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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.

OBJECTIVE Fluid restriction is reported to be a barrier in providing adequate nutrition following cardiac surgery. The specific aim of this study was to evaluate the adequacy of nutritional intake during the postoperative period using anthropometrics by comparing preoperative weight status, as measured by weight-for-age z scores, to weight status at discharge home. DESIGN Prospective cohort study. SETTING Cardiac ICU at Miami Children's Hospital. PATIENTS Infants from birth to 12 months old who were scheduled for cardiac surgery at Miami Children's Hospital between December 2013 and September 2014 were followed during the postoperative stay. INTERVENTIONS Observational study. MEASUREMENTS AND MAIN RESULTS Preoperative and discharge weight-for-age z scores were analyzed. The Risk Adjustment for Congenital Heart Surgery 1 categories were obtained to account for the individual complexity of each case. In patients who had preoperative and discharge weights available (n = 40), the mean preoperative weight-for-age z score was -1.3 ± 1.43 and the mean weight-for-age z score at hospital discharge was -1.89 ± 1.35 with a mean difference of 0.58 ± 0.5 (p < 0.001). A higher Risk Adjustment for Congenital Heart Surgery 1 category was correlated with a greater decrease in weight-for-age z scores (r = -0.597; p = 0.002). CONCLUSIONS Nutritional status during the postoperative period was found inadequate through the use of objective anthropometric measures and by comparing them with normal growth curves. Increase in surgical risk categories predicted a greater decrease in weight-for-age z scores. The development of future protocols for nutritional intervention should consider surgical risk categories.

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

The purpose of the present study was to determine the association of unhealthy dietary food items with cardiometabolic risk factors with and without sociodemographic factors.This cross-sectional study used data available to the public from the National Health and Nutrition Survey (NHANES) 2009-2010 where unhealthy food consumption was based on responses to the Dietary Screener Questionnaire (unique to this NHANES cycle), and cardiometabolic risk factors were based on laboratory results, anthropometric measures, interview and examination questions for 2045 adults aged 20-69 and belonging to four racial/ethnic groups: 473 Mexican Americans (MA); 267 Other Hispanics (OH); 389, non-Hispanic Blacks (NHB) and 916 non-Hispanic Whites (NHW) (characterised by NHANES).A higher percent of MA, followed by OH and NHB, consumed soft drinks as compared to NHW. Consumption of fried potatoes was over 75% across groups and was associated with higher odds dyslipidaemia (high non-HDL cholesterol) in the reduced model: OR = 1.38 (1.10, 1.73), P = 0.009 and full model: OR = 1.50 (1.15, 1.96), P = 0.005. All unhealthy foods measured were consumed more often by males as compared to females.Dyslipidaemia was associated with fried potato consumption and marginally with processed meats. Dietary interventions, tailored to specific populations, are needed to determine if substituting healthy foods in place of unhealthy ones will improve cardiometabolic outcomes.

Background. The Older Americans Act (OAA) requires that nutrition programs provide meals and related nutrition services that promote health and help manage chronic diseases. The purpose of this study was to compare health status, food security, functional limitations, and chronic diseases of older adults who received or did not receive OAA meals using data from a representative sample of US adults.Methods. Data were from the National Health and Nutrition Surveys 2011–2014 for 2,392 older adults ≥ 65 years of age, including 187 Mexican Americans, 212 other Hispanics, 521 non-Hispanic Blacks, 219 non-Hispanic Asians, and 1253 non-Hispanic Whites.Results. Those receiving OAA meals had higher percent of food insecurity and functional disabilities. Adjusting for potential confounders, adults who received OAA meals had higher odds of emphysema (OR = 2.02; 1.05, 3.89) and lower odds of good-to-excellent health (OR = 0.52; 0.36, 0.77). Women and minorities had poorer health status compared to non-Hispanic Whites.Conclusion. A higher proportion of older adults who received nutritional services reported poorer health as compared to older adults who do not participate in these services. Future studies should assess nutritional adequacy for older adults who participate in nutritional programs comparing sex and race/ethnicity.

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 (

Background. Lack of adherence to dietary and physical activity guidelines has been linked to an increase in chronic diseases in the United States (US). The aim of this study was to assess the association of lifestyle behaviors with self-rated health (SRH).Methods. This cross-sectional study used self-reported data from Living for Health Program (N=1,701) which was conducted from 2008 to 2012 in 190 health fair events in South Florida, US.Results. Significantly higher percent of females as compared to males were classified as obese (35.4% versus 27.0%), reported poor/fair SRH (23.4% versus 15.0%), and were less physically active (33.9% versus 25.4%). Adjusted logistic regression models indicated that both females and males were more likely to report poor/fair SRH if they consumed≤2 servings of fruits and vegetables per day (OR=2.14, 95% CI 1.30–3.54;OR=2.86, 95% CI 1.12–7.35, resp.) and consumed mostly high fat foods (OR=1.58, 95% CI 1.03–2.43;OR=3.37, 95% CI 1.67–2.43, resp.). The association of SRH with less physical activity was only significant in females (OR=1.66, 95% CI 1.17–2.35).Conclusion. Gender differences in health behaviors should be considered in designing and monitoring lifestyle interventions to prevent cardiovascular diseases.

