The Effect of Vitamin D3 Supplementation on Kidney Function and Cardiovascular Disease Markers among Hispanics and African Americans with Type 2 Diabetes

Serum vitamin D deficiency/insufficiency, Chronic Kidney Disease (CKD) and elevated blood pressure are important health concerns especially among minorities with type 2 diabetes. The effect of vitamin D3 supplementation (cholecalciferol) at 6,000 IU/day (d) vs. 4,000 IU/d on kidney function and cardiovascular disease markers among Hispanics and African Americans with type 2 diabetes and hypovitaminosis D (/ml) was evaluated. Subjects (n=63) were recruited from two clinics in Miami-Dade County, FL. Fasting venous blood and fresh, single-voided first morning urine samples were collected from each participant by a certified phlebotomist and analyzed by Solstas Lab Partners, Davie, FL. Linear mixed models were used to compare the interaction between time and intervention. Least Significant Difference (LSD) comparisons were used to detect significant differences within and between 4,000 IU/d and 6,000 IU/d groups from baseline, 3 and 6 months. In the 4,000 IU/d and 6,000 IU/d groups, a significant increase in serum 25-hydroxy vitamin D [25(OH)D] levels were observed from baseline [(19.9±1.1 ng/mL) and (21.4±1.3 ng/mL)] to 3 months [(36.1±2.2 ng/mL, p3 longer than 6 months may be needed to determine sustained long term effects in kidney and cardiovascular disease markers. Further research could provide more information for translation of these findings into recommendations for individuals with CKD, hypertension and type 2 diabetes. The efficacy of vitamin D3 supplementation as complementary therapy for CKD and blood pressure in minority and other ethnic groups needs further investigation in larger and longer duration randomized controlled trials

Waist Circumference and BMI in Relation to Serum High Sensitivity C-Reactive Protein (hs-CRP) in Cuban Americans With and Without Type 2 Diabetes

Relationship between high-sensitivity C-reactive protein (hs-CRP) and adiposity by diabetes status and gender in Cuban-Americans with and without type 2 diabetes (T2D) was studied. Adult subjects, 226 females, 129 males participated in a case control, single time point study. Subjects with T2D were older, had higher waist circumference (WC) and body mass index (BMI). WC and BMI were associated with ln hs-CRP (P < 0.001). An interaction with diabetes status was found for BMI (P = 0.037). Gender showed a strong relationship with ln hs-CRP (P < 0.001), which was moderated by diabetes status. Only males without diabetes exhibited a significant relationship for both WC and BMI with ln hs-CRP. In this sample of Cuban-Americans, WC and BMI had stronger associations with ln hs-CRP but not with diabetes status. Obesity prevention and controlling for CRP levels may be necessary to eliminate its contributions to develop diabetes and cardiovascular disease (CVD)

Health-Related Characteristics of Older Adults Who Attend Congregate Meal Sites in the United States

The purpose of this study was to determine health-related characteristics of a representative sample of older adults who attend congregate meal sites in the United States, and compare races/ethnicities and sexes. Participants were adults, aged 60 years and older, (N = 901) of the 2015 Tenth Annual National Survey of Older American Act Participants (NSOAAP). Difficulties with mobility and Activities of Daily Living were common among older adults who attended congregate meals. Health-related characteristics differed by race/ethnicity and sex. Higher percentages of men reported eating more than half their calories from the site: 61.0% (53, 68), compared to women: 41.2% (33,50); while twice the number of women reported exercising at the site: 42.7% (36, 50), compared to 21.8% (16, 29) for men. Hispanics reported poor/fair health, food insecurity, diabetes, and poverty more often than White non-Hispanics. The odds of reporting that meals helped maintain independence were higher for persons with food insecurity: OR = 2.67 (1.05, 6.80) and those who reported eating half or more of their calories from the site: OR = 5.78 (2.36, 14.30). Strategies that consider preferences by sex and race/ethnicity are required at congregate meal sites to encourage mobility and healthy eating

The Effect of Carbohydrate Amount, Quality and Type on Arterial Pulse Pressure in Cuban-Americans with and Without Type 2 Diabetes

