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1.  Persistence of the metabolic syndrome and its influence on carotid artery intima media thickness in overweight Latino children 
Atherosclerosis  2009;206(2):594-598.
Objective
The objective of this study was to examine the influence of persistence of the MetS (MetS) and its individual components over a 3-year period on carotid intima media thickness (CIMT) in overweight Latino children.
Methods
Ninety-seven healthy male and female overweight Latino children (mean age at baseline: 11.0±1.8 yrs) were assessed for MetS on four annual evaluations and classified according to the persistence of MetS: NEVER (0 annual visits with the MetS, n=53), INTERMITTENT (1 or 2 visits with the MetS, n=28), and PERSISTENT (3 or 4 visits with the MetS, n=16). CIMT was measured with high-resolution B-mode ultrasound (7.9±0.7 months after the most recent MetS assessment; mean age: 14.6±1.8 yr).
Results
PERSISTENT MetS was associated with significantly higher CIMT (0.647mm±0.018 compared to (0.600mm±0.007 in those who NEVER had MetS, p<0.01). This difference remained significant after controlling for gender, baseline age, total fat mass, total lean tissue mass and insulin sensitivity. PERSISTENT high waist circumference and PERSISTENT high blood pressure were also significantly associated with higher mean CIMT, but these differences were no longer significant after controlling for total fat and lean tissue mass. Baseline systolic blood pressure and 2-hour glucose were significantly related to CIMT independent of all other MetS components (p<0.05).
Conclusions
Persistence of the MetS over a 3-year period was uniquely associated with increased CIMT during childhood. Children with hypertension, persistent abdominal adiposity and impaired glucose tolerance may also be at higher risk for elevated CIMT.
doi:10.1016/j.atherosclerosis.2009.03.013
PMCID: PMC3767145  PMID: 19446812
CIMT; obesity; children; MetS
2.  Persistence of the metabolic syndrome over 3 annual visits in overweight Latino children: Association with progressive risk for type 2 diabetes 
The Journal of pediatrics  2009;155(4):535-541.
Objective
To examine whether persistent Metabolic syndrome (MetS) was associated with risk for type 2 diabetes in overweight Latino children.
Study design
73 participants (age 11.0±1.7 years) from a longitudinal study were classified as: NEVER (negative for MetS at all 3 visits); INTERMITTENT (positive for MetS at 1 or 2 visits); or PERSISTENT (positive for MetS at all 3 visits). Measures included DEXA, MRI, 2-h oral glucose tolerance test, and frequently sampled intravenous glucose tolerance test.
Results
The PERSISTENT group had a faster rate of fat mass gain than the NEVER group (20% vs. 15% gain of baseline value, p<0.05 for time*group interaction (time= visit)). Independent of body composition, the PERSISTENT group increased by 70% in insulin incremental area under the curve, and the other groups decreased (p<0.05 for time*group interaction). Despite no time*group interactions for insulin sensitivity, acute insulin response, or disposition index, the PERSISTENT maintained 43% lower insulin sensitivity (p<0.01) and by visit 2 had a 25% lower disposition index (p<0.05) compared with the NEVER group.
Conclusion
Participants with persistent MetS had accelerated fat gain, increasing insulin response to oral glucose, and lower insulin sensitivity and beta cell function, indicators of progressively greater risk for type 2 diabetes.
doi:10.1016/j.jpeds.2009.04.008
PMCID: PMC3709847  PMID: 19555970
longitudinal; beta cell function; insulin sensitivity; insulin resistance; insulin IAUC
3.  Effects of a randomized maintenance intervention on adiposity and metabolic risk factors in overweight minority adolescents 
Pediatric Obesity  2012;7(1):16-27.
Objective
To assess the effects of a maintenance program (monthly newsletters versus monthly group classes and telephone behavioral sessions) on obesity and metabolic disease risk at one year in overweight minority adolescents.
Methods
After a 4-month nutrition and strength training intervention, 53 overweight Latino and African American adolescents (15.4 ±1.1 yrs) were randomized into one of two maintenance groups for 8 months: monthly newsletters (n=23) or group classes (n=30; monthly classes + individualized behavioral telephone sessions). The following outcomes were measured at months 4 (immediately following the intense intervention) and month 12: height, weight, blood pressure, body composition via BodPod™, lipids and glucose/insulin indices via frequently sampled intravenous glucose tolerance test (FSIVGTT).