OBJECTIVES: The prevalence of overweight and obesity has become a major public health concern in the United States. Snacks contribute to the diet quality in youth, which is often poor. Currently, there is a USDA guideline for healthy snacks which is lost in translation when youth are faced with the decision to choose a snack. This could be done using a smartphone application (app) to help identify healthy and unhealthy snacks. This study aimed to develop a user-friendly app to provide a simple output by assigning a score and feedback based on how compliant the snack is to the USDA guideline for healthy snacks and to evaluate it. METHODS: “Snackability” app was developed following the ADDIE (analysis, design, development, implementation, and evaluation) model. The app was pilot tested with 12 non-nutrition college age students (18–25 years) using a mixed method approach. Participants were instructed to use the app for 2 weeks. After this time, we evaluated the app in 2 ways: (1) using a questionnaire to evaluate if thefeasibility, usability, satisfaction, and acceptability was >50%; and (2) using focus groups to explore participants’ experiences and feedbacks with the app, which were audio recorded, transcribed, and coded to generate themes by NVivo software. This study was approved by the IRB and all participants signed an informed consent. RESULTS: The developed app had a simple score (0–10) and feedback. The higher the score, the healthier the snack is. The app feasibility and usability was significantly greater than 50% (P

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

Thymulin is a thymic peptide important for the maturation and differentiation of immature thymocytes, which have been found to be depressed in patients with low-level CD4(+) cell recovery despite viral control. Substance use is associated with faster progression of HIV disease, which has been ascribed to poor adherence to antiretroviral medication. Recent findings of an association between cocaine use and decline in CD4(+) cell counts independent of antiretroviral adherence indicate alternative mechanisms for disease progression. We evaluated the relationship between thymulin activity, CD4(+) and CD8(+) cell counts and the CD4(+)/CD8(+) ratio, and the covariate effects of substance use cross-sectionally in 80 HIV(+) active substance users and over 12 months in 40 participants. Thymulin activity was analyzed in plasma using a modification of the sheep rosette bioassay. Thymulin activity was negatively associated with cocaine use (β = -0.908,95% CI: -1.704, -0.112; p = 0.026). Compared to those who do not use cocaine, cocaine users were 37% less likely to have detectable thymulin activity (RR = 0.634, 95% CI: 0.406, 0.989 p = 0.045) and were 75 times more likely to show a decrease in thymulin activity (OR = 74.7, 95% CI: 1.59, 3519.74; p = 0.028) over time. CD4(+) cell count was positively associated with thymulin activity (β = 0.127, 95% CI: 0.048,0.205; p = 0.002), detectable thymulin activity was 2.32 times more likely in those with a CD4 cell count ≥200 cells/μl (RR = 2.324, 95% CI: 1.196, 4.513, p = 0.013), and those with an increase in CD4 cell counts were more likely to show an increase in thymulin activity (OR = 1.02, 95% CI: 1.00, 1.034; p = 0.041) over time. Thymulin activity is predictive of HIV disease progression and is depressed in cocaine users independent of antiretroviral treatment (ART) and HIV viral load. Understanding the mechanisms for accelerated HIV disease progression provides opportunities to find alternative strategies to counteract immunosuppression.

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.