Background: Arterial pulse pressure, the difference between systolic and diastolic blood pressure, has been used as an indicator (surrogate measure) of arterial stiffness. High arterial pulse pressure (\u3e 40) has been associated with increased cardiovascular disease and mortality. Several clinical trials have reported that the proportion of calories from carbohydrate has an effect on blood pressure. The primary objective of this study was to assess arterial pulse pressure and its association with carbohydrate quantity and quality (glycemic load) with diabetes status for a Cuban American population. Methods: A single point analysis included 367 participants. There was complete data for 365 (190 with and 175 without type 2 diabetes). The study was conducted in the investigator’s laboratory located in Miami, Florida. Demographic, dietary, anthropometric and laboratory data were collected. Arterial pulse pressure was calculated by the formula systolic minus the diastolic blood pressure. Glycemic load, fructose, sucrose, percent of average daily calories from carbohydrate, fat and protein, grams of fiber and micronutrient intakes were calculated from a validated food frequency questionnaire. Results: The mean arterial pulse pressure was significantly higher in participants with (52.9 ± 12.4) than without (48.6 ± 13.4) type 2 diabetes. The odds of persons with diabetes having high arterial pulse pressure (\u3e40) was 1.85 (95% CI =1.09, 3.13); p=0.023. For persons with type 2 diabetes higher glycemic load was associated with lower arterial pulse pressure. Conclusions: Arterial pulse pressure and diet are modifiable risk factors of cardiovascular disease. Arterial pulse pressure may be associated with carbohydrate intake differently considering diabetes status. Results may be due to individuals with diabetes following dietary recommendations. The findings of this study suggest clinicians take into consideration how medical condition, ethnicity and diet are associated with arterial pulse pressure before developing a medical nutrition therapy plan in collaboration with the client

The Role of Family/Friend Social Support in Diabetes Self-Management for Minorities with Type 2 Diabetes

This study investigated how ethnicity, perceived family/friend social support (FSS), and health behaviors are associated with diabetes self-management (DSM) in minorities. The participants were recruited by community outreach methods and included 174 Cuban-, 121 Haitian- and 110 African-Americans with type 2 diabetes. The results indicated that ethnicity and FSS were associated with DSM. Higher FSS scores were associated with higher DSM scores, independent of ethnicity. There were ethnic differences in several elements of FSS. DSM was highest in Haitian- as compared to African-Americans; yet Haitian Americans had poorer glycemic control. The findings suggest FSS together with ethnicity may influence critical health practices. Studies are needed that further investigate the relationships among minorities with diabetes, their intimate network (family and friends) and the diabetes care process

Impact of Vegetable Preparation Method and Taste-Test on Vegetable Preference for First Grade Children in the United States

How children rate vegetables may be influenced by the preparation method. The primary objective of this study was for first grade students to be involved in a cooking demonstration and to taste and rate vegetables raw and cooked. First grade children of two classes (N= 52: 18 boys and 34 girls (approximately half Hispanic) that had assented and had signed parental consent participated in the study. The degree of liking a particular vegetable was recorded by the students using a hedonic scale of five commonly eaten vegetables tasted first raw (pre-demonstration) and then cooked (post-demonstration). A food habit questionnaire was filled out by parents to evaluate their mealtime practices and beliefs about their child’s eating habits. Paired sample t-tests revealed significant differences in preferences for vegetables in their raw and cooked states. Several mealtime characteristics were significantly associated with children’s vegetable preferences. Parents who reported being satisfied with how often the family eats evening meals together were more likely to report that their child eats adequate vegetables for their health (p=0.026). Parents who stated that they were satisfied with their child’s eating habits were more likely to report that their child was trying new foods (p&lt;.001). Cooking demonstrations by nutrition professionals may be an important strategy that can be used by parents and teachers to promote vegetable intake. It is important that nutrition professionals provide guidance to encourage consumption of vegetables for parents so that they can model the behavior of healthy food consumption to their children

Effect of Medical Advice for Diet on Diabetes Self-Management and Glycemic Control for Haitian and African Americans with Type 2 Diabetes

Adequate care of type 2 diabetes is reflected by the individual’s adherence to dietary guidance; yet, few patients are engaged in diabetes self-care at the recommended level, regardless of race/ethnicity. Few studies on the effect of dietary medical advice on diabetes self-management (DSM) and glycemic control have been conducted on Haitian and African American adults with type 2 diabetes. These relationships were assessed in total of 254 Blacks with type 2 diabetes (Haitian Americans = 129; African Americans = 125) recruited from Miami-Dade and Broward Counties, Florida by community outreach methods. Although dietary advice received was not significantly different between the two Black ethnicities, given advice “to follow a diet” as a predictor of “using food groups” was significant for Haitian Americans, but not for African Americans. Haitian Americans who were advised to follow a diet were approximately 3 times more likely to sometimes or often use food groups (or exchange lists) in planning meals. Less than optimal glycemic control (A1C \u3e 7.2) was inversely related to DSM for African Americans; but the relationship was not significant for Haitian Americans. A one unit increase in DSM score decreased the odds ratio point estimate of having less than optimal glycemic control (A1C \u3e 7.2%) by a factor of 0.94 in African Americans. These results suggest that medical advice for diet plans may not be communicated effectively for DSM for some races/ethnicities. Research aimed at uncovering the enablers and barriers of diet management specific to Black ethnicities with type 2 diabetes is recommended

