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Type 2 Diabetes mellitus (DM2) affects 9.3% of the U.S. population. Health disparities are evident in DM2, twice as many Hispanics as non-Hispanic Whites have DM2. The objective of this study was to pilot test the feasibility of implementing and evaluating trends of nutrition and exercise interventions to improve diabetes management and physical function in 29 disadvantaged older Hispanics with DM2. We delivered combined diet and exercise (n = 8) and diet-only (n = 6) interventions and compared the results to a control/no intervention group (n = 15). We cluster-randomized the participants into the three arms based on the senior center they attended. The interventions were delivered twice a week for 3 months (24 sessions) and assessments were conducted pre and post intervention. The results indicate the feasibility of implementing the interventions and slight improvements in both intervention groups compared to the control group. The diet-only group tended to have larger improvements on body composition measures (especially in muscle mass), while the diet + exercise group tended to have larger improvements on physical function (especially in chair stands). There was a high rate of attrition, especially in the diet + exercise group, but those who completed the intervention tended to have improvements in body composition and physical function.

OBJECTIVES: The prevalence of diet-related chronic diseases, such as obesity, hypertension and type 2 diabetes, among adults in the U.S. is of increasing import during the COVID-19 pandemic. These conditions are among the top risk factors associated with severe COVID-19 morbidity and mortality. The aim of this study was to assess the of diet-related diseases among a multi-racial/ethnic uninsured group in South Florida. METHODS: Electronic heath records of adult patients (N = 272) from a free clinic in South Florida, a 4-week pre COVID-19 pandemic de-identified dataset was analyzed. Presence of diet-related conditions for each patient was quantified. Numerical and categorical data were compared using independent t-test and Chi-Squared test, respectively. Spearman`s correlation, multi-linear regression, and binary regression models were used to assess the relationship between the variables. RESULTS: The sample included females (65%) and males (35%). The mean age was 49.08 ± 14.56 years. There were 26.5% Whites, 33.8% Blacks, 35.6% Asians/Asian-Indians, and 1.1% American Indians. About 24% were Hispanic/Latino. The mean BMI was 29.45 ± 6.76 kg/m² (n = 250). Overall, 87% of patients had at least one diet-related condition with overweight/obesity being the most observed (75.2%), followed by hypertension (39%), dyslipidemia (27.2%), and diabetes (23.9%). The inter-racial analysis revealed that BMI is a significant predictor of prevalence of hypertension among Whites (P = 0.008) and Blacks (P = 0.002), but not Asians/Asian-Indians (P = 0.536). BMI was a significant predictor of prevalence of dyslipidemia (P = 0.027) and type 2 diabetes (P = 0.006) among Hispanics/Latinos. Bivariate analysis showed a 70.8% co-incidence of hypertension and a 64.4% co-incidence of dyslipidemia among adults with type 2 diabetes. Co-incidence of hypertension among adults with dyslipidemia was at 73%. CONCLUSIONS: High rate of diet-related chronic diseases was found among the multi-ethnic group of uninsured adults in this study. This supports the need for increased patient-education regarding nutrition in free clinic settings. Nutrition programs tailored for low economic resources and culturally appropriate dietary recommendations could assist uninsured patients with management of their diet-related chronic diseases. FUNDING SOURCES: This research was supported by an NIH sub-award.

OBJECTIVES: To identify risk factors associated with the risk for overweight/obesity in preschool children ages 3 up to 5 years participating in the Broward County Special Supplementation Nutrition Program for Women, Infants, and Children (WIC). METHODS: Cross-sectional data were collected from all 7 Broward County Health Department WIC clinics over 4 months via a researcher-administered questionnaire. Additional data were extracted from the WIC data system. Children were classified into weight categories following the CDC's BMI-for-age percentiles, which were further combined into under/normal weight and overweight/obese. RESULTS: A total of 197 participants [90 boys (45.7%) and 107 girls (54.3%)] were included. From those, 68% were overweight/obese and 32% under/normal weight. Sugar sweetened beverage (SSB) intake was significantly greater in the overweight/obese group (7.45 ± 8.71 vs. 4.60 ± 6.64 oz/d, P = 0.024). Fruits were consumed daily by 67% of the children, and vegetables by 35%, with no significant association with weight category. Breakfast was skipped at least once/week by 16.5% of the children, independent of body weight. On average, children had 2.3 h/d of screen time and were physically active for 37.9 min/d. While screen time was not significantly different by weight category, children in the under/normal weight group were significantly more physically active when compared to their counterparts (41.9 ± 29.3 vs. 29.3 ± 27.0 min/d, P = 0.004). Only 15.2% of parents/guardians of overweight and 43.3% of obese children identified their child as being too big. Mean birth weight for overweight/obese children was significantly higher (7.41 ± 1.12 vs. 7.04 ± 1.17 lbs, P = 0.038). On a logistic regression model, SSB intake, physical activity, and birth weight were significant predictors of overweight/obesity. CONCLUSIONS: Physical activity was negatively correlated with the risk of overweight/obesity, while the intake of SSB and birth weight were positively correlated. In addition, most participants failed to perceive their overweight/obese child as such. This study points out important factors to be considered in obesity prevention interventions in this population. FUNDING SOURCES: AC was supported by a NIH/NIGMS R25 grant. The FIU Dietetics and Nutrition research foundation supported the study.

Objective: To assess the effectiveness of an eight-week nutrition and physical activity intervention, entitled: “My Healthy Habits”, at summer camps to prevent obesity, reduce screen time, promote healthy eating habits and physical activity among children. Material and Methods: Eight-week pretest-posttest: intervention versus a comparison group was conducted, in two comparable summer camps in Kuwait and randomized at the site level. Convenient sampling (n=79) included children aged 6-10, receiving 8 weeks of nutrition education: 2 days/week, 40 minutes/day and physical activity sessions: 4 days/week for 20 minutes/day. Outcomes included: the Modified Healthy Habits Survey (items about diet, physical activity and sedentary behavior) and anthropomorphic: Body mass index (BMI) for age and gender percentile and waist-to-height ratio (WHtR). Group changes were measured by independent t-test, and within group changes by the McNemar’s test (categorical data) and paired t-test (interval data). Results: Significant increases in nutrition knowledge scores (from 4.3±1.7 to 10.5±1.2) and in the total score of the major food groups (from 10.0±2.6 to 13.7±2.2) were observed from pretest to posttest. Healthy eating significantly increased (from 12.8±1.8 to 14.5±1.5) for the intervention group only; however, intake of French fries, chips (FF) and sugarsweetened beverages (SSB) remained the same for both groups. Physical activity increased and screen time decreased,only in the intervention group. The participants’ BMI and WHtR decreased significantly in the intervention group: p-value=0.001. Conclusion: Healthy food and physical activity increased, while screen time decreased. Consumption of unhealthy food (FF and SSB) remains an issue.

The purpose of this study was to present the challenges faced when implementing a diet and exercise intervention for low-income older Hispanics with type 2 diabetes with an observational study of recruitment, attendance, and characteristics of Hispanic adults with type 2 diabetes in a community congregate meal site pre and post administration of a diet and exercise intervention. This report evaluates retentions and diabetes self-management beliefs Hispanic adults ≥60 years with type 2 diabetes (n=17) at baseline, and completion of the six-month intervention in terms of the Health Belief Model. There was limited interest in controlling diabetes with diet and exercise. Major barriers included lack of perceived vulnerability to diabetes complications and a belief that medication alone is sufficient to stabilize blood glucose. Environmental barriers included lack of transportation, access to exercise groups, access grocery stores, and limited ability to pay for healthy foods. A lesson learned from this intervention was that the diet and exercise intervention given was insufficient as a cue to action for this population interventions to engage low-income, older Hispanics with diabetes in diet and exercise need to consider strategies to overcome barriers such as health beliefs, transportation issues, lack of access to nutritious food and group exercise classes.

