research and interventions among ethnically diverse groups should consider individual ethnic backgrounds to optimally address diet quality and cardiometabolic health. This trial was registered at clinicaltrials.gov as NCT02060344.

Alcohol Consumption and Metabolic Syndrome Among Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos

BACKGROUND

The association between alcohol consumption and metabolic syndrome (MetS) among Hispanic/Latino populations has not been studied in great detail. Our study examined the relationship between alcohol consumption and MetS among U.S. Hispanics/Latinos and explored whether this relationship varied by age, body mass index, gender, and Hispanic/Latino backgrounds.

METHODS

The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a multisite, prospective, population-based, cohort study of Hispanics/Latinos, ages 18-74 years from four U.S. communities. Participants were categorized into never, former, occasional, low, moderate, and high alcohol consumption categories. A cross-sectional analysis of 15,905 participants with complete data was conducted. Survey design appropriate chi-squared and logistic regression models were run to detect significant associations between alcohol consumption categories and cases of MetS.

RESULTS

Almost half (47.4%) of the sample was classified as occasional, low, moderate, or heavy drinkers. Low and moderate alcohol consumers had lower odds of MetS than never drinkers. Low and heavy drinkers had higher odds of presenting with elevated central obesity, while occasional, low, moderate, and heavy drinkers had higher odds of having low high-density lipoprotein cholesterol levels compared to never drinkers. Low and moderate wine drinkers had lower odds of MetS compared to never drinkers. There were no significant findings among beer or liquor drinkers, or with binge drinking after model adjustments.

CONCLUSIONS

Our findings suggest that low and moderate alcohol consumption may lower the odds of MetS in a sample of Hispanic/Latino adults, but that the relationship of alcohol consumption varies with the individual components of MetS.

Smoking cessation among U.S. Hispanic/Latino adults: Findings from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

This paper examines patterns of smoking cessation among Hispanics/Latinos with particular attention to gender, acculturation, and national background. Data are from the Hispanic Community Health Study/Study of Latinos, a population-based study of 16,415 non-institutionalized Hispanics/Latinos ages 18-74 from a stratified random sample of households in Chicago, Miami, the Bronx, and San Diego. Face-to-face interviews, in English or Spanish, were conducted from 2008 to 2011. Findings are based on 6398 participants who reported smoking at least 100 cigarettes in their lifetime. Associations with smoking cessation outcomes were assessed in bivariate and multivariable analyses. Findings indicate that approximately equal proportions of men and women were former smokers. There was little difference by gender in socioeconomic characteristics associated with smoking cessation. Both men and women who lived in households with smokers were less likely to be abstinent. Multivariable analysis indicated that the likelihood of quitting varied by national background primarily among men, however, Puerto Rican and Cuban smokers of both genders were the least likely to successfully quit smoking. Among women, but not men, younger and more socially acculturated individuals had lower odds of sustaining cessation. Over 90% of female and male former smokers reported quitting on their own without cessation aids or therapy. The results suggest that many Hispanics/Latinos are self-motivated to quit and are able to do so without clinical assistance. Heterogeneity in smoking behaviors among Hispanics/Latinos should be taken into account when developing and delivering smoking cessation interventions and public health campaigns.

Cigarette Smoking and Depressive Symptoms Among Hispanic/Latino Adults: Results From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

INTRODUCTION

In the present study, we investigated associations among cigarette smoking, smoking cessation treatment, and depressive symptoms in Hispanic/Latino adults.

METHODS

The multisite prospective population-based Hispanic Community Health Study/Study of Latinos (HCHS/SOL) enrolled a cohort of Hispanic/Latino adults (aged 18-74) from diverse backgrounds (n = 16,412) in 4U.S. communities (Chicago, San Diego, Miami, and Bronx). Households were selected using a stratified 2-stage probability sampling design and door-to-door recruitment, and sampling weights calibrated to the 2010U.S. Population Census. Hispanic/Latino individuals of Dominican, Central American, South American, Cuban, Mexican, and Puerto Rican background were considered. Cigarette smoking, smoking cessation treatment, and depressive symptoms were measured by self-report.

