Dietary patterns of Hispanic elders are associated with acculturation and obesity

The association of dietary patterns and obesity, particularly in Hispanics, is relatively poorly understood. This large U.S. population subgroup has a high prevalence of obesity and associated chronic conditions, and Hispanics are changing their dietary practices as they acculturate. Our objectives were 1) to identify dietary patterns among elderly Hispanics in Massachusetts, compared with those of non-Hispanic whites; 2) to associate dietary patterns with acculturation; and 3) to associate dietary patterns with total and central obesity. We used a representative sample of 449 Puerto Rican and 133 Dominican elders and a neighborhood-based sample of 243 non-Hispanic white elders, aged 60 to 92 y, from the cross-sectional Massachusetts Hispanic Elders Study. Obesity and central obesity were assessed with BMI (kg/m2) and waist circumference measurement, respectively. Acculturation was assessed by evaluating language use. Usual diet was assessed with a food frequency questionnaire specifically designed for use with this population. Dietary patterns were defined by cluster analysis of food group variables. We identified five clusters of individuals by dietary pattern, with proportionately greater energy intake from 1) fruit and breakfast cereal, 2) starchy vegetables, 3) rice, 4) whole milk and 5) sweets, respectively. Hispanics were less likely to follow the fruit and cereal or sweets patterns, and more likely to follow the starchy vegetables or milk patterns, than were non-Hispanic whites. Only Hispanics followed the rice pattern. Among Hispanics, acculturation was positively associated with the fruit and cereal pattern, and negatively with the rice pattern. Total and central obesity were positively associated with the rice pattern. Longitudinal studies are needed to clarify the causal nature of these associations.     

Type 2 diabetes is prevalent and poorly controlled among Hispanic elders of Caribbean origin

OBJECTIVES: We estimated prevalence and control of type 2 diabetes in Puerto Rican, Dominican, and non-Hispanic White (NHW) elders and associated them with sociodemographic and health behavior variables and with body mass index (BMI) and waist circumference. METHODS: We used a cross-sectional analysis with a sample of Hispanic elders in Massachusetts and a comparison group of NHWs (1991-1997). The analysis included 379 Puerto Ricans, 113 Dominicans, and 164 NHWs, aged 60 to 96 years, with complete questionnaires and blood samples. RESULTS: Type 2 diabetes was significantly more prevalent among Puerto Ricans (38%) and Dominicans (35%) than among NHWs (23%). Differences remained after covariates were adjusted for. Hispanics with diabetes were approximately 3 times more likely to use insulin than NHWs. Puerto Ricans were 2 times, and Dominicans 3 times, more likely to have glycosylated hemoglobin concentrations of 7% or above than NHWs. BMI and waist circumference were individually associated with diabetes. When included in the model together, waist circumference, but not BMI, remained independently associated with diabetes. CONCLUSIONS: Ethnicity was more strongly associated with diabetes status and control than were socioeconomic or measured health behavior variables, suggesting that genetic or other culturally related factors may explain these differences.     

Dietary and plasma lipid,lipoprotein, and apolipoprotein profiles among elderly Hispanics and non-Hispanics and their association with diabetes

BACKGROUND: There are limited data about dietary intakes and plasma lipids of elderly US Hispanics. OBJECTIVE: The disparity in prevalence of type 2 diabetes among population groups underscored our need to assess dietary and plasma risk factors for cardiovascular disease. DESIGN: Plasma lipids and apolipoproteins and dietary intakes of macronutrients were measured in elderly subjects (60-98 y): 490 Hispanics of Caribbean origin (Puerto Ricans and Dominicans) and 163 non-Hispanic whites. Plasma values were related to ethnicity and to macronutrient intake. Differences in plasma lipids due to diabetes were assessed among the Hispanics. RESULTS: Intakes of carbohydrate and polyunsaturated fatty acids were higher and intakes of cholesterol and saturated and monounsaturated fatty acids were lower in Hispanics than in non-Hispanic whites. Concentrations of total cholesterol, HDL cholesterol, and apolipoprotein A-I were significantly lower among Hispanic women than among non-Hispanic white women; a similar trend was seen in men. Dyslipidemia (high triacylglycerols and low HDL cholesterol) was more prevalent among Hispanics with than without diabetes. CONCLUSIONS: Ethnic differences in serum lipids exist and appear to be associated with differences in dietary intakes. However, both Hispanics and non-Hispanic whites had lipid profiles indicating a high risk of cardiovascular disease. Hispanics with diabetes were at higher risk of dyslipidemia than were those without diabetes. Our data suggest that lifestyle changes, including diet modification and exercise, could be of significant benefit to both ethnic groups.     