Results
There were no significant group by time interactions for any of the health outcomes. There were significant time effects in several outcomes for both groups from month 4 to 12: bench press and leg press decreased by 5% and 14% (p=0.004 & p=0.01), fasting insulin and acute insulin response decreased by 26% and 16% (p<0.001 & p=0.046); while HDL cholesterol and insulin sensitivity improved by 5% and 14% (p=0.042 and p=0.039).
Conclusions
Newsletters as opposed to group classes may suffice as follow-up maintenance programs to decrease type 2 diabetes and cardiovascular risk in overweight minority adolescents.
doi:10.1111/j.2047-6310.2011.00002.x
PMCID: PMC3313084  PMID: 22434736
Maintenance; Obesity Intervention; Type 2 Diabetes; Cardiovascular risk factors; Latino and African American adolescents
4.  Randomized Controlled Trial to Improve Adiposity, Inflammation, and Insulin Resistance in Obese African-American and Latino Youth 
Obesity (Silver Spring, Md.)  2011;20(4):811-818.
The purpose of this study was to examine ethnic differences in the metabolic responses to a 16-week intervention designed to improve insulin sensitivity (SI), adiposity, and inflammation in obese African-American and Latino adolescents. A total of 100 participants (African Americans: n = 48, Latino: n = 52; age: 15.4 ± 1.1 years, BMI percentile: 97.3 ± 3.3) were randomly assigned to interventions: control (C; n = 30), nutrition (N; n = 39, 1×/week focused on decreasing sugar and increasing fiber intake), or nutrition + strength training (N+ST; n = 31, 2×/week). The following were measured at pre- and postintervention: strength, dietary intake, body composition (dual-energy X-ray absorptiometry/magnetic resonance imaging) and glucose/insulin indexes (oral glucose tolerance test (OGTT)/intravenous glucose tolerance test (IVGTT)) and inflammatory markers. Overall, N compared to C and N+ST reported significant improvements in SI (+16.5% vs. −32.3% vs. −6.9% respectively, P < 0.01) and disposition index (DI: +15.5% vs. −14.2% vs. −13.7% respectively, P < 0.01). N+ST compared to C and N reported significant reductions in hepatic fat fraction (HFF: −27.3% vs. −4.3% vs. 0% respectively, P < 0.01). Compared to N, N+ST reported reductions in plasminogen activator inhibitor-1 (PAI-1) (−38.3% vs. +1.0%, P < 0.01) and resistin (−18.7% vs. +11.3%, P = 0.02). There were no intervention effects for all other measures of adiposity or inflammation. Significant intervention by ethnicity interactions were found for African Americans in the N group who reported increases in total fat mass, 2-h glucose and glucose incremental areas under the curve (IAUC) compared to Latinos (P’s < 0.05). These interventions yielded differential effects with N reporting favorable improvements in SI and DI and N+ST reporting marked reductions in HFF and inflammation. Both ethnic groups had significant improvements in metabolic health; however some improvements were not seen in African Americans.
doi:10.1038/oby.2010.343
PMCID: PMC3106142  PMID: 21293446
5.  Ethnic Differences in Pancreatic Fat Accumulation and Its Relationship With Other Fat Depots and Inflammatory Markers 
Diabetes Care  2011;34(2):485-490.
OBJECTIVE
Visceral adipose tissue (VAT) and hepatic fat are associated with insulin resistance and vary by sex and ethnicity. Recently, pancreatic fat fraction (PFF) has also been linked with increasing obesity. Our aim was to assess ethnic and sex differences in PFF and its relationship to other fat depots, circulating free fatty acids (FFA), insulin secretion and sensitivity, and inflammation in obese adolescents and young adults.
RESEARCH DESIGN AND METHODS
We examined 138 (40 males, 98 females) obese Hispanics and African Americans (13–25 years). Subcutaneous adipose tissue and VAT volumes, hepatic fat fraction (HFF), and PFF were determined by magnetic resonance imaging. Insulin sensitivity and β-cell function were assessed during an intravenous glucose tolerance test.
