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It is important to characterize the level and magnitude of changes in food consumption patterns in Latin American populations as they undergo demographic and developmental transitions because of the effects of such changes on the development and progression of chronic diseases. This paper examines trends in food intake across regions in Latin America. Although trends in apparent food consumption differ in magnitude and timing, the overall patterns of change are remarkably consistent. Intakes of total fat, animal products, and sugar are increasing, even while there have been rapid declines in the intake of cereals, fruit, and some vegetables. The costs of the increased prevalence of chronic disease associated with these dietary changes are already affecting health systems still coping with malnutrition and infectious disease. Because this pattern of change is predictable, it is important to learn from the experiences gained in countries that are more advanced in the transition. Efforts to educate the population on the importance of a healthy diet and to issue policies to improve the availability of a healthy food supply can help to reduce the rapid escalation of obesity and chronic diseases.

Objectives. We investigated Cambodian refugee women's past food experiences and the relationship between those experiences and current food beliefs, dietary practices, and weight status. Methods. Focus group participants (n=11) described past food experiences and current health-related food beliefs and behaviors. We randomly selected survey participants (n=133) from a comprehensive list of Cambodian households in Lowell, Massachusetts. We collected height, weight, 24-hour dietary recall, food beliefs, past food experience, and demographic information. We constructed a measure of past food deprivation from focus group and survey responses. We analyzed data with multivariate logistic and linear regression models. Results. Participants experienced severe past food deprivation and insecurity. Those with higher past food-deprivation scores were more likely to currently report eating meat with fat (odds ratio [OR]=1.14 for every point increase on the 9-to-27-point food-deprivation measure), and to be overweight or obese by Centers for Disease Control and Prevention (OR=1.28) and World Health Organization (OR=1.18) standards. Conclusions. Refugees who experienced extensive food deprivation or insecurity may be more likely to engage in unhealthful eating practices and to be overweight or obese than are those who experienced less-extreme food deprivation or insecurity. (Am J Public Health. 2010;100:1930-1937. doi: 10.2105/AJPH.2009.175869)

Iron status and dietary correlates of iron status have not been well described in Hispanic older adults of Caribbean origin. The aim of this study was to evaluate iron status and describe dietary components and correlates of iron status in Hispanic older adults and in a neighborhood-based comparison group of non-Hispanic white older adults. Six hundred four Hispanic and non-Hispanic white adults (59-91 y of age) from the Massachusetts Hispanic Elders Study were included in the analysis. We examined physiological markers of iron status as well as dietary factors in relation to iron status. Dietary intake was assessed by FFQ. Our results revealed that Hispanics had significantly lower geometric mean serum ferritin (74.1 [micro]g/L vs. 100 [micro]g/L; P < 0.001), lower hemoglobin concentrations (137 [+ or -] 13 vs. 140 [+ or -] 12 g/L; P < 0.01), higher prevalence of anemia (11.5 vs. 7.3%; P < 0.05), and suboptimal hemoglobin concentrations (

[alpha]-Tocopherol from foods has been associated with protection against several chronic diseases and maintenance of immune function. However, most people do not meet current recommendations for intake. We examined [alpha]-tocopherol intake and plasma concentration in a representative sample of Puerto Rican and Dominican older adults (n = 447) and in neighborhood-matched non-Hispanic whites (n = 155). A validated food frequency questionnaire was used to assess dietary intake. Mean dietary intakes of [alpha]-tocopherol were 6 mg in both ethnicities. Only 4.7% of women and 7.9% of men met the estimated average requirement (12 mg/d) for vitamin E from food alone. Top sources of [alpha]-tocopherol for Hispanics included oils and milk, and for non-Hispanic whites they were ready-to-eat breakfast cereal and sweet baked products. Mean plasma [alpha]-tocopherol concentrations were 24.5 [micro]mol/L for Hispanics and 25.8 [micro]mol/L for non-Hispanic whites (P > 0.05). Plasma [alpha]-tocopherol was positively associated with [alpha]-tocopherol intake (P = 0.003), and significance remained after adjusting covariates and after exclusion of supplement users (P for trend = 0.008). We identified the following 5 dietary patterns by cluster analysis: 1) fruit and breakfast cereal, 2) starchy vegetables, 3) rice, 4) milk and milk products, and 5) sweets. Those following the sweets pattern had the lowest plasma [alpha]-tocopherol relative to those following the fruit and breakfast cereal or milk patterns (P < 0.05 for all), although they had similar intakes. A large proportion of these elders (>90%) have inadequate intake of [alpha]-tocopherol, and plasma concentrations were associated with intake patterns.

