RESUMEN
Puerto Rican adults have a greater prevalence of type 2 diabetes (T2D) and lower HDL-cholesterol (HDL-C) than the general U.S. population. Carbohydrate nutrition may play a role in this disparity. Cross-sectional analyses included data from 1219 Puerto Ricans aged 45-75 y enrolled in the Boston Puerto Rican Health Study. Using the Pearson chi-square test and ANCOVA, lifestyle characteristics and dietary intake, as assessed by semiquantitative FFQ, were compared by T2D status based on fasting plasma glucose concentration and medication use. Food source rankings for carbohydrate, dietary glycemic load (GL), and fiber were obtained using the SAS procedure PROC RANK. Geometric mean plasma HDL-C and TG concentrations were compared across quintiles of dietary carbohydrate, glycemic index (GI), GL, and fiber by using ANCOVA and tests for linear trend. In multivariable analyses, individuals with T2D (39.5%) had lower dietary carbohydrate, GL, and total sugar intake from lower intake of sugar, fruit drinks, and soda compared with those without T2D. In individuals without T2D, dietary carbohydrate and GL were inversely associated with HDL-C (P < 0.0001). Associations between dietary fiber and HDL-C were confounded by carbohydrate intake, apparently from concurrent consumption of legumes with white rice, a refined carbohydrate food. No associations were observed between carbohydrate, dietary GI, GL, or fiber and TG. In conclusion, individuals with T2D showed evidence of dietary modification. Among those without diabetes, a high intake of refined carbohydrates was associated with decreased HDL-C. Longitudinal research on carbohydrate nutrition in relation to diabetes risk factors and blood lipids in Puerto Ricans is warranted.
Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Carbohidratos de la Dieta/administración & dosificación , Dislipidemias/complicaciones , Anciano , Bebidas/efectos adversos , Bebidas/análisis , Boston/epidemiología , HDL-Colesterol/sangre , Estudios de Cohortes , Estudios Transversales , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/etnología , Carbohidratos de la Dieta/efectos adversos , Fibras de la Dieta/administración & dosificación , Dislipidemias/etnología , Femenino , Manipulación de Alimentos , Calidad de los Alimentos , Índice Glucémico , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Puerto Rico/etnología , Triglicéridos/sangreRESUMEN
BACKGROUND: Previous studies have shown negative consequences of acculturation on lifestyle factors, health status, and dietary intake of Hispanic immigrants in the US. Despite prevalent type 2 diabetes and low socioeconomic status (SES) among Puerto Rican adults living on the US mainland, little is known about acculturation in this group. OBJECTIVE: We investigated associations among acculturation, lifestyle characteristics, health status, and carbohydrate nutrition in Puerto Rican adults. A secondary objective was to investigate possible confounding and/or effect modification on these associations by SES. DESIGN: Cross-sectional data from the Boston Puerto Rican Health Study, which included 1219 Puerto Ricans in the Boston area, aged 45-75 years. STATISTICAL ANALYSES: Characteristics were compared using ANCOVA, linear trend and Pearson's chi-square tests across quartiles of acculturation. Tests for interaction by poverty status were conducted. Proportional contributions of foods to intake of total carbohydrate and fiber were assessed using SAS RANK. RESULTS: Levels of acculturation were low, despite young age at first arrival to the US mainland (25.4 ± 12.3 y) and long length of stay (34.2 ± 12.2 y). Greater English language use was associated with higher SES, alcohol consumption, physical activity, better perceived health, and less central obesity. Acculturation was associated with lower legume fiber and greater cereal fiber intake. Among those above the poverty threshold, acculturation was associated with lower dietary glycemic index and starch intake, and greater fruit and non-starchy vegetable intake. CONCLUSIONS: In contrast to studies with Mexican Americans, the association of acculturation with dietary quality in these Puerto Rican adults was mixed, but tended toward better carbohydrate quality. Dietary recommendations should include maintenance of traditional, healthful dietary practices including consumption of legumes, but also reduction in refined grains, and greater inclusion of fruit, non-starchy vegetables, and whole grains. Interventions to improve access to better quality carbohydrate sources are necessary for this group disproportionately affected by diabetes.
Asunto(s)
Aculturación , Dieta/etnología , Dieta/estadística & datos numéricos , Estado de Salud , Hispánicos o Latinos/psicología , Anciano , Estudios Transversales , Características Culturales , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/etnología , Encuestas sobre Dietas , Carbohidratos de la Dieta/administración & dosificación , Fibras de la Dieta/administración & dosificación , Ingestión de Energía/fisiología , Fabaceae , Femenino , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Estilo de Vida , Masculino , Massachusetts/epidemiología , Persona de Mediana Edad , Pobreza , Puerto Rico/etnología , Factores SocioeconómicosRESUMEN
OBJECTIVES: This article describes physical function in Puerto Rican older adults and examines associations between health status and physical function. It also assesses relationships between physical function and disability. METHOD: This study uses a cross-sectional study of Puerto Ricans 45 to 75 years in Boston (N = 1,357). Measures included performance-based physical function (handgrip strength, walking speed, balance, chair stands, foot tapping), health conditions (obesity, diabetes, depressive symptomatology, history of heart disease, heart attack, stroke, and arthritis), and self-reported disability (activities of daily living, instrumental activities of daily living). RESULTS: Older women (60-75 years) had the poorest physical function. Poor physical function was associated with obesity, diabetes, depression, history of heart attack, stroke, and arthritis, after adjusting for age, sex, education, income, and lifestyle (p < .05). Physical function and disability were correlated (p < .01). DISCUSSION: Health status among Puerto Ricans appears to contribute to poor physical function. Targeted interventions to improve strength, endurance, and balance are needed to combat physical frailty and its consequences in this population.