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Background: Emerging evidence supports significant variations in cardiovascular health (CVH), as defined by the American Heart Association (AHA) using “Life’s Simple 7” metrics, among Hispanics in the mainland US by sex and heritage group. Of these, Hispanic men and those of Puerto Rican background are less likely to meet favorable CVH criteria. Yet data on young men and women residing in Puerto Rico, an understudied population with a unique sociocultural context, are scarce. We assessed sex differences in CVH among young adults living in Puerto Rico. Measures: We used PR-OUTLOOK baseline data, collected between September 2020 and September 2022, for this analysis. Participants were between the ages of 18-29 years. CVH was measured using the AHA Life’s Essential 8 (LE8) score, a revised composite metric of physical activity, smoking, diet, sleep, body mass index (BMI), blood pressure, blood glucose, and non-HDL cholesterol. The total score ranges from 0-100, with higher scores indicating better CVH. For this analysis, the measure was modified to exclude diet given the lack of dietary data. Multivariable linear regression models were used to assess sex differences in the overall CVH score and its components. Analyses were adjusted for age, sex, marital status, and childhood material deprivation. Results: The sample included 964 adults - 619 women and 345 men. In adjusted analysis, women had a higher overall CVH score compared to men (β=2.77, 95% CI: 1.10, 4.44). Women also had higher scores for nicotine exposure (β=9.24, 95% CI: 5.18, 13.29), non-HDL cholesterol (β=4.31, 95% CI: 1.11, 7.51), and blood pressure (β=13.22, 95% CI: 10.39, 16.05) but lower for physical activity (β=-9.55, 95% CI: -15.18, -3.91). There were no significant sex differences in scores for sleep health, BMI, and blood glucose. Conclusion: There are sex differences in CVH among young adults in Puerto Rico, with women having overall better CVH. Interventions to improve nicotine exposure, non-HDL cholesterol, and blood pressure in men and participation in physical activity in women are needed to enhance and preserve overall CVH.

Background: Depressive symptoms are associated with cardiovascular disease (CVD) incidence, morbidity and mortality. Less is known about the association between depressive symptoms and overall cardiovascular health (CVH) of young adults, an age group that commonly experiences depressive symptoms. We examined the association between depressive symptoms and a metric of overall CVH among young Puerto Ricans, a high risk but understudied population. Measures: We used data from PR-OUTLOOK, a study of CVH among individuals aged 18-29 residing in Puerto Rico, obtained between September 2020 and September 2022. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). CVH was assessed using the AHA Life’s Essential 8 metric, which includes modifiable behavioral (nicotine exposure, diet, physical activity, sleep health) and biological (body mass index- BMI, blood lipids, blood pressure, and blood glucose) components. For this analysis, this metric was modified to exclude diet. Higher scores (range 0-100), overall and for each component, indicate better CVH. Covariates included age, sex, marital status, and childhood material deprivation. Multivariable linear regression models were used to assess the relationships of CES-D-10 score with overall CVH score and its individual components. An interaction term for sex and CES-D-10 was added to the models to examine potential differences by sex. Results: The sample (n=964; mean age: 22.6 ±3.1) was largely female (64%) and single (89%), and a third (33%) reported having experienced material deprivation in childhood. Over half (58.6%) reported depressive symptoms above the cut-off for likely clinical depression (CES-D-10 >10). The overall mean CVH score was 80.2±12.8, with almost half of the sample (42.8%) having a score < 80. Mean scores for the CVH components were lowest for physical activity (57.2±43.2) and BMI (71.4±33.9). In adjusted models, significant inverse associations were observed between CES-D-10 with overall CVH (-4.21, 95%CI: -5.84,-2.58) and several CVH components: nicotine exposure (-4.28; 95%CI: -8.28,-0.28), physical activity (-9.32; 95%CI: -14.87,-3.78), BMI (-6.54; 95%CI: -10.94,-2.15), and blood pressure (-3.02; 95%CI: -5.81,-0.23). No significant interaction was observed between CES-D-10 and sex. Conclusion: Depressive symptoms were inversely associated with CVH and four of the seven assessed CVH components. Longitudinal analyses should elucidate the potential contribution of depressive symptoms to reduction in CVH in young adults. Understanding factors associated with CVH among young Puerto Ricans may help elucidate CVD prevention targets for this vulnerable population.

Objective Despite evidence on allostatic load (AL) as a model explaining associations between stress and disease, there is no consensus on its operationalization. This study aimed to contrast various AL constructs and their longitudinal associations with disease and disability. Methods Baseline and 5-year follow-up data from 738 adults participating in the Boston Puerto Rican Health Study were used. Five AL scores were created by summing presence of 21 dysregulated multi-system physiological parameters using: (1) z-scores, (2) population-based quartile cutoffs, (3) clinical-based cutoffs, (4) ten pre-selected clinical-based cutoffs (AL-reduced); and (5) twelve clinical-based cutoffs selected a posteriori based on association with disease (AL-select). Adjusted logistic regression models examined associations between each AL score at baseline and 5-year incident type 2 diabetes (T2D), cardiovascular disease (CVD), activities (or instrumental activities) of daily living (ADL; IADL) for physical impairment, and cognitive impairment. Results AL-quartile was associated with greater odds of T2D (OR = 1.20; 95%CI = 1.07-1.35) and CVD (OR = 1.14; 95%CI = 1.06-1.22). AL-reduced was associated with higher odds of IADL (OR = 1.21; 95%CI = 1.07-1.37) and AL-clinical with CVD (OR = 1.14; 95%CI = 1.07-1.21), IADL (OR = 1.11; 95%CI = 1.04-1.19), and ADL (OR = 1.15; 95%CI = 1.04-1.26). AL-select showed associations with T2D (OR = 1.35; 95%CI = 1.14-1.61), CVD (OR = 1.21; 95%CI = 1.11-1.32), IADL (OR = 1.15; 95%CI = 1.04-1.26), and ADL, (OR = 1.24; 95%CI = 1.08-1.41). No associations were found with AL-zscore. Conclusion AL scores computed with clinical-based cutoffs performed robustly in our sample of mainland Puerto Ricans, whereas z-scores did not predict disease and disability. AL-select was the most consistent predictor, supporting its use as a disease-predicting model. Future assessment of AL-select in other populations may help operationalize AL.