Vitamin D and its association with cardiovascular disease (CVD) are currently a topic of investigation. The objective of this study was to explore the association between vitamin D status (serum 25-hydroxyvitamin D (25(OH)D)) and a cardiometabolic risk score (CMRS) derived from markers of cardiac autonomic nervous system activity, vascular dynamics, and body composition, using an innovative non-invasive technology. We found that individuals who were vitamin D sufficient ((25(OH)D) ≥ 30 ng/ml, n = 51), compared to those who were vitamin D insufficient (

Background: Diabetes and diabetes-related complications are major causes of morbidity and mortality in the United States. Depressive symptoms and perceived stress have been identified as possible risk factors for beta cell dysfunction and diabetes. The purpose of this study was to assess associations between depression symptoms and perceived stress with beta cell function between African and Haitian Americans with and without type 2 diabetes. Participants and Methods: Informed consent and data were available for 462 participants (231 African Americans and 231 Haitian Americans) for this cross-sectional study. A demographic questionnaire developed by the Primary Investigator was used to collect information regarding age, gender, smoking, and ethnicity. Diabetes status was determined by self-report and confirmed by fasting blood glucose. Anthropometrics (weight, and height and waist circumference) and vital signs (blood pressure) were taken. Blood samples were drawn after 8 - 10 hours over-night fasting to measure lipid panel, fasting plasma glucose and serum insulin concentrations. The homeostatic model assessment, version 2 (HOMA2) computer model was used to calculate beta cell function. Depression was assessed using the Beck Depression Inventory-II (BDI-II) and stress levels were assessed using the Perceived Stress Scale (PSS). Results: Moderate to severe depressive symptoms were more likely for persons with diabetes (p = 0.030). There were no differences in perceived stress between ethnicity and diabetes status (p = 0.283). General linear models for participants with and without type 2 diabetes using beta cell function as the dependent variable showed no association with depressive symptoms and perceived stress; however, Haitian Americans had significantly lower beta cell function than African Americans both with and without diabetes and adjusting for age, gender, waist circumference and smoking. Further research is needed to compare these risk factors in other race/ethnic groups.

Background: Omega-3 fatty acids (n-3) may be protective of cardiovascular risk factors for vulnerable populations. The purpose of this study was to assess the association between n-3 with, C-reactive protein (CRP), and homocysteine (HCY) in Black minorities with and without type 2 diabetes. Methods: A cross-sectional study was conducted with 406 participants: Haitian Americans (HA): n=238. African Americans (AA): n=172. Participants were recruited from a randomly generated mailing lists, local diabetes educators, community health practitioners and advertisements from 2008-2010. Sociodemographics and anthropometrics were collected and used to adjust analyses. All dietary variables were collected using the semi-quantitative food frequency questionnaire (FFQ) and used to quantify vitamin components. Blood was collected to measure CVD risk factors (blood lipids, HCY, and CRP). Results: African Americans had higher waist circumferences and C-reactive protein and consumed more calories as compared to Haitian Americans. Omega 3 fatty acid intake per calorie did not differ between these ethnicities, yet African Americans with low n-3 intake were three times more likely to have high C-reactive protein as compared to their counterparts [OR=3. 32 (1. 11, 9. 26) p=0.031]. Although homocysteine did not differ by ethnicity, African Americans with low omega 3 intake (12 mg/L) as compared to their counterparts, adjusting for confounders [OR=4.63 (1.59, 12.0) p=0.004]. Consumption of n-3 by diabetes status was not associated with C-reactive protein or homocysteine levels. Conclusions: Consumption of n-3 may be protective of cardiovascular risk factors such as C-reactive protein and homocysteine for certain ethnicities. Prospective studies are needed to confirm these results.

Introduction Vitamin D deficiency and type 2 diabetes are common among Hispanics and African Americans in the US. The aim of the study was to determine the effect of supplemental vitamin D intake (4000 IU/day or 6000 IU/day of vitamin D3 over a 6-month period) on blood lipids in a sample of African Americans and Hispanics with type 2 diabetes and vitamin D insufficiency. Materials and methods Participants (n = 75) were recruited by community outreach. Participants in both groups were required to take either 4000 IU or 6000 IU of vitamin D (Cholecalciferol) per day given in the form of a pill in a single daily dose. Mixed model was used to compare treatment effects (4000 IU vs. 6000 IU) on the outcome variables. Bonferroni multiple comparison test was used to detect significant changes from baseline, 3 months, and 6 months. Results A significant decrease in total cholesterol (from 193.88 ± 41.03 to 180.48 ± 27.53 mg/dl, P = 0.040) and triglycerides (from 201.44 ± 91.35 to 172.92 ± 76.87 mg/dl, P = 0.037) was found for the 6000 IU group at 6 months. The significance was lost after adjusting for confounders. Conclusion Our results suggest that the positive effect of vitamin D supplementation on lipid profile may be mediated by other cofactors related to vitamin D metabolism among Hispanic and African American participants with type 2 diabetes.

OBJECTIVES: HIV infection has previously been associated with malnutrition and wasting; however, with the initiation of antiretroviral therapy (ART), a growing number of people living with HIV (PLWH) are becoming centrally obese, with disproportionate weight accumulation around the abdominal area and fat losses in the rest of their body (periphery face, arms and legs), indicative of lipodystrophy. As a result, some PLWH may struggle simultaneously with central fat accumulation and peripheral losses, trying to balance these 2 opposite effects. METHODS: PB is a 62-year-old, African-American male infected with HIV for 12 years, receiving an NRTI regimen. Participating in the Miami Adult Studies in HIV (MASH) Cohort, PB started a 6-month nutrition intervention targeted to lower diabetes risk in prediabetic PLWH. Baseline body mass index (BMI) was 24.1 kg/m(2) and waist circumference (WC) was 36.5 inches. Despite having the initial intention to lose weight, PB gained ∼12.4 lbs just a month after initiation. When questioned about the weight gain, PB revealed that he had started taking an appetite stimulant (Megace) to address the wasting on his periphery, claiming that he looked “sickly”. PB stopped taking Megace after he gained >20 lbs (12.3% Wt∆) in 4 months. BMI at this time was 26.3 kg/m(2) and WC was 45.5 inches, reflecting a substantially increased risk for metabolic complications. With WC increasing 9 inches and hip circumference increasing only 2 inches, it is evident that a considerable amount of the weight accumulation occurred around the waist. As can be seen, he among others in his situation, are struggling with conflicting goals by simultaneously trying to reduce central obesity and prevent peripheral losses and wasting, something that may be unique to PLWH. RESULTS: Despite the participant's difficulties in weight management, his fasting blood glucose (FBG) improved after the 6-month nutrition intervention, with a −14 mg/dL improvement, lowering associated risk for diabetes and cardiometabolic complications. CONCLUSIONS: This improvement in FBG levels suggests that despite the difficulty of effective weight management in these patients, proper glucose values may still be achieved with nutrition counseling and education, thus lowering risk for diabetes and associated complications. FUNDING SOURCES: NIGMS-RISE funding, National Institute on Drug Abuse 5U01DA040381-03 and FIU-Dissertation Funding.

