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1.  Is Acculturation Related to Obesity in Hispanic/Latino Adults? Results from the Hispanic Community Health Study/Study of Latinos 
Journal of Obesity  2015;2015:186276.
Background. The study examined the association of obesity with acculturation in a large and diverse sample of US Hispanic/Latino adults. Methods. The Hispanic Community Health Study (HCHS)/Study of Latinos (SOL) is a community-based cohort study of Hispanic/Latino adults aged 18–74 years (N = 16,415) from four urban areas. Height and weight were directly measured using a standardized protocol. Acculturation was assessed by the Short Acculturation Scale for Hispanics (SASH). Other immigration related variables included place of birth, length of residency in the US, and age at immigration. Odds ratios were calculated to assess the association of overweight, moderate obesity, and extreme obesity (≥40 kg/m2) with acculturation and sociodemographic variables. Results. The prevalence of obesity was 42.4% for women and 36.5% for men and varied by field center and Hispanic/Latino background. The strongest predictor of moderate and extreme obesity was length of residency in mainland US. This association was consistent across Hispanic/Latino backgrounds. Acculturation was not significantly associated with obesity. Discussion. The burden of obesity is high among Hispanic/Latino adults. The study findings suggest that prolonged exposure to the environments in these communities, rather than acculturation, is an important risk factor for obesity in this population.
PMCID: PMC4393894  PMID: 25893114
2.  Behavioral Self-Regulation and Weight-Related Behaviors in Inner-City Adolescents: A Model of Direct and Indirect Effects 
Childhood obesity (Print)  2011;7(4):306-315.
This study examined the association of two distinct self-regulation constructs, effortful control and dysregulation, with weight-related behaviors in adolescents and tested whether these effects were mediated by self-efficacy variables.
A school-based survey was conducted with 1771 adolescents from 11 public schools in the Bronx, New York. Self-regulation was assessed by multiple indicators and defined as two latent constructs. Dependent variables included fruit/vegetable intake, intake of snack/junk food, frequency of physical activity, and time spent in sedentary behaviors. Structural equation modeling examined the relation of effortful control and dysregulation to lifestyle behaviors, with self-efficacy variables as possible mediators.
Study results showed that effortful control had a positive indirect effect on fruit and vegetable intake, mediated by self-efficacy, as well as a direct effect. Effortful control also had a positive indirect effect on physical activity, mediated by self-efficacy. Dysregulation had direct effects on intake of junk food/snacks and time spent in sedentary behaviors.
These findings indicate that self-regulation characteristics are related to diet and physical activity and that some of these effects are mediated by self-efficacy. Different effects were noted for the two domains of self-regulation. Prevention researchers should consider including self-regulation processes in programs to improve health behaviors in adolescents.
PMCID: PMC3522174  PMID: 23243551
3.  Computational Fluid Dynamics Endpoints for Assessment of Adenotonsillectomy Outcome in Obese Children with Obstructive Sleep Apnea Syndrome 
Journal of biomechanics  2014;47(10):2498-2503.
Improvements in obstructive sleep apnea syndrome (OSAS) severity may be associated with improved pharyngeal fluid mechanics following adenotonsillectomy (AT). The study objective is to use image-based computational fluid dynamics (CFD) to model changes in pharyngeal pressures after AT, in obese children with OSAS and adenotonsillar hypertrophy.
Three-dimensional models of the upper airway from nares to trachea, before and after AT, were derived from magnetic resonance images obtained during wakefulness, in a cohort of 10 obese children with OSAS. Velocity, pressure, and turbulence fields during peak tidal inspiratory flow were computed using commercial software. CFD endpoints were correlated with polysomnography endpoints before and after AT using Spearman’s rank correlation (rs).
Apnea hypopnea index (AHI) decrease after AT was strongly correlated with reduction in maximum pressure drop (dPTAmax) in the region where tonsils and adenoid constrict the pharynx (rs=0.78, P = 0.011), and with decrease of the ratio of dPTAmax to flow rate (rs = 0.82, P = 0.006). Correlations of AHI decrease to anatomy, negative pressure in the overlap region (including nasal flow resistance), or pressure drop through the entire pharynx, were not significant. In a subgroup of subjects with more than 10% improvement in AHI, correlations between flow variables and AHI decrease were stronger than in all subjects.
