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2.  Standardization of the Food Composition Database Used in the Latin American Nutrition and Health Study (ELANS) 
Nutrients  2015;7(9):7914-7924.
Between-country comparisons of estimated dietary intake are particularly prone to error when different food composition tables are used. The objective of this study was to describe our procedures and rationale for the selection and adaptation of available food composition to a single database to enable cross-country nutritional intake comparisons. Latin American Study of Nutrition and Health (ELANS) is a multicenter cross-sectional study of representative samples from eight Latin American countries. A standard study protocol was designed to investigate dietary intake of 9000 participants enrolled. Two 24-h recalls using the Multiple Pass Method were applied among the individuals of all countries. Data from 24-h dietary recalls were entered into the Nutrition Data System for Research (NDS-R) program after a harmonization process between countries to include local foods and appropriately adapt the NDS-R database. A food matching standardized procedure involving nutritional equivalency of local food reported by the study participants with foods available in the NDS-R database was strictly conducted by each country. Standardization of food and nutrient assessments has the potential to minimize systematic and random errors in nutrient intake estimations in the ELANS project. This study is expected to result in a unique dataset for Latin America, enabling cross-country comparisons of energy, macro- and micro-nutrient intake within this region.
doi:10.3390/nu7095373
PMCID: PMC4586568  PMID: 26389952
nutrition; Latin America; food composition database; standardization
3.  Physical Function and Health Status in Aging Puerto Rican Adults: The Boston Puerto Rican Health Study 
Journal of aging and health  2010;22(5):653-672.
Objectives
This article describes physical function in Puerto Rican older adults and examines associations between health status and physical function. It also assesses relationships between physical function and disability.
Method
This study uses a cross-sectional study of Puerto Ricans 45 to 75 years in Boston (N = 1,357). Measures included performance-based physical function (handgrip strength, walking speed, balance, chair stands, foot tapping), health conditions (obesity, diabetes, depressive symptomatology, history of heart disease, heart attack, stroke, and arthritis), and self-reported disability (activities of daily living, instrumental activities of daily living).
Results
Older women (60-75 years) had the poorest physical function. Poor physical function was associated with obesity, diabetes, depression, history of heart attack, stroke, and arthritis, after adjusting for age, sex, education, income, and lifestyle (p < .05). Physical function and disability were correlated (p < .01).
Discussion
Health status among Puerto Ricans appears to contribute to poor physical function. Targeted interventions to improve strength, endurance, and balance are needed to combat physical frailty and its consequences in this population.
doi:10.1177/0898264310366738
PMCID: PMC4413929  PMID: 20495158
Puerto Ricans older adults; physical function; physical frailty; health status
4.  Genome-wide meta-analysis identifies six novel loci associated with habitual coffee consumption 
Cornelis, Marilyn C | Byrne, Enda M | Esko, Tõnu | Nalls, Michael A | Ganna, Andrea | Paynter, Nina | Monda, Keri L | Amin, Najaf | Fischer, Krista | Renstrom, Frida | Ngwa, Julius S | Huikari, Ville | Cavadino, Alana | Nolte, Ilja M | Teumer, Alexander | Yu, Kai | Marques-Vidal, Pedro | Rawal, Rajesh | Manichaikul, Ani | Wojczynski, Mary K | Vink, Jacqueline M | Zhao, Jing Hua | Burlutsky, George | Lahti, Jari | Mikkilä, Vera | Lemaitre, Rozenn N | Eriksson, Joel | Musani, Solomon K | Tanaka, Toshiko | Geller, Frank | Luan, Jian’an | Hui, Jennie | Mägi, Reedik | Dimitriou, Maria | Garcia, Melissa E | Ho, Weang-Kee | Wright, Margaret J | Rose, Lynda M | Magnusson, Patrik KE | Pedersen, Nancy L | Couper, David | Oostra, Ben A | Hofman, Albert | Ikram, Mohammad Arfan | Tiemeier, Henning W | Uitterlinden, Andre G | van Rooij, Frank JA | Barroso, Inês | Johansson, Ingegerd | Xue, Luting | Kaakinen, Marika | Milani, Lili | Power, Chris | Snieder, Harold | Stolk, Ronald P | Baumeister, Sebastian E | Biffar, Reiner | Gu, Fangyi | Bastardot, François | Kutalik, Zoltán | Jacobs, David R | Forouhi, Nita G | Mihailov, Evelin | Lind, Lars | Lindgren, Cecilia | Michaëlsson, Karl | Morris, Andrew | Jensen, Majken | Khaw, Kay-Tee | Luben, Robert N | Wang, Jie Jin | Männistö, Satu | Perälä, Mia-Maria | Kähönen, Mika | Lehtimäki, Terho | Viikari, Jorma | Mozaffarian, Dariush | Mukamal, Kenneth | Psaty, Bruce M | Döring, Angela | Heath, Andrew C | Montgomery, Grant