Ethnicity,maternal risk,and birth weight among Hispanics in Massachusetts, 1987-89.

National data reveal that low birth weight and infant mortality rates among Hispanics are, in general, between the rates for whites and those for blacks. The question remains, do differences in low birth weight reflect distributions of known risk factors, or do ethnic differences persist after simultaneously adjusting for intervening variables? In this study, Massachusetts birth certificate data for 206,973 white non-Hispanic infants and 19,571 Hispanic infants are used to examine differences in low birth weight between white non-Hispanic and Hispanic infants, as well as variation among seven subgroups of Hispanic mothers--Puerto Rican, Dominican, Central American, South American, Mexican, Cuban, and other Hispanic. Regression analysis is used to estimate the association between risk factors and birth weight and the relative risk of low birth weight. Risk factors include ethnicity, demographic characteristics, biological factors, access to prenatal care, and infants'' conditions. Results indicate substantial variation in mean birth weight, low birth weight, and levels of risk among Hispanic subgroups and between Hispanics and white non-Hispanics. Puerto Rican infants had the lowest mean birth weight and, in general, the highest level of risk factors in this population. None of the adjusted odds ratios for low birth weight for any Hispanic group was significantly elevated at the 95 percent level compared with white non-Hispanics. Findings in this study confirm the previous observations of the wide variation among Hispanic subgroups and the high level of risk among Puerto Ricans.(ABSTRACT TRUNCATED AT 250 WORDS)     

Low vitamin B-12 intake and status are more prevalent in Hispanic older adults of Caribbean origin than in neighborhood-matched non-Hispanic whites

Vitamin B-12 deficiency is a recognized problem among older adults, although vitamin B-12 status among differing ethnic groups remains unclear. We examined vitamin B-12 intake and status in a representative sample of elderly Hispanics of Caribbean origin (Puerto Rican and Dominican) and non-Hispanic whites. Dietary intake and plasma values were available for 347 Puerto Ricans, 102 Dominicans and 154 non-Hispanic whites (60-93 y). Relative to non-Hispanic whites, Hispanics had significantly lower vitamin B-12 intake and plasma concentrations; 17% of Hispanics and 10% of non-Hispanic whites had concentrations < 185 pmol/L (P < 0.05). Among Hispanics, log transformed vitamin B-12 intake was significantly associated with plasma concentration (beta = 60 pmol/L per log unit vitamin B-12 intake, P < 0.002 for supplement users and beta = 74 pmol/L per log unit vitamin B-12 intake, P < 0.01 for nonsupplement users). Intake and plasma concentrations were significantly associated among non-Hispanic whites only when supplement users were included (beta = 95 pmol/L per log unit vitamin B-12 intake, P < 0.0001). Hispanic supplement users (18%) had higher plasma concentrations than did nonsupplement users (364 +/- 17 and 297 +/- 8 pmol/L, respectively, P < 0.001). For Hispanics, consumption of breakfast cereal > 4 times/wk compared to no cereal was protective against lower plasma concentrations (8 vs. 24% < 185 pmol/L, P < 0.01). Approximately 40% of both groups with plasma vitamin B-12 < 185 pmol/L had homocysteine > 14 micromol/L, relative to < 17% of those with B-12 > 185 pmol/L. The high prevalence of low vitamin B-12 status in elderly Hispanics appears largely attributed to inadequate intake. As in other populations, sources of unbound vitamin B-12 such as supplements and fortified cereal appear to be protective. Dietary intervention programs targeted to the Hispanic population should promote these vitamin B-12 sources.     

