RESUMO
A diet high in quality is essential for prevention of chronic diseases. Specific healthy eating behaviors may modulate dietary intake. However, these behaviors have been seldomly studied, particularly in Puerto Rico (PR), a population with documented poor dietary quality and high burden of chronic diseases. This study aimed to document self-reported engagement in eating behaviors and examine their associations with intake of nutrients and diet quality. We hypothesized that greater engagement in healthy eating behavior would be associated with greater diet quality. This cross-sectional analysis used data from the PRADLAD study (adults aged 30-75 years residing in the San Juan, PR, area [n = 234]). Frequency (never, sometimes, often, always) of habitual eating behaviors was measured. Dietary intake was assessed with a food frequency questionnaire. Diet quality was measured with the Alternate Healthy Eating Index-2010. Statistical analyses included adjusted linear models. The most common behavior was "controlling intake of salt" (51.7%). Engaging "always" (vs. less frequently) in making healthier meals, reading nutrition facts labels, searching media for healthy eating information, counting calories, buying organic foods, eating a vegetarian diet, and controlling intake of salt, fat, carbohydrates/sugar, and portions were associated with higher Alternate Healthy Eating Index-2010 scores (P < .05). Controlling intakes of fats, carbohydrates/sugars, and portions "always" was associated with lower intakes of trans fats, added sugars, and total food (g), respectively (P < .05). Engagement in eating a vegetarian diet "always" was associated with higher intake of plant-based protein (P < .05). In conclusion, adults following several habitual eating behaviors had greater diet quality and a lower amount of unfavorable nutrients. Encouraging adherence to these behaviors may contribute to healthier dietary intake.
Assuntos
Dieta Saudável , Comportamento Alimentar , Humanos , Adulto , Porto Rico , Autorrelato , Estudos Transversais , Ingestão de Alimentos , Dieta , Ingestão de Energia , Doença Crônica , Açúcares , CarboidratosRESUMO
BACKGROUND: An increasingly industrialized food system has marginalized local, traditional food cultures in Puerto Rico (PR). Recent efforts to decolonize diets have promoted local food intake; however, how resulting dietary patterns may influence cardiometabolic disease remains unknown. OBJECTIVES: This study aimed to 1) identify dietary patterns in PR and 2) determine their associations with metabolic syndrome (MetS) and its components. METHODS: Data were obtained from participants (30-75 y) in PROSPECT (PR Observational Study of Psychosocial, Environmental, and Chronic Disease Trends; n = 989). Dietary patterns were derived using partial least squares analysis with food frequency questionnaire data, using nutrients associated with local food purchasing (dietary fiber, magnesium, saturated fat) as response variables. MetS was classified using harmonized criteria from clinical and laboratory measures and medication use. Fully adjusted generalized linear models tested associations between tertiles of dietary patterns and MetS. RESULTS: Approximately half (52%) of the participants were classified with MetS. Four dietary patterns were revealed: conventional (legumes, coffee, and dairy), industrialized starch and meat-centric (red/processed meats, pasta, and starchy roots), industrialized sugar-centric (rice, sugary beverages, and refined grains), and neo-traditional (local plants and seafood). Individuals in the highest (compared with lowest) tertile of the industrialized starch and meat-centric dietary pattern had higher mean waist circumference (102 compared with 99 cm) (P = 0.01), fasting glucose (106 compared with 98 mg/dL) (P = 0.019), and systolic blood pressure (123 compared with 119 mmHg) (P = 0.022). Individuals in the highest (compared with lowest) tertile of the neo-traditional diet were 0.69 (0.49, 0.97) times less likely to have MetS (P = 0.035) and had 4.1 cm lower mean waist circumference (P = 0.002). CONCLUSIONS: Promoting a neo-traditional diet and curbing industrialized starch and meat-centric diets may improve cardiometabolic health in PR. Results can guide local food promotion as a healthful, decolonizing approach in island settings.