RESULTS

Results indicated that current smokers had greater odds for significant depressive symptoms (CES-D score ≥ 10) than never smokers in all Hispanic background groups [odds ratio (OR) > 1.5]. Depressed persons were not more likely to receive prescribed smoking cessation medications from a doctor (OR = 1.43, 95% CI = 0.98-2.08), take over-the-counter medications (OR = 1.11, 95% CI = 0.75-1.66), or receive psychotherapy (OR = 1.02, 95% CI = 0.57-1.85).

CONCLUSIONS

In conclusion, these findings suggest that the positive association between smoking status and depressive symptoms is present in all examined Hispanic/Latino background groups.

Prevalence of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds in the United States

CONTEXT

Major cardiovascular diseases (CVDs) are leading causes of mortality among US Hispanic and Latino individuals. Comprehensive data are limited regarding the prevalence of CVD risk factors in this population and relations of these traits to socioeconomic status (SES) and acculturation.

OBJECTIVES

To describe prevalence of major CVD risk factors and CVD (coronary heart disease [CHD] and stroke) among US Hispanic/Latino individuals of different backgrounds, examine relationships of SES and acculturation with CVD risk profiles and CVD, and assess cross-sectional associations of CVD risk factors with CVD.

DESIGN, SETTING, AND PARTICIPANTS

Multicenter, prospective, population-based Hispanic Community Health Study/Study of Latinos including individuals of Cuban (n = 2201), Dominican (n = 1400), Mexican (n = 6232), Puerto Rican (n = 2590), Central American (n = 1634), and South American backgrounds (n = 1022) aged 18 to 74 years. Analyses involved 15,079 participants with complete data enrolled between March 2008 and June 2011.

MAIN OUTCOME MEASURES

Adverse CVD risk factors defined using national guidelines for hypercholesterolemia, hypertension, obesity, diabetes, and smoking. Prevalence of CHD and stroke were ascertained from self-reported data.

RESULTS

Age-standardized prevalence of CVD risk factors varied by Hispanic/Latino background; obesity and current smoking rates were highest among Puerto Rican participants (for men, 40.9% and 34.7%; for women, 51.4% and 31.7%, respectively); hypercholesterolemia prevalence was highest among Central American men (54.9%) and Puerto Rican women (41.0%). Large proportions of participants (80% of men, 71% of women) had at least 1 risk factor. Age- and sex-adjusted prevalence of 3 or more risk factors was highest in Puerto Rican participants (25.0%) and significantly higher (P < .001) among participants with less education (16.1%), those who were US-born (18.5%), those who had lived in the United States 10 years or longer (15.7%), and those who preferred English (17.9%). Overall, self-reported CHD and stroke prevalence were low (4.2% and 2.0% in men; 2.4% and 1.2% in women, respectively). In multivariate-adjusted models, hypertension and smoking were directly associated with CHD in both sexes as were hypercholesterolemia and obesity in women and diabetes in men (odds ratios [ORs], 1.5-2.2). For stroke, associations were positive with hypertension in both sexes, diabetes in men, and smoking in women (ORs, 1.7-2.6).

CONCLUSION

Among US Hispanic/Latino adults of diverse backgrounds, a sizeable proportion of men and women had adverse major risk factors; prevalence of adverse CVD risk profiles was higher among participants with Puerto Rican background, lower SES, and higher levels of acculturation.

Cardiovascular responsivity to stress in adolescents with and without persistently elevated blood pressure

OBJECTIVES

The goal of this study was to compare the cardiovascular responses to behavioural stressors of three groups of adolescents who differed in blood pressure status across assessments.

DESIGN

Casual blood pressure of adolescents who were identified as having elevated blood pressure during a school screen was re-evaluated in the laboratory. The adolescents were classified into two groups: (i) those with consistently elevated blood pressure across school and laboratory assessments and (i) those with labile blood pressure whose blood pressure in the laboratory was below 130/80 mmHg. A comparison group of adolescents with consistently normal blood pressure was also included.