The correlation between change in dPTAmax and improved AHI suggests that dPTAmax may be a useful index for internal airway loading due to anatomical narrowing, and may be better correlated to AHI than direct airway anatomic measurements.
PMCID: PMC4057952  PMID: 24840295
Magnetic Resonance Imaging; Humans; Computer Simulation; Airway Resistance; Pediatrics
4.  Associations of chronic stress burden, perceived stress, and traumatic stress with cardiovascular disease prevalence and risk factors in the HCHS/SOL Sociocultural Ancillary Study 
Psychosomatic medicine  2014;76(6):468-475.
The current study examined multiple stress indicators (chronic, perceived, traumatic) in relation to prevalent coronary heart disease (CHD), stroke, and major cardiovascular disease (CVD) risk factors (i.e., diabetes, dyslipidemia, hypertension, current smoking) in the multi-site Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study (2010–2011).
Participants were 5313 men and women, 18–74 years old, representing diverse Hispanic/Latino ethnic backgrounds, who underwent a comprehensive baseline clinical exam and sociocultural exam with measures of stress.
Chronic stress burden was related to a higher prevalence of CHD after adjusting for sociodemographic, behavioral and biological risk factors [OR (95% CI) = 1.22, (1.10–1.36)] and related to stroke prevalence in the model adjusted for demographic and behavioral factors [OR (95% CI) = 1.26, (1.03–1.55∂)]. Chronic stress was also related to a higher prevalence of diabetes [OR=1.20, (1.11–1.31)] and hypertension [OR=1.10 (1.02–1.19)] in individuals free from CVD (N=4926). Perceived stress [OR=1.03 (1.01–1.05)] and traumatic stress [OR=1.15 (1.05–1.26)] were associated with a higher prevalence of smoking. Participants who reported a greater number of lifetime traumatic events also unexpectedly showed a lower prevalence of diabetes [OR=.89 (.83–.97)] and hypertension [OR=.88 (.82–.93)]. Effects were largely consistent across age and sex groups.
The study underscores the utility of examining multiple indicators of stress in relation to health, since the direction and consistency of associations may vary across distinct stress conceptualizations. In addition, the study suggests that chronic stress is related to higher CVD risk and prevalence in Hispanics/Latinos, the largest U.S. ethnic minority group.
PMCID: PMC4349387  PMID: 24979579
Cardiovascular Disease; Coronary Heart Disease; Hispanic; Latino; Stress
5.  Association of Pulmonary Function with Adiposity and Metabolic Abnormalities in Urban Minority Adolescents 
Rationale: Childhood obesity is a known risk factor for pulmonary diseases, likely due to obesity-mediated alteration of pulmonary function. Inflammation and mechanical fat load are two proposed causative mechanisms for altered pulmonary function among obese children; however, the association of metabolic abnormalities with pulmonary function among children is poorly understood.
Objectives: We investigated the independent association of truncal and general adiposity and metabolic abnormalities with pulmonary function in a sample of urban minority adolescents.
Methods: Spirometry and lung volume indices were compared between adolescents with general (body mass index [BMI] > 95th percentile) or truncal adiposity (waist circumference > 90th percentile) and normal-weight (BMI < 85th percentile or waist circumference ≤ 90th percentile) and between those with metabolic abnormalities (homeostatic model assessment of insulin resistance [HOMA-IR] in the top quartile or high-density lipoprotein [HDL] < 40 mg/dl) and those with a normal metabolic profile.
Measurements and Main Results: Obese adolescents had lower lung volumes, including residual volume (RV), RV/TLC ratio, expiratory reserve volume (ERV), and FRC, and higher inspiratory capacity (IC) than normal-weight adolescents, but did not differ in measures of lower airway obstruction, FEV1/FVC ratio, and mid-expiratory flow rate. Adolescents with high HOMA-IR had lower FEV1/FVC ratio, RV, RV/TLC ratio, ERV, and FRC and higher IC, whereas those with low HDL had lower FEV1/FVC and RV/TLC ratios. After adjusting for adiposity, HOMA-IR remained a predictor of ERV (β = −1.4; P = 0.02) and FEV1/FVC ratio (β = −0.5; P = 0.03), and HDL remained a predictor of FEV1/FVC ratio (β = 0.1; P = 0.01). General adiposity was a predictor of FRC (β = −0.5; P < 0.001), IC (β = 0.3; P < 0.001), RV (β = −0.8; P < 0.0001), and RV/TLC ratio (β = −0.2; P < 0.0001), and truncal adiposity was a predictor of RV (β = −20.3; P = 0.03) and FRC (β = −13.8; P = 0.004). Thus, adiposity and metabolic abnormalities were independent predictors of ERV, but only metabolic abnormalities independently predicted FEV1/FVC ratio. Although general adiposity predicted RV and RV/TLC ratio, truncal adiposity was predictive of RV and FRC, conferring additional risk above general adiposity.