The current study was designed to determine the maximal amount of [alpha]-tocopherol intake obtained from food in the U.S. diet, and to examine the effect of different food group intakes on this amount. Data from 2138 men and 2213 women aged >18 y were obtained from the National Health and Nutrition Examination Survey (NHANES) 2001-2002. Linear programming was used to generate diets with maximal [alpha]- tocopherol intake, with the conditions of meeting the recommended daily allowances or adequate intakes for a set of nutrients, sodium and fat recommendations, and energy limits, and that were compatible with the observed dietary patterns in the population. With food use and energy constraints in models, diets formulated by linear programming provided 19.3-24.9 mg [alpha]-tocopherol for men and women aged 19-50 or >50 y. These amounts decreased to 15.4-19.9 mg with the addition of the sodium, dietary reference intake, and fat constraints. The relations between maximal [alpha]-tocopherol intake and food group intakes were influenced by total fat restrictions. Although meeting current recommendations (15 mg/d) appears feasible for individuals, dramatic dietary changes that include greater intakes of nuts and seeds, and fruit and vegetables, are needed. Careful selection of the highest vitamin E source foods within these groups could further increase the likelihood of meeting the current recommended daily allowance. KEY WORDS: * linear programming * [alpha]-tocopherol * Dietary Reference intakes * dietary pattern

Carotenoids have been linked with protective roles against diseases associated with aging, including cancer, cardiovascular disease, cataracts, and age-related macular degeneration. With data from a semiquantitative, validated FFQ, we examined carotenoid intake of 340 Puerto Ricans, 98 Dominicans, and 146 non-Hispanic whites (>60 y old) in Massachusetts. Compared with non-Hispanic white men, Hispanic men reported a higher intake of lycopene and lower intakes of [alpha]-carotene, lutein + zeaxanthin, [beta]-carotene (from diet only), and total [beta]-carotene (diet and supplements) (P < 0.001). Hispanic women reported higher intakes of [beta]-cryptoxanthin and lycopene but lower intakes of lutein + zeaxanthin (P < 0.001) than non-Hispanic white women. The frequency of consumption of fruit and vegetables was higher among Hispanic women, relative to non-Hispanic white women (P < 0.05). Plasma concentrations of s-carotene and lycopene were higher in Hispanic than in non-Hispanic white men and women. For both ethnic groups, higher intakes of carotenoids were associated with higher plasma concentrations of the respective carotenoids, except for lycopene (Hispanics) and lutein + zeaxanthin (non-Hispanic whites). Food sources contributing most to total intakes differed among the groups. The major sources of [alpha]- and [beta]-carotene were carrots for non-Hispanic whites and winter squash for Hispanics. The major source of lycopene was cooked tomato products for Hispanics, and pasta dishes for non-Hispanic whites. Traditional foods such as beans and plantains were also important contributors of carotenoids for Hispanics. Because of the potential importance of carotenoids as protective factors against chronic diseases, more attention to food-related practices associated with carotenoid intake in differing population groups is warranted. KEY WORDS: * carotenoids * elderly * Hispanic * Puerto Rican * Dominican

Objective To examine [alpha]-tocopherol intake and food sources of [alpha]-tocopherol in the US population relative to current Dietary Reference Intakes for vitamin E. Design We analyzed food source and intake data from the 1994 to 1996 Continuing Survey of Food Intakes by Individuals (CSFII) with added values for [alpha]-tocopherol from the US Department of Agriculture National Nutrient Database for Standard Reference Release 15. Subjects Data from 5,056 men and 4,703 women aged 20 years and older were obtained from the 1994 to 1996 CSFII. Statistical Analyses Performed The complex design and sampling weights of the CSFII survey were taken into account to calculate the mean [alpha]-tocopherol intake from diet, the SEM, and the percent of the Estimated Average Requirements (EARs) for [alpha]-tocopherol intake by age group and region. Results Only 8.0% of men and 2.4% of women in the United States met the new EARs for vitamin E intake from foods alone. Regionally, only 5.8% of men and 2.1% of women in the South met these EARs, relative to 9.0% and 2.6%, respectively, in the Northeast. Top contributors of [alpha]-tocopherol for men and women included ready-to-eat cereal, sweet baked products, white bread, beef, oils, and salad dressing. Applications/Conclusions The majority of men and women in the United States fail to meet the current recommendations for vitamin E intake. Many of the top contributors are not particularly high sources of [alpha]-tocopherol but are consumed frequently. Greater inclusion of sources such as nuts, seeds, and vitamin E-rich oils, could improve intake of [alpha]-tocopherol. J Am Diet Assoc. 2004;104:567-575.