W | Dahmen, Norbert | Carithers, Teresa | Tucker, Katherine L | Ferrucci, Luigi | Boyd, Heather A | Melbye, Mads | Treur, Jorien L | Mellström, Dan | Hottenga, Jouke Jan | Prokopenko, Inga | Tönjes, Anke | Deloukas, Panos | Kanoni, Stavroula | Lorentzon, Mattias | Houston, Denise K | Liu, Yongmei | Danesh, John | Rasheed, Asif | Mason, Marc A | Zonderman, Alan B | Franke, Lude | Kristal, Bruce S | Karjalainen, Juha | Reed, Danielle R | Westra, Harm-Jan | Evans, Michele K | Saleheen, Danish | Harris, Tamara B | Dedoussis, George | Curhan, Gary | Stumvoll, Michael | Beilby, John | Pasquale, Louis R | Feenstra, Bjarke | Bandinelli, Stefania | Ordovas, Jose M | Chan, Andrew T | Peters, Ulrike | Ohlsson, Claes | Gieger, Christian | Martin, Nicholas G | Waldenberger, Melanie | Siscovick, David S | Raitakari, Olli | Eriksson, Johan G | Mitchell, Paul | Hunter, David J | Kraft, Peter | Rimm, Eric B | Boomsma, Dorret I | Borecki, Ingrid B | Loos, Ruth JF | Wareham, Nicholas J | Vollenweider, Peter | Caporaso, Neil | Grabe, Hans Jörgen | Neuhouser, Marian L | Wolffenbuttel, Bruce HR | Hu, Frank B | Hyppönen, Elina | Järvelin, Marjo-Riitta | Cupples, L Adrienne | Franks, Paul W | Ridker, Paul M | van Duijn, Cornelia M | Heiss, Gerardo | Metspalu, Andres | North, Kari E | Ingelsson, Erik | Nettleton, Jennifer A | van Dam, Rob M | Chasman, Daniel I
Molecular psychiatry  2014;20(5):647-656.
doi:10.1038/mp.2014.107
PMCID: PMC4388784  PMID: 25288136
5.  Prevalence and Changes over Time of Ideal Cardiovascular Health Metrics among African-Americans: The Jackson Heart Study 
Preventive medicine  2015;74:111-116.
Objectives
To assess the prevalence and changes over time of ideal Life’s Simple Seven (LSS) in African-Americans.
Methods
Prospective cohort of 5301 African-Americans from the Jackson Heart Study (JHS) from 2000 to 2013. Each of the LSS metrics was categorized as poor, intermediate, or ideal.
Results
Among men, the prevalence of having 0, 1, 2, 3, 4, 5, 6, and 7 ideal LSS was 3.3%, 23.0%, 33.5%, 24.7%, 11.6%, 3.6%, 0.3%, and 0%, respectively. Corresponding values for women were 1.7%, 26.3%, 33.1%, 22.8%, 11.9%, 3.7%, 0.6%, and 0%. Prevalence of ideal diet was 0.9%. The proportions of those meeting LSS ideal recommendations for cholesterol and fasting glucose declined from the first through third JHS visits across all age groups, whereas prevalence of ideal BMI declined only in participants <40 years at a given visit. Prevalence of ideal blood pressure did not change over time and being ideal on physical activity improved from the first [18.3% (95% CI: 17.3% to 19.3%)] to third visit [24.8% (95% CI: 23.3% to 26.3%)].
Conclusions
Our data show a low prevalence of ideal LSS (especially diet, physical activity, and obesity) in the JHS and a slight improvement in adherence to physical activity recommendations over time.
doi:10.1016/j.ypmed.2015.02.006
PMCID: PMC4397893  PMID: 25712326
Epidemiology; cardiovascular disease; risk factors; diet
6.  Neighborhood Socioeconomic Context and Change in Allostatic Load Among Older Puerto Ricans: the Boston Puerto Rican Health Study 
Health & place  2015;33:1-8.
Neighborhood context may influence health and health disparities. However, most studies have been constrained by cross-sectional designs that limit causal inference due to failing to establish temporal order of exposure and disease. We tested the impact of baseline neighborhood context (neighborhood socioeconomic status factor at the block-group level, and relative income of individuals compared to their neighbors) on allostatic load two years later. We leveraged data from the Boston Puerto Rican Health Study, a prospective cohort of aging Puerto Rican adults (aged 45–75 at baseline), with change in AL modeled between baseline and the 2nd wave of follow-up using two-level hierarchical linear regression models. Puerto Rican adults with higher income, relative to their neighbors, exhibited lower AL after two years, after adjusting for NSES, age, gender, individual-level SES, length of residence, and city. After additional control for baseline AL, this association was attenuated to marginal significance. We found no significant association of NSES with AL. Longitudinal designs are an important tool to understand how neighborhood contexts influence health and health disparities.
doi:10.1016/j.healthplace.2015.02.001
PMCID: PMC4409499  PMID: 25706323
Allostatic load; Neighborhood context; Relative income; Puerto Ricans
7.  Association of total protein intake with bone mineral density (BMD) and bone loss in men and women from the Framingham Offspring Study 
Public health nutrition  2013;17(11):2570-2576.
Objective
To examine the association of % of total energy from protein (protein%) with bone mineral density (BMD, g/cm2) and bone loss at the femoral neck (FN), trochanter (TR); L2–L4 spine (LS). To examine calcium as an effect modifier.