RESULTS
Hispanics had higher PFF than African Americans (7.3 ± 3.8 vs. 6.2 ± 2.6%, P = 0.03); this ethnic difference was higher in young adults compared with children and adolescents (ethnicity × age: P = 0.01). Males had higher PFF than females (P < 0.0001). PFF was positively correlated with VAT (r = 0.45, P < 0.0001), HFF (r = 0.29, P < 0.0001), and FFA (r = 0.32, P = 0.001). PFF positively correlated with inflammatory markers but lost significance when adjusted for VAT. In multiple stepwise regression analysis, VAT and FFA were the best predictors of PFF (adjusted R2 = 0.40). There were no significant correlations between PFF and markers of insulin sensitivity or β-cell function.
CONCLUSIONS
PFF is higher in Hispanics than African Americans, and this difference increases with age. In young obese individuals, PFF is related to VAT, HFF, and circulating FFA, thus possibly contributing to their increased risk for type 2 diabetes and related metabolic disorders.
doi:10.2337/dc10-0760
PMCID: PMC3024373  PMID: 21270204
6.  Increased physical activity and reduced adiposity in overweight Hispanic adolescents 
Purpose
Objectives of this study were to examine 1) whether changes in total PA (counts/minute, cpm) and time spent in moderate to vigorous PA (MVPA) are associated with changes in adiposity and 2) whether energy intake influences the relationship between changes in PA and changes in adiposity in overweight Hispanic adolescents.
Methods
Analysis included 38 overweight (BMI ≥ 85th %ile) Hispanic adolescents with complete pre- and post-test data on relevant variables after participating in a 16-week intervention. The intervention treatment did not influence physical activity, so the sample was combined and randomization group was adjusted for in the analysis. Body composition by DEXA, 7-day physical activity by accelerometry, and dietary intake by 3-day diet records were assessed pre- and post-intervention.
Results
Within individuals, the mean increase of PA (n=19) and mean decrease of PA (n=19) was approximately 105 cpm. A 100 cpm increase in total PA was associated with a decrease of 1.3 kg fat mass and 0.8% body fat after adjusting for pre-test adiposity, PA, age, sex, and treatment (p < 0.05). Controlling for energy intake modestly strengthened the relationships between total PA and fat mass and percent body fat. Changes in MVPA were not related to changes in adiposity after controlling for total PA (p>0.05).
Conclusion
Increasing total PA by 28% (100 cpm) was associated with a decrease of 1.4 kg of fat mass and 1% body fat over 16 weeks in overweight Hispanic adolescents independent of intervention group assignment. Increases in total physical activity, as compared to MVPA, may be sufficient to improve body composition in overweight Hispanic adolescents.
doi:10.1249/MSS.0b013e3181b9c45b
PMCID: PMC3163456  PMID: 19952807
Obesity; children; Hispanic; accelerometer; youth; DEXA
7.  Dietary Intake and the Metabolic Syndrome in Overweight Latino Children 
Little is known about the relationship between diet and metabolic health in Latino children, a population at increased risk for diabetes. The present study evaluates diet composition and the metabolic syndrome in a cross-sectional sample of 109 overweight Latino children aged 10 to 17 years with a family history of type 2 diabetes. Dietary intake was assessed by two 24-hour recalls. Associations between nutrients and features of the metabolic syndrome were examined using multiple linear regression and analysis of covariance. Log cholesterol intake was positively associated with log systolic blood pressure (β=0.034, P=0.017) and log soluble dietary fiber intake was inversely associated with log waist circumference (β=−0.069, P=0.036). Log soluble fiber intake was significantly higher in participants with 0 features compared to those with 3+ features of the metabolic syndrome (P=0.046), which translates to 5.2 g vs 4.1 g soluble fiber daily. No other significant associations were found between dietary variables and either the individual features of the metabolic syndrome or the clustering of metabolic syndrome components. Increases in soluble fiber through the daily consumption of fruits, vegetables, and beans may improve metabolic health in Latino children.
doi:10.1016/j.jada.2008.05.006
PMCID: PMC2882193  PMID: 18656576
8.  Reduction in Added Sugar Intake and Improvement in Insulin Secretion in Overweight Latina Adolescents 
Background
To date, no study has assessed the effects of modifying carbohydrate intake (specifically decreasing added sugar and increasing fiber) on insulin secretion, nor has any study used an overweight Latino adolescent population. The objective of this study was to examine whether changes in dietary intake, specifically reductions in added sugar and/or increases in fiber, following a 12-week, modified carbohydrate dietary intervention, were associated with changes in insulin secretion and other metabolic risk factors for type 2 diabetes.