Assuntos
Doenças Cardiovasculares , Síndrome Metabólica , Humanos , Adulto , Fatores de Risco , Porto Rico , Dieta , Síndrome Metabólica/epidemiologia , Doenças Cardiovasculares/epidemiologia , Amido , Comportamento AlimentarRESUMO
BACKGROUND: Consuming foods away from home (FAFH) is ubiquitous, yet, it is unclear how it influences diet in diverse populations. OBJECTIVE: The study aimed to evaluate the association between frequency and type of consumption of FAFH and diet quality. DESIGN: The study had a cross-sectional design. Participants self-reported the frequency of consuming FAFH as "rarely" (≤1 time per week) vs "frequently" (≥2 times per week) at various commercial establishments or noncommercial FAFH (ie, friends' or relatives' homes). PARTICIPANTS/SETTING: Participants were adults (aged 30 through 75 years) from the PRADLAD (Puerto Rico Assessment of Diet, Lifestyle, and Diseases) study conducted in San Juan, Puerto Rico metro area (n = 239) in 2015. MAIN OUTCOME MEASURES: A validated food frequency questionnaire captured dietary intake. The Alternate Healthy Eating Index-2010 defined diet quality. Secondary outcomes included whether participants met 2015-2020 Dietary Guidelines for Americans recommendations for sodium, added sugars, saturated fat, dietary fiber, total energy, and alcohol. STATISTICAL ANALYSES PERFORMED: Linear or logistic regression models adjusted for age, sex, employment, income, education, and food insufficiency tested differences in mean Alternate Healthy Eating Index-2010 scores or odds of meeting (vs not meeting) intake recommendations by FAFH type and frequency. RESULTS: Overall, 54.4% and 37.2% of participants reported consuming commercial FAFH and noncommercial FAFH "frequently," respectively. Consuming FAFH "frequently" (vs "rarely") was associated with lower mean Alternate Healthy Eating Index-2010 scores for both commercial FAFH (57.92 vs 63.58; P = .001) and noncommercial FAFH (56.22 vs 62.32; P < .001). Consuming commercial FAFH "frequently" (vs "rarely") at any type of food establishment was associated with lower odds of meeting the dietary fiber Dietary Reference Intakes (odds ratio 0.43; 95% CI 0.23 to 0.81). Consuming noncommercial FAFH "frequently" was associated with lower odds of meeting recommendations for sodium (odds ratio 0.30; 95% CI 0.11 to 0.79) and added sugars (odds ratio 0.41; 95% CI 0.18 to 0.93). CONCLUSIONS: Frequent consumption of FAFH is associated with lower diet quality and lower adherence to dietary recommendations in Puerto Rico. Future studies should explore whether diet quality can be improved by prioritizing healthy at-home meals and reformulating the quality of commercial FAFH.
Assuntos
Dieta , Ingestão de Energia , Adulto , Humanos , Porto Rico , Estudos Transversais , Refeições , Fibras na Dieta , Sódio , Açúcares , Comportamento AlimentarRESUMO
Introduction: Latinos report lower self-rated health (SRH) than non-Hispanic White persons. However, the association between SRH and medically diagnosed chronic diseases (MDCDs) remains understudied in Latino populations. This study assessed the relationship between a single-item SRH indicator and MDCD status among predominantly Latino adults in Puerto Rico. Methods: Participants (30-75 years; n=965) of the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT) reported SRH (excellent/very good, good, or fair/poor) and MDCD (ever vs never). We performed multivariate logistic regressions to evaluate the association between SRH and MDCD, which adjusted for key socioeconomic, demographic, and behavioral confounders. Results: Twenty-seven percent of participants reported excellent/very good SRH, 39% good, and 34% fair/poor. Participants with fair/poor SRH (vs excellent/very good) were more likely to report MDCD for painful inflammation (odds ratio [OR]=4.95 [95% CI, 3.27-7.48]), kidney disease (4.64 [2.16-9.97]), sleep disorder (4.47 [2.83-7.05]), migraine headaches (4.07 [2.52-6.58]), overweight/obesity (3.84 [2.51-5.88]), depression (3.61 [2.28-5.74]), hypertension (3.59 [2.43-5.32]), high blood sugar (3.43 [2.00-5.89]), cardiovascular disease (3.13 [2.01-4.87]), anxiety (2.87 [1.85-4.44]), arthritis (2.80 [1.83-4.30]), diabetes (2.46 [1.57-3.83]), respiratory problems (2.45 [1.59-3.79]), stomach problems (2.44 [1.57-3.81]), eye disease (2.42 [1.44-4.06]), gallbladder disease (2.34 [1.35-4.05]), liver disease (2.26 [1.38-3.70]), heartburn (2.25 [1.55-3.26]), hyperlipidemia (2.10 [1.44-3.06]), and thyroid conditions (2.04 [1.30-3.21]). Conclusions: SRH may reflect MDCD burden and serve as a valid screener to efficiently identify Latino individuals in high need of clinical services. This is relevant in Puerto Rico, where chronic disease rates remain high amid limited, disparate access to health care.