OBJECTIVES: To compare the value of Subjective Global Assessment (SGA) and Malnutrition-Inflammation Score (MIS) for the prediction of mortality and examine their relationship with other nutritional parameters. METHODS: Nutrition status was assessed at baseline by SGA and MIS; albumin, protein catabolic rate (nPCR) were obtained from chart; 24-hr dietary recalls were used to estimate daily dietary protein intake (DPI) and dietary energy intake (DEI). Deaths were recorded for 12 months RESULTS: Seventy-seven participants receiving HD were included, with a mean age of 63.2 ± 14.2 years; 71.2% were male, 58.4% had diabetes and the average time on dialysis was 6.2 ± 4.2 years. The Mean ± SD of nPCR was 0.9 ± 0.2, albumin was 3.8 ± 0.3, DEI was 1867.3 ± 367.9 kcal/kg and DPI was 80.0 ± 15.8 gm/kg. MIS ≥ 6 and SGA > 1 were used as cut-off values to detect malnourished participants; 46% were malnourished by MIS vs. 35% by SGA. Albumin, nPCR, DPI and DEI were all inversely correlated with both indices (P

OBJECTIVES: Nutrition plays a critical role in systemic inflammation regulation and the risk of developing inflammatory diseases such as type 2 diabetes (T2D). The Dietary Inflammatory Index (DII) is a non-invasive comprehensive literature-derived tool that evaluates the inflammatory potential of each individual's diet. The aim of this study was to assess the relationship between DII and biomarker of inflammation (CRP), DNA/RNA oxidative stress (8OHdG), glycemic control [HbA1c, glycated albumin (GA) and insulin], and blood pressure (BP) among individuals with T2D and hypovitaminosis D. METHODS: Sixty-eight participants were recruited by community outreach. DII for each individual was calculated based on the values obtained from the Willett food frequency questionnaire. DII score was categorized into quartiles (Q1-Q4) ranged from −5.214 (maximally anti-inflammatory) to +3.999 (maximally pro-inflammatory). CRP, 8OHdG, HbA1c and GA were measured by enzymatic assays. Linear regression analysis was performed to test for the linear trend between DII and CRP, 8-OHdG, HbA1c, GA, insulin, and BP. RESULTS: Mean age was 54.94 ± 7.93 with 60.3% of participants being female. Participants in the DII Q4 were less likely to be female and had higher 8OHdG, HbA1c and GA levels. A significant inverse association was observed between DII Q3-Q4 and insulin level (P = 0.006 and P = 0.030, respectively). After adjusting for covariates, the model remained significant for both Q3 and Q4 (P = 0.040 and P = 0.049, respectively). There was a significant association between systolic BP and DII in Q4 (P = 0.029). However, after adjusting the model for the covariates the model lost significance. There was no statistically significant relationship between the overall DII, CRP, 8OHdG, HbA1c and GA. CONCLUSIONS: A pro-inflammatory diet may be associated with increased risk of hypo-insulinemia and incidence of higher systolic BP among individuals with T2D and vitamin D deficiency/insufficiency. To our knowledge, this was the first study assessing the relationship between DII, 8-OHdG, HbA1c, GA, insulin, and SBP among individuals with type 2 diabetes and hypovitaminosis D. The results of this study may serve as a basis for future nutrition interventions to improve health status of individuals with type 2 diabetes. FUNDING SOURCES: Funding for this research was provided through an NIH/NIDDK sponsored grant.

OBJECTIVES: The objective of this study is to assess the effectiveness of a 6-month nutrition intervention to improve glycemic parameters and inflammation in prediabetic PLWH on stable ART with undetectable HIV viral load. METHODS: A 6-month randomized, controlled nutrition intervention was conducted in prediabetic PLWH. The study participants for the intervention were recruited from the Miami Adult Studies for HIV (MASH) cohort at the FIU-Borinquen Research Clinic. Upon their consent, the participants were randomized into the intervention group or the control group. Participants randomized in the intervention group met once a month for approximately 1 hour where they received medical nutrition therapy, nutrition counseling and nutrition education; participants randomized into the control group received educational material at baseline. Blood was drawn at baseline and at 6-month to measure fasting blood glucose (FBG) and high sensitivity C-reactive protein (hs-CRP). RESULTS: A total of 38 participants were recruited and randomized into either the intervention group (n = 20) or the control group (n = 18). We found that the FBG for the 6-month follow-up for the intervention group was significantly lower than the baseline FBG values of the same study group (paired t-test; P = 0.031). No significant difference was found in the control group between the baseline and 6-month fasting blood glucose values (P = 0.068). Moreover, no significant difference was found in pre/post C-reactive protein (CRP) levels in the intervention or control group (paired t-test; P = 0.404 and P = 0.117 respectively). There was a significant difference in CRP levels at baseline (P = 0.028) between the study groups but no difference at the 6-month follow up (Mann Whitney U test: P = 0.430). CONCLUSIONS: The results from this intervention support the notion that a nutrition intervention is effective in prediabetic PLWH to lower diabetes risk by significantly lowering fasting blood glucose and may be implemented into larger scale interventions; however, no significant changes was seen in hs-CRP values between the 2 groups. FUNDING SOURCES: National Institute of General Medical Sciences (NIGMS): Research Initiative for Scientific Enhancement (RISE), Biomedical Research Initiative (BRI) Grant, National Institute on Drug Abuse 5U01DA040381-03 and FIU-Dissertation Funding.

OBJECTIVES: The purpose of this study was to assess the feasibility of using the Miami Adult Studies on HIV (MASH) cohort to conduct research on markers of gut integrity, MT, immune-activation and inflammation and their relationship to Vitamin D status in this cohort. We hypothesize that drug users infected with HIV, who have vitamin D deficiency or insufficiency, will have higher levels of MT, immune-activation, inflammation and deterioration of the gut integrity than drug users infected with HIV with sufficient Vitamin D levels. METHODS: Ninety HIV-infected drug users and HIV-infected drug non-users were identified from the MASH cohort with IRB approval. Data for this study will be collected at baseline, 6-months and 12-months. Laboratory analyses will include: determination of Lipopolysaccharide for MT, Soluble CD14, Interleukin 6, and Tumor Necrosis Factor alpha to assess immune-activation and inflammation; 25(OH)D levels for Vitamin D status, and Intestinal Fatty Acid Binding Protein as a gut integrity marker. All laboratory analyses will be completed using plasma samples and determined by enzyme-linked immunosorbent assays in the laboratories of the MASH cohort. Dietary and anthropometric data, disease progression and medical history will be collected. The MASH cohort assesses drug use with questionnaires, urine toxicology, and cocaine metabolites. RESULTS: We hypothesize that drug users infected with HIV, who have vitamin D deficiency or insufficiency, will have higher levels of MT, immune-activation, inflammation and deterioration of the gut integrity than drug users infected with HIV with sufficient Vitamin D levels. CONCLUSIONS: The MASH cohort participants are well-characterized and followed longitudinally enabling access to the participants and their information. This study will provide information to develop adjunct therapies for the management of HIV, gut health and nutrition. FUNDING SOURCES: The National Institute of Drug Abuse provides funding for the MASH cohort.