Methods
Participants were 16 overweight (≥85th percentile BMI) Latina adolescent females (12–17 years) who completed a 12-week modified carbohydrate intervention. Dietary intake was assessed by 3-day diet records, body composition by dual-energy X-ray absorptiometry, and insulin dynamics by an extended 3-hour oral glucose tolerance test (OGTT) at baseline and post-intervention.
Results
There was a trend for unadjusted change in reported added sugar intake (% of kcals) to be associated with change in insulin secretion, i.e. IAUC (r = 0.47; p = 0.075), and this relationship became significant after controlling for age, baseline insulin secretion, added sugar and adiposity, and change in adiposity (r = 0.85; p < 0.05). No other changes in dietary variables were related to changes in insulin secretion or other metabolic risk factors for type 2 diabetes.
Conclusions
Participants with greater reductions in added sugar intake showed significantly greater improvements in insulin secretion following a modified carbohydrate nutrition intervention. These findings suggest that interventions focused on decreasing added sugar intake have the potential to reduce type 2 diabetes risk in overweight youth.
doi:10.1089/met.2006.0038
PMCID: PMC2847394  PMID: 18370826
9.  Randomized Control Trial to Improve Adiposity and Insulin Resistance in Overweight Latino Adolescents 
Obesity (Silver Spring, Md.)  2009;17(8):1542-1548.
Few randomized trials attempt to improve insulin sensitivity and associated metabolic risks in overweight Latino youth. The purpose of this study is to examine the effects of a modified carbohydrate nutrition program combined with strength training on insulin sensitivity, adiposity, and other type 2 diabetes risk factors in overweight Latino adolescents. In a 16-week randomized trial, 54 overweight Latino adolescents (15.5 ± 1.0 years) were randomly assigned to: (i) Control (C; n = 16), (ii) Nutrition (N; n = 21), or (iii) Nutrition + Strength training (N+ST; n = 17). The N group received modified carbohydrate nutrition classes (once per week), while the N+ST received the same nutrition classes plus strength training (twice per week). The following were measured at pre- and postintervention: strength by 1-repetition maximum, dietary intake by 3-day records, body composition by dual-energy X-ray absorptiometry, glucose/insulin indices by oral glucose tolerance test (OGTT) and intravenous glucose tolerance test with minimal modeling. Across intervention group effects were tested using analysis of covariance with post hoc pairwise comparisons. A significant overall intervention effect was found for improvement in bench press (P < 0.001) and reductions in energy (P = 0.05), carbohydrate (P = 0.04) and fat intake (P = 0.03). There were no significant intervention effects on insulin sensitivity, body composition, or most glucose/insulin indices with the exception of glucose incremental area under the curve (IAUC) (P = 0.05), which decreased in the N and N+ST group by 18 and 6.3% compared to a 32% increase in the C group. In conclusion, this intense, culturally tailored intervention resulted in no significant intervention effects on measured risk factors with the exception of a beneficial effect on glycemic response to oral glucose.
doi:10.1038/oby.2009.19
PMCID: PMC2846423  PMID: 19247280
10.  Aerobic and Strength Training Reduces Adiposity in Overweight Latina Adolescents 
Purpose
To date, no study has examined the synergistic effects of a nutrition and combination of aerobic and strength training (CAST) on both adiposity and metabolic parameters in overweight Latina adolescent females. The goal was to assess if a 16-wk nutrition plus CAST pilot study had stronger effects on reducing adiposity and on improving glucose/insulin indices compared with control (C), nutrition only (N), and a nutrition plus strength training (N + ST) groups.
Methods
In a 16-wk randomized trial, 41 overweight Latina girls (15.2 ± 1.1 yr) were randomly assigned to C (n = 7), N (n = 10), N + ST (n = 9), or N + CAST (n = 15). All intervention groups received modified carbohydrate nutrition classes (once a week), whereas the N + ST also received strength training (twice a week) and the N + CAST received a combination of strength and aerobic training (twice a week). The following were measured before and after intervention: strength by one repetition maximum, physical activity by the 7-d accelerometry and the 3-d physical activity recall, dietary intake by 3-d records, body composition by dual-energy x-ray absorptiometry (DEXA), glucose/insulin indices by oral glucose tolerance test, and intravenous glucose tolerance test with minimal modeling. Across intervention group, effects were tested using ANCOVA with post hoc pairwise comparisons.