OBJECTIVE: To compare self-perceived body size, desired body size, and actual body mass index (BMI) among adolescents in Jamaica, and to discuss the implications of these perceptions for chronic disease prevention. METHODS: A total of 276 Jamaican adolescents 14-19 years of age, randomly selected from grades 9-12 at 10 high schools participated in the study, which was conducted in October 2007. The perceived and desired BMI were measured using a silhouette of body figures representing nine BMI categories for males and females; these were compared to participants' actual BMI. RESULTS: Mean age was 15.6 ± 1.2 years. Actual BMI values classified 24.6% of the participants as underweight; 39.9% as normal; 14.5% as overweight; and 21% as obese. There were significant differences between participants' actual and perceived BMI (P < 0.01), actual and desired BMI (P < 0.01), and perceived and desired BMI (P < 0.01). Gender was significantly different for actual (P < 0.05), perceived, and desired BMI (P < 0.01). Females had significantly higher actual mean BMI than males (P < 0.05). Adolescent males perceived themselves as having a higher BMI and a desired higher BMI than females. There were no differences among ethnicity, age, place of residence, and socioeconomic status on the actual, perceived, and desired BMI in this study population (P > 0.05). CONCLUSIONS: Females had higher actual BMI and lower perceived BMI than males. Jamaican adolescents, irrespective of ethnicity, age, place of residence, and socioeconomic status, had similar BMI. Interventions are needed to improve knowledge of a healthy body weight and the relationships among body weight, lifestyle choices, and the implications of excess body weight on chronic diseases.OBJETIVO: Comparar el tamaño corporal autopercibido, el tamaño corporal deseado y el índice de masa corporal real (IMC) en adolescentes de Jamaica y analizar las implicaciones de dichas percepciones en la prevención de las enfermedades crónicas. MÉTODOS: El estudio se realizó en octubre del 2007 y participaron 276 adolescentes jamaiquinos de 14 a 19 años de edad, seleccionados aleatoriamente entre los grados 9 y 12 de 10 escuelas secundarias. Se midió el IMC percibido y el deseado usando figuras con una silueta corporal que representaban nueve categorías del IMC para hombres y mujeres, y se compararon con el IMC real de los participantes. RESULTADOS: La media de la edad fue de 15,6 ± 1,2 años. De acuerdo con los valores reales del IMC, 24,6% de los participantes se clasificaron como con peso inferior al normal; 39.9%, como normales; 14,5%, como con sobrepeso; y 21%, como obesos. Hubo diferencias significativas entre el IMC real y el percibido (P < 0,01), entre el IMC real y el deseado (P < 0,01) y entre el IMC percibido y el deseado (P < 0,01). El sexo constituyó una diferencia significativa para el IMC real (P < 0,05), percibido y deseado (P < 0,01). Las mujeres tenían un IMC real medio significativamente mayor que los hombres (P < 0,05). Los adolescentes varones se autopercibían como con un IMC mayor y un IMC deseado mayor que las mujeres. No hubo diferencias en cuanto al grupo étnico, la edad, el lugar de residencia y la situación socioeconómica en el IMC real, percibido y deseado en esta población de estudio (P > 0,05). CONCLUSIONES: Las mujeres tenían un IMC real mayor y un IMC percibido menor que los hombres. Los adolescentes jamaiquinos tenían un IMC similar, independientemente de su grupo étnico, edad, lugar de residencia o situación socioeconómica. Es necesario realizar intervenciones para mejorar los conocimientos sobre el peso corporal saludable y sobre la relación entre el peso corporal, las opciones de modos de vida y las implicaciones del peso corporal excesivo en las enfermedades crónicas.

To compare self-perceived body size, desired body size, and actual body mass index (BMI) among adolescents in Jamaica, and to discuss the implications of these perceptions for chronic disease prevention.A total of 276 Jamaican adolescents 14-19 years of age, randomly selected from grades 9-12 at 10 high schools participated in the study, which was conducted in October 2007. The perceived and desired BMI were measured using a silhouette of body figures representing nine BMI categories for males and females; these were compared to participants' actual BMI.Mean age was 15.6 ± 1.2 years. Actual BMI values classified 24.6% of the participants as underweight; 39.9% as normal; 14.5% as overweight; and 21% as obese. There were significant differences between participants' actual and perceived BMI (P0.01), actual and desired BMI (P0.01), and perceived and desired BMI (P0.01). Gender was significantly different for actual (P0.05), perceived, and desired BMI (P0.01). Females had significantly higher actual mean BMI than males (P0.05). Adolescent males perceived themselves as having a higher BMI and a desired higher BMI than females. There were no differences among ethnicity, age, place of residence, and socioeconomic status on the actual, perceived, and desired BMI in this study population (P0.05).Females had higher actual BMI and lower perceived BMI than males. Jamaican adolescents, irrespective of ethnicity, age, place of residence, and socioeconomic status, had similar BMI. Interventions are needed to improve knowledge of a healthy body weight and the relationships among body weight, lifestyle choices, and the implications of excess body weight on chronic diseases.

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

Objectives Few studies address gender and ethnic variations in essential fatty acid (EFA) intake and risk factors for coronary heart disease (CHD). The purpose of this study was to estimate EFA intake among college students of 3 ethnic groups and compare the relationship between EFA intake and CHD risk factors. Methods Using a cross-sectional design, 300 subjects from 3 ethnic groups—one-third (n=100) non-Hispanic white, one-third Hispanic, and one-third non-Hispanic black—completed the Cardiovascular Risk Assessment Instruments and a Food Frequency Questionnaire to determine fatty acid intake. Measured CHD risk factors were quantified as CHD Risk Point Standards (CHDRPS). Results Results showed that Hispanic females had a significantly higher mean percent intake of arachidonic acid and ratio of linoleic acid to a-linolenic acid than non-Hispanic white females, and Hispanic males had significantly higher mean percent intake of EPA and [EPA plus docosahexae-noic acid (DHA)] than non-Hispanic white males. An inverse correlation was found between CHDRPS and DHA among non-Hispanic blacks. A significant positive correlation was found between CHDRPS and linoleic acid among non-Hispanic white females, as well as serum homocysteine (tHcy) concentrations and the ratio of linoleic acid to a-linolenic acid intake among non-Hispanic black females. Conclusion Gender and ethnic differences play a role in adherence to dietary guidelines, demonstrating relevance for future research in this area.