Gender Distrust and Intimate Unions among Low-Income Hispanic and African-American Women

We investigate levels of generalized distrust of men among low-income African American, Mexican, Puerto Rican, Dominican, and non-Hispanic white women in a three-city survey. The results reveal substantial variation. We find Hispanics' overall levels of distrust to be higher than levels for either African Americans or whites. Among Hispanics, however, Dominicans are the most distrusting group followed by Puerto Ricans; whereas Mexicans report levels of distrust that are comparable to African Americans and non-Hispanic whites. Married women are less distrusting than cohabiting women who, in turn, are less distrusting than non-cohabiting women. Nevertheless, distrust is not a significant predictor of a woman's total number of lifetime marital and cohabiting relationships; and distrust only marginally predicts a woman's desire to be in a steady relationship. We suggest that studies of trust in this population should focus more on attitudes displayed in specific encounters than on overall, generalized attitudes about gender distrust.     

Prevalence of diabetes among Hispanics--selected areas, 1998-2002

Diabetes disproportionately affects Hispanics in the United States. However, the Hispanic population is composed of culturally distinct subpopulations that tend to be regionally concentrated, and the prevalence of diabetes can differ in these subpopulations. CDC analyzed data from Behavioral Risk Factor Surveillance System (BRFSS) surveys to estimate the prevalence of diabetes among Hispanic and non-Hispanic white adults residing in six states and among Hispanics in Puerto Rico, assessing disparities by geographic location. This report summarizes the findings of that analysis, which indicated that Hispanics continued to have a higher prevalence of diabetes than non-Hispanic whites and that disparities in diabetes between these two populations varied by area of residence. These findings underscore the need to target Hispanics and other populations with higher prevalence of diabetes to eliminate racial/ethnic disparities.     

Immunization coverage among Hispanic ancestry, 2003 National Immunization Survey

BACKGROUND: The Hispanic population is increasing and heterogeneous (Hispanic refers to persons of Spanish, Hispanic, or Latino descent). The objective was to examine immunization rates among Hispanic ancestry for the 4:3:1:3:3 series (> or = 4 doses diphtheria, tetanus toxoids, and pertussis vaccine; > or = 3 doses poliovirus vaccine; > or = 1 doses measles-containing vaccine; > or = 3 doses Haemophilus influenzae type b vaccine; and > or = 3 doses hepatitis B vaccine). METHODS: The National Immunization Survey measures immunization coverage among 19- to 35-month-old U.S. children. Coverage was compared from combined 2001-2003 data among Hispanics and non-Hispanic whites using t-tests, and among Hispanic ancestry using a chi-square test. Hispanics were categorized as Mexican, Mexican American, Central American, South American, Puerto Rican, Cuban, Spanish Caribbean (primarily Dominican Republic), other, and multiple ancestry. RESULTS: Children of Hispanic ancestry increased from 21% in 1999 to 25% in 2003. These Hispanic children were less well immunized than non-Hispanic whites (77.0%, +/-2.1% [95% confidence interval] compared to 82.5%, +/-1.1% (95% CI) > in 2003). Immunization coverage did not vary significantly among Hispanics of varying ancestries (p=0.26); however, there was substantial geographic variability. In some areas, immunization coverage among Hispanics was significantly higher than non-Hispanic whites. CONCLUSIONS: Hispanic children were less well immunized than non-Hispanic whites; however, coverage varied notably by geographic area. Although a chi-square test found no significant differences in coverage among Hispanic ancestries, the range of coverage, 79.2%, +/-5.1% for Cuban Americans to 72.1%, +/-2.4% for Mexican descent, may suggest a need for improved and more localized monitoring among Hispanic communities.     

Prevalence of doctor-diagnosed arthritis and arthritis-attributable effects among Hispanic adults, by Hispanic subgroup--United States, 2002, 2003, 2006, and 2009

Arthritis affects approximately 50 million adults in the United States, making it one of the most prevalent health conditions among U.S. adults and the most common cause of disability. Arthritis is associated with substantial activity limitation, work disability, increased prevalence of obesity, reduced quality of life, and high health-care costs. Among U.S. adults, the prevalence of arthritis and arthritis-attributable effects (e.g., arthritis-attributable activity limitations [AAAL]) varies among racial/ethnic groups; non-Hispanic whites and non-Hispanic blacks have a higher prevalence of doctor- diagnosed arthritis compared with Hispanics, but Hispanics and non-Hispanic blacks have a higher prevalence of arthritis-attributable effects compared with non-Hispanic whites. The prevalence of arthritis and its effects among specific Hispanic subgroups has not been studied in a nationally representative sample of U.S. adults. To determine the annualized prevalence of arthritis and arthritis-attributable effects among Hispanic subgroups, CDC analyzed National Health Interview Survey (NHIS) data for 2002, 2003, 2006, and 2009 combined. This report describes the results of that analysis, which indicated that the age-adjusted prevalence of arthritis ranged from 11.7% among Cubans/Cuban Americans to 21.8% among Puerto Ricans; an estimated 3.1 million Hispanics had arthritis during these years. Among all subgroups of Hispanics with arthritis, at least 20% of persons with arthritis reported an arthritis-attributable effect: AAAL (range: 21.1% among Cubans/Cuban Americans to 48.5% among Puerto Ricans); arthritis-attributable work limitations (AAWL) (range: 32.9% among Central/South Americans to 41.6% among Mexican Americans); and severe joint pain (SJP) (range: 23.7% among Cubans/Cuban Americans to 44.1% among Puerto Ricans). These findings identify Hispanic subgroups with high burdens of arthritis who likely are in need of interventions designed to improve their quality of life.     

