RESUMO
Hispanics of Mexican descent have disproportionate rates of non-alcoholic fatty liver disease (NAFLD). The purpose of this work is to investigate the association between the traditional Mexican diet score (tMexS) and hepatic steatosis and fibrosis, two NAFLD-related clinical endpoints, in Hispanic adults of Mexican descent. Data from 280 Hispanic adults of Mexican descent (n = 102 men, 178 women) with overweight or obesity enrolled in a cross-sectional observational study were analyzed. The tMexS was calculated from 24 h dietary recalls. Hepatic steatosis and fibrosis measurements were assessed using transient elastography (Fibroscan®). Linear regression models testing the association between tMexS and hepatic steatosis and fibrosis were run individually and through the stratification of significant modifiers. Mean tMexS were 5.9 ± 2.1, hepatic steatosis scores were 288.9 ± 48.9 dB/m, and fibrosis scores were 5.6 ± 2.2 kPa. Among the US-born group, with every point increase in the tMexS, there was a statistically significant 5.7 lower hepatic steatosis point (95% CI: -10.9, -0.6, p-value = 0.07). Higher adherence to a traditional Mexican diet was associated with lower hepatic steatosis in US-born Hispanics of Mexican descent. Findings from the current work may serve to inform future culturally relevant interventions for NAFLD prevention and management in individuals of Mexican descent.
Assuntos
Hepatopatia Gordurosa não Alcoólica , Adulto , Masculino , Humanos , Feminino , Hepatopatia Gordurosa não Alcoólica/complicações , Sobrepeso/complicações , Estudos Transversais , Obesidade/complicações , Dieta , Cirrose Hepática/complicações , Hispânico ou LatinoRESUMO
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
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
Legumes are a traditional healthy staple food in Latin America, with great potential for use in diet-related chronic disease prevention interventions. This study aimed to investigate attitudes about legume consumption and associations with dietary intake. Adult participants from the Puerto Rico Assessment of Diet, Lifestyle, and Diseases, who completed a validated food frequency questionnaire and a legumes questionnaire (n = 229) were included. A 25-item Likert scale was used to assess agreement with stated attitudes regarding legumes consumption. Exploratory factor analysis produced 3 factors: (1) taste and perceived benefits; (2) barriers and negative attitudes; and (3) social support and cultural beliefs. A combined attitudes scale was computed, with higher scores indicating more positive attitudes toward legumes. Adjusted linear regression models examined associations between each factor and the combined scale with legumes intake, rice intake, and ratio of legumes to rice intake. Significant positive associations were observed for the taste and perceived benefits factor (ß = 0.14; 95% confidence interval [CI], 0.07-0.21) and the social support and cultural beliefs factor (ß = 0.14; 95% CI, 0.07-0.22) with legume intake. The social support and cultural beliefs factor was also associated with a higher ratio of legumes to rice intake (ß = 1.59; 95% CI, 0.04-3.14). A 3-unit increase in the combined attitudes scale (corresponding to 1 additional positive attitude) was associated with a 0.03 (95% CI, 0.01-0.05) higher servings/day legume intake. The barriers and negative attitudes factor was inversely associated with rice intake (ß = -0.10; 95% CI, -0.02 to -0.17) and positively associated with ratio of legumes to rice intake (ß = 1.55; 95% CI, 0.03-3.07). Nutritional programs to increase legume intake as a healthy staple food among Puerto Ricans and Hispanic/Latino populations should emphasize building positive attitudes, especially those related to taste, perceived benefits, social support, and cultural beliefs, while diminishing barriers and negative attitudes.
Assuntos
Fabaceae , Adulto , Dieta , Humanos , Otimismo , Porto Rico , VerdurasRESUMO
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.
Assuntos
Dieta Saudável , Dieta/psicologia , Dieta/normas , Ingestão de Energia , Estresse Psicológico/epidemiologia , Adulto , Idoso , Estudos Transversais , Inquéritos sobre Dietas , Gorduras na Dieta/administração & dosagem , Fibras na Dieta/administração & dosagem , Proteínas Alimentares/administração & dosagem , Açúcares da Dieta/administração & dosagem , Humanos , Análise dos Mínimos Quadrados , Modelos Lineares , Pessoa de Meia-Idade , Porto Rico/epidemiologiaRESUMO
OBJECTIVE: Diminished diet quality in the Caribbean and other island settings may be related to a dietary transition from local foods towards imported products. The current study aimed to characterise the association between intentionally purchasing local foods (IPLF) and diet quality in Puerto Rico (PR). DESIGN: Cross-sectional study. SETTING: Primary care clinics in the PR metropolitan area. PARTICIPANTS: Data were obtained from adult participants (30-75 years; n 243) of the Puerto Rico Assessment of Diet, Lifestyle, and Diseases. IPLF was probed by asking: 'How often do you purposely purchase foods from PR (like fruits, vegetables, meat and other products that are produced on the island rather than being imported)?' Dietary intake was measured using a FFQ, and diet quality was assessed by the Alternate Healthy Eating Index (range 0-110; higher scores indicating higher diet quality). Multivariate-adjusted generalised linear models tested the association between IPLF and Alternate Healthy Eating Index 2010 (AHEI) and its component scores. RESULTS: A third (33·9 %) of participants reported seldom, 33·5 % reported often and 30·6 % reported always IPLF. Compared with seldom IPLF, fully adjusted mean AHEI scores were 3·6 (P = 0·038) points higher among those often IPLF and 9·3 (P < 0·0001) points higher among those always IPLF. Compared with seldom IPLF, those who always IPLF had significantly higher fully adjusted mean component scores for vegetables, fruits, whole grains, nuts and legumes, trans fat and n-3 fats. CONCLUSIONS: Adults in PR who intentionally purchase local foods had higher diet quality, especially for intake of plant-based foods and healthy fats, highlighting potential dietary benefits associated with improved local food availability in PR.
Assuntos
Dieta , Verduras , Adulto , Estudos Transversais , Inquéritos sobre Dietas , Humanos , Porto RicoRESUMO
The Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT) is a prospective cohort study in Puerto Rico (PR) aiming to identify trends and longitudinal associations in risk factors for cardiovascular disease (CVD). In 2019, PROSPECT investigators started recruiting a sample of 2,000 adults aged 30-75 years in PR using multistage probabilistic sampling of households and community approaches. Culturally sensitive trained research assistants assess participants, at baseline and at 2-year follow-up, in private rooms at a network of partner clinics. The study collects comprehensive data on demographic factors, socioeconomic and environmental factors, medical history, health conditions, lifestyle behaviors, psychosocial status, and biomarkers of CVD and stress. PROSPECT will estimate the prevalence and incidence of psychosocial, lifestyle, and biological CVD risk factors, describe variations in risk factors by urbanicity (urban areas vs. rural areas) and exposure (before and after) to natural disasters, and determine predictors of longitudinal changes in CVD risk factors. The study has 4 coordinated operational strategies: 1) research productivity (including synergy with existing epidemiologic cohorts of Hispanics/Latinos for comparison); 2) research infrastructure (biorepository, ancillary studies, and clinical research network); 3) capacity-building, education, and training; and 4) community outreach, dissemination, and policy. PROSPECT will inform public health priorities to help reduce CVD in PR.