Given the prevalence and consequences of childhood obesity, efforts are being made to identify risk factors and design evidence-based interventions to reduce its impact. Food and beverage consumption habits are established early in life, making preschool-age children an important group to focus on. This cross-sectional study explored beverage intake and its association with body weight status among low-income preschool-age children enrolled in the Special Supplementation Nutrition Program for Women, Infants, and Children (WIC). Authorized representatives for children between the ages of 3 and 4.9 years were interviewed at WIC clinics in Broward County, Florida. Anthropometric data were collected from the WIC data system. The intake of sugar-sweetened beverages (SSB), particularly fruit drinks, was significantly higher in overweight/obese children when compared with their under/normal weight counterparts. Independent of body weight status, the preschool-age children were consuming on average over twice as much as the recommended intake of 100% fruit juice per day for that age group. Close to 80% of the overweight/obese children consumed low-fat or fat-free milk most often than any other type of milk. The intake of SSB was positively correlated with both the intakes of 100% fruit juice and milk, and negatively correlated with the intake of water. When body weight status, race/ethnicity, and intake of other beverages were held constant, SSB intake was positively associated with milk intake and negatively associated with water intake. Results from this study support the need to encourage water intake and discourage SSB intake in an effort to reduce the risk for overweight and obesity in WIC-participating preschool-age children. Emphasizing the need to follow the recommendation to limit 100% fruit juice intake to 4 to 6 oz. per day is important when counseling families with young children. Efforts to increase awareness of the health consequences associated with consuming high-fat milk should continue.

Environmental factors, preventive medical care, and behaviors play a role in childhood obesity. This study used the National Survey of Children’s Health, 2011-2012, for 42,828 children, ages 10–17 years. Greater percent of children in the overweight/obese category performed no moderate-to-vigorous physical activity: 11.9 (10.6, 13.3) as compared to children in the underweight/normal weight category: 9.7 (8.9 10.6). No moderate-to-vigorous physical activity was associated with no preventive medical care, inadequate or no health care, parents reporting higher percent of no parks or playgrounds, and unsafe and unsupportive neighborhoods. Odds ratios of overweight/obesity were higher for males [OR = 2.06 (1.64, 2.60)], Hispanics [OR = 1.49 (1.17, 1.90)], non-Hispanic Black females [OR = 1.59 (1.20, 2.08)], younger females [OR10–12 yrs. = 1.35 (1.03, 1.79) and OR13–15 yrs. = 1.4. (1.06, 1.89) vs. OR = 1.0016-17 yrs.], children with high television viewing [OR0-1 hr./day = 0.72 (0.61, 0.86); OR>1 to 0.84 (0.72, 0.99) = vs. OR = 1.00≥ 4 hrs./day,] and lower categories of physical activity [OR 0 days/wk. = 1.38 (1.13, 1.62); OR1–3 days/wk. = 1.14 (1.22, 1.62) vs. OR7 days/wk. = 1.00], higher poverty, smoke exposure, and parental perception of their neighborhood as unsupportive. Promoting preventive medical care and neighborhood cooperation may have potential to lower childhood obesity.

This study examined sex by race/ethnicity differences in medical advice received for diet and exercise with corresponding health behaviors of a U.S. representative sample of adults with type 2 diabetes ( N = 1,269). Data from the National Health and Nutrition Examination Surveys for 2011-2014 for 185 Mexican Americans, 123 Other Hispanics, 392 non-Hispanic Blacks, 140 non-Hispanic Asians, and 429 non-Hispanic Whites were analyzed using logistic regression analyses. Reporting being given dietary and exercise advice was positively associated with reporting following the behavior. There were differences in sex and sex by race/ethnicity for reporting receiving medical advice and performing the advised health behavior. These results suggest the importance of physicians having patient-centered communication skills and cultural competency when discussing diabetes management.

OBJECTIVES: Albumin is the most abundant protein in serum with half-life of 2–3 weeks. Several studies suggested glycated albumin (GA) may provide a more accurate measure of extracellular glycation status, compared to hemoglobin A1C. Low serum vitamin D level [25(OH)D3] has been linked to diabetes. The aim of this study was to investigate the effect of different doses of vitamin D3 supplementation for 3 and 6 months on serum glycated albumin (GA) in individuals with type 2 diabetes (T2D) and hypovitaminosis D. METHODS: In this clinical trial, we assessed the effect of daily supplementation with 4000 and 6000 IU of vitamin D3 over 6 months on GA among 68 adults with T2D and hypovitaminosis D. Measurements of variables were conducted at baseline, 3 months and 6 months. Mixed model was used to compare treatment groups. Covariates in the adjusted model included age, gender, body mass index (BMI), sun exposure, fasting plasma glucose, insulin and C-reactive protein (CRP). RESULTS: After testing for normal distribution of variables, 65 participants, females (n = 40) and males (n = 25), were included in the analysis. Mean age was 54.52 ± 7.86 years. Mean serum 25(OH)D3 at baseline, 3 months and 6 months were 22.4 ± 6.77, 40.4 ± 13.68, and 40.57 ± 14.55, respectively. Mean GA at baseline, 3 months and 6 months were 4.69 ± 1.7, 4.13 ± 1.09, and 4.42 ± 1.23, respectively. Mixed model analysis controlling for interactions between 4000 IU and 6000 IU/day doses and outcome variables showed no differences between 2 treatment groups. Unadjusted pairwise comparisons between GA were a statistically significant from baseline to 3 months (P = 0.015), and from 3 months to 6 months (P = 0.039), but not from baseline to 6 months (P = 0.488). After adjusting for covariates, the model remained statistically significant for baseline and 3 months (P = 0.018) but not for 3 months to 6 month (P = 0.069), nor for baseline and 6 months (P = 0.471). CONCLUSIONS: GA may be a more sensitive biomarker for oxidative/glycemic changes in individuals with T2D and hypovitaminosis D and daily supplementation with higher doses of vitamin D3 may have beneficial effects on their health status. Larger studies with longer durations among different racial and ethnic groups may help to confirm these findings. FUNDING SOURCES: Funding for this research was provided through an NIH/NIDDK sponsored grant.

OBJECTIVES: To understand the influence of eating frequency and snack quality on body weight of preschool children ages 3 up to 5 years participating in the Broward County Special Supplementation Nutrition Program for Women, Infants, and Children (WIC). METHODS: Cross-sectional data were collected from all 7 Broward County Health Department WIC clinics over 4 months via a researcher-administered questionnaire. Additional data were extracted from the WIC data system. Centers for Disease Control and Prevention's BMI-for-age percentiles were used to classify children into weight categories that were combined into under/normal weight and overweight/obese. Snacks were categorized into nutrient-based food groups and assigned a quality score. RESULTS: A total of 197 participants [90 boys (45.7%) and 107 girls (54.3%)] were included. From those, 3.6% were underweight, 64.4% normal weight, 16.8% overweight and 15.2% were obese. Most children consumed 3 meals (97.5%) and between 2 (33%) to 3 (37.1%) snacks on average per day. Mean number of snacks on the weekend was significantly higher than on weekdays (2.78 ± 1.20 vs. 2.67 ± 1.08, P = 0.001). We found a tendency for a lower prevalence of overweight/obesity as the number of eating events increased, although it was not significant. The most frequently consumed snacks were milk, 100% fruit juice, and fresh fruits, consumed daily by more than 75% of the children, irrespective of weight category. There was an overall higher consumption of more nutritious snacks when compared to nutrient-poor snacks (66% vs. 33.5%), with under/normal weight children consuming nutritious snacks more frequently than overweight/obese children (P = 0.09). CONCLUSIONS: Most children included in this study engaged in frequent eating events with a higher intake of the more nutritious snacks, which were both associated with a lower prevalence of overweight/obesity. Our findings suggest that in this age range, participation in the WIC program may foster positive eating behaviors. FUNDING SOURCES: A.C. was supported by a NIH/NIGMS R25 grant. Support to conduct the study was provided by the FIU Dietetics and Nutrition research foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