Use of Hemoglobin A1C to Detect Haitian-Americans with Undiagnosed Type 2 Diabetes

OBJECTIVE: To evaluate the validity of hemoglobin A1C (A1C) as a diagnostic tool for type 2 diabetes and to determine the most appropriate A1C cutoff point for diagnosis in a sample of Haitian-Americans. SUBJECTS AND METHODS: Subjects (n = 128) were recruited from Miami-Dade and Broward counties, FL. Receiver operating characteristics (ROC) analysis was run in order to measure sensitivity and specificity of A1C for detecting diabetes at different cutoff points. RESULTS: The area under the ROC curve was 0.86 using fasting plasma glucose ≥ 7.0 mmol/L as the gold standard. An A1C cutoff point of 6.26% had sensitivity of 80% and specificity of 74%, whereas an A1C cutoff point of 6.50% (recommended by the American Diabetes Association – ADA) had sensitivity of 73% and specificity of 89%. CONCLUSIONS: A1C is a reliable alternative to fasting plasma glucose in detecting diabetes in this sample of Haitian-Americans. A cutoff point of 6.26% was the optimum value to detect type 2 diabetes

Hypertension, poor glycemic control, and microalbuminuria in Cuban Americans with type 2 diabetes

Gustavo G Zarini1, Joel C Exebio1, Deva Gundupalli1, Subrata Nath2, Fatma G Huffman11Florida International University, Robert R Stempel School of Public Health, Department of Dietetics and Nutrition, Miami, Florida, USA; 2Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USAPurpose: To investigate to what degree the presence of hypertension (HTN) and poor glycemic control (GC) influences the likelihood of having microalbuminuria (MAU) among Cuban Americans with type 2 diabetes (T2D).Methods: A cross-sectional study conducted in Cuban Americans (n = 179) with T2D. Participants were recruited from a randomly generated mailing list purchased from KnowledgeBase Marketing, Inc. Blood pressure (BP) was measured twice and averaged using an adult size cuff. Glycosylated hemoglobin (A1c) levels were measured from whole blood samples with the Roche Tina-quant method. First morning urine samples were collected from each participant to determine MAU by a semiquantitative assay (ImmunoDip).Results: MAU was present in 26% of Cuban Americans with T2D. A significantly higher percentage of subjects with MA had HTN (P = 0.038) and elevated A1C (P = 0.002) than those with normoalbuminuria. Logistic regression analysis showed that after controlling for covariates, subjects with poor GC were 6.76 times more likely to have MAU if they had hypertension compared with those without hypertension (P = 0.004; 95% confidence interval [CI]: 1.83, 23.05). Conclusion: The clinical significance of these findings emphasizes the early detection of MAU in this Hispanic subgroup combined with BP and good GC, which are fundamentals in preventing and treating diabetes complications and improving individuals&amp;rsquo; renal and cardiovascular outcomes.Keywords: blood pressure, A1c, kidney function, cardiovascular disease, Hispanic

Television Watching, Diet Quality, Physical Activity and Diabetes Among Three Ethnicities in the United States

Diabetes is a world-wide epidemic associated with multiple environmental factors. Prolonged television viewing (TV) time has been related to increased risk of obesity and type 2 diabetes in several studies. TV viewing has been positively associated with cardiovascular disease risk factors, lower energy expenditure, over-eating high-calorie and high-fat foods. The objective of this study was to assess the associations of hours of TV viewing with dietary quality, obesity and physical activity for three ethnic minorities with and without type 2 diabetes. Diet quality and physical activity were inversely related to prolonged TV viewing. African Americans and participants with type 2 diabetes were more likely to watch more than 4 hours of TV per day as compared to their counterparts. Diet quality was inversely associated with physical activity level. Future studies are needed to establish the risk factors of prolonged TV watching in adult populations for the development of diabetes or diabetes-related complications. Although strategies to reduce TV watching have been proven effective among children, few trials have been conducted in adults. Intervention trials aimed at reducing TV viewing targeting people with type 2 diabetes may be beneficial to improve dietary quality and physical activity, which may reduce diabetes complications