Assuntos
Nível de Saúde , Humanos , Porto Rico/epidemiologia , Porto Rico/etnologia , Pessoa de Meia-Idade , Masculino , Feminino , Adulto , Idoso , Doença Crônica , Autorrelato , Hispânico ou Latino/estatística & dados numéricosRESUMO
In the public health portfolio of disaster tools, rapid needs assessments are essential intelligence data mining resources that can assess immediate needs in almost all hazard scenarios. Following prolonged and unusual seismic activity that caused significant structural damage, mainly in the southwest part of the island of Puerto Rico, thousands of area residents were forced to leave their homes and establish improvised camps. The austere environmental exposure and limited access to safety and hygiene services prompted public health authorities to request assistance with conducting a rapid needs assessment of those encampments. This report summarizes the design, organization, and execution of a rapid needs assessment of improvised camps following a strong sequence of earthquakes in Puerto Rico.
Assuntos
Desastres , Terremotos , Humanos , Porto Rico , Exposição Ambiental , Avaliação das NecessidadesRESUMO
OBJECTIVES: To evaluate the association between adverse experiences during Hurricane María and mental and emotional distress in Puerto Rico. METHODS: This cross-sectional study used baseline data from adult (30-75 years) participants of the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT). Enrolled individuals prior to COVID-19 who completed a 33-item questionnaire on Hurricane María-related experiences (sub-categorized as personal, service, or property losses), depression symptomatology, post-traumatic stress disorder (PTSD), and anxiety were included for analysis (n = 456). RESULTS: Most participants experienced fear for their family's safety, damage to their home and personal items, communication outages, and water shortages. Each additional stressor was significantly associated with higher odds of depression symptoms, PTSD, and anxiety. Personal losses were significantly associated with higher likelihood of all outcomes, while services losses were associated with depression symptoms and anxiety; property loss was not significantly associated with any outcome. CONCLUSIONS: Adverse experiences during a major natural disaster are associated with mental and emotional distress. Strategies to minimize hardships during natural disasters, especially personal and service losses, are essential to preserve mental health. Post-disaster psychological support to individuals is crucial.
Assuntos
COVID-19 , Tempestades Ciclônicas , Angústia Psicológica , Adulto , Humanos , Porto Rico/epidemiologia , Estudos Transversais , COVID-19/epidemiologiaRESUMO
INTRODUCTION: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic revealed a worldwide lack of effective molecular surveillance networks at local, state, and national levels, which are essential to identify, monitor, and limit viral community spread. SARS-CoV-2 variants of concern (VOCs) such as Alpha and Omicron, which show increased transmissibility and immune evasion, rapidly became dominant VOCs worldwide. Our objective was to develop an evidenced-based genomic surveillance algorithm, combining reverse transcription polymerase chain reaction (RT-PCR) and sequencing technologies to quickly identify highly contagious VOCs, before cases accumulate exponentially. METHODS: Deidentified data were obtained from 508,969 patients tested for coronavirus disease 2019 (COVID-19) with the TaqPath COVID-19 RT-PCR Combo Kit (ThermoFisher) in four CLIA-certified clinical laboratories in Puerto Rico (n = 86,639) and in three CLIA-certified clinical laboratories in the United States (n = 422,330). RESULTS: TaqPath data revealed a frequency of S Gene Target Failure (SGTF) > 47% for the last week of March 2021 in both, Puerto Rico and US laboratories. The monthly frequency of SGTF in Puerto Rico steadily increased exponentially from 4% in November 2020 to 47% in March 2021. The weekly SGTF rate in US samples was high (>8%) from late December to early January and then also increased exponentially through April (48%). The exponential increase in SGFT prevalence in Puerto Rico was concurrent with a sharp increase in VOCs among all SARS-CoV-2 sequences from Puerto Rico uploaded to Global Influenza Surveillance and Response System (GISAID) (n = 461). Alpha variant frequency increased from <1% in the last week of January 2021 to 51.5% of viral sequences from Puerto Rico collected in the last week of March 2021. CONCLUSIONS: According to the proposed evidence-based algorithm, approximately 50% of all SGTF patients should be managed with VOCs self-quarantine and contact tracing protocols, while WGS confirms their lineage in genomic surveillance laboratories. Our results suggest this workflow is useful for tracking VOCs with SGTF.