Results
There were significant overall intervention effects for all adiposity measures (weight, body mass index [BMI], BMI z-scores, and DEXA total body fat), with a decrease of 3% in the N + CAST group compared with a 3% increase in the N + ST group (P ≤ 0.05). There was also an intervention effect for fasting glucose with the N group increasing by 3% and the N + CAST group decreasing by 4% (P ≤ 0.05).
Conclusion
The CAST was more effective than nutrition alone or nutrition plus strength training for reducing multiple adiposity outcomes and fasting glucose in overweight Latina girls. However, further research investigating and identifying intervention approaches that improve both adiposity and insulin indices, particularly in high-risk populations, are warranted.
doi:10.1249/MSS.0b013e31819b6aea
PMCID: PMC2836768  PMID: 19516150
EXERCISE; NUTRITION; INTERVENTION; OVERWEIGHT; TEENAGERS
11.  Association of Breakfast Skipping With Visceral Fat and Insulin Indices in Overweight Latino Youth 
Obesity (Silver Spring, Md.)  2009;17(8):1528-1533.
Few studies have investigated the relationship between breakfast consumption and specific adiposity or insulin dynamics measures in children. The goal of this study is to determine whether breakfast consumption is associated with adiposity, specifically intra-abdominal adipose tissue (IAAT), and insulin dynamics in overweight Latino youth. Participants were a cross-sectional sample of 93 overweight (≥85th percentile BMI) Latino youth (10–17 years) with a positive family history of type 2 diabetes. Dietary intake was assessed by two 24-h recalls, IAAT, and subcutaneous abdominal adipose tissue (SAAT) by magnetic resonance imaging, body composition by dual-energy X-ray absorptiometry, and insulin dynamics by a frequently sampled intravenous glucose tolerance test and minimal modeling. Participants were divided into three breakfast consumption categories: those who reported not eating breakfast on either day (breakfast skippers; n = 20), those who reported eating breakfast on one of two days (occasional breakfast eaters; n = 39) and those who ate breakfast on both days (breakfast eaters; n = 34). Using analyses of covariance, breakfast omission was associated with increased IAAT (P = 0.003) independent of age, Tanner, sex, total body fat, total body lean tissue mass, and daily energy intake. There were no significant differences in any other adiposity measure or in insulin dynamics between breakfast categories. Eating breakfast is associated with lower visceral adiposity in overweight Latino youth. Interventions focused on increasing breakfast consumption are warranted.
doi:10.1038/oby.2009.127
PMCID: PMC2836758  PMID: 19424166
12.  Cardiorespiratory fitness predicts changes in adiposity in overweight Hispanic boys 
Obesity (Silver Spring, Md.)  2008;16(5):1072-1077.
We have previously shown that cardiorespiratory fitness predicts increasing fat mass during growth in white and African-American youth, but limited data are available examining this issue in Hispanic youth. Study participants were 160 (53% boys) overweight (BMI ≥ 85th percentile for age and gender) Hispanic children (mean ± SD age at baseline =11.2 ± 1.7 yrs). Cardiorespiratory fitness, or VO2max, was measured via a maximal effort treadmill test at baseline. Body composition by dual-energy x-ray absorptiometry and Tanner stage by clinical exam were measured at baseline and annually thereafter for up to four years. Linear mixed models were used to examine the gender specific relationship between VO2max and increases in adiposity (change in fat mass independent of change in lean tissue mass) over four years. The analysis was adjusted for changes in Tanner stage, age, and lean tissue mass. In boys, higher VO2max at baseline was inversely associated with the rate of increase in adiposity (β= -0.001, p=0.03); this effect translates to a 15% higher VO2max at baseline resulting in a 1.38kg lower fat mass gain over four years. However, VO2max was not significantly associated with changes in fat mass in girls (β=0.0002, p=0.31). In overweight Hispanic boys, greater cardiorespiratory fitness at baseline was protective against increasing adiposity. In girls however, initial cardiorespiratory fitness was not significantly associated with longitudinal changes in adiposity. These results suggest that fitness may be an important determinant of changes in adiposity in overweight Hispanic boys but not in girls.
doi:10.1038/oby.2008.16
PMCID: PMC2780237  PMID: 18309303
Children; Youth; Longitudinal; Gender
13.  The relation of sugar intake to β cell function in overweight Latino children123 
Background
Few studies have investigated the association between sugar intake and insulin dynamics in children, and none have examined this association in overweight Latino youth.