METHODS

Cardiovascular parameters were assessed during rest and during two behavioural stressors, the evaluated speaking task and the mirror tracing task.

RESULTS

Adolescents with elevated blood pressure were more vascularly responsive across stressors than adolescents with labile blood pressure, who, in turn, were more reactive than adolescents with normal blood pressure.

CONCLUSIONS

These results suggest that vascular reactivity to behavioural stressors may be useful in predicting risk of hypertension because of its sensitivity in distinguishing adolescents with consistently elevated blood pressure from those with labile blood pressure and those with normal blood pressure.

History of gestational diabetes, insulin resistance and coronary risk

The purpose of this study was to examine characteristics associated with the insulin metabolic syndrome, including insulin resistance, abnormal glucose tolerance, dyslipidemia, obesity, and elevated blood pressure, among women who have experienced gestational diabetes. 39 nondiabetic, young (20-42 years), postpartum (3-18 months) white women were recruited from obstetrical clinics. Twenty-one women had a history of gestational diabetes; 18 had uncomplicated pregnancies. Multivariate analyses revealed a significant difference between groups in insulin resistance (M, measured by euglycemic clamp) and insulin levels (from an oral glucose tolerance test), with insulin resistance showing a statistically stronger difference than insulin levels. Groups also differed significantly when compared on a set of variables associated with insulin metabolic syndrome: glucose tolerance, triglycerides, blood pressure, and body-mass index. Using insulin resistance as a covariate eliminated these group differences, suggesting that insulin resistance is the key factor underlying insulin metabolic syndrome. The higher risk of later developing type 2 diabetes and hypertension in women who have a history of gestational diabetes is explicable by their poorer profile on variables associated with insulin metabolic syndrome, and appears to be attributable to insulin resistance. Thus, insulin resistance appears to distinguish young women at risk for cardiovascular disease.

Posture, place, and mood effects on ambulatory blood pressure

Ambulatory blood pressure was studied as a function of posture, place, and mood in 131 subjects classified according to race, gender, and hypertensive status. The effect of posture was significant and explained a substantial proportion of within-subject variability. After controlling for posture, significant place and mood effects were observed when subjects were sitting but not when they were standing. Home vs. work differences in both systolic and diastolic blood pressure were significantly greater in Whites than in Blacks. Similar differences in systolic blood pressure were greater in mild hypertensive than in normotensive subjects. The results of this study underscore the need to control for effects of posture when interpreting ambulatory blood pressure readings.

Pulmonary functions during peritoneal dialysis

Lung volumes, flows, flow volume loop, diffusing capacity and closing volume were studied in 7 patients (Group I) before, with 2 liter dialyzate in the peritoneal cavity and after 8 hours of peritoneal dialysis. The functional residual capacity, residual volume and the total lung capacity decreased (P less than 0.01, less than 0.05, and less than 0.05 respectively) with 2 liter dialyzate in the peritoneal cavity and returned to baseline after the dialyzate was removed. Arterial blood gas analysis was performed in another 8 patients (Group II) before, with 2 liter dialyzate in the peritoneal cavity, and after the dialyzate had been drained. No significant difference was observed in PaO2, PaCO2 or pHa during any phase of the study. It is concluded that except for a minor decrease in FRC, RV and TLC, there were no deleterious effects with the use of 2 liter dialyzate volume on gas exchange or pulmonary functions during peritoneal dialysis.

Comparison of soflens contact lenses (polymacon) with hard contact lenses and spectacles

A study, comparing Soflens TM contact lenses (polymacon) with hard contact lenses and spectacles, and using 150 male and female patients, has been done. Volunteers qualified for the study if they had healthy eyes and had worn one type of corrective lenses for six months before they were interviewed and examined. During each patient's examination, his type of correction was not known. Such matters as visual acuity, corneal measurements and average wearing time were considered. (Soflens contact lenses were felt to be safer than hard contact lenses.)