Assuntos
COVID-19 , SARS-CoV-2 , Sequência de Bases , COVID-19/diagnóstico , COVID-19/epidemiologia , Humanos , Medicina de Precisão , SARS-CoV-2/genética , Estados Unidos/epidemiologiaRESUMO
Importance: As public health emergencies become more prevalent, it is crucial to identify adverse physical and mental health conditions that may be triggered by natural disasters. There is a lack of data on whether Hurricane Maria in 2017 influenced the disease burden of adults in Puerto Rico. Objective: To estimate the prevalence of chronic diseases and their associated risk factors among adults living in Puerto Rico before and after Hurricane Maria in 2017. Design, Setting, and Participants: This cross-sectional study used data from 2 previous cross-sectional studies, including the pre-Hurricane Maria Puerto Rico Assessment on Diet, Lifestyles and Disease (PRADLAD) study, conducted in 2015, and the post-Hurricane Maria Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT), conducted in 2019. Participants included adults aged 30 to 75 years residing in Puerto Rico. Data were analyzed from April to October 2020. Exposures: Self-reported data were obtained on sociodemographic, lifestyle, and psychosocial factors and medically diagnosed conditions using validated questionnaires. Anthropometrics were measured in triplicate. Main Outcomes and Measures: Data were obtained using similar protocols in both studies. Characteristics were contrasted for all participants across studies and for 87 PRADLAD participants who returned to PROSPECT. Results: A total of 825 participants from both cohorts were included, with 380 PRADLAD participants and 532 PROSPECT participants. In the 2019 PROSPECT study, the mean (SD) age was 53.7 (10.8) years, and 363 participants (68.2%) were assigned female at birth and 169 participants (31.8%) were assigned male at birth. In the 2019 cohort, 360 participants (67.7%) had college education or higher, 205 participants (38.5%) reported annual income greater than $20â¯001, and 263 participants (49.5%) were employed. Most sociodemographic variables were similar between studies, except for higher income and employment after the hurricane. In the main analysis, participants in 2019, compared with participants in 2015, had higher abdominal obesity (389 participants [73.2%] vs 233 participants [61.3%]), sedentarism (236 participants [44.4%] vs 136 participants [35.8%]), binge drinking (95 participants [17.9%] vs 46 participants [12.1%]), and social support (mean [SD] score, 26.9 [7.2] vs 24.7 [7.1]) but lower depressive symptoms (169 participants [31.7%] vs 200 participants [52.6%]) and perceived stress (mean [SD] score, 19.3 [9.5] vs 21.7 [7.7]). In 2019, compared with 2015, there were higher rates of hypertension (252 participants [47.3%] vs 149 participants [39.2%]), arthritis (172 participants [32.3%] vs 97 participants [25.6%]), high cholesterol (194 participants [36.4%] vs 90 participants [23.8%]), high triglycerides (123 participants [23.1%] vs 56 participants [14.7%]), eye disease (94 participants [17.6%] vs 48 participants [12.7%]), fatty liver disease (68 participants [12.8%] vs 29 participants [7.5%]), and osteoporosis (74 participants [13.9%] vs 20 participants [5.2%]). Secondary analysis for the 87 returning participants showed similar results. Conclusions and Relevance: In this cross-sectional study, a higher prevalence of unhealthy behaviors and chronic conditions was noted among adults in Puerto Rico after Hurricane Maria, warranting long-term studies. Psychosocial factors were better, but still need attention. As natural disasters intensify, efforts should focus on continuous surveillance of health outcomes and promoting healthy behaviors, positive emotional health, and disease control, particularly in populations with higher risk for poor health.
