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Epidemiological data suggest that populations exposed to starvation show increased incidence of type 2 diabetes but these studies are limited by lack of person-level data. Cambodians resettled in the USA survived severe malnutrition during distinct historical eras. We examined the relationship of individual exposure to starvation with current HbA1c, anthropometrics, and trauma symptoms among Cambodian Americans.Participants were excluded for extant diabetes but all had elevated risk factors for type 2 diabetes and depression. Participants identified images on a 5-point scale that best depicted their body size during four distinct periods: before 1970 (peacetime), 1970-1975 (USA bombing campaign, widespread hunger), 1975-1979 (Pol Pot regime, mass starvation), and "now" (2016-2019, resettled in the USA). They reported trauma symptoms and provided anthropometrics and a blood sample.The n = 189 participants were mean = 55 years old and had glycosylated hemoglobin (HbA1c) mean = 5.5%. Self-reported body size showed excellent validity by strong correlations between body thinness "now" and objectively measured waist circumference (r = -0.35), weight (r = -0.50), and body mass index (r = -0.50). Whereas there was some variability, modal self-reported body size started as normal during peacetime, became thinner during the USA bombing campaign, became emaciated during the Pol Pot regime, and rebounded to normal/slightly heavy "now." Body size during Pol Pot showed the strongest associations with long-term outcomes; thinner body size (greater starvation) was associated with higher trauma symptoms and higher HbA1c even after controlling for age, current waist circumference, and current body mass index.Greater degree of starvation was associated with higher HbA1c and trauma symptoms four decades later.

This paper reports secondary data analysis of associations between psychological distress and health behaviours among Cambodian Americans. Data are from baseline assessments from a diabetes prevention trial. All participants met stucriteria for depression and were free of diabetes. Participants (n = 191) completed surveys, a food frequency assessment, and wore sleep and physical activity actigraphy devices for 7 days. A factor analysis of symptoms of post-traumatic stress, baksbat (a Cambodian culture-bound syndrome), depression, and anxiety yielded a single factor named 'psychological distress'. Multivariate models controlling for psychotropic medications were run for the following outcomes: sleep actigraphy, self-reported sleep, physical activity actigraphy, self-reported physical activity, nutrition, and substance use. For actigraphy, higher distress was associated with lower moderate/vigorous physical activity and higher mean variability of 24 h total sleep time. Higher distress was also associated with worse self-reported sleep quality as indicated by standard, and culturally-specific, sleep indicators. Higher distress was also associated with lower use of food labels, lower carbohydrate consumption, and higher alcohol consumption as a coping mechanism. Interventions to mitigate diabetes risk in high-distress populations may benefit from strategies to decrease psychological distress. The sequelae of complex trauma may transcend discrete psychiatric diagnoses.

OBJECTIVES: Food insecurity (FI) is higher among Latinos than non-Hispanic Whites and associated with risk for type 2 diabetes (T2D). Autonomic nervous system (ANS) dysfunction increases mortality in diabetes. We examined FI and ANS function among Latinos with T2D. METHODS: Participants were drawn from the CALMS-D (Community Health Workers Assisting Latinos Manage Stress and Diabetes) stress management intervention trial. Inclusion: age 18 years, Latino or Hispanic, Spanish speaking, ambulatory status, T2D 6 months, A1c > 7.0%. Exclusion: medical or psychiatric instability; pain or dysfunction in hands precluding handgrip testing. Measures: FI was assessed with the 6-item US household food security survey module; affirmative responses to > = 1 questions was coded as FI. Six autonomic measures were scored 0 = normal or 1 = abnormal based on published cutoffs and then summed for a total ANS dysfunction index. ANS measures and their normal cutoffs were: 1) metanephrine 15 mmHg; and, 6) difference between baseline supine and the minimal BP after standing up, normal = decline in SBP

Aims: Food insecurity (FI) is higher among Latinos than non-Hispanic Whites and associated with risk for type 2 diabetes (T2D). Autonomic nervous system (ANS) dysfunction increases mortality in diabetes. We examined FI and ANS function among Low-income Latinos with T2D enrolled in a parent stress management trial. Methods: Inclusion: age > 18 years, Latino or Hispanic, Spanish speaking, ambulatory status, T2D > 6 months, A1c>7.0%. Exclusion: medical or psychiatric instability; pain or dysfunction in hands precluding handgrip testing. Measures: FI was assessed with the 6-item U.S. household food security survey module; affirmative responses to >=1 question was coded as FI. Six autonomic measures were scored 0=normal or 1=abnormal based on published cutoffs and then summed for a total ANS dysfunction index. ANS measures and their normal cutoffs were: 1) metanephrine 15 mmHg; and, 6) difference between baseline supine and the minimal BP after standing up, normal = decline in SBP Results: N=35 participated, n=23 (65.7%) were women, age M=61.6 (SD=11.2) years, A1c M=8.5% (SD=1.6) and n=20 (57.1%) used insulin. N=22 (62.9%) reported FI and n=25 (71.4%) had at least one abnormal ANS measure. In t-tests, participants with FI had a higher ANS dysfunction index (M=1.5, SD=0.9) than patients who were food secure (M=0.7, SD=0.8), p=0.02. Total ANS index was not related to A1c or insulin use. Discussion: In this Latino sample with T2D, FI was associated with greater ANS dysfunction. Increasing food security may confer autonomic benefits. Disclosure K. Seng: None. R. Feinn: None. A. Bermudez-Millan: None. R. Perez-Escamilla: None. J. Wagner: None. Funding American Diabetes Association (7-13-TS-31 to J.W.); National Institute on Minority Health and Health Disparities (R01MD005879)