Conclusions: These results suggest that metabolic abnormalities and adiposity are independently associated with pulmonary function deficits among urban adolescents. Metabolic assessment of obese adolescents may identify those at risk of developing obesity-associated pulmonary morbidity.
PMCID: PMC4225805  PMID: 24785169
obesity; metabolic abnormalities; pulmonary function; children
6.  Theoretical foundations of the Study of Latino (SOL) Youth: implications for obesity and cardiometabolic risk 
Annals of epidemiology  2013;24(1):10.1016/j.annepidem.2013.10.011.
This article describes the conceptual model developed for the Hispanic Community Health Study/Study of Latino Youth, a multisite epidemiologic study of obesity and cardiometabolic risk among U.S. Hispanic/Latino children.
Public health, psychology, and sociology research were examined for relevant theories and paradigms. This research, in turn, led us to consider several study design features to best represent both risk and protective factors from multiple levels of influence, as well as the identification of culturally relevant scales to capture identified constructs.
The Socio-Ecological Framework, Social Cognitive Theory, family systems theory, and acculturation research informed the specification of our conceptual model. Data are being collected from both children and parents in the household to examine the bidirectional influence of children and their parents, including the potential contribution of intergenerational differences in acculturation as a risk factor. Children and parents are reporting on individual, interpersonal, and perceived organizational and community influences on children's risk for obesity consistent with Socio-Ecological Framework.
Much research has been conducted on obesity, yet conceptual models examining risk and protective factors lack specificity in several areas. Study of Latino Youth is designed to fill a gap in this research and inform future efforts.
PMCID: PMC3879411  PMID: 24246265
Hispanic/Latino; Children; Obesity; Acculturation; Socio-Ecological Framework; Theory
7.  The association of emotion regulation with lifestyle behaviors in inner-city adolescents 
Eating behaviors  2013;14(4):10.1016/j.eatbeh.2013.07.009.
Recent research suggests a role of cognitive self-regulation skills on obesity and lifestyle behaviors. However, very little is known about the role of emotion regulation. This study examined the association of emotion regulation with lifestyle behaviors and examined a mediational model testing effects of emotion regulation through self-efficacy and depressive symptoms.
A cross-sectional study was conducted with 602 adolescents (mean age 12.7 years) from 4 public schools in the Bronx, NY. The sample was 58% female, predominantly Hispanic (74%) and US born (81%). Emotion regulation was assessed by 3 indicators and defined as a latent variable. Dependent variables included fruit/vegetable intake, snack/junk food intake, frequency of physical activity, and time spent in sedentary behaviors. Structural equation modeling examined the association of emotion regulation with lifestyle behaviors, with self-efficacy and depressive symptoms defined as potential mediators.
The analyses showed that there was a positive association of emotion regulation with higher intake of fruits/vegetable and greater physical activity, which was mediated by self-efficacy. Emotion regulation was related to snack/junk food intake and sedentary behavior, and the structural equation model indicated pathways through an inverse relation to depressive symptoms, but these pathways were only observed in adolescent girls and not boys.
These findings indicate that the ability to regulate emotions among adolescents has a role in weight-related behaviors. Future studies may need to explore the relation of other dimensions of emotion to positive health behaviors and study aspects of emotion regulation that may be more relevant for boys.
PMCID: PMC3817414  PMID: 24183148
Adolescents; Lifestyle behaviors; Emotion regulation; Depressive Symptoms; Self-efficacy
8.  Health Effects of Low-Carbohydrate Diets: Where Should New Research Go? 
Current diabetes reports  2013;13(2):271-278.