Prevalence of usual-corrected distance visual acuity impairment in Hispanic and non-Hispanic children and adolescents

Data from the Hispanic Health and Nutrition Examination Survey and the National Health and Nutrition Examination Survey I were analysed to determine the prevalence of visual acuity impairment among US Hispanics and non-Hispanics aged 6-19 years. The prevalence of 20/30 or worse distance visual acuity with usual or habitual correction ranged from 10.8% in non-Hispanic whites to 19.1% in Puerto Ricans. Puerto Rican boys aged 13-19 years had significantly greater rates of moderate or greater impairment (20/70 or worse) than 6-12-year-old Puerto Rican boys (5.7% vs. 0.7%). The prevalence of visual impairment was generally greater in girls than in boys. Assessment and comparison of refractive error and eye disease prevalence rates are necessary in future studies to determine factors influencing prevalence of visual acuity impairment in children.     

Sociodemographic Factors and Self-Management Practices Related to Type 2 Diabetes Among Hispanics and Non-Hispanic Whites in a Rural Setting

CONTEXT: Hispanics in the United States have a higher prevalence of non-insulin-dependent diabetes mellitus (type 2 diabetes) and experience more complications for the disease than non-Hispanic whites. Differences in medical management or self-management practices may, in part, explain the relative high risk for diabetes complications among Hispanics. PURPOSE: Using data from a community-randomized intervention study on cancer prevention, we examined the medical management and self-management practices of Hispanics and non-Hispanic whites who have diabetes. METHODS: Locally hired bilingual personnel conducted in-person interviews of a random selection of 1,863 adults in 20 communities in the Yakima Valley of eastern Washington State. FINDINGS: A total of 70 Hispanics (11% age-adjusted prevalence) and 87 non-Hispanic whites (7.3% age-adjusted prevalence) reported having type 2 diabetes. Hispanics with a high level of acculturation were slightly more likely to have diabetes, compared to those with a low level of acculturation, though the association was nonsignificant. Hispanics were significantly less likely than non-Hispanic whites to treat their diabetes with diet and exercise (36% vs 61.3%; P < or = .001). Annual eye examinations were less commonly reported among Hispanics (48.9%) than among non-Hispanic whites (72.7%). CONCLUSIONS: Our data indicate that Hispanics engage less frequently in self-management practices to control diabetes than non-Hispanic whites.     

Development of sex-specific equations for estimating stature of frail elderly Hispanics living in the northeastern United States

BACKGROUND: The accurate measurement of stature is not possible in many frail elderly persons because of problems affecting their ability to stand straight. In such cases, knee height may be used to estimate stature. OBJECTIVE: This study was designed to explore the applicability of published regression equations to estimate stature of Puerto Rican and other Hispanic elderly persons living in the northeastern United States and to formulate ethnicity-specific equations for these persons. DESIGN: The study subjects (60-92 y of age) included 569 Hispanics and a comparison group of 153 non-Hispanic whites. Equations to estimate stature of Hispanics and Puerto Ricans living in the northeastern United States were developed with regression models in a randomly selected subgroup of the Hispanics. These equations were tested with the remaining Hispanic subgroup. RESULTS: The published equations significantly overestimated stature of our Hispanic subjects. Equations developed for Massachusetts Hispanics and Puerto Ricans provided estimates of stature that did not differ significantly from measured stature. We found further that equations for non-Hispanic whites published in 1985 predicted statures of our relatively low-income, non-Hispanic white subjects better than did newer 1998 equations developed from a national sample. CONCLUSIONS: The stature of elderly Hispanics from the northeastern United States can be estimated by using equations derived from the same population. These, or similar equations, should be used to estimate stature of frail elderly persons for whom standing height cannot be taken accurately. Socioeconomic status as well as ethnicity may affect results when knee height equations are used.     

