Sabrina E. Noel

The Boston Puerto Rican Health Study, a longitudinal cohort study on health disparities in Puerto Rican adults: challenges and opportunities.

BackgroundThe Boston Puerto Rican Health Study is an ongoing longitudinal cohort study designed to examine the role of psychosocial stress on presence and development of allostatic load and health outcomes in Puerto Ricans, and potential modification by nutritional status, genetic variation, and social support.MethodsSelf-identified Puerto Ricans, aged 45-75 years and residing in the Boston, MA metro area, were recruited through door-to-door enumeration and community approaches. Participants completed a comprehensive set of questionnaires and tests. Blood, urine and salivary samples were extracted for biomarker and genetic analysis. Measurements are repeated at a two-year follow-up.ResultsA total of 1500 eligible participants completed baseline measurements, with nearly 80% two-year follow-up retention. The majority of the cohort is female (70%), and many have less than 8th grade education (48%), and fall below the poverty level (59%). Baseline prevalence of health conditions is high for this age range: considerable physical (26%) and cognitive (7%) impairment, obesity (57%), type 2 diabetes (40%), hypertension (69%), arthritis (50%) and depressive symptomatology (60%).ConclusionsThe enrollment of minority groups presents unique challenges. This report highlights approaches to working with difficult to reach populations, and describes some of the health issues and needs of Puerto Rican older adults. These results may inform future studies and interventions aiming to improve the health of this and similar communities.

Race and Region Are Associated with Nutrient Intakes among Black and White Men in the United States

Stroke mortality rates and prevalence of several chronic diseases are higher in Southern populations and blacks in the US. This study examined the relationships of race (black, white) and region (Stroke Belt, Stroke Buckle, other) with selected nutrient intakes among black and white American men (n = 9229). The Block 98 FFQ assessed dietary intakes and multivariable linear regression analysis was used to examine whether race and region were associated with intakes of fiber, saturated fat, trans fat, sodium, potassium, magnesium, calcium, and cholesterol. Race and region were significant predictors of most nutrient intakes. Black men consumed 1.00% lower energy from saturated fat compared with white men [multivariable-adjusted β: 1.00% (95% CI = -0.88, -1.13)]. A significant interaction between race and region was detected for trans fat (P < 0.0001), where intake was significantly lower among black men compared with white men only in the Stroke Belt [multivariable-adjusted β: -0.21 (95% CI = -0.11, -0.31)]. Among black men, intakes of sodium, potassium, magnesium, and calcium were lower, whereas cholesterol was higher, compared with white men (P < 0.05 for all). Comparing regions, men in the Stroke Buckle had the lowest intakes of fiber, potassium, magnesium, and calcium compared with those in the Stroke Belt and other regions; men in both the Stroke Buckle and Stroke Belt had higher intakes of cholesterol compared with those in other regions (P < 0.005 for all). Given these observed differences in dietary intakes, more research is needed to understand if and how they play a role in the health disparities and chronic disease risks observed among racial groups and regions in the US.

Variants of the CD36 gene and metabolic syndrome in Boston Puerto Rican adults

OBJECTIVE Puerto Ricans experience a high prevalence of several chronic conditions, including metabolic syndrome. Genetic variants of the CD36 gene have been associated with metabolic syndrome. We aimed to determine the association between 6 single nucleotide polymorphisms (SNPs) for CD36 and metabolic syndrome and its components in Puerto Ricans (45-75 year) living in the Greater Boston area. METHODS Associations between each SNP, metabolic syndrome and its components were examined using multivariate logistic regression models. Haplotype trend regression analysis was used to determine associations between haplotypes and metabolic syndrome. RESULTS For two SNPs of CD36 (rs1049673 and rs3211931), homozygous subjects of the minor allele (G and T, respectively) were associated with a higher likelihood of metabolic syndrome (odds ratio (OR) (95% confidence interval (CI)): 1.89 (1.0, 3.5) and 1.77 (1.0, 3.1), respectively) relative to carriers of the major allele. Although CD36 haplotypes were not significantly associated with metabolic syndrome overall (global significance, P=0.23), one haplotype (G-C-C vs. C-C-C (reference haplotype)) was marginally associated (P=0.049). CONCLUSION SNPs of CD36 were associated with metabolic syndrome in Puerto Ricans. Prospective studies should further explore the role of CD36 variants in the development of this condition.