There has been considerable debate about the metabolic effects of restricting carbohydrate intake in weight and diabetes management. However, the American Diabetes Association has noted that weight and metabolic improvements can be achieved with low carbohydrate, low fat (implicitly higher carbohydrate), or a Mediterranean style diet (usually an intermediate level of carbohydrate). Our paper addresses variability in the definition for low or restricted carbohydrate, the effects of carbohydrate restriction on diabetes-related health outcomes, strategies for restricting carbohydrate intake, and potential genetic variability in response to dietary carbohydrate restriction. Issues for future research are also addressed.
PMCID: PMC3595318  PMID: 23266565
diabetes; diet; nutrition; low carbohydrate; eating patterns; available carbohydrate; genetic variability; Paleolithic diet; nutrition guidelines; insulin resistance; gut hormones; health effects; diabetes; research
9.  Sleep and Cardiometabolic Function in Obese Adolescent Girls with Polycystic Ovary Syndrome 
Sleep medicine  2012;13(10):1307-1312.
To compare the polysomnography findings and cardiometabolic function among adolescent girls with PCOS and matched female and male controls.
Retrospective chart review of electronic medical records of 28 girls with PCOS (age: 16.8±1.9 yrs, BMI Z-score 2.4±0.4), 28 control females (age: 17.1±1.8, BMI Z-score 2.4±0.3) and 28 control males (age: 16.6±1.6, BMI Z-score 2.5±0.5) in a tertiary care center.
The prevalence of obstructive sleep apnea (OSA) was higher in girls with PCOS compared to control females (16/28 (57%) vs. 4/28(14.3%), p<0.01), however, was comparable to that of the control males (16/28(57%) vs. 21/28(75%), p=0.4). Girls with PCOS had a significantly higher prevalence of insulin resistance compared to control females and control males (20/28 (71.4%) vs. 9/22 (41.0%) (p=0.04) vs. 8/23 (34.8%) (p=0.01). Among girls with PCOS, those with OSA had significantly higher proportions of metabolic syndrome (9/16 (56.3% ) vs. 1/12 (8.3%) p=0.03), higher insulin resistance (13/16 (81.3%) vs. 5/12 (41.6%), p=0.03), elevated daytime systolic blood pressure (128.4±12.8 vs. 115.6±11.4, p<0.01), lower HDL (38.6±8.7 vs. 49±10.9, p=0.01) and elevated triglycerides (149.7±87.7 vs. 93.3±25.8, p=0.03) compared to those without OSA.
We report a higher prevalence of OSA and metabolic dysfunction in a selected group of obese girls with PCOS referred with sleep related complaints compared to BMI matched control girls without PCOS. We also report higher prevalence of cardiometabolic dysfunction in girls with PCOS and OSA compared to girls with PCOS without OSA.
PMCID: PMC3509263  PMID: 22921588
AHI: Apnea hypopnea index; HDL: High density lipoprotein; HOMA-IR: Homeostatic model assessment a measure of Insulin resistance; MetS: Metabolic syndrome; OSA: Obstructive sleep apnea; PCOS: Polycystic ovary syndrome; TG: Triglyceride
10.  Associations of Obesity and Asthma with Functional Exercise Capacity in Urban Minority Adolescents 
Pediatric pulmonology  2012;47(11):1061-1069.
To examine the independent association of asthma and obesity and of their coexistence with functional exercise capacity among urban adolescents.
One hundred and eighteen Hispanic and African American adolescents including 33 obese asthmatics, 18 normal-weight asthmatics, 38 obese non-asthmatics and 29 normal-weight non-asthmatics underwent anthropometric measures, 6 minute walk test (6MWT) as measure of functional exercise capacity and spirometry as measure of pulmonary function. The 6 minute walk distance (6MWD) was compared between the four study groups. The association of 6MWD with measures of lower airway obstruction, and measures of adiposity was assessed.