Dysfunctional eating behaviors (DEB: emotional eating (EE), uncontrolled eating (UE) and cognitive restraint (CR)) are prevalent in U.S. Latinos and may influence diet. However, this has not been studied in Puerto Rico (PR). This study documents DEB in PR, and explores associations with diet. Cross-sectional study of adults (n = 92) in Ponce, PR. DEB were measured with the TFEQ-R18-V2. The Block Fat and Fruits and Vegetables Screener measured dietary intake. Analysis included adjusted proportions, means and linear regressions. 76%, 88%, and 87% of participants experienced EE, UE and CR, respectively. EE was associated with calories from fats (β = 1.95, 95% CI 0.40, 3.51) and saturated fats (β = 3.26, 95% CI 0.67, 5.85), and CR with fruits and vegetables (β = 0.69, 95% CI 0.20, 1.19). A large percentage of the sample experienced DEB. EE and CR were associated with dietary intake. Studies are needed to understand associations between DEB, diet and health in PR.

Background: Widespread vaccination against COVID-19 is essential to control the pandemic. Estimates of unwillingness and uncertainty toward COVID-19 vaccination and factors associated with it remain unclear among adults in Puerto Rico (PR). Objective: To examine factors associated with uncertainty and unwillingness of COVID-19 vaccination among adults in PR. Methods: The Health Belief Model was used to develop an online survey. Analyses included adjusted logistic regressions (aOR). A total of 1,911 adults completed the survey from December 2020 to February 2021. Results: Overall, 76.2% were females, 33.7% were aged 50 or older, and 82.7% reported an intent to get vaccinated. Individuals who did not perceive that their chances of getting COVID-19 were high (aOR = 2.94; 95%CI = 2.24–3.86), that getting COVID-19 was not a possibility for them (aOR = 2.86; 95%CI = 2.19–3.74), or unafraid of getting COVID-19 (aOR = 3.80; 95%CI = 2.76–5.23) had higher odds of uncertainty and unwillingness to get vaccinated against COVID-19. Participants who perceived that COVID-19 complications were not serious also had higher odds of uncertainty and unwillingness (aOR = 7.50; 95%CI = 3.94–14.3), whereas those who did not perceive that they would get very sick with COVID-19 had 89% increased odds. Those who agreed that they would only take the vaccine if many individuals took it had higher odds of uncertainty and unwillingness (aOR = 3.32; 95%CI = 2.49–4.43). The most reported reasons for uncertainty and unwillingness toward COVID-19 vaccination were vaccine safety (63.8%), efficacy (49.4%), and novelty (45.5%). Discussion: Although COVID-19 vaccination intent was high, the study highlights concern over vaccine safety and efficacy that should be addressed by public health campaigns and interventions to enhance vaccine uptake.

This systematic review examined the extent to which lifestyle physical activity interventions that used wearable devices (eg, pedometers, accelerometers) reported on the length of device wear time requested in their protocols, criteria for analytic inclusion of data, and participant compliance with device use protocols. Literature were searches were conducted using PubMed, Cochrane Central Register, and PsychInfo. Studies were included if they were the main outcomes paper of a trial that reported on a randomized or quasi-randomized trial focused on increasing lifestyle physical activity and were published between January 1, 2006 and March 30, 2016. Titles and abstracts were screened by 2 independent reviewers; eligible full texts were retrieved and reviewed by 2 independent reviewers. A total of 104 studies used wearable devices (n = 57 pedometers, n = 47 accelerometers). Most studies (n = 65, 67.3%) asked participants to wear devices for 7 days. Almost half of the studies (n = 46, 44.2%) did not report minimum device wear time required for analytic inclusion of data, and variation existed among studies reporting these criteria. Most studies (n = 60, 57.7%) did not report average device wear time, or participant compliance with device wear. Overall, there was heterogeneity in reporting of physical activity device data. Refinement and streamlining of guidelines for device use, analysis, and reporting of data could improve comparability across studies.

Background Latinos experience disparities in obesity. Although causes of obesity are multifactorial, overeating is a major contributor. Emotional eating (EE) is associated with obesity and with intake of energy-dense foods. However, the relationship between EE and overeating, and the mediating role of energy-dense foods on this relationship, has not been studied. Objective This study examined the association between EE and overeating among Latinos and the potential mediating role of energy-dense food consumption on this relationship. Methods This study had a cross-sectional design. Participants were recruited from a community health center. EE was assessed with the Three Factor Eating Behavior Questionnaire R18-V2. Overeating was calculated from the Mifflin-St Jeor equation. Energy-dense food intake was assessed with a Food Frequency Questionnaire. Mediation was tested with bootstrapping. Results Participants (n = 200) were 53.5% female and 78% were overweight or obese. Approximately 60% of the sample reported EE and 45.5% engaged in overeating. Percentage of calories from energy-dense foods was 23%. EE was significantly associated with overeating (OR total effect = 1.23; 95%CI = 1.03, 1.45) and this relationship was partly mediated by intake of energy-dense foods (OR indirect effect = 1.06; 95%CI = 1.02, 1.15; mediated proportion = 31.5%). Conclusion In this Latino sample, EE was positively associated with overeating and intake of energy-dense foods partially mediated this association. Examination of longitudinal associations between EE, energy-dense foods, overeating and obesity is warranted. Understanding these associations may provide information to develop effective interventions to prevent and manage obesity among Latinos.

