Association between food insecurity and CVD risk factors is moderated by intake of fruits and vegetables in Latinos

Background: Food insecurity has been consistently associated with CVD risk factors (i.e., obesity, type 2 diabetes, hypertension and hypercholesterolemia). Consumption of fruits and vegetables may reduce CVD risk factors among food insecure Latinos. Objective: To examine the potential moderating effect of fruit and vegetable intake in the association between food insecurity and CVD risk factors in a sample of Latino men and women in the northeast U.S. Methods: A representative community sample of Latino individuals was recruited from a community health center in Lawrence, MA. Food insecurity was measured with the 6-item USDA Household Food Security Scale. Fruit and vegetable intake, was measured with Block’s Fruit and Vegetable Screener. CVD risk factors examined included: obesity assessed by body mass index (BMI), and diagnoses of type 2 diabetes, hypertension and hyperlipidemia abstracted from electronic health records. Covariates considered included: age, gender, education and BMI (except in the obesity model). Statistical analyses included multivariable logistic regression testing for interaction between food insecurity and diet. Results: Overall, 51% of the sample were women and most self-identified as Dominicans (73%). Thirty-one percent of the sample experienced food insecurity and 79% consumed less than 5 servings of fruits and vegetables per day. Twenty percent of food secure participants and 23% of food insecure individuals consumed 5 servings or more of fruits and vegetables per day (p=0.439). In adjusted models, food insecurity was positively associated with type 2 diabetes in individuals consuming less than 5 servings of fruits and vegetables per day (OR=1.79; 95% CI=1.11–2.89) but not in individuals consuming 5 servings or more of fruits and vegetables per day. Interaction analyses showed that these estimates were significantly different from each other (p=0.04). Conclusion: Among those who were food insecure, low consumption of fruits and vegetables, was associated with type 2 diabetes in this Latino sample. Studies are needed to confirm our findings. Further, longitudinal studies are needed to understand a potential causal relationship. Interventions to increase availability of fruits and vegetables among food insecure Latinos may help alleviate diabetes disparities in this vulnerable group

Association between food insecurity and CVD risk factors is moderated by intake of fruits and vegetables in Latinos

Background: Food insecurity has been consistently associated with CVD risk factors (i.e., obesity, type 2 diabetes, hypertension and hypercholesterolemia). Consumption of fruits and vegetables may reduce CVD risk factors among food insecure Latinos. Objective: To examine the potential moderating effect of fruit and vegetable intake in the association between food insecurity and CVD risk factors in a sample of Latino men and women in the northeast U.S. Methods: A representative community sample of Latino individuals was recruited from a community health center in Lawrence, MA. Food insecurity was measured with the 6-item USDA Household Food Security Scale. Fruit and vegetable intake, was measured with Block’s Fruit and Vegetable Screener. CVD risk factors examined included: obesity assessed by body mass index (BMI), and diagnoses of type 2 diabetes, hypertension and hyperlipidemia abstracted from electronic health records. Covariates considered included: age, gender, education and BMI (except in the obesity model). Statistical analyses included multivariable logistic regression testing for interaction between food insecurity and diet. Results: Overall, 51% of the sample were women and most self-identified as Dominicans (73%). Thirty-one percent of the sample experienced food insecurity and 79% consumed less than 5 servings of fruits and vegetables per day. Twenty percent of food secure participants and 23% of food insecure individuals consumed 5 servings or more of fruits and vegetables per day (p=0.439). In adjusted models, food insecurity was positively associated with type 2 diabetes in individuals consuming less than 5 servings of fruits and vegetables per day (OR=1.79; 95% CI=1.11–2.89) but not in individuals consuming 5 servings or more of fruits and vegetables per day. Interaction analyses showed that these estimates were significantly different from each other (p=0.04). Conclusion: Among those who were food insecure, low consumption of fruits and vegetables, was associated with type 2 diabetes in this Latino sample. Studies are needed to confirm our findings. Further, longitudinal studies are needed to understand a potential causal relationship. Interventions to increase availability of fruits and vegetables among food insecure Latinos may help alleviate diabetes disparities in this vulnerable group

Emotional Eating is Associated with Intake of Energy-dense Foods in Latinos

Background: Latinos experience profound health disparities in diet-related chronic conditions. Emotional eating (EE) has been positively associated with such conditions, however, little is known about the relationship between EE and energy-dense food intake that may influence risk for developing these conditions. Objective: To examine associations between EE and energy-dense food intake in Latino men and women. Methods: Latino individuals were recruited from a community health center in Lawrence, MA. Participants completed standardized assessments. EE was measured with the Three Factor Eating Behavior Questionnaire R18-V2. Dietary intake was measured with a culturally tailored Food Frequency Questionnaire. Energy-dense food groups defined as food groups exceeding 225calories per 100 grams were identified. Covariates considered in this analysis included: age, sex, education, employment status and BMI. Statistical analysis consisted of multivariable logistic regression. Results: A total of 201 participants were included in this analysis (53.7% female, 68.1% Dominicans). After adjusting for covariates, EE was significantly associated with high intake of sweet and/or fatty foods, namely dairy desserts (i.e., ice-cream, sherbet and frozen yogurt) (OR=1.55; 95%CI=1.08, 2.21; p=0.017), oleaginous fruits (i.e., nuts and seeds) (OR=1.44; 95%CI=1.01, 2.05; p=0.046) and baked goods (i.e., cakes, cookies, pies, doughnuts and muffins) (OR=1.54; 95%CI=1.07, 2.20; p=0.020). Conclusion: EE was positively associated with consumption of energy-dense foods in this Latino sample. Future studies should examine longitudinal associations between EE, intake of energy-dense foods and risk of chronic health conditions. Understanding these associations can unveil potential intervention targets for Latinos at high risk of diet-related chronic health conditions. Also presented at the Experimental Biology 2017 Annual Conference, Chicago, IL