alpha-Tocopherol intake and plasma concentration of Hispanic and non-Hispanic white elders is associated with dietary intake pattern

alpha-Tocopherol from foods has been associated with protection against several chronic diseases and maintenance of immune function. However, most people do not meet current recommendations for intake. We examined alpha-tocopherol intake and plasma concentration in a representative sample of Puerto Rican and Dominican older adults (n = 447) and in neighborhood-matched non-Hispanic whites (n = 155). A validated food frequency questionnaire was used to assess dietary intake. Mean dietary intakes of alpha-tocopherol were 6 mg in both ethnicities. Only 4.7% of women and 7.9% of men met the estimated average requirement (12 mg/d) for vitamin E from food alone. Top sources of alpha-tocopherol for Hispanics included oils and milk, and for non-Hispanic whites they were ready-to-eat breakfast cereal and sweet baked products. Mean plasma alpha-tocopherol concentrations were 24.5 micromol/L for Hispanics and 25.8 micromol/L for non-Hispanic whites (P > 0.05). Plasma alpha-tocopherol was positively associated with alpha-tocopherol intake (P = 0.003), and significance remained after adjusting covariates and after exclusion of supplement users (P for trend = 0.008). We identified the following 5 dietary patterns by cluster analysis: 1) fruit and breakfast cereal, 2) starchy vegetables, 3) rice, 4) milk and milk products, and 5) sweets. Those following the sweets pattern had the lowest plasma alpha-tocopherol relative to those following the fruit and breakfast cereal or milk patterns (P < 0.05 for all), although they had similar intakes. A large proportion of these elders (>90%) have inadequate intake of alpha-tocopherol, and plasma concentrations were associated with intake patterns.     

Long-term secular trends in initiation of cigarette smoking among Hispanics in the United States

Preventing the initiation of cigarette smoking plays a vital role in reducing rates of cigarette smoking. The authors investigated trends in cigarette smoking initiation among Mexican Americans, Cuban Americans, Puerto Rican Americans, compared with whites, by examining the cigarette smoking histories of adults from the 1982-83 Hispanic Health and Nutrition Examination Survey and the 1987 National Health Interview Survey. To evaluate these trends, they calculated the prevalence of cigarette smoking among 20-24-year-olds, an indicator of the rate of smoking initiation, in successive 5-year birth cohorts from 1908-12 to 1958-62 among Hispanics and from 1908-12 to 1963-67 among whites. Recently, rates of smoking initiation among Mexican American and Cuban American men have declined and converged with rates of initiation among white men. However, rates of initiation among Puerto Rican American men appeared to have remained unchanged since the 1950s. During the 1970s rates of smoking initiation among Cuban American and Puerto Rican American women surpassed those of white women. In the early 1980s, however, rates of initiation among these groups of Hispanic women have declined to levels comparable to or perhaps lower than the rates among white women. Although recently the rates among Mexican American women have been the lowest of all groups of women, they have not experienced appreciable declines. In general, rates of smoking initiation either declined or leveled off later for Hispanics than for whites. These results suggest that Hispanics tended to follow the smoking trends observed among whites and that special efforts are needed to prevent cigarette smoking among Hispanics.     

Hispanic and non-Hispanic white elders from Massachusetts have different patterns of carotenoid intake and plasma concentrations