OBJECTIVES: Diabetes related complications include kidney, eye, heart diseases and amputations. Advanced Glycation End Products, (AGEs) are biomarkers of T2D. AGEs are covalent adducts formed from reactions between sugars and proteins or lipids. Vitamin D deficiency, prevalent with T2D, increases oxidative stress and inflammation that promotes the formation of AGEs. This study assessed the effect of 4000 IU vitamin D supplements on AGEs in adults with T2D and vitamin D deficiency/insufficiency. METHODS: We assessed changes in serum AGEs of 41 African Americans and Hispanics with T2D and hypovitaminosis D who were supplemented with 4000 IU of vitamin D3 for 6 months. Total AGEs were assessed using commercially available kits (Biotang Inc/TSZ Elisa, Waltham, MA, USA). RESULTS: The mean age of study participants was 54 ± 8 years. AGEs significantly increased at 3 months compared to baseline (Mean Difference = −13.70 ng/ml, P = 0.007). The mean level of AGEs decreased significantly at 6 months of supplementation (Mean Difference = 9.79 ng/ml, P = 0.020). Additionally, the mean serum levels of AGEs were significantly higher at 3 months compared to 6 months among study participants (Mean Difference = 24.52 ng/ml, P

Adverse outcomes in hemodialysis patients have been attributed, in part, to the pro-inflammatory state prevalent in this population. This study examines the relationship between blood neutrophil-to-lymphocyte ratio (NLR) with nutrition markers and health outcomes in hemodialysis (HD) patients. This is a 12-month prospective cohort study that recruited 77 participants from May to Jun 2017. Patients receiving maintenance hemodialysis. Hospitalization, transplants and mortality. Of the 77 participants, 63.8% were hospitalized, 10 (13%) died of cardiovascular diseases and 6 (7.8%) had a kidney transplant. Spearman correlations using baseline values showed an inverse significant correlation between the total number of hospitalizations and BMI kg/m2 (BMI rho = − 0.37, P 1.75). Participants with NLR ≤ 1.75 had 100% survival rate (log-rank test, P = 0.059) and lower hospitalization rate (log-rank test, P = 0.025); participants with diabetes had lower hospitalization rate (log-rank test, P = 0.039). NLR at baseline was associated with nutritional markers (albumin, BMI). Low NLR at baseline was a predictor of lower risk for hospitalizations in HD patients with diabetes.

Osteoporosis, a chronic disease that results in low bone mass with an increased risk of fragility fractures, is prevalent in older adults. Diet can prevent or lessen the severity of osteoporosis. The purpose of this cross-sectional study was to assess differences in diet, quality of life, self-rated health, and physical function between congregate meal participants with and without osteoporosis. Data were from telephone survey, 10th Annual National Survey of Older American Act Participants, a representative sample of congregate meal attendees across the United States. (N = 888). Osteoporosis was present in 20% of this population. Participants with, as compared to without, osteoporosis reported that their physical health limited moderate activities (31.5% vs. 18.9%, p = 0.026), stair climbing (32.2% vs. 22.8%, p = 0.032), and shopping (27.4 vs. 15.3, p = 0.018). More than half of the participants consumed less than the recommended servings of dairy, meat, grains, and fruits/vegetables regardless of osteoporosis status. Participants with osteoporosis had lower self-rated health and more physical limitations than people without osteoporosis. Although congregate meals are a way to improve nutritional intake, additional methods to improve nutrition (including education) may be of benefit, since undernutrition is a concern in this population.

Aims: Nutritional status can be compromised by food insecurity which is common among HIV infected persons. Providing food assistance is expected to improve food insecurity and nutritional status among persons infected with HIV. This study aimed at examining the relationship of participating in the Supplemental Nutrition Assistance Program (SNAP), the largest food assistance program in the United States, with food security and nutritional status among HIV infected adults. Study Design : A cross - sectional study de sign was used in this study. Place and Duration of Study: This study was conducted in Miami, FL, USA, between April 2011 and August 2012. Methodology: We included 159 HIV infected individuals in this study, 113 participants were SNAP recipients while 46 w ere not. All study participants were, however, eligible to participate in SNAP. Each participant completed demographic and food security surveys as well as dietary and nutrition status assessment. Statistical analyses were conducted using univariate and mu ltivariate analyses.

Background To report the association of serum 25-hydroxyvitamin D [25(OH)D] and its association with adipokines and cardiometabolic risk factors in Haitian Americans (HA) and African Americans (AA) by ethnicity and type 2 diabetes (T2D) status. Methods A cross-sectional study in 197 HA (92 with T2D and 102 without T2D) and 200 AA (97 with T2D and 103 without T2D) recruited in South Florida. Serum 25(OH)D concentrations and adipokines were analyzed by ELISA and cardiometabolic risk factors were indexed by obesity, glycemic control, insulin sensitivity, lipid profile, and blood pressure. Results Controlling for age, BMI, energy intake, smoking status and HOMA2-IR in multivariate linear regression analyses, serum 25(OH)D concentrations were significantly associated with WC (R2 = 0.760, B = − 0.092, P = 0.027), HbA1C (R2 = 0.142, B = − 0.012, P = 0.010), and TG (R2 = 0.159, B = − 1.192, P = 0.003) in only HA without T2D. While serum 25(OH)D concentrations were significantly associated with TC (R2 = 0.168, B = − 0.329, P = 0.040), log leptin (R2 = 0.544, B = − 0.007, P = 0.021), and adiponectin (R2 = 0.144, B = 0.111, P = 0.033), but slightly associated with LDL-c (R2 = 0.133, B = − 0.278, P = 0.064) in only AA without T2D. Among individuals with T2D, serum 25(OH)D concentrations were marginally associated with IL-6 (R2 = 0.109, B = 0.076, P = 0.085) in HA with T2D, and there was a trend toward significance with log leptin (R2 = 0.393, B = − 0.006, P = 0.075) in AA with T2D in regression analysis. Conclusions The findings that the associations of serum 25(OH)D concentrations with adipokines and cardiometabolic factors differ between HA and AA has clinical and public implications to guide design of T2D preventive strategies that are culturally specific even within the same ethnicity. Electronic supplementary material The online version of this article (10.1186/s40795-018-0259-2) contains supplementary material, which is available to authorized users.