Background Puerto Rican adults residing in the US mainland experience a high prevalence of metabolic syndrome (MetS). A diet containing healthy protein-rich sources may help control risk factors for MetS. Objective This study aimed to evaluate 2-year longitudinal associations between intake of various protein-rich foods and changes in the six MetS components. Design This is a secondary analysis of a longitudinal cohort study using data from the baseline (2004–2007) and 2-year follow-up visits (2006–2011) in the Boston Puerto Rican Health Study. Participants/setting Participants were self-identified Puerto Ricans, aged 45 to 75 years, residing in Boston, Massachusetts, or the surrounding area (n = 1,126). Main outcome measures MetS components were fasting glucose, high-density lipoprotein (HDL) cholesterol, triglycerides, systolic and diastolic blood pressures, and waist circumference. Statistical analysis Baseline intake of foods reported in a semiquantitative food frequency questionnaire were expressed as servings/day, and protein-rich foods were categorized as unprocessed white meat, unprocessed red meat, processed meat, milk and yogurt, cheese, fish and seafood, beans, nuts, and eggs. Associations between each continuous protein food group and continuous 2-year change in MetS components were assessed using linear mixed models adjusted for socioeconomic and behavioral factors, and other dietary sources. Results The top contributors to total protein intake were unprocessed red meat (13.3%) and unprocessed poultry (13.0%), and the lowest were eggs (2.92%) and nuts (0.91%). Higher intake of processed meats was associated with an increase in waist circumference over 2 years (β = 1.28; standard error [SE] = 0.63), whereas higher intake of fish and seafood was associated with a decrease in waist circumference (β = −3.47; SE = 1.39). Intake of unprocessed poultry was associated with a decrease in triglycerides (β = −24.5; SE = 9.13). No other significant associations were observed between protein sources and 2-year changes in MetS components. Conclusions Consuming less processed meat and more fish and seafood and unprocessed poultry was associated with decreases in waist circumference and triglycerides among US mainland Puerto Ricans. Other dietary protein sources were not related to cardiometabolic health.

OBJECTIVES: To examine the mediating role of emotional eating (EE) in the association between food insecurity (FI) and obesity in U.S. Latina women. METHODS: This study had a cross-sectional design. Participants were Latina women (n = 297) recruited from a community health center serving a large portion of the Latino population in Lawrence, Massachusetts. FI was measured with the 6-item USDA Household Food Security Scale. EE was measured with the Three Factor Eating Questionnaire R18-V2. Measured height and weight were used to calculate BMI; obesity was defined as BMI > 30.0 kg/m2. Covariates included: age, education, marital status, physical activity and country of birth. Mediation was tested using the Baron and Kenny method and the mediated proportion was calculated. Analyses included multivariable logistic regression and linear regression. RESULTS: Women were on average 46 ± 5 years. The majority were Dominicans (73%), born outside of the U.S. (78%), and with an education level of high school or less (70%). Overall, 36% of women experienced FI. Compared to food secure women, FI women were more likely to be obese (42% vs. 58%; P = 0.01), and had higher emotional eating scores (2.02 vs. 1.78; P = 0.03). In adjusted models, FI was associated with higher odds of obesity (Step 1 = OR: 1.78; 95% CI: 1.08–2.94) and higher EE scores (Step 2 = 0.23; 95% CI: 0.009–0.45). In turn, EE was associated with higher odds of obesity (Step 3 = OR: 1.81; 95% CI: 1.37–2.41). When EE was included in the main effects model, FI was only marginally significantly associated with obesity (Step 4 = OR: 1.62; 95% CI: 0.96–2.72) and EE explained 22% of the association between FI and obesity. CONCLUSIONS: The association between FI and obesity is partially mediated by EE in Latina women. Longitudinal studies are needed to confirm our findings and to determine whether EE is an important intervention target to decrease obesity in this vulnerable group. FUNDING SOURCES: Research reported in this abstract was supported by the National Institutes of Health, National Institute of Mental Health, National Institute of Minority Health and Health Disparities and Centers for Disease Control and Prevention.

OBJECTIVES: To evaluate the validity of a single-item diet quality measured as a rapid and cost-effective means of dietary assessment among adults living in Puerto Rico (PR), a population with access to and a cultural preference for specific foods. METHODS: This cross-sectional study used data from the PR Assessment of Diet, Lifestyle, and Diseases (2015). Self-perception of diet quality was reported (n = 247, age = 35–75 y) for the current day, young adulthood, and childhood (five-point scale: excellent to poor). We used a culturally adapted food frequency questionnaire to measure dietary intake, and computed diet quality (range: 0–110) with the Alternate Healthy Eating Index-2010 (AHEI). We conducted multivariable generalized linear models to assess relationships between current AHEI and perception of diet quality at three-time points. RESULTS: We categorized current self-rated diet quality into ‘excellent or very good’ (37%), ‘good’ (35%), or ‘fair or poor’ (28%); the overall mean AHEI was 60.1 +/– 11.0. Sensitivity of single-item measure was 60% and specificity was 34%. Current self-rated diet quality was not significantly associated with AHEI score, although adjusted mean scores for fruit and or long-chain fatty acids were significantly lower among participants reporting fair or poor diet, vs. excellent or very good (β = −0.49, 95% CI = −0.97, −0.014; β = −0.52, 95% CI = −0.98, −0.049). In contrast, mean adjusted AHEI score was significantly higher among those rating their diet quality as fair or poor in young adulthood (36%; β = 6.4, 95% CI = 2.4,10.5), and marginally higher among those reporting fair or poor diet quality in childhood (27%; β = 3.99; 95% CI = −0.01,8.04), vs. those rating their diet as excellent or very good, at respective time points. CONCLUSIONS: A single-item perceived diet measure is not a valid assessment of current diet quality for adults in PR. Interestingly, perception of low diet quality in earlier life stages is associated with higher quality of the actual current diet. Nutrition researchers may use self-rated diet quality in earlier life stages to estimate current diet quality; the mechanisms driving this relationship warrant further investigation. FUNDING SOURCES: CG is supported by an NIH/NCI training grant. PRADLAD was funded with anonymous donations and an NIH/NHLBI award.

