Hostility and quality of life among Hispanics/Latinos in the HCHS/SOL Sociocultural Ancillary Study

The purpose of this study was to determine if hostility is associated with physical and mental health-related quality of life (QoL) in U.S. Hispanics/Latinos after accounting for depression and anxiety

Smoking patterns and chronic kidney disease in US Hispanics: Hispanic Community Health Study/Study of Latinos

Intermittent smoking is prevalent among Hispanics, but little is known about whether this smoking pattern associates with increased chronic kidney disease (CKD) risk in this population. The objective of the present study is to identify patterns of exposure associated with CKD in US Hispanics

Acculturation and chronic kidney disease in the Hispanic community health study/study of Latinos (HCHS/SOL)

Hispanics/Latinos are burdened by chronic kidney disease (CKD). The role of acculturation in this population has not been explored. We studied the association of acculturation with CKD and cardiovascular risk factor control. We performed cross-sectional analyses of 13,164 U.S. Hispanics/Latinos enrolled in the HCHS/SOL Study between 2008 and 2011. Acculturation was measured using the language and ethnic social relations subscales of the Short Acculturation Scale for Hispanics, and proxies of acculturation (language preference, place of birth and duration of residence in U.S.). CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 or urine albumin-to-creatinine ratio ≥ 30 mg/g. On multivariable analyses stratified by age, lower language subscale score was associated with higher odds of CKD among those older than 65 (OR 1.29, 95% CI, 1.03, 1.63). No significant association was found between proxies of acculturation and CKD in this age strata. Among individuals aged 18–44, a lower language subscale score was associated with lower eGFR (β = −0.77 ml/min/1.73 m2, 95% CI −1.43, −0.10 per 1 SD increase) and a similar pattern was observed for ethnic social relations. Among those older than 65, lower language subscale score was associated with higher log-albuminuria (β = 0.12, 95% CI 0.03, 0.22). Among individuals with CKD, acculturation measures were not associated with control of cardiovascular risk factors. In conclusion, lower language acculturation was associated with a higher prevalence of CKD in individuals older than 65. These findings suggest that older individuals with lower language acculturation represent a high risk group for CKD

Objectively Measured Sedentary Time and Cardiometabolic Biomarkers in US Hispanic/Latino AdultsCLINICAL PERSPECTIVE: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Sedentary behavior is recognized as a distinct construct from lack of moderate-vigorous physical activity and is associated with deleterious health outcomes. Previous studies have primarily relied on self-reported data, while data on the relationship between objectively-measured sedentary time and cardiometabolic biomarkers are sparse, especially among U.S. Hispanics/Latinos

Inactivity, Inflammation, and Insulin Resistance in Type 2 Diabetes and the Metabolic Syndrome

Both type 2 diabetes (T2D) and the the metabolic syndrome (MetS) have been shown to increase the risk of cardiovascular disease (CVD). Inflammation and insulin resistance have each been associated with the development of MetS and the onset of T2D as well as the risk of CVD. Inflammation and insulin resistance are therefore suitable targets for public health initiatives and interventions in persons at risk for or living with CVD. Physical inactivity is a major risk factor for CVD as well as MetS and T2D. Conversely, increased physical activity is associated with improved health outcomes for individuals with a high risk for developing CVD. Two possible mechanisms for the deleterious effects of inactivity on health are inflammation and insulin resistance. Researchers have hypothesized that increased adiposity and reduced fitness are partially responsible for the associations between inactivity, inflammation, and insulin resistance. However, these relationships have not been studied extensively in overweight/obese individuals, who are often unfit and sedentary. The purpose of this study was to further examine the relationship between baseline measures of walking activity and sedentary behavior, and inflammation and insulin resistance in a sample of adults with type 2 diabetes and/or metabolic syndrome. This thesis examined baseline data from participants enrolled in either of two studies of patients with T2D (n = 116) or MetS without T2D (n = 126). Participants included low income men and women (not pregnant or nursing) between the ages of 18 and 70 who either show depressed affect (BDI \u3e 11), and were overweight (BMI ≥ 27 kg/m2) and had type 2 diabetes or had at least 3 components of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) classification of the metabolic syndrome (MetS). Structural equation modeling was used to determine if physical inactivity is associated with inflammation or insulin resistance in these conditions. Possible mediational roles of adiposity and low cardiorespiratory fitness were also examined. Additional analyses were conducted to determine if these relationships can be estimated equally in MetS and T2D conditions. Activity was indirectly related to abdominal adiposity via an indirect, positive association with cardiorespiratory fitness. Abdominal adiposity was positively related to both inflammation and insulin resistance. There were no direct associations between activity and inflammation or insulin resistance in this population. Therefore, walking may be negatively related to cardiovascular risk, insofar as it reduces abdominal adiposity