Carotenoids have been linked with protective roles against diseases associated with aging, including cancer, cardiovascular disease, cataracts, and age-related macular degeneration. With data from a semiquantitative, validated FFQ, we examined carotenoid intake of 340 Puerto Ricans, 98 Dominicans, and 146 non-Hispanic whites (>60 y old) in Massachusetts. Compared with non-Hispanic white men, Hispanic men reported a higher intake of lycopene and lower intakes of alpha-carotene, lutein + zeaxanthin, beta-carotene (from diet only), and total beta-carotene (diet and supplements) (P < 0.001). Hispanic women reported higher intakes of beta-cryptoxanthin and lycopene but lower intakes of lutein + zeaxanthin (P < 0.001) than non-Hispanic white women. The frequency of consumption of fruit and vegetables was higher among Hispanic women, relative to non-Hispanic white women (P < 0.05). Plasma concentrations of alpha-carotene and lycopene were higher in Hispanic than in non-Hispanic white men and women. For both ethnic groups, higher intakes of carotenoids were associated with higher plasma concentrations of the respective carotenoids, except for lycopene (Hispanics) and lutein + zeaxanthin (non-Hispanic whites). Food sources contributing most to total intakes differed among the groups. The major sources of alpha- and beta-carotene were carrots for non-Hispanic whites and winter squash for Hispanics. The major source of lycopene was cooked tomato products for Hispanics, and pasta dishes for non-Hispanic whites. Traditional foods such as beans and plantains were also important contributors of carotenoids for Hispanics. Because of the potential importance of carotenoids as protective factors against chronic diseases, more attention to food-related practices associated with carotenoid intake in differing population groups is warranted.     

Protein nutritional status and function are associated with type 2 diabetes in Hispanic elders

BACKGROUND: Hispanic elders have a high prevalence of diabetes and poor glycemic control, leading to inadequate nutritional status, muscle wasting, and impaired function. OBJECTIVE: We examined the association of type 2 diabetes with nutritional status measured by serum albumin concentrations and midupper arm muscle area (MAM) and with function measured by difficulty with at least one activity of daily living. DESIGN:: Health history and disability were assessed by self report in 556 Hispanics with a mean (+/- SD) age of 69 +/- 7 y and 158 non-Hispanic whites (NHW; aged 71 +/- 7 y) from the Massachusetts Hispanic Elders Survey. Energy intake (in MJ/d) and protein intake (in g/d) were estimated with use of a food-frequency questionnaire. Body mass index (BMI; in kg/m(2)) and C-reactive protein concentrations (in mg/L) were also measured. Multiple logistic regression models by ethnic group were used. RESULTS: There were no significant differences between Hispanics and NHWs in the proportion of those with low albumin concentrations or low MAM. Hispanic diabetic women had the lowest proportion of low MAM. The risk of low serum albumin concentration was twice as high in Hispanics taking insulin as in their NHW counterparts. Among Hispanics, low albumin concentration and low BMI were associated with low MAM; female sex, low albumin concentration, high BMI, and insulin use were significantly associated with risk of functional impairment. CONCLUSION: Type 2 diabetes is associated with poor nutritional status, muscle loss, and functional impairment among Hispanic elders.     

Health disparities experienced by Hispanics--United States

In the 2000 census, 35.3 million persons in the United States and 3.8 million persons in the Commonwealth of Puerto Rico identified themselves as Hispanic (i.e., Hispanic, Spanish, or Latino; of all races). Hispanics constituted 12.5% of the U.S. population in the 50 states; by subpopulation, they identified as Mexican (7.3%), Puerto Rican (1.2%), Cuban (0.4%), and other Hispanic (3.6%). For certain health conditions, Hispanics bear a disproportionate burden of disease, injury, death, and disability when compared with non-Hispanic whites, the largest racial/ethnic population in the United States. The leading causes of death among Hispanics vary from those for non-Hispanic whites. This week's MMWR is the second in a series focusing on racial/ethnic health disparities; eliminating these disparities will require culturally appropriate public health initiatives, community support, and equitable access to quality health care.     

Health disparities between island and mainland Puerto Ricans.