OBJECTIVE: To examine the mediating role of emotional eating (EE) in the association between food insecurity (FI) and obesity in Latina women. DESIGN: Cross-sectional study. PARTICIPANTS: Women (n=297) were recruited from a community health center in Lawrence, Massachusetts. VARIABLES MEASURED: The 6-item USDA Household Food Security Scale was used to measure FI. The Three Factor Eating Questionnaire R18-V2 was used to measure EE. Measured height and weight were used to calculate BMI. Covariates included: age, education, marital status, number of children in the house, physical activity and country of birth. ANALYSIS: Multivariable logistic and linear regressions. Mediation was tested using the Baron and Kenny method and the mediated proportion was calculated. RESULTS: Overall, 36.7% of women experienced FI. In adjusted regression models, FI was positively associated with obesity (OR: 1.79; 95%CI: 1.08–2.97; p=0.023) and with EE (β: 0.22; 95%CI: 0.001–0.44; p=0.049), and EE was positively associated with obesity (OR: 1.82; 95%CI: 1.37–2.42; p

BACKGROUND: Psychological stress may influence health by negatively affecting dietary intake. However, there are few studies on the connection between stress and dietary intake in Puerto Rico (PR), a population with documented poor diet quality. OBJECTIVE: To explore the association between perceived stress and intake of macronutrients and diet quality among adults in PR. DESIGN: Cross-sectional data came from the Puerto Rico Assessment of Diet, Lifestyle, and Diseases study (2015). PARTICIPANTS: This analysis included data from 238 adults (30–75y) in the San Juan metro area. MAIN OUTCOME MEASURES: Dietary intake was measured with a food frequency questionnaire adapted and validated to the PR population. The Alternate Healthy Eating Index (AHEI) score was calculated to measure diet quality. STATISTICAL ANALYSES: Multivariate linear models adjusted for socio-demographics, anthropometrics, behavioral factors and social support were used to determine adjusted mean macronutrient intake and AHEI scores by perceived stress category. RESULTS: In models adjusted for socio-demographic characteristics, high perceived stress was significantly associated with higher intake of total energy, added sugars, and saturated fats, lower intake of dietary fiber and vegetable protein, and lower AHEI score, compared to low perceived stress (all p

Key Points Question What was the prevalence of chronic diseases and their associated risk factors among adults living in Puerto Rico before and after Hurricane Maria? Findings This cross-sectional study using data from 825 participants in 2 studies conducted in 2015 and 2019 found statistically significantly higher prevalence of unhealthy lifestyle behaviors and multiple chronic conditions among adults in Puerto Rico after Hurricane Maria. Higher social support, lower depressive symptoms, and lower perceived stress were observed after the hurricane. Meaning These findings suggest that as public health emergencies upsurge, continuous efforts will be necessary to sustain healthy behaviors, positive emotional health, and low rates of chronic diseases., This cross-sectional study assesses the prevalence of chronic diseases and their associated risk factors among adults living in Puerto Rico before vs after Hurricane Maria., Importance As public health emergencies become more prevalent, it is crucial to identify adverse physical and mental health conditions that may be triggered by natural disasters. There is a lack of data on whether Hurricane Maria in 2017 influenced the disease burden of adults in Puerto Rico. Objective To estimate the prevalence of chronic diseases and their associated risk factors among adults living in Puerto Rico before and after Hurricane Maria in 2017. Design, Setting, and Participants This cross-sectional study used data from 2 previous cross-sectional studies, including the pre–Hurricane Maria Puerto Rico Assessment on Diet, Lifestyles and Disease (PRADLAD) study, conducted in 2015, and the post–Hurricane Maria Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT), conducted in 2019. Participants included adults aged 30 to 75 years residing in Puerto Rico. Data were analyzed from April to October 2020. Exposures Self-reported data were obtained on sociodemographic, lifestyle, and psychosocial factors and medically diagnosed conditions using validated questionnaires. Anthropometrics were measured in triplicate. Main Outcomes and Measures Data were obtained using similar protocols in both studies. Characteristics were contrasted for all participants across studies and for 87 PRADLAD participants who returned to PROSPECT. Results A total of 825 participants from both cohorts were included, with 380 PRADLAD participants and 532 PROSPECT participants. In the 2019 PROSPECT study, the mean (SD) age was 53.7 (10.8) years, and 363 participants (68.2%) were assigned female at birth and 169 participants (31.8%) were assigned male at birth. In the 2019 cohort, 360 participants (67.7%) had college education or higher, 205 participants (38.5%) reported annual income greater than $20 001, and 263 participants (49.5%) were employed. Most sociodemographic variables were similar between studies, except for higher income and employment after the hurricane. In the main analysis, participants in 2019, compared with participants in 2015, had higher abdominal obesity (389 participants [73.2%] vs 233 participants [61.3%]), sedentarism (236 participants [44.4%] vs 136 participants [35.8%]), binge drinking (95 participants [17.9%] vs 46 participants [12.1%]), and social support (mean [SD] score, 26.9 [7.2] vs 24.7 [7.1]) but lower depressive symptoms (169 participants [31.7%] vs 200 participants [52.6%]) and perceived stress (mean [SD] score, 19.3 [9.5] vs 21.7 [7.7]). In 2019, compared with 2015, there were higher rates of hypertension (252 participants [47.3%] vs 149 participants [39.2%]), arthritis (172 participants [32.3%] vs 97 participants [25.6%]), high cholesterol (194 participants [36.4%] vs 90 participants [23.8%]), high triglycerides (123 participants [23.1%] vs 56 participants [14.7%]), eye disease (94 participants [17.6%] vs 48 participants [12.7%]), fatty liver disease (68 participants [12.8%] vs 29 participants [7.5%]), and osteoporosis (74 participants [13.9%] vs 20 participants [5.2%]). Secondary analysis for the 87 returning participants showed similar results. Conclusions and Relevance In this cross-sectional study, a higher prevalence of unhealthy behaviors and chronic conditions was noted among adults in Puerto Rico after Hurricane Maria, warranting long-term studies. Psychosocial factors were better, but still need attention. As natural disasters intensify, efforts should focus on continuous surveillance of health outcomes and promoting healthy behaviors, positive emotional health, and disease control, particularly in populations with higher risk for poor health.