Assuntos
Doença Crônica/epidemiologia , Tempestades Ciclônicas , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Porto Rico/epidemiologia , Fatores de Risco , Fatores SocioeconômicosRESUMO
BACKGROUND: Adults in Puerto Rico experience an excessive burden of central obesity. It remains unknown which dietary components are more strongly associated with central obesity in this high-risk group. We aimed to evaluate the relationship of the Mediterranean diet (MeDS) and Alternate Healthy Eating Index 2010 (AHEI) with central obesity in the Puerto Rico Assessment of Diet, Lifestyle and Diseases (PRADLAD) cross-sectional study. METHODS: Data from PRADLAD participants (ages 30-75 years) were used (n = 166). Dietary intake was assessed by food frequency questionnaire. The MeDS [nine components; range: 0 (lowest) to 9 (highest observance of a Mediterranean-like diet)] and AHEI [11 components; range: 0 (lowest) to 110 (highest diet quality)] were defined. Daily intake of foods and beverages within each MeDS component was ranked by contribution to total energy intake. Multivariable logistic regression was used to evaluate associations between MeDS and AHEI with central obesity (waist circumference > 102 cm males,â¯> 88 cm females). RESULTS: Mean ± SD MeDS was 4.46 ± 1.77 and AHEI was 60.2 ± 11.1. Traditional foods representative of the MeDS included potatoes, root vegetables, fruit juice, avocados, bread, oatmeal, beans, chicken, seafood, low-fat milk, cheese, eggs and beer. Adjusted odds ratios and 95% confidence intervals of central obesity were 0.78 (0.63-0.97) per unit increment of MeDS and 0.61 (0.42-0.90) per 10-unit increment of AHEI. CONCLUSIONS: Higher adherence to MeDS or AHEI was associated with lower central obesity in adults in Puerto Rico. Consuming traditional foods reflecting these dietary patterns (i.e., Mediterranean-like) may reduce central obesity in high-risk populations.
Assuntos
Dieta Mediterrânea , Obesidade Abdominal , Adulto , Idoso , Estudos Transversais , Dieta , Ingestão de Energia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Abdominal/epidemiologia , Obesidade Abdominal/etiologia , Porto Rico/epidemiologiaRESUMO
BACKGROUND: Psychological stress may influence health by negatively affecting dietary intake. However, there are few studies on the connection between stress and dietary intake in Puerto Rico (PR), a population with documented poor diet quality. OBJECTIVE: To explore the association between perceived stress and intake of macronutrients and diet quality among adults in PR. DESIGN: Cross-sectional data came from the Puerto Rico Assessment of Diet, Lifestyle, and Diseases study (2015). PARTICIPANTS: This analysis included data from 238 adults (30-75 years old) in the San Juan metro area. MAIN OUTCOME MEASURES: Dietary intake was measured with a food frequency questionnaire adapted and validated to the PR population. The Alternate Healthy Eating Index (AHEI) score was calculated to measure diet quality. STATISTICAL ANALYSES: Multivariate linear models adjusted for sociodemographics, anthropometrics, behavioral factors, and social support were used to determine adjusted mean macronutrient intake and AHEI scores by perceived stress category. RESULTS: In models adjusted for sociodemographic characteristics, high perceived stress was significantly associated with higher intake of total energy, added sugars, and saturated fats; lower intake of dietary fiber and vegetable protein; and lower AHEI score compared with low perceived stress (all P < .05). With further adjustment for lifestyle behaviors, central obesity, and social support, high perceived stress remained significantly associated with added sugars, saturated fats, and vegetable protein only. CONCLUSIONS: Higher perceived stress was associated with unhealthy dietary intake in adults residing in the San Juan area, PR. Future longitudinal studies with larger sample size are needed to build on these findings and to test the potential mediating and moderating roles of behavioral and social support factors in this population.