Do U.S. adults living in food insecure households experience poorer cardiovascular health?

Background Twelve percent of U.S. adults live in food insecure households, putting them at risk for adverse health outcomes. Relationships between food insecurity and cardiovascular disease (CVD) risk factors range from well-established to inconsistent and understudied. Food insecurity has been positively associated with poor glycemic control, tobacco use, and poor diet. The link with unhealthy body mass index (BMI) is only observed among women. Inconsistent evidence of relationships with hypertension and dyslipidemia has been found and literature examining physical activity is sparse. The relationships between food insecurity and overall cardiovascular health metrics have not been studied in a nationally representative sample of U.S. adults. Objective To quantify the extent to which food insecurity in U.S. adults is associated with poorer cardiovascular health, as measured by the Life Simple 7 metrics, and to assess gender differences in these associations. Methods This was a cross-sectional analysis of 1,446 National Health and Nutrition Examination Survey participants (2011-2012) aged \u3e20 years. The United States Department of Agriculture Adult Food Security Module 10-item questionnaire assessed food insecurity status. Affirmative responses were summed and dichotomized as food secure (responses) or food insecure (\u3e3). An ideal cardiovascular health score was generated from the sum of American Heart Association’s (AHA) Life’s Simple 7 metrics components achieved. The metrics included three health factors (blood glucose, cholesterol, and blood pressure) and four health behaviors (non-smoking, physical activity, healthy BMI, and healthy diet) as measured by laboratory values, anthropometric measures, self-reported questionnaires, and dietary recalls. Multiple linear and logistic regressions determined the associations between food insecurity and overall ideal cardiovascular health, defined as meeting all of the AHA Life Simple 7 metrics, and individual cardiovascular health components, respectively. The interaction between food insecurity and gender and ideal cardiovascular health was tested. Results No U.S. adults met all ideal cardiovascular health components. The 15.8% of adults living in food insecure households achieved a lower ideal cardiovascular health score (adjusted β coefficient: -0.27; 95% Confidence Interval (CI): [-0.50 to -0.04]) than adults living in food secure households. Tests for gender interaction were non-significant. In analyses assessing individual cardiovascular health components, only smoking was significant; adults living in food insecure households were half as likely to be non-smokers or recent quitters relative to their food secure counterparts (adjusted Odds Ratio 0.51; 95% CI: [0.31-0.81]). Conclusion Adults living in food insecure households achieved a lower ideal cardiovascular health score, which was driven by its association with smoking status. In addition to primary and secondary prevention, primordial prevention and cardiovascular health promotion approaches are necessary to reduce CVD burden. Effective policies and health behavior interventions are prudent, specifically to improve diet quality among all U.S. adults and tobacco cessation within food insecure populations

Trajectories of Weight for Length Growth for Infants During the First Year of Life

Background: Childhood obesity is a major public health problem. Studies of patterns of child growth contributing to the development of obesity are scarce, particularly in infancy. Group based trajectory analyses among infants are a novel procedure that may help characterize subgroups of infants with similar longitudinal growth profiles. Objective: To identify trajectories of weight for length growth during the first year of life. Methods: Subjects were singleton infants and their mothers (N=90 mother-infant pairs) who participated in the Pregnancy and Postpartum Observational Dietary Study. Women completed assessments throughout their infant\u27s first year of life and included sociodemographic characteristics and feeding behaviors. Infant weight for length measures from birth to 12 months were abstracted from pediatric office records. Weight for length percentiles were calculated according to the World Health Organization guidelines for infants. Group-based trajectory analysis was done to identify subgroups of infants with similar growth profiles. Results: Infants were from mother’s with average of 28 years (SD=5.2), 70.0% White, 60.0% high-school educated and 63.2% had two or more children. Over half of mothers introduced solid foods to their infants by 6 months of age (63.2%) and about one third self-reported breast feeding at 12 months post-partum (31.9%). Three growth trajectories were identified: a low and stable growth group (38.3%), a rapid growth group (35.0%) and a moderate growth group (26.7%). Maternal and feeding variables were all similar across the three infant growth trajectory groups (p\u3e0.05). Conclusion: Trajectory models suggested three patterns of infant growth. If replicated, future studies can help identify and subsequently target modifiable risk factors associated with rapid infant growth trajectories

Association of dysfunctional eating with metabolic risk factors for cardiovascular disease in Latinos