Background: Vitamin D deficiency has been associated with an increased risk of falls in older adults. Several studies have demonstrated an association between vitamin D deficiency and gait and cognitive impairments, which are two risk factors for falls in the elderly. There is lack of research about the role of vitamin D in cognitive function in the context of mobility. Objective: The purpose of this study was to evaluate the association between vitamin D status with the age-related changes in mobility through higher order cognitive function using a dual task physical performance test. Design: Cross-sectional Setting: Community-dwelling older adult population located in Miami, Fl. Participants: Healthy participants over the age of 55 (n=97) who participated in the parent interventional study. Measurements: Participants completed assessments that included serum levels of vitamin D, surveys, and dual task physical performance tests. Spearman’s correlations, independent t-tests, repeated measures ANOVAs and multiple logistic regressions were used to examine the relationship between vitamin D insufficiency (25-hydroxyvitamin D

Asthma is a chronic disease increasing in prevalence in Western cultures. Sedentary behaviors, such as television viewing, video game and computer use, have been associated with poor diet and being overweight. The extent to which these factors were associated with asthma was investigated in a representative sample of U.S. children ages 2–11 years (N = 4133). Results showed low dietary fiber, reported being told your child was overweight by a healthcare provider, and race/ethnicity were associated with asthma; whereas, screen time, fat intake, and meals out were not associated with asthma. Implications for clinical practice and research were discussed.

Aims The aim was to investigate the association between serum 25-hydroxyvitamin D [25(OH)D], skin color and sun exposure score. Study design Cross-sectional. Place and duration of study Florida International University, Robert Stempel College of Public Health and Social Work, Department of Dietetics and Nutrition, Miami, Florida from July 2012 to October 2012. Methodology Seventy six adults, ages 18-36 years living in South Florida participated in the study. Skin color was quantified by a IMS Smart Probe 400 scanner and 25(OH)D was measured by ELISA. A sun exposure questionnaire was used to record the weekly sun exposure scores. A food frequency questionnaire was used to record daily vitamin D intake. Results Multiple-linear regression analysis indicated that sun exposure, forearm skin color and vitamin D intake were significant predictors of 25(OH)D (P=.004, P=.003 and P=.021 respectively). This association held after controlling for covariates (B=.371, P=.027 for forearm, B=.031, P=.005 for total sun exposure and B=.689, P=.003 for vitamin D intake). Conclusion Skin color, sun exposure along with vitamin D intake may be used as an indirect non-invasive tools to estimate 25(OH)D levels in healthy individuals in South Florida.

Aim: to determine cut off points for The Homeostatic Model Assessment Index 1 and 2 (HOMA-1 and HOMA-2) for identifying insulin resistance and metabolic syndrome among a Cuban-American population. Study Design: Cross sectional. Place and Duration of Study: Florida International University, Robert Stempel School of Public Health and Social Work, Department of Dietetics and Nutrition, Miami, FL from July 2010 to December 2011. Methodology: Subjects without diabetes residing in South Florida were enrolled (N=146, aged 37 to 83 years). The HOMA1-IR and HOMA2-IR 90th percentile in the healthy group (n=75) was used as the cut-off point for insulin resistance. A ROC curve was constructed to determine the cut-off point for metabolic syndrome. Results: HOMA1-IR was associated with BMI, central obesity, and triglycerides (P3.95 and >2.20 and for metabolic syndrome were >2.98 (63.4% sensitivity and 73.3% specificity) and >1.55 (60.6% sensitivity and 66.7% specificity), respectively. Conclusion: HOMA cut-off points may be used as a screening tool to identify insulin resistance and metabolic syndrome among Cuban-Americans living in South Florida.

Background and aims: The current study evaluates following a special diet with diet quality and comorbidities (hypertension, hypercholesterolemia, and obesity) in four racial/ethnic groups diagnosed with prediabetes or “at risk for diabetes”. Methods and results: This is a cross-sectional analysis of data from the National Health and Nutrition Examination Surveys (NHANES), 2007-2008 and 2009-2010. Sample weights were used to achieve a representative sample. Data were available for N = 2666 adults, aged ≥20 years (508 Mexican American, 294, Other Hispanic, 616 Black non-Hispanic, and 1248 White non-Hispanic) who were medically diagnosed with either prediabetes or “at risk for diabetes”. Those reporting following a special diet had greater odds of meeting saturated fat guidelines (

OBJECTIVES: Advanced Glycation End Products, (AGEs) and their soluble receptor (sRAGE) have been implicated in the development of complications and mortality among individuals with type 2 diabetes (T2D). There is limited information on the relationship between AGEs and sRAGE and risk of cardiovascular diseases (CVD) in minority groups, who have a higher burden of T2D. The relationship between AGEs and sRAGE and CVD risks in adults with T2D and vitamin D insufficiency/deficiency was assessed in a minority population. METHODS: A cross sectional study of Hispanics and African Americans with T2D (n = 64, 41 women and 23 men, mean age = 54 ± 9) recruited from two clinics in Miami Dade. Systolic (SBP) and diastolic blood pressure (DBP), weight and height measurement and serum lipid profile were completed. ELISA kits were used to assess serum levels of AGEs (Biotang Inc/TSZ Elisa, Waltham, MA, USA) and sRAGE (Biotang Inc/TSZ Elisa, Waltham, MA, USA). Multiple linear regression was used to assess association between AGEs, sRAGE and CVD risks. RESULTS: A negative and significant association between AGEs and high-density lipoprotein cholesterol (HDL-C)(B = −0.551, P = 0.029) was found. The relationship between AGEs and HDL-C persisted after adjusting for covariates (P

This study examined the relationships among ethnicity/race, lifestyle factors, phylloquinone (vitamin K₁) intake, and arterial pulse pressure in a nationally representative sample of older adults from four ethnic/racial groups: non-Hispanic Whites, non-Hispanic Blacks, Mexican Americans, and other Hispanics. This was a cross-sectional study of U.S. representative sample with data from the National Health and Nutrition Examination Surveys, 2007-2008 and 2009-2010 of adults aged 50 years and older (N = 5296). Vitamin K intake was determined by 24-hour recall. Pulse pressure was calculated as the difference between the averages of systolic blood pressure and diastolic blood pressure. Compared to White non-Hispanics, the other ethnic/racial groups were more likely to have inadequate vitamin K₁ intake. Inadequate vitamin K₁ intake was an independent predictor of high arterial pulse pressure. This was the first study that compared vitamin K₁ inadequacy with arterial pulse pressure across ethnicities/races in U.S. older adults. These findings suggest that vitamin K screening may be a beneficial marker for the health of older adults.

Adequate care of type 2 diabetes is reflected by the individual’s adherence to dietary guidance; yet, few patients are engaged in diabetes self-care at the recommended level, regardless of race/ethnicity. Few studies on the effect of dietary medical advice on diabetes self-management (DSM) and glycemic control have been conducted on Haitian and African American adults with type 2 diabetes. These relationships were assessed in total of 254 Blacks with type 2 diabetes (Haitian Americans = 129; African Americans = 125) recruited from Miami-Dade and Broward Counties, Florida by community outreach methods. Although dietary advice received was not significantly different between the two Black ethnicities, given advice “to follow a diet” as a predictor of “using food groups” was significant for Haitian Americans, but not for African Americans. Haitian Americans who were advised to follow a diet were approximately 3 times more likely to sometimes or often use food groups (or exchange lists) in planning meals. Less than optimal glycemic control (A1C > 7.2) was inversely related to DSM for African Americans; but the relationship was not significant for Haitian Americans. A one unit increase in DSM score decreased the odds ratio point estimate of having less than optimal glycemic control (A1C > 7.2%) by a factor of 0.94 in African Americans. These results suggest that medical advice for diet plans may not be communicated effectively for DSM for some races/ethnicities. Research aimed at uncovering the enablers and barriers of diet management specific to Black ethnicities with type 2 diabetes is recommended.