Background Latinos are at high risk for cardiovascular disease (CVD). Identifying behavioral factors associated with CVD risk in this population may provide novel targets for further research to reduce chronic disease disparities. Dysfunctional eating patterns (emotional eating [EE], uncontrolled eating [UE], and cognitive restraint of eating [CR]) may be associated with CVD risk but little is known about this relationship in Latinos. Objective The aim of this study was to examine associations between dysfunctional eating patterns and metabolic risk factors for CVD in Latinos. Design The study used a cross-sectional design. Participants/setting Latino individuals (n=602), aged 21 to 84 years, were enrolled in the study from September 2011 to May 2013 from a community health center that serves 80% to 85% of the Latino population in Lawrence, MA. Individuals with complete data were included in this analysis (n=578). Measures Dysfunctional eating patterns were measured with the Three Factor Eating Questionnaire-R18V2. CVD risk factors examined included obesity assessed by body mass index and waist circumference and diagnoses of type 2 diabetes, hypertension, and hyperlipidemia abstracted from electronic health records. Statistical analysis Multivariable logistic and Poisson regressions adjusting for age, sex, perceived income, employment, education, physical activity, and perceived stress were performed. The no dysfunctional eating category (ie, no EE, no UE, or no CR) was used as the reference category in all analyses. Results High EE was associated with greater odds of obesity (odds ratio [OR] 2.19, 95% CI 1.38 to 3.45) and central obesity (OR 2.97, 95% CI 1.81 to 4.87), and diagnosis of type 2 diabetes (OR 1.99, 95% CI 1.13 to 3.48) and hypertension (OR 2.01, 95% CI 1.16 to 3.48). High UE was associated with obesity (OR 1.96, 95% CI 1.20 to 3.21) and central obesity (OR 2.33, 95% CI 1.38 to 3.94). Low and high CR were associated with obesity (OR 2.26, 95% CI 1.43 to 3.56 and OR 2.77, 95% CI 1.75 to 4.37, respectively) and central obesity (OR 2.04, 95% CI 1.25 to 3.32 and 2.51, 95% CI 1.54 to 4.08, respectively) and diagnosis of type 2 diabetes (OR 1.83, 95% CI 1.05 to 3.16 and OR 2.73, 95% CI 1.58 to 4.70, respectively) and hyperlipidemia (OR 1.94, 95% CI 1.16 to 3.24 and OR 2.14, 95% CI 1.28 to 3.55, respectively). Lastly, high EE and low and high CR were associated with increased odds of having a greater number of metabolic CVD risk factors (incidence-rate ratio [IRR] 1.33, 95% CI 1.13 to 1.58; IRR 1.34, 95% CI 1.13 to 1.58; and IRR 1.44, 95% CI 1.22 to 1.71, respectively). Conclusions Dysfunctional eating patterns were positively associated with metabolic CVD risk factors in this Latino sample, with dose–response relationships for some associations. Future studies are needed to determine whether dysfunctional eating patterns influence CVD risk factors among Latinos.

Valid, reliable, and direct measures of physical activity (PA) are critical to assessing the impact of lifestyle PA interventions. However, little is known about the extent to which objective measures have been used to assess the outcomes of lifestyle PA interventions. This systematic review had two aims: 1) evaluate the extent to which PA is measured objectively in lifestyle PA interventions targeting adults and 2) explore and summarize what objective measures have been used and what PA dimensions and metrics have been reported. Pubmed, Cochrane Central Register, and PsychInfo were searched for lifestyle PA interventions conducted between 2006 and 2016. Of the 342 articles that met the inclusion criteria, 239 studies measured PA via subjective measures and 103 studies measured PA via objective measures. The proportion of studies using objective measures increased from 4.4% to 70.6% from 2006 to 2016. All studies measuring PA objectively utilized wearable devices; half (50.5%) used pedometers only and 40.8% used accelerometers only. A majority of the 103 studies reported steps (73.8%) as their PA metric. Incorporating objective measures of PA should continue to be a priority in PA research. More work is needed to address the challenges of comprehensive and consistent collecting, reporting, and analyzing of PA metrics. Keywords: Accelerometry, Pedometer, Physical activity, Interventions, Systematic review/meta-analysis