Objective
We aimed to examine the relation between dietary components, especially sugar intake, and insulin dynamics in overweight Latino youth.
Design
We examined 63 overweight Latino children aged 9–13 y. Dietary intake was determined by 3-d records, and body composition was measured with dual-energy X-ray absorptiometry. Insulin sensitivity (SI), acute insulin response (AIR), and disposition index (an index of β cell function) were measured by using a frequently sampled intravenous-glucose-tolerance test and minimal modeling. Hierarchical regression analysis ascertained the potential independent relation between insulin dynamics and dietary components.
Results
The relation between macronutrient intake and any variable related to insulin dynamics was not significant. However, higher total sugar intake, although not related to SI, was significantly associated with lower AIR (β = −0.296, P = 0.045) and lower β cell function (β = −0.421, P = 0.043), independent of the covariates age, sex, body composition, Tanner stage, and energy intake. Sugar-sweetened beverage intakes trended toward inverse association with lower AIR (β = −0.219, P = 0.072) and β cell function (β = −0.298, P = 0.077).
Conclusions
In overweight Latino children, higher intakes of sugar and sugar-sweetened beverages were associated with lower AIR and disposition index, which suggested that these children already have early signs of poor β cell function. These results emphasize the need for early nutritional interventions to reduce daily sugar intake in overweight Latino children and potentially reduce their risk for type 2 diabetes.
PMCID: PMC2538439  PMID: 16280431
Latino adolescents; overweight; obesity; sugar; sugary beverages; β cells; disposition index; type 2 diabetes
14.  Interventions for improving metabolic risk in overweight Latino youth 
This review highlights various components of interventions that reduced obesity and type 2 diabetes risk factors among overweight Latino youth. A total of 114 overweight Latino adolescents completed one of four randomized controlled trials: 1) strength training (ST; boys only); 2) modified carbohydrate nutrition program (N); 3) combination of N+ST; or 4) N + Combination of Aerobic and ST (N+CAST; girls only). Measures included: strength by 1-repetition max, dietary intake by 3-d records, body composition by DEXA/MRI, glucose/insulin indices by oral and IV glucose tolerance tests. ST improved insulin sensitivity by 45% in Latino boys, and N, N+ST, and N+CAST improved glucose control in Latino boys and girls. The CAST approach reduced all adiposity measures by ∼3% in Latina girls. Participants who decreased added sugar, increased dietary fiber, and had increased parental attendance, regardless of intervention group, improved insulin action and reduced visceral adipose tissue. In conclusion, ST, CAST, and a modified carbohydrate nutrition program with separate parental classes were all successful components of the interventions that decreased obesity and related metabolic diseases.
doi:10.3109/17477161003770123
PMCID: PMC3752963  PMID: 20387989
Latino adolescents; randomized controlled trials; insulin sensitivity and secretion; diet and exercise interventions; adiposity
15.  A brief dietary screener: Appropriate for overweight Latino adolescents? 
To assess whether a brief dietary screener designed to assess fast food and beverage consumption in a primarily Caucasian, adolescent population, is also valid and reliable in an overweight, adolescent, Latina population. This screener was developed by University of Minnesota to assess beverage consumption (9 items) and fast food consumption (13 items) in normal weight, primarily Caucasian, adolescents (ages 11–18). Thirty-five at risk for overweight (BMI ≥85th percentile), adolescent (ages 14–17), Latina females were recruited from East Los Angeles and completed the screener twice, approximately seven to 14 days apart, during the fall of 2007. Dietary intake was also assessed by three-day diet records. Spearman correlation and simple Kappas were employed for test-retest assessment and comparisons between the screener and the records. Test-retest assessment yielded a mean Spearman or Kappa statistic of 0.49 with 17 of the 21 responses being significant (P<0.05). Validity was much lower and yielded a Kappa statistic of only 0.08 and no responses were significant. Although this screener appeared to be a valid and reliable measure to assess beverage and fast food consumption in a primarily Caucasian, adolescent population, it does not appear to be appropriate for an overweight Latina female adolescent population.
doi:10.1016/j.jada.2008.12.025
PMCID: PMC2684875  PMID: 19328270
Validation and Reliability; Brief Dietary Screener; Overweight Latino Adolescents

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