Elevated C-reactive protein (CRP) and plasma total homocysteine (Hcy) were recently identified as risk factors for cardiovascular disease. However, few studies have related fruit and vegetable consumption to these markers of inflammation and B vitamin deficiency, particularly in the Hispanic population. We examined the relation of fruit and vegetable intake with plasma CRP and Hcy concentrations in a cross-sectional study. Subjects were 445 Hispanic elders and 154 neighborhood-based non-Hispanic white elders living in Massachusetts. Diet was assessed with a FFQ designed for this population. There were significant inverse dose-response associations between fruit and vegetable intake and plasma CRP (P for trend = 0.010) and Hcy (P for trend = 0.033) concentrations, after adjustment for potential confounders. The prevalence of high plasma CRP (> 10 mg/L), and high Hcy (>10.4 [micro]mol/L for women and >11.4 micro]mol/L for men), was significantly greater among subjects in the lowest quartile of fruit and vegetable consumption relative to those in the highest quartile, 17.9 vs. 9.1% and 58.7 vs. 44.4%, respectively. With each additional serving of fruit and vegetable intake, adjusted odd ratios for high plasma CRP and Hcy were 0.79 (95% CI: 0.65 to 0.97) and 0.83 (95% CI: 0.72 to 0.96), respectively. Greater frequency of fruit and vegetable intake was associated with significantly lower plasma CRP and Hcy concentrations. Because both of these metabolites are known risk factors for CVD, these findings contribute to the evidence that a higher intake of fruit and vegetables may reduce the risk of CVD. KEY WORDS: * C-reactive protein * homocysteine * fruit * vegetable * elderly

The association of dietary patterns and obesity, particularly in Hispanics, is relatively poorly understood. This large U.S. population subgroup has a high prevalence of obesity and associated chronic conditions, and Hispanics are changing their dietary practices as they acculturate. Our objectives were 1) to identify dietary patterns among elderly Hispanics in Massachusetts, compared with those of non-Hispanic whites; 2) to associate dietary patterns with acculturation; and 3) to associate dietary patterns with total and central obesity. We used a representative sample of 449 Puerto Rican and 133 Dominican elders and a neighborhood-based sample of 243 non-Hispanic white elders, aged 60 to 92 y, from the cross-sectional Massachusetts Hispanic Elders Study. Obesity and central obesity were assessed with BMI (kg/[m.sup.2]) and waist circumference measurement, respectively. Acculturation was assessed by evaluating language use. Usual diet was assessed with a food frequency questionnaire specifically designed for use with this population. Dietary patterns were defined by cluster analysis of food group variables. We identified five clusters of individuals by dietary pattern, with proportionately greater energy intake from 1) fruit and breakfast cereal, 2) starchy vegetables, 3) rice, 4) whole milk and 5) sweets, respectively. Hispanics were less likely to follow the fruit and cereal or sweets patterns, and more likely to follow the starchy vegetables or milk patterns, than were non-Hispanic whites. Only Hispanics followed the rice pattern. Among Hispanics, acculturation was positively associated with the fruit and cereal pattern, and negatively with the rice pattern. Total and central obesity were positively associated with the rice pattern. Longitudinal studies are needed to clarify the causal nature of these associations. KEY WORDS: * Dietary patterns * cluster analysis * elderly * Hispanic * Puerto Rican

Vitamin B-12 deficiency is a recognized problem among older adults, although vitamin B-12 status among differing ethnic groups remains unclear. We examined vitamin B-12 intake and status in a representative sample of elderly Hispanics of Caribbean origin (Puerto Rican and Dominican) and non-Hispanic whites. Dietary intake and plasma values were available for 347 Puerto Ricans, 102 Dominicans and 154 non-Hispanic whites (60-93 y). Relative to non-Hispanic whites, Hispanics had significantly lower vitamin B-12 intake and plasma concentrations; 17% of Hispanics and 10% of non-Hispanic whites had concentrations < 185 pmol/L (P < 0.05). Among Hispanics, log transformed vitamin B-12 intake was significantly associated with plasma concentration ([beta] = 60 pmol/L per log unit vitamin B-12 intake, P < 0.002 for supplement users and [beta] = 74 pmol/L per log unit vitamin B-12 intake, P < 0.01 for nonsupplement users). Intake and plasma concentrations were significantly associated among non-Hispanic whites only when supplement users were included ([beta] = 95 pmol/L per log unit vitamin B-12 intake, P < 0.0001). Hispanic supplement users (18%) had higher plasma concentrations than did nonsupplement users (364 [+ or -] 17 and 297 [+ or -] 8 pmol/L, respectively, P < 0.001). For Hispanics, consumption of breakfast cereal > 4 times/wk compared to no cereal was protective against lower plasma concentrations (8 vs. 24% < 185 pmol/L, P < 0.01). Approximately 40% of both groups with plasma vitamin B-12 < 185 pmol/L had homocysteine > 14 [micro]mol/L, relative to < 17% of those with B-12 185 pmol/L. The high prevalence of low vitamin B-12 status in elderly Hispanics appears largely attributed to inadequate intake. As in other populations, sources of unbound vitamin B-12 such as supplements and fortified cereal appear to be protective. Dietary intervention programs targeted to the Hispanic population should promote these vitamin B-12 sources. KEY WORDS: * vitamin B-12 * homocysteine * ethnicity * elderly * Hispanic * Puerto Rican * Dominican