Obesity remains a persistent public health and health disparity concern in the United States. Eliminating health disparities, particularly among racial/ethnic minority groups, is a major health priority in the US. The primary aim of this review was to evaluate representation of racial/ethnic sub-group members in behavioral weight loss interventions conducted among adults in the United States. The secondary aims were to assess recruitment and study design approaches to include racial/ethnic groups and the extent of racial/ethnic sub-group analyses conducted in these studies. PubMed, PsycInfo, Medline, and CINAHL were searched for behavioral weight loss intervention trials conducted in 2009–2015 using keywords: weight, loss, overweight, obese, intervention and trial. Most of the 94 studies included a majority of White participants compared to any other racial/ethnic group. Across the included studies, 58.9% of participants were White, 18.2% were African American, 8.7% were Hispanic/Latino, 5.0% were Asian and 1.0% were Native Americans. An additional 8.2% were categorized as “Other”. Nine of the 94 studies exclusively included minority samples. Lack of adequate representation of racial and ethnic minority populations in behavioral trials limits the generalizability and potential public health impact of these interventions to groups that might most benefit from weight loss. Given racial/ethnic disparities in obesity rates and the burden of obesity and obesity-related diseases among minority groups in the United States, greater inclusion in weight loss intervention studies is warranted., Highlights • Describes racial/ethnic minority inclusion in behavioral weight loss studies • Majority of studies continue to include a majority white sample. • Modest increases in the representation of some racial/ethnic minority groups. • Lack of adequate representation of minority groups limits generalizability. • Greater racial/ethnic inclusion in weight loss intervention studies is warranted.

To calculate micronutrient adequacy among infants and toddlers and to determine the contribution of dietary supplements to this adequacy, micronutrient intake was assessed using two nonconsecutive 24-hour recalls in a sample of 296 infants aged 0-24 months. Micronutrient intake was calculated from foods and beverages and from supplements and compared between nonusers and users of supplements. Percentages of children below the Dietary Reference Intake (DRI) and above the tolerable upper limit intake (UL) were also compared between groups. A total of 241 participants had complete data. The prevalence of dietary supplement use among the sample was 15%. Mean intake of all micronutrients from foods and beverages was similar between nonusers and users of supplements (p.05) but significantly higher for the following vitamins when supplements were included: D, E, B1, B2, B3, and B6 (p.05). From foods only, the nutrients with highest percentage of children below the DRI were vitamins D and E and potassium. When supplements were included, this percentage significantly decreased among users compared to nonusers (p.05) for vitamins D and E. From foods, the UL was exceeded for magnesium, zinc, and vitamin B3. These were similar when supplements were added. Supplements significantly increased the intake of some vitamins. Vitamins D and E had the highest percentage of children below the DRI, which was partly corrected with the use of supplements. The UL was exceeded for magnesium, zinc, and vitamin B3 in many children. It is important to understand these patterns as they may be indicative of future nutritional deficiencies and excesses.

Objective:To examine the association between food insecurity and emotional eating (EE) in US Latinxs and explore the mediating role of perceived stress.Design:Cross-sectional analysis. Food insecurity was measured with the six-item US Department of Agriculture Household Food Security Scale; EE with the Three-Factor Eating Questionnaire R18-V2; and perceived stress with Cohen’s Perceived Stress Scale-10. Covariates included age, sex, education, marital status, household size and country of birth. Mediation was tested using the Baron and Kenny method and the mediated proportion was calculated. Analyses included multivariable linear regression and multinomial logistic regression.Setting:A largely Latinx city in Massachusetts, USA. Participants were recruited from a community health centre serving a large portion of this Latinx community.Participants:Latinx individuals (n 580), aged 21–84 years.Results:Overall, 34·4 % were food insecure and 33·8 % experienced High EE. Food insecurity was associated (adjusted OR; 95 % CI) with higher odds of High EE (1·96; 1·28, 3·02) but not Low EE (1·27; 0·82, 1·99). Food insecurity was associated (β; 95 % CI) with higher perceived stress (5·69; 4·20, 7·19). Perceived stress was associated (adjusted OR; 95 % CI) with High EE (1·09; 1·06, 1·12) but not Low EE (1·00; CI 0·97, 1·02). When perceived stress was added in the main effects model, food insecurity was no longer associated (OR; 95 % CI) with High EE (1·31; 0·83, 2·07) and explained 69·9 % of the association between food insecurity and High EE.Conclusions:The association between food insecurity and high EE among Latinxs may be largely mediated by perceived stress. Longitudinal studies are needed.

OBJECTIVES: To examine the association between maternal diet quality and infant weight for length growth trajectory during their first year of life. METHODS: Participants were singleton infant-mother pairs (N = 77) enrolled in the Pregnancy and Postpartum Observational Dietary Study. Mothers completed socio-demographics and dietary (24-hour recalls) assessments at 3 months postpartum. The Alternate Healthy Eating Index (aHEI) was calculated to measure maternal diet quality. Infant weight for length measures from birth to 12 months were abstracted from pediatric records. World Health Organization guidelines were used to calculate infants’ weight for length percentiles. Group-based trajectory analysis was done to identify subgroups of infants with similar growth profiles and to evaluate the association between maternal aHEI and infant's growth trajectory. Models were adjusted for maternal age, race, education and excessive gestational weight gain (GWG). RESULTS: Mothers’ mean age was 28 years ± 5.2; 27% were Latina, and 55% had some college education or more; 60% had experienced excessive GWG; and their average aHEI was 26.7 ± 7.5. Three infant growth trajectories were identified: a low and stable growth group (43.2%), a rapid growth group (33.5%), and a moderate growth group (23.3%). Maternal aHEI was significantly associated with lower odds of having their infant in the rapid growth group (OR = 0.83; P = 0.012), with each unit increase in aHEI score being associated with 17% lower odds of infant's rapid growth. CONCLUSIONS: Trajectory models suggested three patterns of infant growth. Higher maternal diet quality was associated with lower odds of infant rapid growth. Future studies are needed to replicate these findings in larger cohorts and identify mediators of this association to prevent childhood obesity. FUNDING SOURCES: CCTS (UL1TR001453), NCATS (UL1TR000161), NIMHD (1P60MD006912-02), CDC (U48-DP001933), NIGMS (R25GM113686-02), NHLBI (F30HL128012), and Canadian Institutes of Health Research (DFS-140394).