Background.The State of Kuwait has a growing obesity epidemic in both genders and all age groups; however, obesity rates in the young seem to be rising.Methods.We conducted a cross-sectional survey in 169 Kuwaiti female adolescents attending both private and public schools spanning the six governorates in the State of Kuwait in order to explore female adolescents’ self-image, body dissatisfaction, type of school (private versus public), TV viewing, and computer games and their relationship to body mass index.Results.Approximately half the students classified as obese perceived their body image to lie in the normal range. Females in the obese category were the most dissatisfied with their body image, followed by those in the overweight category. Eating behavior, level of physical activity, school type, television viewing, computer/video usage, and desired BMI were not significantly associated with level of obesity.Conclusion.This study was one of the few studies to assess adolescent females’ body image dissatisfaction in relation to obesity in the State of Kuwait. The results suggest that including body image dissatisfaction awareness into obesity prevention programs would be of value.

Background: Malnutrition of children in Ghana continues during school years. There is limited information on how school meals meet nutrient recommendations in Ghana. Objectives: The aim of this study was to compare energy and nutrient content of meals served by Ghana School Feeding Programme (GSFP) and Non-Governmental School Feeding Programme (NGSFP) and adherence to nutrient recommendations. Methods: This was a cross sectional study design involving observation of school meals at two sites: GSFP and NGSFP. Average weights of a week’s meal were converted to energy and nutrient equivalence and compared with international recommendations. Differences assessed with t-tests. Results: NGSFP provided significantly higher portion size (416 ± 96 g vs. 243 ± 50 g; p=0.007), energy (776 ± 427 kcal vs. 315 ± 24 kcal; p=0.042) and fats (17± 8 vs. 6 ± 2; p=0.019) but similar micronutrient contributions to GSFP. NGSFP met energy and macronutrient recommendation set by World Food Programme; whereas, GSFP did not meet the recommendations. Conclusion and Recommendations: The NGSFP had more energy and macronutrients per serving size than the GSFP. Regulation of meals served by GSFP should be reviewed to ensure they contribute to the adequacy of children’s diets as well as meet recommendations set by World Food Programme., {"references":["Best C, Neufingerl N, Van Geel L, van den Briel T, Osendarp S. The nutritional status of school-aged children: why should we care? Food & Nutrition Bulletin 2010; 31(3): 400-417. http://dx.doi.org/10.1177/156482651003100303","Fentiman A, Hall A, Bundy D. Health and cultural factors associated with enrolment in basic education: a study in rural Ghana. Soc Sci Med 2001; 52(3): 429-439. http://dx.doi.org/10.1016/S0277-9536(00)00152-0","GSS G, Macro I. Ghana demographic and health survey 2008. Accra, Ghana: Ghana Statistical Service, Ghana Health Service, and ICF Macro 2009."]}

Background. Approximately 17% of children aged 6–11 years were classified as obese in the United States. Obesity adversely affects physical functioning and leads to reduced quality of life. Heart function for overweight and obese children has not been reported.Methods. Data for this study were from NHANES National Youth Fitness Survey (NNYFS) conducted in conjunction with the National Health and Nutrition Examination Survey (NHANES) in 2012. This study used data from children aged 6–12 (N=732) that had the cardiorespiratory endurance measure, body mass index for age and sex, and dietary data (N=682). Cardiovascular endurance was estimated by heart rate reserve.Results. Compared to the highest percentile of heart rate reserve, those in the first percentile had 3.52 (2.36, 5.24) odds and those in the second percentile had 3.61 (1.84, 7.06) odds of being in the overweight/obese as compared to the under/normal weight category. Considering the highest percentile, boys had a heart rate reserve of 35%, whereas girls had a heart rate reserve of 13% (less than half that of boys).Conclusion. Having an overweight or obese classification for children in this study demonstrated a compromise in cardiovascular endurance. Parental awareness should be raised as to the detrimental consequence of overweight and heart health.

Diabetes is a major public health problem that affects certain ethnicities disproportionately. Physical activity (PA) (exercise) is a key component necessary for the prevention and treatment of type 2 diabetes. Adults with and without diabetes may face challenges that interfere with following exercise recommendations. This article reviews the relationships among PA, race/ethnicity, behaviors, and health outcomes of adults with prediabetes and type 2 diabetes. The authors review recent cross-sectional and intervention studies and assess their relevance to clinical practice. This is a focused review of the literature from January 2010 to September 2012 on the relationship among PA, type 2 diabetes, and race/ ethnicity with respect to the following components: (1) PA and the likelihood of persons with prediabetes developing diabetes; (2) PA and improvements in health outcomes of persons with prediabetes; (3) PA and improvements in health outcomes of persons with type 2 diabetes; and (4) enablers of and barriers to PA for persons with type 2 diabetes. The initiation of effective PA programs designed to reduce the incidence of type 2 diabetes or improve diabetes outcomes rely on a critical interpretation of current research findings.

Race/ethnicity-, gender- and age-specific differences in dietary micronutrient intakes of US adults ≥ 21 years were assessed from National Health and Nutrition Examination Survey, 2007-2008. The participants included Black non-Hispanics, Mexican-American and White non-Hispanics who signed an informed consent form for the interview and who completed the in-person 24-h recall. Micronutrient intakes were based on the Institute of Medicines' classifications of recommended dietary allowances specific for age and gender. Likelihood of many micronutrient insufficiencies was associated with being female, over 65 years, having diabetes and minority status. Younger and female adults had a greater likelihood of iron insufficiency than male and older adults. These findings demonstrate the importance of considering the intersection of age, gender and race in setting policies for micronutrient deficiency screening, particularly in young female adults and minorities.

The purpose of this study was to investigate the association between 25-hydroxyvitamin D [25(OH)D] levels and diabetes status in three ethnicities. This cross sectional study included Cuban Americans (n = 199), Haitian Americans (n = 253) and African Americans (n = 248) with and without type 2 diabetes (T2D) from Florida, U.S. Recruitment of participants was through mailing lists (Cuban Americans and African Americans) and community based sources (Haitian Americans). Adjusted logistic regression analysis indicated significant differences in the odds of having insufficient 25(OH)D levels by ethnicity [P

ObjectiveTo 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).DesignIn 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.SettingMiami Dade and Broward Counties, FL, USA.SubjectsCuban Americans (n 358) aged ≥30 years.ResultsParticipants 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.

Gustavo G Zarini1, Joel C Exebio1, Deva Gundupalli1, Subrata Nath2, Fatma G Huffman11Florida International University, Robert R Stempel School of Public Health, Department of Dietetics and Nutrition, Miami, Florida, USA; 2Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USAPurpose: To investigate to what degree the presence of hypertension (HTN) and poor glycemic control (GC) influences the likelihood of having microalbuminuria (MAU) among Cuban Americans with type 2 diabetes (T2D).Methods: A cross-sectional study conducted in Cuban Americans (n = 179) with T2D. Participants were recruited from a randomly generated mailing list purchased from KnowledgeBase Marketing, Inc. Blood pressure (BP) was measured twice and averaged using an adult size cuff. Glycosylated hemoglobin (A1c) levels were measured from whole blood samples with the Roche Tina-quant method. First morning urine samples were collected from each participant to determine MAU by a semiquantitative assay (ImmunoDip).Results: MAU was present in 26% of Cuban Americans with T2D. A significantly higher percentage of subjects with MA had HTN (P = 0.038) and elevated A1C (P = 0.002) than those with normoalbuminuria. Logistic regression analysis showed that after controlling for covariates, subjects with poor GC were 6.76 times more likely to have MAU if they had hypertension compared with those without hypertension (P = 0.004; 95% confidence interval [CI]: 1.83, 23.05). Conclusion: The clinical significance of these findings emphasizes the early detection of MAU in this Hispanic subgroup combined with BP and good GC, which are fundamentals in preventing and treating diabetes complications and improving individuals’ renal and cardiovascular outcomes.Keywords: blood pressure, A1c, kidney function, cardiovascular disease, Hispanics