Milk Intakes Are Not Associated with Percent Body Fat in Children from Ages 10 to 13 Years

Epidemiologic studies report conflicting results for the relationship between milk intake and adiposity in children. We examined prospective and cross-sectional associations between milk intake and percent body fat among 2245 children from the Avon Longitudinal Study of Parents and Children. Cross-sectional analyses were performed at age 13 y between total, full-fat, and reduced-fat milk intake assessed using 3-d dietary records and body fat from DXA. Prospective analyses were conducted between milk intakes at age 10 y and body fat at 11 and 13 y. Models were adjusted for age, sex, height, physical activity, pubertal status, maternal BMI, maternal education, and intakes of total fat, sugar-sweetened beverages, 100% fruit juice, and ready-to-eat cereals; baseline BMI was added to prospective models. Subset analyses were performed for those with plausible dietary intakes. Mean milk consumption at 10 and 13 y was (mean ± SD) 0.90 ± 0.73 and 0.85 ± 0.78 servings/d [1 serving = 8 oz of milk (244 g of plain and 250 g flavored milk)], respectively. Cross-sectional results indicated an inverse association between full-fat milk intake and body fat [β = -0.47 (95% CI = -0.76, -0.19); P = 0.001]. Milk intake at age 10 y was inversely associated with body fat at 11 y [β = -0.16 g/d (95%CI = -0.28, -0.04); P = 0.01], but not among those with plausible dietary intakes, suggesting that this association was influenced by dietary measurement errors. Milk intake was not associated with body fat at age 13 y after adjustment. Although our prospective results corroborate other findings of a null associations between milk intake and adiposity, our inconsistent findings across analyses suggest further investigation is needed to clarify the relation, and accounting for dietary reporting errors is an important consideration.

Metabolic syndrome in the elderly living in marginal peri-urban communities in Quito, Ecuador

OBJECTIVE The proportion of the Latin American population aged >60 years is expected to double during the next few decades. Metabolic syndrome (MetS) is associated with high morbidity and mortality worldwide. However, little is known about MetS in Latin America in general, and in Ecuador in particular. The present study aimed to examine the prevalence of MetS and its association with blood micronutrient, homocysteine (Hcy) and C-reactive protein (CRP) concentrations in the elderly living in a low-income urban area. DESIGN We performed a cross-sectional study. MetS, using the International Diabetes Federation definition, dietary intake and plasma micronutrient, CRP and Hcy concentrations were assessed. SUBJECTS A total of 352 elderly (≥65 years) Ecuadorians. SETTING Quito, Ecuador. RESULTS MetS was prevalent (40%)--considerably more so among women (81%) than men (19%; χ² = 32·6, P < 0·0001). Further, 53 % of those without MetS exhibited two or more of its components. Micronutrient deficiencies were prevalent, including those of vitamin C, zinc, vitamin B₁₂ and folate. Vitamin C and E concentrations were inversely (OR = 0·78, 95% CI 0·71, 0·86; OR = 0·16, 95% CI 0·03, 0·81, respectively) and CRP (OR = 1·79, 95 % CI 1·04, 3·06) was positively associated with MetS. CONCLUSIONS The coexistence of MetS with micronutrient deficiencies suggests that elderly Ecuadorians suffer from the double burden of diseases that are increasingly being observed in less developed countries. More research is needed to determine the causal factors, but results presented suggest that these older adults would benefit from interventions to reduce the risk factors for MetS, in particular higher consumption of micronutrient-rich foods.