OBJECTIVE: To detect health disparities among three populations--Puerto Ricans living in Puerto Rico as well as Puerto Ricans and non-Hispanic whites living on the United States (U.S.) mainland. METHODS: Data from two similarly designed surveys conducted in 1999-2000 were analyzed. The Behavioral Risk Factor Surveillance System (BRFSS) provided data on Puerto Ricans living on the island and on non-Hispanic whites in the U.S. Another survey of Puerto Ricans living in New York City provided data on mainland Puerto Ricans. The age- and sex-standardized weighted prevalences of various health parameters (e.g., obesity, diabetes, smoking, and physical illness) and indicators of access to health care (e.g., frequencies of routine checkups and diabetes care) were compared between populations by means of standardized rate ratios (SRR). RESULTS: Puerto Ricans living on the mainland and those living on the island had a similar prevalence of obesity (21% to 22%). Compared with islanders, mainland Puerto Ricans had a higher prevalence of diabetes (SRR = 1.4; 95% confidence interval [95% CI] = 1.01 to 2.0); those with diabetes also showed higher prevalences of smoking (SRR = 4.2; 95% CI = 2.3 to 7.7) and physical illness (SRR = 1.5; 95% CI = 1.1 to 2.0) than Puerto Ricans living on the island. While mainland Puerto Ricans were similar to non-Hispanic whites in terms of their utilization of primary prevention and diabetes care, island Puerto Ricans trailed behind significantly. CONCLUSIONS: Puerto Ricans living on the U.S. mainland and those living in Puerto Rico both need to target lowering their prevalence of obesity and diabetes. For island Puerto Ricans, improved education about the significance of primary prevention and diabetes care is needed. For mainland Puerto Ricans, the accessibility of the primary health care system renders it a potentially effective venue for interventions, particularly for smoking cessation. More studies are warranted to identify factors associated with the poor health status observed in mainland Puerto Ricans.     

Ethnic Disparities in the Association of Body Mass Index with the Risk of Hypertension and Diabetes

Despite having lower body mass index (BMI) compared to other ethnic groups, Asians continue to develop significant metabolic diseases such as hypertension and diabetes. To evaluate the disparate association of BMI and risk of hypertension and diabetes in Asians. We retrospectively studied 150,753 adults from the 1985–2011 California Behavioral Risk Factor Survey. Trends in prevalence of obesity, hypertension, and diabetes were stratified by ethnicity. Multivariate logistic regression models evaluated the incremental effect of one unit BMI increase on risk of hypertension and diabetes and the disparate risks of hypertension and diabetes at different BMI thresholds. Asians had the lowest BMI among all groups. However, the impact of increasing BMI on risk of hypertension and diabetes was significantly greater in Asians. For each one unit increase in BMI, Asians were significantly more likely to have hypertension (OR 1.15; 95 % CI 1.13–1.18) compared to non-Hispanic whites, blacks, and Hispanics. Similar trends were seen for diabetes (Asians: OR 1.15; 95 % CI 1.13–1.18). The risk of hypertension in Asians with BMI ≥ 22 was similar to non-Hispanic whites with BMI ≥ 27 and blacks with BMI ≥ 28. The risk of diabetes in Asians with BMI ≥ 28 was similar to non-Hispanic whites with BMI ≥ 30. Despite lower overall BMI compared to other groups, weight gain in Asians is associated with significantly higher risks of hypertension and diabetes. Compared to other ethnic groups, similar risks of hypertension and diabetes are seen in Asians at much lower BMI.     

Rural Residence and Hispanic Ethnicity: Doubly Disadvantaged for Diabetes?

CONTEXT: Hispanics are at increased risk for diabetes, while rural residents have historically had decreased access to care. PURPOSE: To determine whether living in a rural area and being Hispanic confers special risks for diagnosis and control of diabetes. METHODS: We analyzed the Third National Health and Nutrition Examination Survey (1988-1994). Hispanics and non-Hispanic white adults were classified according to rural/urban residence to create 4 ethnicity-residence groups. Investigated outcomes were previously diagnosed and undiagnosed diabetes. Among those with diagnosed diabetes, we investigated control of glucose, hypertension, and lipids. FINDINGS: The prevalence of diagnosed diabetes was greatest for rural residents, especially for rural Hispanics (8.2%) versus that for urban whites (4.6%), rural whites (6.5%), or urban Hispanics (4.5%), (P < .01). However, urban Hispanics were most likely to have undiagnosed diabetes at 3.7%, versus 2.3% of rural whites, 2.8% of urban whites, and 2.7% of rural Hispanics (P = .04). Among people with diagnosed diabetes, there was no difference in glycemic control between the 4 groups. Rural Hispanics with diagnosed diabetes had the greatest prevalence of elevated systolic blood pressure at 45%, compared to 37% of urban whites, 29% of rural whites, 28% of urban Hispanics (P = .01). In regression models controlling for potential confounders, there were no differences among urban and rural whites and Hispanics in the likelihood of undiagnosed diabetes or in glycemic control for those with diagnosed diabetes. CONCLUSIONS: Initiatives that target Hispanic health, and especially diabetes, should acknowledge rural/urban Hispanic health differences.