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).

Objective To assess risk factors for diarrheal illness among clients of a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinic in Miami, FL. Design A cross-sectional survey with questions about demographics, food safety practices, and diarrheal illness. Setting WIC clinic operated by the Miami-Dade County Health Department in Florida. WIC is a national program for nutritionally at-risk, low-income young children and pregnant or postpartum women. Participants WIC female clients at least 18 years of age who are able to read and speak English (n = 299). Main Outcome Measure Diarrheal illness, defined as having at least 3 loose stools for 2 or more consecutive days during the previous 30 days. Analysis Univariate and multiple logistic regression analyses. Results Food safety behaviors significantly associated with diarrheal illness included not washing hands before preparing meals ( P = .048) and baby bottles ( P = .045) or after changing diapers ( P = .009) and not washing all items that touched raw meat before preparing the next food item ( P = .023). In general, pregnant women reported less frequent hand washing and had a lower food safety score than nonpregnant women ( P = .002). Conclusions and Implications These findings suggest that interventions to improve food handling practices such as proper hand washing are needed for WIC clients, particularly pregnant women.

This study investigated the practices, attitudes, and beliefs of Florida's nurses and dietitians regarding dietary supplements (DS). Eighty-nine dietitians and 64 nurses responded to a self-reported online survey about nutrient-based supplements, defined as nutrients taken to supplement the diet for enhancing health, and herbal supplements, defined as plants used for enhancing health rather than food seasoning. Personal use of nutrient-based supplements for treatment of a health condition was higher among nurses (67%) than dietitians (42%) (p

Pregnant women and infants are two groups at the highest risk of severe outcomes from foodborne illnesses. We surveyed adult clients of a Women, Infants, and Children (WIC) clinic serving predominately African Americans in inner-city Miami, Florida, to assess food safety practices. Eligible and consenting women completed a 23-item self-administered survey with questions concerning food handling practices around the Partnership for Food Safety Education's Fight BAC! campaign constructs of "clean", "separate" (not cross-contaminated), "cook", and "chill". Of 342 eligible clients, 299 (87.4%) consented to participate. In general, the clients' food safety practices were most problematic in the cook and chill constructs. Using a cooking thermometer, refrigerating foods within 2 h, and thawing them safely were the least commonly reported safe practices. Women who were pregnant with their first child had the lowest food safety practice scores. Of the 62 pregnant participants, 32 (51.6%) reported eating hot dogs or deli meats without first reheating them some of the time or more often, and 22 (35.5%) reported eating soft cheeses and blue-veined cheeses some of the time or more often, putting the women at risk of listeriosis. Although all women in the WIC program could benefit from food safety education, these findings indicate that women during their first pregnancy should especially be targeted for food safety education.

Cereal grains and germs are good sources of various phytochemicals. The major phytochemicals present in cereal grains are: phenolic acids, flavones, phytic acid, flavanoids, coumarins, and terpenes. Cereal germs are good sources of ferulic acid, phytic acid, glutathione, and phytosterols. In addition, the cereal germ acontains the vitamins E, B1, B2, and B3, the minerals P, K, Mg, Ca, Zn, and S, and fiber. Because of its rich nutrient content, cereal germ would be a valuable ingredient for production of functional foods. Our article examines the feasibility of using constituents of selected cereal grains such as wheat, oat, psyllium, and barley in producing functional foods.

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...

Objective: The aim of this study was to assess the relationship between pulse pressure (systolic blood pressure (SBP) and diastolic blood pressure (DBP) differences), and blood triglyceride levels in a young multi-ethnic group living in South Florida. Methods: This cross-sectional study included 77 young adults, males (n=40) and females (n=37), ages 18-36 years recruited from Florida International University campus. Serum 25-hydroxy vitamin D and triglyceride were measured by ELISA method. SBP and DBP were measured by an automated monitor. Alcohol consumption and tobacco use were calculated from a demographic questionnaire. A multi-linear regression model was run, adjusting for age, body mass index, serum vitamin D level, alcohol consumption and tobacco use. Results: Pulse pressure was positively associated with triglycerides (P=0.002), while 25(OH)D was negatively associated (P=0.047). This association remained significant after controlling for covariates (B=2.541, P=0.002 for pulse pressure, B=-2.049, P...