Adherence to an (n-3) Fatty Acid/Fish Intake Pattern Is Inversely Associated with Metabolic Syndrome among Puerto Rican Adults in the Greater Boston Area

Combinations of fatty acids may affect risk of metabolic syndrome. Puerto Ricans have a disproportionate number of chronic conditions compared with other Hispanic groups. We aimed to characterize fatty acid intake patterns of Puerto Rican adults aged 45-75 y and living in the Greater Boston area (n = 1207) and to examine associations between these patterns and metabolic syndrome. Dietary fatty acids, as a percentage of total fat, were entered into principle components analysis. Spearman correlation coefficients were used to examine associations between fatty acid intake patterns, nutrients, and food groups. Associations with metabolic syndrome were analyzed by using logistic regression and general linear models with quintiles of principal component scores. Four principal components (factors) emerged: factor 1, short- and medium-chain SFA/dairy; factor 2, (n-3) fatty acid/fish; factor 3, very long-chain (VLC) SFA and PUFA/oils; and factor 4, monounsaturated fatty acid/trans fat. The SFA/dairy factor was inversely associated with fasting serum glucose concentrations (P = 0.02) and the VLC SFA/oils factor was negatively related to waist circumference (P = 0.008). However, these associations were no longer significant after additional adjustment for BMI. The (n-3) fatty acid/fish factor was associated with a lower likelihood of metabolic syndrome (Q5 vs. Q1: odds ratio: 0.54, 95% CI: 0.34, 0.86). In summary, principal components analysis of fatty acid intakes revealed 4 dietary fatty acid patterns in this population. Identifying optimal combinations of fatty acids may be beneficial for understanding relationships with health outcomes given their diverse effects on metabolism.

Race and region have independent and synergistic effects on dietary intakes in black and white women

BackgroundFew studies have examined the effects of race and region on dietary intakes and the evidence on racial and regional disparities among women is limited. We aimed to examine whether race and region were associated with nutrient intakes among black and white women living in the Stroke Belt, Stroke Buckle, and Other regions in the United States. We hypothesized that significant differences would be observed among population sub-groups and that the effects of race on dietary intakes would vary across regions.MethodsThis study included dietary data from 12,105 women from the Reasons for Geographic and Racial Differences in Stroke study (United States). Dietary data were collected using the Block 98 food frequency questionnaire.ResultsBlacks consumed 1.05% lower energy from saturated fat (95% CI: -0.95, -1.16), and intakes were also lower in the Buckle (β = -0.20; 95% CI: -0.08, -0.32) and Belt (β = -0.35; 95% CI: -0.24, -0.46) compared to the Other regions. Within each region, sodium, potassium, and magnesium intakes were all lower among black women compared to white women (P <0.05 for all); intakes were significantly lower among blacks living in the Belt and Buckle compared to those in the Other regions. Significant interactions between race and region were detected for trans fat, calcium, and cholesterol (P <0.05 for all), where black women in the Other regions consumed the lowest dietary cholesterol and calcium while black women in the Belt consumed the lowest trans fat.ConclusionsRace and region were significantly associated with nutrient intakes in a large study of black and non-Hispanic white women in the United States. Intakes of trans fat, calcium, and cholesterol among black and white women differed across regions. Race and region thus interact to impact dietary intakes, and their effects may be mediated by such factors as the broader food environment and food availability as well as food customs and culture. Race, region, and their correlates should therefore be considered together when examining diet and disease associations and planning dietary advice for population sub-groups.