Migration to the United States has been linked to obesity and poor diet quality. We investigated the relationship among diabetes self-management, diet, age and acculturation factors for 182 Cuban-Americans (Females = 110, Males = 72) with type 2 diabetes recruited from a randomized mailing list in South Florida. Inadequate glycemic control (β = 0.257), BMI (β = 0.251), total fat intake (β = 0.251), and smoking (β = 0.200), were positively associated, while understanding of overall diabetes care (β = -0.165), was negatively associated with migration (N = 162, adj.R2 = 0.286, F = 14.65, p < 0.001). These associations suggest that effective diabetes education targeting acculturation issues is lacking.

Prevalence of childhood obesity and its complications have increased world-wide. Parental status may be associated with children’s health outcomes including their eating habits, body weight and blood cholesterol. The National Health and Nutrition Examination Survey (NHANES) for the years 1988–1994, provided a unique opportunity for matching parents to children enabling analyses of joint demographics, racial differences and health indicators. Specifically, the NHANES III data, 1988–1994, of 219 households with single-parents and 780 dual-parent households were analyzed as predictors for primary outcome variables of children’s Body Mass Index (BMI), dietary nutrient intakes and blood cholesterol. Children of single-parent households were significantly (p < 0.01) more overweight than children of dual-parent households. Total calorie and saturated fatty acid intakes were higher among children of single-parent households than dual-parent households (p < 0.05). On average, Black children were more overweight (p < 0.04) than children of other races. The study results implied a strong relationship between single-parent status and excess weight in children. Further studies are needed to explore the dynamics of single-parent households and its influence on childhood diet and obesity. Parental involvement in the development of school- and community-based obesity prevention programs are suggested for effective health initiatives. Economic constraints and cultural preferences may be communicated directly by family involvement in these much needed public health programs.

This study evaluated the use of HbA(1c) as a screening tool for undiagnosed type 2 diabetes (fasting plasma glucose ≥7.0 mmol/l) in a sample of Cuban-Americans aged ≥ 30 years old. Subjects were randomly recruited from Miami-Dade and Broward counties, FL. Fasting plasma glucose was measured by hexokinase enzymatic method. HbA(1c) was measured by the DCA2000 + system using the monoclonal antibody method. HbA(1c) demonstrated a high predictive value in detecting undiagnosed diabetes. The area under the receiver operating characteristics (ROC) curve was 0.87. Also, HbA(1c) had high sensitivity and specificity when using a cut off value of 6.37 (71 and 86%, respectively). Moderate sensitivity and very high specificity were shown with a cut off value of 6.84 (57 and 96%, respectively). HbA(1c) is a reliable alternative to fasting plasma glucose in screening for undiagnosed diabetes in Cuban-Americans.

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

Relationship between high-sensitivity C-reactive protein (hs-CRP) and adiposity by diabetes status and gender in Cuban-Americans with and without type 2 diabetes (T2D) was studied. Adult subjects, 226 females, 129 males participated in a case control, single time point study. Subjects with T2D were older, had higher waist circumference (WC) and body mass index (BMI). WC and BMI were associated with ln hs-CRP (P < 0.001). An interaction with diabetes status was found for BMI (P = 0.037). Gender showed a strong relationship with ln hs-CRP (P < 0.001), which was moderated by diabetes status. Only males without diabetes exhibited a significant relationship for both WC and BMI with ln hs-CRP. In this sample of Cuban-Americans, WC and BMI had stronger associations with ln hs-CRP but not with diabetes status. Obesity prevention and controlling for CRP levels may be necessary to eliminate its contributions to develop diabetes and cardiovascular disease (CVD).

Although studies regarding health issues and the obesity epidemic have increased in recent years, few of these studies target college-aged students. The primary purpose of this study was to evaluate the differences in race/ethnicity with respect to prevalence of overweight/obesity (defined by body mass index or BMI) among college students attending an urban university. In addition, the demographic characteristics and cardiovascular risks between the overweight and obese group (n=138) were compared to the underweight and normal weight group (n=349). The study included 487 college students under 40 years of age who identified their origin as white (non-Hispanic), black (non-Hispanic), or Hispanic. There were 32.65% white, 33.26% Hispanic, and 34.09% black. The mean and median ages were 21 and 19 years, respectively. The overall prevalence of overweight/obesity was 28.11%, with 23.91% (white), 34.06% (Hispanic), and 42.03% (black). Age-, gender-, and race-/ethnicity-adjusted cardiovascular risk leve...

Men, particularly minorities, have higher rates of diabetes as compared with their counterparts. Ongoing diabetes self-management education and support by specialists are essential components to prevent the risk of complications such as kidney disease, cardiovascular diseases, and neurological impairments. Diabetes self-management behaviors, in particular, as diet and physical activity, have been associated with glycemic control in the literature. Recommended medical care for diabetes may differ by race/ethnicity. This study examined data from the National Health and Nutrition Examination Surveys, 2007 to 2010 for men with diabetes ( N = 646) from four racial/ethnic groups: Mexican Americans, other Hispanics, non-Hispanic Blacks, and non-Hispanic Whites. Men with adequate dietary fiber intake had higher odds of glycemic control (odds ratio = 4.31, confidence interval [1.82, 10.20]), independent of race/ethnicity. There were racial/ethnic differences in reporting seeing a diabetes specialist. Non-Hispanic Blacks had the highest odds of reporting ever seeing a diabetes specialist (84.9%) followed by White non-Hispanics (74.7%), whereas Hispanics reported the lowest proportions (55.2% Mexican Americans and 62.1% other Hispanics). Men seeing a diabetes specialist had the lowest odds of glycemic control (odds ratio = 0.54, confidence interval [0.30, 0.96]). The results of this study suggest that diabetes education counseling may be selectively given to patients who are not in glycemic control. These findings indicate the need for examining referral systems and quality of diabetes care. Future studies should assess the effectiveness of patient-centered medical care provided by a diabetes specialist with consideration of sociodemographics, in particular, race/ethnicity and gender.

This cross sectional study examines the association between caffeine intake and type 2 diabetes (T2D) markers in three ethnicities: Haitian Americans (HA), African Americans (AA) and Cuban Americans (CA) with or without T2D. Subjects (CA=349, HA=257 HA and AA=249) with a mean age of 58.47 years were recruited at various community centers in South Florida. Fasting plasma glucose (FPG), glycosylated hemoglobin (A1C) and insulin levels were measured from blood samples following an overnight fast. Homeostasis Model Assessment 2 (HOMA-2) was used to estimate beta cell function (HOMA2-β) and insulin resistance (HOMA2-IR). Caffeine intake was collected using the semi-quantitative food frequency questionnaire (FFQ) developed by Walter Willett. Statistical analysis included t-test, chi-square and linear regression controlling for age, gender and waist circumference. Results indicated that as caffeine intake increased, CA with diabetes and AA without diabetes had significantly higher A1C levels (p=0.001 and p=0.042...