Background: Latinos bear high burden of nutrition related cardiovascular disease (CVD) risk factors. Dysfunctional eating behaviors (emotional eating, uncontrolled eating and cognitive restraint of eating) may influence metabolic CVD risk factors but little is known about this relationship in Latinos. Objective: To examine associations between dysfunctional eating behaviors and metabolic risk factors for CVD in Latinos. Methods: Latino individuals were recruited from a community health center. Participants completed standardized interviews (i.e., demographics, Three Factor Eating Questionnaire-TFEQ-R18V2, Perceived Stress Scale-10) and anthropometric measurements. Data on diagnosis of type 2 diabetes, hypertension and hyperlipidemia were abstracted from medical records. Statistical analysis included multivariable logistic and Poisson regression models. Results: A total of 578 participants (51% female, 67% Dominican), ages 21-84, were included in this analysis. Controlling for age, sex, education and perceived stress high emotional eating (hEE) was associated with greater odds of obesity (OR=2.25 (1.47, 3.24)) and diabetes (OR=1.80 (1.07, 3.01)). High uncontrolled eating (hUE) was associated with obesity (OR=2.16 (1.34, 3.47)) and high cognitive restraint (hCR) was associated with greater odds of obesity (OR=2.55 (1.64, 3.98)), diabetes (OR=2.39 (1.40, 4.04) and hyperlipidemia (OR=1.92 (1.17, 3.14)). Lastly, hEE, hUE and hCR were significantly associated increased odds of having a greater number of the metabolic CVD risk factors (IRR=1.39 (1.20, 1.59), IRR=1.21 (1.04, 1.42), IRR=1.45 (1.24, 1.69); respectively). Conclusion: Interventions that target eating behaviors may facilitate reduction of metabolic CVD risk factors and health disparities in CVD among Latinos

Recruiting Low Income Post-Partum Women into a Weight Loss Trial: In-Person versus Facebook Delivery

Several studies, such as the Diabetes Prevention Program (DPP), have provided foundational evidence for the effect of lifestyle modification interventions on diabetes prevention and weight loss. However, translating these programs to the real-world has proven difficult. There remains a need to increase the feasibility and reach of translational weight loss interventions. PURPOSE: To compare the recruitment rates of overweight low income postpartum women into a DPP-adapted behavioral weight loss program delivered in-person versus delivered via Facebook. METHODS: We compared two 8-week pilot behavioral weight loss trials; one delivered via weekly in-person group sessions and the other delivered entirely via Facebook. Both trials used the same recruitment methods: participants were overweight low income postpartum women within five Women Infants and Children (WIC) clinics in the Worcester, Massachusetts area recruited by nutritionists during routine WIC visits. Inclusion criteria included, childbirth in the previous 6 weeks to 6 months, age 18 or older, a body mass index (BMI) of \u3e 27 kg/m2, and obstetric provider approval for participation in the diet and physical activity components of the intervention. Additional eligibility criteria for the Facebook intervention included: 1) ability to use the Internet daily; 2) having a Facebook account; 3) currently using Facebook at least once per week. RESULTS: 27 and 54 women participated in the in-person and Facebook pilot trials, respectively. Among eligible women in the in-person trial, 62.1% gave permission to be contacted for the in-person trial, and 23.3% enrolled. Among eligible women in the Facebook trial, 59.7% of women agreed to be contacted, and 39.1% enrolled. CONCLUSIONS: Recruitment rates for a Facebook-based weight loss intervention were higher than rates for an in-person intervention. Future efforts are needed to increase reach of weight loss interventions among overweight and obese low income diverse women

Adapting a Behavioral Weight Loss Intervention for Delivery via Facebook: A Pilot Series 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\u27 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

Racial/ethnic representation in lifestyle weight loss intervention studies in the United States: A systematic review

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

Physiological and Psychological Stressors Associated with Glucose Metabolism in the Boston Puerto Rican Health Study

Background: Puerto Ricans experience high prevalence of type 2 diabetes (diabetes). Stress is a risk factor for diabetes. The allostatic load (AL) model explains how stress influences disease through a chain of physiological changes. Puerto Ricans experience psychological and physiological (obesity and high glycemic load (GL)) stressors linked with diabetes, yet how these stressors impact the AL chain and how their interplay affects glucose metabolism remains unknown. Methods: Using data from the Boston Puerto Rican Health Study, this thesis sought to examine: 1) the relationship between GL and primary AL markers, 2) the interaction between perceived stress and GL on HbA1c, and if primary AL markers mediate this interaction, and 3) the interaction between change in weight and in perceived stress on HbA1c. Results: 1) GL change over 2 years was associated with increases in primary AL markers in women. 2) Women with high perceived stress and high GL had higher HbA1c and primary AL markers did not mediate this interaction. 3) In women, there was an interaction between change in weight and perceived stress on HbA1c over 2 years, with the effect of weight change on HbA1c being greater with increases in perceived stress. None of these associations were observed in men. Conclusion: This study partially confirms the AL model in Puerto Rican women but not in men. It provides data to inform intervention targets to prevent and manage diabetes in Puerto Rican women and identifies women at high risk of diabetes in this minority group