OBJECTIVES: To assess the association between weight change and change in HbA1c in Puerto Rican men and women, and to evaluate the moderating role of perceived stress in this association METHODS: Baseline and 2-year data from the Boston Puerto Rican Health Study were used. Individuals on diabetes medications were excluded. The sample included 218 men and 549 women with complete measures at baseline and 2-year follow up. Stress was assessed with the Perceived Stress Scale-14 and HbA1c from fasting blood samples. Changes in weight, perceived stress, and HbA1c from baseline to year 2 were calculated (i.e., year 2 – baseline). Analyses included linear regression models stratified by sex and adjusted for baseline age, education, smoking status, diet quality, physical activity, body mass index (BMI), baseline HbA1c, diabetes status, menopause status and use of medications for hypertension, hyperlipidemia, depression and thyroid disease. Likelihood ratio (LR) tests were used to evaluate the interaction between weight change and change in perceived stress. RESULTS: Mean baseline to year 2 change in weight was −0.3 kg + 6.1 for women and 0.3 kg + 4.7 for men. Mean change in HbA1c was 0.03% + 0.87 for women and −0.07% + 1.16 for men. Weight change was associated with HbA1c change in women (= 0.037; P

Background Puerto Ricans experience a high prevalence of type 2 diabetes. Dietary glycemic load (GL) and allostatic load (AL) have been linked with diabetes. AL, the wear and tear on the body from chronic stress, starts with secretion of primary stress markers from activation of the hypothalamic-pituitary-adrenal (HPA) axis, sympathetic nervous system (SNS), and immune system. GL can act as a physiological stressor, contributing to the primary AL response. Objective We examined the relation between GL and a composite score of primary stress markers of AL in Puerto Rican adults. Methods Data were from the Boston Puerto Rican Health Study, a cohort study of Puerto Ricans, aged 45-75 y, including 262 men and 697 women with complete data at baseline and 2-y follow-up. GL was calculated from dietary intake obtained with an FFQ. Sex-specific composite primary AL scores included markers of the HPA axis (cortisol and dehydroepiandrosterone sulfate), SNS (epinephrine and norepinephrine), and immune system (C-reactive protein). Linear regression models were stratified by sex and adjusted for covariates. Results Mean ± SD baseline GL score was 155 ± 28 for men and 135 ± 34 for women. Mean primary stress AL score was 1.25 ± 1.14 for men and 1.25 ± 1.06 for women. GL was not associated with AL score in men. In women, increasing GL from baseline to 2 y was significantly associated with increasing AL, after adjusting for sociodemographics, physical activity, smoking, BMI, menopause, and baseline AL score (β = 0.03; P = 0.049). Results became marginally significant after further adjustment for chronic diseases (P = 0.06) and intake of fats (P values: saturated fats = 0.08; trans fats = 0.06; unsaturated fats = 0.07), but the magnitude of the association remained unchanged. Conclusions Increasing GL over 2 y was positively associated with increasing composite score of primary markers of AL in Puerto Rican women. More studies are needed to confirm our findings.

Puerto Ricans are burdened by nutrition-related diseases, with greater disease prevalence among Puerto Ricans residing in the continental U.S. compared to those in Puerto Rico (PR). However, little is known about diet quality of these two groups. To compare diet quality of Puerto Ricans in Massachusetts (MA) and PR. Puerto Rican patients from health centers in MA (n = 42) and PR (n = 52) completed a food frequency questionnaire. Diet quality was assessed with the Healthy Eating Index-2010 (HEI). Analysis included Mann-Whitney, Chi square and logistic and quantile regressions. 57.1 % of participants in MA and 19.6 % in PR had a poor diet. Adjusting for age and education, participants in MA were more likely to have a poor diet (OR 3.4; p = 0.02) and lower HEI scores than participants in PR. Diet quality among Puerto Ricans is poor, and is worse among mainland Puerto Ricans compared to islanders.

OBJECTIVES: To document the level of dysfunctional eating behaviors, specifically emotional eating (EE), uncontrolled eating (UE) and cognitive restraint (CR), among adults in Puerto Rico (PR), and explore the association between each behavior and dietary intake (i.e., percentage of calories from fats, saturated fats and servings of fruits and vegetables). METHODS: Cross-sectional study of adults (n = 94) recruited from three health clinics serving low-income communities in Ponce, PR. The Three Factor Eating Questionnaire R18-V2 was used to measure EE, UE and CR; each score ranged from 1 to 4 (higher values indicate stronger behaviors). The Block Fat and Fruits and Vegetables Screener was used to capture percentage of calories from fats, saturated fats and servings of fruits and vegetables. Analysis included adjusted means (SD) and proportions, and linear regressions adjusted for sex, age and marital status. RESULTS: Mean age was 45 years, 52% were female and 55% were married. Adjusted mean (SD) scores for EE, UE and CR were 1.92 (0.78), 1.85 (0.66), and 2.32 (0.85), respectively. Adjusted proportions showed that 76%, 88% and 87% experienced any level of EE, UE and CR, respectively. EE and UE scores were significantly associated with greater percentage of calories from total fats (b = 12.0, 95% CI = 0.42, 3.60 for EE; and b = 1.99, 95% CI = 0.05, 3.93 for UE) and saturated fats (b = 3.36, 95% CI = 0.71, 6.01 for EE; and b = 3.31, 95% CI = 0.09, 6.54 for UE). CR scores were significantly associated with greater intake of fruits and vegetables (b = 0.69, 95% CI = 0.20, 1.19). CONCLUSIONS: Dysfunctional eating behaviors are prevalent among adults in PR and were associated with dietary intake. Results support the need for larger representative studies of dysfunctional eating behaviors, dietary intake and health in PR to shed light into potential intervention targets to decrease the observed health disparities among adults in PR. FUNDING SOURCES: National Institutes of Health, Centers for Disease Control and Prevention and Ponce Health Sciences University Seed Program.