Dating Violence Among Adolescents Presenting to a Pediatric Emergency Department

OBJECTIVES To determine the prevalence and characteristics of dating violence experienced by adolescents seeking care in a pediatric emergency department and how often adolescents reporting victimization follow up with suggested resources. DESIGN Cross-sectional survey. SETTING An urban pediatric emergency department. PARTICIPANTS Of 327 participants, 235 (71.9%) were female and 92 (28.1%) were male, with a mean (SE) age of 18.7 (0.10) years. INTERVENTIONS Adolescents aged 13 to 21 years completed a survey including demographic characteristics and a validated measure of dating violence. Those reporting victimization received information about local resources and were contacted 1 month later by telephone to determine their use of local resources. MAIN OUTCOME MEASURES Dating violence exposure and subsequent use of resources. RESULTS Among the adolescents, 54.8% reported physical and/or sexual victimization (54.0% of girls vs 56.7% of boys; odds ratio = 0.9; 95% CI, 0.6-1.5), and 59.4% reported perpetration of physical and/or sexual violence (62.1% of girls vs 52.3% of boys; odds ratio = 1.4; 95% CI, 0.9-2.4). Girls were more likely than boys to perpetrate physical violence (52.2% vs 36.1%, respectively; odds ratio = 1.9; 95% CI, 1.2-3.2) but were also more than 5 times as likely to report fear of sustaining serious injury from a partner (16.2% vs 3.1%, respectively; odds ratio = 6.0; 95% CI, 1.4- 26.2). Young age, more intimate partners, and a history of a recent physical fight were independently associated with both dating violence victimization and perpetration. Only 4 of the 127 participants with follow-up interviews (3.1%) used any resources provided. CONCLUSION Dating violence perpetration and victimization rates for both boys and girls who had at least 1 dating relationship are high in this pediatric emergency department population.

Physical function and health status in aging Puerto Rican adults: the Boston Puerto Rican Health Study.

Objectives: This article describes physical function in Puerto Rican older adults and examines associations between health status and physical function. It also assesses relationships between physical function and disability. Method: This study uses a cross-sectional study of Puerto Ricans 45 to 75 years in Boston (N = 1,357). Measures included performance-based physical function (handgrip strength, walking speed, balance, chair stands, foot tapping), health conditions (obesity, diabetes, depressive symptomatology, history of heart disease, heart attack, stroke, and arthritis), and self-reported disability (activities of daily living, instrumental activities of daily living). Results: Older women (60-75 years) had the poorest physical function. Poor physical function was associated with obesity, diabetes, depression, history of heart attack, stroke, and arthritis, after adjusting for age, sex, education, income, and lifestyle (p < .05). Physical function and disability were correlated (p < .01). Discussion: Health status among Puerto Ricans appears to contribute to poor physical function. Targeted interventions to improve strength, endurance, and balance are needed to combat physical frailty and its consequences in this population.

Apolipoprotein A2 Polymorphism Interacts with Intakes of Dairy Foods to Influence Body Weight in 2 U.S. Populations

The interaction between a functional apolipoprotein A2 gene (APOA2) variant and saturated fatty acids (SFAs) for the outcome of body mass index (BMI) is among the most widely replicated gene-nutrient interactions. Whether this interaction can be extrapolated to food-based sources of SFAs, specifically dairy foods, is unexplored. Cross-sectional analyses were performed in 2 U.S. population-based samples. We evaluated interactions between dairy foods and APOA2 -265T > C (rs5082) for BMI in the Boston Puerto Rican Health Study (n = 955) and tested for replication in the Genetics of Lipid Lowering Drugs and Diet Network (GOLDN) study (n = 1116). Dairy products were evaluated as total dairy, higher-fat dairy (>1%), and low-fat dairy (≤ 1%) in servings per day, dichotomized into high and low based on each population median and also as continuous variables. We identified a statistically significant interaction between the APOA2 -265T > C variant and higher-fat dairy food intake in the Boston Puerto Ricans (P-interaction = 0.028) and replicated this relation in the GOLDN study (P-interaction = 0.001). In both groups, individuals with the previously demonstrated SFA-sensitive genotype (CC) who consumed a greater amount of higher-fat dairy foods had greater BMI (P = 0.013 in Boston Puerto Ricans; P = 0.0007 in GOLDN women) compared with those consuming less of the higher-fat dairy foods. The results expand the understanding of the metabolic influence of dairy products, an important food group for which variable relations to body weight may be in part genetically based. Moreover, these findings suggest that other strongly demonstrated gene-nutrient relations might be investigated through appropriate food-based, translatable avenues and may be relevant to dietary management of obesity.