The 6MWD was lower among the obese groups with the least distance covered by the obese asthmatic group (p=0.02). In the obese asthmatic group, there was a negative correlation between 6MWD and body mass index (BMI) (r= −0.35, p= 0.03) but no association was noted with percent-predicted Forced Expiratory Volume in the 1st second (FEV1) (r=0.07, p=0.70). Conversely, the 6MWD correlated with FEV1 among normal-weight asthmatics (r=0.45, p=0.04) and normal-weight non-asthmatics (r=0.4, p=0.03) but was not associated with BMI in either of the two groups. After adjusting for age, height, gender and ethnicity, BMI was noted to be a significant predictor (β −2.76, 95% CI −4.77- −0.76, p<0.01)) of the 6MWD among the obese while percent predicted FEV1 (β 1.87, 95%CI 0.28–3.45, p=0.02) was a significant predictor among the normal-weight participants.
Our findings suggest that among urban minority obese asthmatic adolescents, functional exercise capacity was associated with obesity, rather than pulmonary function.
PMCID: PMC3389560  PMID: 22467360
Asthma; Obesity; Functional Exercise Capacity; Adolescents
11.  Considering Options for Attenuating Postmeal Glucose Excursions 
Diabetes Care  2010;33(12):2709-2710.
PMCID: PMC2992216  PMID: 21115773
12.  High Prevalence of Obesity Among Inner-City Adolescent Boys in the Bronx, New York: Forgetting Our Boys 
Preventing Chronic Disease  2010;8(1):A23.
We examined sex differences in overweight and obesity in a sample of 1,619 inner-city adolescents. Participants were enrolled from 11 public schools in the Bronx, New York. The prevalence of overweight and obesity was 21.7% and 22.5%, respectively; prevalence of obesity was significantly higher among adolescent boys than adolescent girls (24.9 vs 20.1%). Childhood obesity is a public health concern in the United States, and the higher prevalence of obesity in adolescent boys requires additional attention.
PMCID: PMC3044034  PMID: 21159235
13.  Comparative Study of the Effects of a 1-Year Dietary Intervention of a Low-Carbohydrate Diet Versus a Low-Fat Diet on Weight and Glycemic Control in Type 2 Diabetes 
Diabetes Care  2009;32(7):1147-1152.
To compare the effects of a 1-year intervention with a low-carbohydrate and a low-fat diet on weight loss and glycemic control in patients with type 2 diabetes.
This study is a randomized clinical trial of 105 overweight adults with type 2 diabetes. Primary outcomes were weight and A1C. Secondary outcomes included blood pressure and lipids. Outcome measures were obtained at 3, 6, and 12 months.
The greatest reduction in weight and A1C occurred within the first 3 months. Weight loss occurred faster in the low-carbohydrate group than in the low-fat group (P = 0.005), but at 1 year a similar 3.4% weight reduction was seen in both dietary groups. There was no significant change in A1C in either group at 1 year. There was no change in blood pressure, but a greater increase in HDL was observed in the low-carbohydrate group (P = 0.002).
Among patients with type 2 diabetes, after 1 year a low-carbohydrate diet had effects on weight and A1C similar to those seen with a low-fat diet. There was no significant effect on blood pressure, but the low-carbohydrate diet produced a greater increase in HDL cholesterol.
PMCID: PMC2699720  PMID: 19366978
14.  Self-Control Constructs Related to Measures of Dietary Intake and Physical Activity in Adolescents 
To test self-regulation concepts in relation to dietary intake and physical activity patterns in adolescence, which we predicted to be influenced by components of a self-control model.
A survey was conducted with a multiethnic sample of 9th grade public school students in a metropolitan area (N = 539). Confirmatory analysis tested the measurement structure of self-control. Structural equation modeling tested the association of self-control constructs with measures of fruit and vegetable intake, saturated-fat intake, physical activity, and sedentary behavior.
Confirmatory analysis of 14 indicators of self-control showed best fit for a two-factor structure, with latent constructs of good self-control (planfulness) and poor self-control (impulsiveness). Good self-control was related to more fruit and vegetable intake, more participation in sports, and less sedentary behavior. Poor self-control was related to more saturated-fat intake and less vigorous exercise. These effects were independent of gender, ethnicity, and parental education, which themselves had relations to diet and exercise measures. Multiple-group modeling indicated that effects of self-control were comparable across gender and ethnicity subgroups.
Self-control concepts are relevant for patterns of dietary intake and physical activity among adolescents. Attention to self-control processes may be warranted for prevention programs to improve health behaviors in childhood and adolescence.
PMCID: PMC2190087  PMID: 18023783
self-control; diet; exercise; adolescents; gender; ethnicity

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