Randomized Controlled Trial of a Behavioral Weight Loss Intervention for Primary Prevention of Renal Decline in Type 2 Diabetics

Reduced glomerular filtration rate and increased albuminuria often develop in Type 2 Diabetes Mellitus (T2DM) and are predictive of chronic kidney and cardiovascular disease. Risk for renal disease in T2DM has been associated with cardiometabolic risk factors including, hypertension, dyslipidemia, and hyperglycemia. Weight loss is associated with improved outcomes in T2DM patients with existing renal disease and may also reduce risk in patients without renal disease via reduction of cardiometabolic risk factors. The aims of this study were (1) to examine the effects of a behavioral weight loss intervention on renal outcomes in T2DM patients without evidence of renal disease, and (2) to determine if change in renal outcomes is related to key demographic and cardiometabolic risk factors. A sample of 111 T2DM patients (mean age = 54.81 years, 28.8% male) was recruited from community health clinics and by word-of-mouth and randomized to receive a 17-session lifestyle intervention or usual care (control). Eligible participants were overweight or obese, reported significant symptoms of depression, and had no evidence of existing renal or cardiovascular disease at screening. Demographic, psychosocial, anthropometric, blood and urine measures were collected at baseline and repeated at 6-months and 12-months post randomization. Primary outcomes included weight, depressive symptoms, glycosylated hemoglobin (HbA1c), creatinine-based estimated glomerular filtration rate (eGFRCR), cystatin c and creatinine-based eGFRCY-CR, (estimated using Chronic Kidney Disease Epidemiology Collaboration formulas), and urinary albumin to creatinine ratio (UACR). Relative to usual care, the intervention resulted in significant increases in eGFRCY-CR (B= .331, SE = .142, p \u3c .05), as well as significant decreases in weight (B = -.320, SE = .125, p \u3c .01), depressed affect (B = -.993, SE = .228, p \u3c .001), and HbA1c (B = -.068, SE = .030, p \u3c .05). There was no effect of intervention on eGFRCR (B = -.146, SE = .119, p = .219) or UACR (B = .228, SE = .336, p = .497). The model estimated normative change in eGFRCY-CR was significant (B = .468, SE = .200, p \u3c .05) and non-linear, indicating a change in direction of the slope after 6 months and an overall decline. Normative change in eGFRCR was not significant, (B= -.146, SE = .119, p \u3e .05). Independent predictors of rate of change in eGFRCR were UACR, systolic blood pressure, high density lipoprotein cholesterol (HDL-C) and eGFR at baseline. The intervention effect on eGFR was related to UACR and HDL-C, HbA1C and triglycerides at baseline. UACR increased among all participants (B= .460, SE = .163, p \u3c .05), and was related to UACR at baseline. Additional cardiometabolic risk factors were not related to change in UACR. Behavioral weight loss strategies may be implemented to preserve renal function among T2DM patients and prevent or delay the onset of renal disease in this population. Such strategies may be particularly effective for patients with dyslipidemia and hyperglycemia, and less effective for patients with elevated albumin excretion. Future studies should identify potential mediators of beneficial effects

Effects of a Multicomponent Life-Style Intervention on Weight, Glycemic Control, Depressive Symptoms, and Renal Function in Low-Income, Minority Patients With Type 2 Diabetes: Results of the Community Approach to Lifestyle Modification for Diabetes Randomized Controlled Trial

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Objectively Measured Physical Activity, Sedentary Behavior, and Genetic Predisposition to Obesity in U.S. Hispanics/Latinos: Results From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Studies using self-reported data suggest a gene-physical activity interaction on obesity, yet the influence of sedentary behavior, distinct from a lack of physical activity, on genetic associations with obesity remains unclear. We analyzed interactions of accelerometer-measured moderate to vigorous physical activity (MVPA) and time spent sedentary with genetic variants on obesity among 9,645 U.S. Hispanics/Latinos. An overall genetic risk score (GRS), a central nervous system (CNS)-related GRS, and a non-CNS-related GRS were calculated based on 97 BMI-associated single nucleotide polymorphisms (SNPs). Genetic association with BMI was stronger in individuals with lower MVPA (first tertile) versus higher MVPA (third tertile) (β = 0.78 kg/m [SE, 0.10 kg/m ] vs. 0.39 kg/m [0.09 kg/m ] per SD increment of GRS; = 0.005), and in those with more time spent sedentary (third tertile) versus less time spent sedentary (first tertile) (β = 0.73 kg/m [SE, 0.10 kg/m ] vs. 0.44 kg/m [0.09 kg/m ]; = 0.006). Similar significant interaction patterns were observed for obesity risk, body fat mass, fat percentage, fat mass index, and waist circumference, but not for fat-free mass. The CNS-related GRS, but not the non-CNS-related GRS, showed significant interactions with MVPA and sedentary behavior, with effects on BMI and other adiposity traits. Our data suggest that both increasing physical activity and reducing sedentary behavior may attenuate genetic associations with obesity, although the independence of these interaction effects needs to be investigated further