Background. Studies have suggested that both high and low body mass index (BMI) and weight change are related to functional disability in elderly populations. Elderly Hispanics have a high prevalence of both obesity and disability, yet few studies have examined their interrelationship in this population. Therefore, we examined these relationships in a mostly Puerto Rican group of Hispanic elders. Methods. We investigated associations between a three-level disability score created from responses to a questionnaire on activities of daily living and BMI, waist circumference (WC), and weight change since age 50, using the proportional odds model in a cross-sectional study of 763 elderly Hispanics, aged 60 to 92 years, residing in Massachusetts. Results. After adjusting for potential confounders, men with a WC [greater than or equal to] 109.3 cm (vs Conclusions. Abdominal obesity (WC [greater than or equal to] 109.3 cm for men, or WC [greater than or equal to] 91.5 cm for women) and weight gain [greater than or equal to] 0.55 kg/year after age 50 in men or [greater than or equal to] 0.23 kg/year in women may increase the risk of disability among elderly Hispanics.

Abstract Background Identifying risk factors that affect excess weight gain during pregnancy is critical, especially among women who are at a higher risk for obesity. The goal of this study was to determine if acculturation, a possible risk factor, was associated with gestational weight gain in a predominantly Puerto Rican population. Methods We utilized data from Proyecto Buena Salud, a prospective cohort study of Hispanic women in Western Massachusetts, United States. Height, weight and gestational age were abstracted from medical records among participants with full-term pregnancies (n=952). Gestational weight gain was calculated as the difference between delivery and prepregnancy weight. Acculturation (measured via a psychological acculturation scale, generation in the US, place of birth and spoken language preference) was assessed in early pregnancy. Results Adjusting for age, parity, perceived stress, gestational age, and prepregnancy weight, women who had at least one parent born in Puerto Rico/Dominican Republic (PR/DR) and both grandparents born in PR/DR had a significantly higher mean total gestational weight gain (0.9 kg for at least one parent born in PR/DR and 2.2kg for grandparents born in PR/DR) and rate of weight gain (0.03 kg/wk for at least one parent born in PR/DR and 0.06 kg/wk for grandparents born in PR/DR) vs. women who were of PR/DR born. Similarly, women born in the US had significantly higher mean total gestational weight gain (1.0 kg) and rate of weight gain (0.03 kg/wk) vs. women who were PR/ DR born. Spoken language preference and psychological acculturation were not significantly associated with total or rate of pregnancy weight gain. Conclusion We found that psychological acculturation was not associated with gestational weight gain while place of birth and higher generation in the US were significantly associated with higher gestational weight gain. We interpret these findings to suggest the potential importance of the US “obesogenic” environment in influencing unhealthy pregnancy weight gains over specific aspects of psychological acculturation.

Abstract Background Consumption of healthy diets that contribute with adequate amounts of fat and fatty acids is needed for children. Among Guatemalan children, there is little information about fat intakes. Therefore, the present study sought to assess intakes of dietary fats and examine food sources of those fats in Guatemalan children. Methods The study subjects consisted of a convenience sample of 449 third- and fourth-grade schoolchildren (8-10 y), attending public or private schools in Quetzaltenango City, Guatemala. Dietary data was obtained by means of a single pictorial 24-h record. Results The percentages of total energy (%E) from total fat, saturated fat (SFA) and monounsaturated fat (MUFA) reached 29%E for total fat and 10%E for each SFA and MUFA, without gender differences. %E from fats in high vs. low-socio economic status (SES) children were significantly higher for boys, but not for girls, for total fat (p = 0.002) and SFA (p < 0.001). Large proportions of the children had low levels of intakes of some fatty acids (FA), particularly for n-3 FA, with >97% of all groups consuming less than 1%E from this fats. Fried eggs, sweet rolls, whole milk and cheese were main sources of total fat and, SFA. Whole milk and sweet bread were important sources of n-3 FA for high- and low-SES boys and girls, respectively. Fried plantain was the main source of n-3 FA for girls in the high-SES group. Fried fish, seafood soup, and shrimp, consumed only by boys in low amounts, were sources of eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids, which may explain the low intakes of these nutrients. Conclusions α-linolenic acid, EPA and DHA were the most limiting fatty acids in diets of Guatemalan schoolchildren, which could be partially explained by the low consumption of sources of these nutrients, particularly fish and seafood (for EPA and DHA). This population will benefit from a higher consumption of culturally acceptable foods that are rich in these limiting nutrients.