Characteristics of participants are presented in . The majority of participants were female, obese, had less than a high school education, and unemployed. Most participants (83%) identified themselves as Caribbean, while 16% identified themselves as Mexican, and 1% other Latino. The mean age was 51.8 years. The mean risk of developing diabetes in 7.5 years per the Stern formula was 56%. The mean CES-D score was 16.3. Half (50%) of the present sample had CES-D scores of 16 or greater, indicating a depressive disorder, which is more than twice the rate that has been observed in the general population (22%) (11
) and other Latino samples (23%) using the same measure (19
). Latinos at elevated risk for T2D appear to have disproportionately high rates of depression. Given the association of depression with the development of T2D, Latinos with both pre-diabetes and depression represent a particularly high risk group that should be targeted by prevention efforts.
Characteristics of Latinos at Risk for Type 2 Diabetes
Several mechanisms have been proposed to explain the relationship between depression and T2D. Depression can be associated with increased activity of the hypothalamic-pituitary-adrenal axis, which is associated with elevations in cortisol, a stress hormone that stimulates glucose production and in some, promotes abdominal fat storage and insulin resistance (20
). Immune function has also been implicated in the link between depression and T2D (22
). A recent meta-analysis revealed that depression is a risk factor for T2D of comparable magnitude to both smoking and physical activity (4
). Once T2D develops, Latinos are more likely to have worse glycemic control when compared to Caucasians (23
). To the extent that depression contributes to the manifestation of T2D, treating depression in people with pre-diabetes should be a priority.
Results also revealed that higher depression scores were associated with lower AHEI scores (p=.001; See ). Depression scores were not associated with BMI, caloric intake, percentage calories BMI, or physical activity (p=.95). The diet quality of at-risk Latinos with depression was lower per the AHEI, a measure of diet quality that has been associated with risk for both T2D (8
) and cardiovascular disease (24
). Average AHEI score was 33 out of 80. Several components of AHEI did not meet dietary recommendations, including intake of vegetables (1.3 servings/day), fruit (2.6 servings/day), nuts and soy protein (0.67 servings/day), cereal fiber (1.84 grams/day), and trans fat (1.2%). Deficient areas of diet included total fiber, vegetables (particularly non-starchy), fruit, nuts, and cereal fiber, which were considerably lower than the general US population (24
), while trans fat intake was higher (25
). These specific areas should be targeted clinically as well in public health campaigns for Latinos (8
Regression Analyses Predicting Lifestyle Factors, Body Mass Index (BMI), and Stern index by Depression Status among Latinos at Risk for Type 2 Diabetes a
Our finding that depression was associated with worse dietary quality is consistent with findings from a cross-sectional study of women with breast cancer. Scores on the CES-D were inversely related to diet quality (26
). The authors suggested that diet quality may be an important factor influencing the manifestation of depressive symptoms or conversely, poorer diet quality may be an outcome of depression. Among Latinos, a diagnosis of depression might be an indicator of the need not only for depression treatment but also for nutrition counseling to help reduce risk for T2D. The CES-D is an easy-to-use tool that can be used by health care professionals in primary care settings to assess depressive symptomatology in high risk patients.
Depression was not associated with BMI, caloric intake, or physical activity in Latinos. The lack of association between depression and obesity might be attributed to the homogeneity of the population (77% obese). Obesity is a concern in Latinos regardless of depression status. Mean caloric intake was modest at 1515 kcal per day and did not vary by depression status. However, in a previous investigation, energy intake underreporting by a mean of 254 kcal per day was observed in this sample (27
Limitations of this study include its cross-sectional nature, which limits conclusions regarding the temporal relationship between depression and dietary quality. Second, dietary underreporting in this population (27
) might impact diet quality estimates. Third, the CES-D is a self-report measure and although it is frequently used in research (19
), a diagnostic interview is the most valid measure of depression. Finally, most participants were female, of Caribbean descent (83%), unemployed, and may not be representative of Latino men or non-Caribbean Latinos. Recruitment did not attempt to oversample by gender, however, women enrolled in higher numbers.