Abstract MP027: Gene-environment Interaction Analysis Reveals Evidence for Independent Influences of Physical Activity and Sedentary Behavior on Obesity: Results From the Hispanic Community Health Study/study of Latinos (HCHS/SOL)

Background: Studies using self-reported data support gene-physical activity interaction on obesity, yet the influence of sedentary behavior, distinct from lack of physical activity, on genetic associations with obesity remains unclear. Methods: We examined interactions of accelerometer-measured physical activity and sedentary behavior with genetic variants on BMI/obesity risk in 9,645 participants aged 18-74 years from the HCHS/SOL, a population-based cohort of US Hispanics/Latinos (2008-2011). A genetic risk score (GRS) was calculated by summing the BMI-increasing alleles of known 97 SNPs (identified primarily in European-ancestry in the GIANT BMI GWAS; P <5х10 -8 ). Specific GRSs were also calculated based on the possible biological categories of these SNPs. Results: The overall GRS was significantly associated with BMI in the HCHS/SOL (β=0.65 per SD [~6-allele increase]; P=1.0х10 -39 ). The genetic effect on BMI was stronger in participants with lower moderate-to-vigorous physical activity (MVPA) (1 st tertile, <8min/day) compared to those with higher MVPA (3 rd tertile, >23min/day) (0.78 [0.10] vs 0.39 [0.10]; P int =0.005), as well as in participants with more sedentary time (3 rd tertile, >13h/day) compared to those with less sedentary time (1 st tertile, <11h/day) (0.73 [0.1] vs 0.44 [0.1]; P int =0.005). The genetic effects on obesity risk were stronger in participants with lower MVPA (P int =0.016) or more sedentary time (P int =0.016). Interactions of GRS with MVPA and sedentary behavior remained significant after further adjustment for each other. Of note, 4 biological category-specific GRSs showed nominally significant interactions with both MVPA and sedentary behavior, while a number of different GRSs interacted with only MVPA or sedentary behavior, in relation to BMI ( Figure ). Conclusions: Our data suggest that both increasing physical activity and reducing sedentary behavior may attenuate the genetic association with obesity, possibly through interacting with shared and different genetic pathways

Elucidating the Multidimensionality of Socioeconomic Status in Relation to Metabolic Syndrome in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Socioeconomic (SES) factors underlying disparities in the prevalence of metabolic syndrome (MetSyn) and consequently, type 2 diabetes among Hispanics/Latino populations are of considerable clinical and public health interest. However, incomplete and/or imprecise measurement of the multidimensional SES construct has impeded a full understanding of how SES contributes to disparities in metabolic disease. Consequently, a latent-variable model of the SES-MetSyn association was investigated and compared with the more typical proxy-variable model. A community-based cross-sectional probability sample (2008-2011) of 14,029 Hispanic/Latino individuals of Puerto Rican, Cuban, Dominican, Central American, South American, and Mexican ancestry living in the USA was used. SES proxy's education, income, and employment were examined as effect indicators of a latent variable, and as individual predictors. MetSyn was defined using 2009 harmonized guidelines, and MetSyn components were also examined individually. In multivariate regression analyses, the SES latent variable was associated with 9% decreased odds of MetSyn (95% confidence interval: 0.85, 0.96, P < .001) and was associated with all MetSyn components, except diastolic blood pressure. Additionally, greater income, education, and employment status were associated with 4%, 3%, and 24% decreased odds of having MetSyn, respectively (Ps < .001). The income-MetSyn association was only significant for women and those with current health insurance. Hispanic/Latinos exhibit an inverse association between SES and MetSyn of varying magnitudes across SES variables. Public health research is needed to further probe these relationships, particularly among Hispanic/Latina women, to ultimately improve healthcare access to prevent diabetes in this underserved population