Several studies, such as the Diabetes Prevention Program (DPP), have provided foundational evidence for the efficacy of lifestyle interventions on weight loss and cardiometabolic prevention. However, translating these interventions to real-world settings and engaging at-risk populations has proven difficult. Social media-delivered interventions have high potential for reaching high-risk populations, but there remains a need to understand the extent to which these groups are interested in social media as a delivery mode. One potential way to this is by examining recruitment rates as a proxy for interest in the intervention delivery format. The aim of this study was to describe the recruitment rates of overweight and obese low-income postpartum women into two asynchronous behavioral weight loss interventions: one delivered in-person and the other delivered via Facebook. Both interventions used the same recruitment methods: participants were overweight low-income postpartum women who were clients of Women, Infants, and Children (WIC) clinics in Worcester, MA, screened for the study by nutritionists during routine WIC visits. Similarly, eligibility criteria were the same for both interventions except for a requirement for the Facebook-delivered intervention to currently use Facebook at least once per week. Among women pre-eligible for the in-person intervention, 42.6% gave permission to be contacted to determine full eligibility and 24.1% of eligible women enrolled. Among women pre-eligible for the Facebook intervention, 31.8% gave permission to be contacted and 28.5% of eligible women enrolled. Recruitment rates for a Facebook-based weight loss intervention were similar to recruitment rates for an in-person intervention, suggesting similar interest in the two program delivery modes among low-income postpartum women.

BACKGROUND Efforts to translate evidence-based weight loss interventions, such as the Diabetes Prevention Program (DPP), to low-income postpartum women have resulted in poor intervention attendance and high attrition. Strategies that improve engagement and retention in this population are needed to maximize the reach of evidence-based weight loss interventions. OBJECTIVE The objective of this study was to adapt a DPP-based weight loss intervention (Fresh Start) for Facebook delivery and to evaluate its feasibility among low-income postpartum women. METHODS This study comprised 3 single-group pilot studies where feasibility outcomes iteratively informed changes from one pilot to the next. We paralleled the in-person program for Facebook delivery by translating the protocol to a content library of Facebook posts with additional posts from lifestyle coaches. Low-income postpartum women were recruited from Women, Infants, and Children (WIC) clinics in Worcester, Massachusetts. Participants were enrolled into a 16-week weight loss intervention delivered via Facebook. During the first 8 weeks, Facebook intervention posts were delivered 2 times per day, with additional posts from coaches aiming to stimulate interaction among participants or respond to participants’ questions and challenges. For the following 8 weeks, posts were delivered once per day without additional coaching. Feasibility outcomes were engagement (defined by number of likes, comments, and posts measured throughout intervention delivery), acceptability, and retention (survey at follow-up and assessment completion rate, respectively). Changes in weight were also assessed at baseline and follow-up. RESULTS Pilot 1 had a retention rate of 89% (24/27), and on average, 62% (17/27) of women actively engaged with the group each week during the 8-week coached phase. Mean weight loss was 2.6 (SD 8.64) pounds, and 79% (19/27) would recommend the program to a friend. Pilot 2 had a retention rate of 83% (20/24), and on average, 55% (13/24) of women actively engaged with the group weekly during the 8-week coached phase. Mean weight loss was 2.5 (SD 9.23) pounds, and 80% (16/24) would recommend the program to a friend. Pilot 3 had a retention rate of 88% (14/16), and on average, 67% (11/16) of women actively engaged with the group weekly during the 8-week coached phase. Mean weight loss was 7.0 (SD 11.6) pounds, and 100% (16/16) would recommend the program to a friend. CONCLUSIONS Our findings demonstrated that a Facebook-delivered intervention was acceptable and could be feasibly delivered to low-income postpartum women. Future research is needed to evaluate the efficacy of a Facebook-delivered weight loss intervention.

Abstract. Background: Micronutrients are critical for healthy growth and development of children. Micronutrient intake from dietary sources is inadequate among some children and may be improved by use of multivitamin and multimineral (MVMM) supplements. Objective: To assess micronutrient intake from dietary and MVMM supplement sources among 12-year-old children in Puerto Rico. Methods: A representative sample of 732 children enrolled in an oral health study in Puerto Rico, who completed dietary and MVMM assessments through one 24-h recall, were included in this analysis. Micronutrient intake sources were described and compared to the Dietary Reference Intakes (DRIs) using the Estimated Average Requirement when available (used Adequate Intake for vitamin K and pantothenic acid). Micronutrient profiles of MVMM users and non-users were compared using t-tests. Results: Mean intakes of vitamins A, D, E, and K, pantothenic acid, calcium, and magnesium from food and beverage sources were below the DRIs. From food and beverage sources, MVMM users had higher intakes of riboflavin and folate compared to non-users (p < 0.05). When MVMM supplements were taken into account, users had higher intakes of all nutrients except vitamin K. With the help of MVMM, users increased intake of vitamins E, A, D, and pantothenic acid to IOM-recommended levels but calcium, magnesium, and vitamin K remained below guidelines. Conclusion: Micronutrient intake from diet was below the IOM-recommended levels in the total sample. MVMM use improved intake of selected micronutrients and facilitated meeting recommendations for some nutrients. Public health measures to improve micronutrient intake among children in Puerto Rico are needed.

Multivitamin and multimineral (MVMM) supplement use in children is associated with adequate intake of micronutrients. This has not been properly studied in Hispanic children. Objective: To assess m...