Setting
The Framingham Offspring Study.
Subjects
1,280 men and 1,639 women completed an FFQ in 1992–95 or 1995–98 and baseline DXA-BMD measurement in 1996–2000. 495 men and 680 women had follow-up BMD measured in 2002–2005.
Design
Cohort study using multivariable regression to examine the association of protein% with each BMD, adjusting for covariates. Statistical interaction between protein% and calcium (total, dietary; supplemental) intake was examined.
Results
The mean age at baseline was 61y(±9). In the cross-sectional analyses, protein% was positively associated with all BMD sites (P:0.02–0.04) in women but not in men. Significant interactions were observed with total calcium intake (<800 vs. ≥800 mg/d) in women at all bone sites (P:0.002–0.02). Upon stratification, protein% was positively associated with all BMD sites (P:0.04–0.10) in women with low calcium intakes but not with high calcium intakes. In the longitudinal analyses, in men, higher protein% was associated with more TR-bone loss (P=0.01) while no associations were seen in women, regardless of calcium intake.
Conclusion
This suggests that greater protein intake benefits women especially those with lower calcium intakes. However, protein effects are not significant for short term changes in bone density. Contrastingly, in men, higher protein intakes lead to greater TR-bone loss. Longer follow-up is required to examine the impact of protein on bone loss.
doi:10.1017/S1368980013002875
PMCID: PMC4103961  PMID: 24168918
Protein; bone mineral density; bone loss; diet; calcium
8.  Cross-Sectional Associations between Empirically-Derived Dietary Patterns and Indicators of Disease Risk among University Students 
Nutrients  2015;8(1):3.
The transition from adolescence to adulthood is a unique period during which lifelong dietary habits are shaped. Dietary patterns (DPs) among young adults attending college have not been adequately described, and associations between DPs and indicators of disease risk are not well understood in this age group. Dietary data were collected from undergraduates participating in the Tufts Longitudinal Health Study (TLHS; 1998–2007) by Food Frequency Questionnaire (FFQ; n = 1323). DPs were derived using principal components analysis with varimax rotation. Scree plots; eigenvalues; factor loadings; and previous studies were used to determine and label the DPs retained. Cross-sectional relationships between DP scores and anthropometric measures (percent body fat (PBF) and (BMI) and lipid biomarkers (total; HDL and LDL cholesterol; and triglycerides) were assessed with multivariable regression models; adjusted for demographics; physical activity; smoking; intention to gain/lose weight; and total energy intake. Effect modification by sex was tested. Three DPs were identified: Prudent; Western; and Alcohol. Greater adherence to the Prudent DP was associated with favorable anthropometric outcomes. The Alcohol DP was associated with a favorable lipid profile. Associations between the Western DP and blood lipids differed by sex; with unfavorable impact observed only among males. Our findings add to the literature linking DPs in young adults with measurable adiposity and cardiometabolic outcomes; suggesting that improving nutrition among college students could reduce chronic disease risk.
doi:10.3390/nu8010003
PMCID: PMC4728617  PMID: 26712784
dietary patterns; principle component analysis; college students; BMI; percent body fat; blood lipids; Tufts Longitudinal Health Study
9.  Milk and yogurt consumption are linked with higher bone mineral density but not with hip fracture: the Framingham Offspring Study 
Archives of osteoporosis  2013;8(0):119.
Purpose
To examine associations of milk, yogurt, cheese, cream, most dairy (total dairy without cream) and fluid dairy (milk+yogurt) with bone density (BMD) at femoral neck (FN), trochanter (TR) and spine, and with incident hip fracture over 12-y follow-up in the Framingham Offspring Study.
Methods
3,212 participants completed a food frequency questionnaire (1991–1995 or 1995–1998) and were followed for hip fracture until 2007. 2,506 participants had DXA BMD (1996–2001). Linear regression was used to estimate adjusted mean BMD while Cox-proportional hazards regression was used to estimate adjusted hazard ratios (HR) for hip fracture risk. Final models simultaneously included dairy foods adjusting for each other.
Results
Mean baseline age was 55 (±1.6)y, range: 26–85). Most dairy intake was positively associated with hip and spine BMD. Intake of fluid dairy and milk were related with hip but not spine BMD. Yogurt intake was associated with TR-BMD alone. Cheese and cream intakes were not associated with BMD. In final models, yogurt intake remained positively associated with TR-BMD, while cream tended to be negatively associated with FN-BMD. Yogurt intake showed a weak protective trend for hip fracture [HR(95%CI): ≤4 serv/wk: 0.46 (0.21–1.03) vs. >4 serv/wk: 0.43 (0.06–3.27)]. No other dairy groups showed a significant association (HRs range: 0.53–1.47) with limited power (n, fractures=43).
Conclusion
Milk and yogurt intakes were associated with hip but not spine BMD, while cream may adversely influence BMD. Thus, not all dairy products are equally beneficial for the skeleton. Suggestive fracture results for milk and yogurt intakes need further confirmation.
doi:10.1007/s11657-013-0119-2
PMCID: PMC3641848  PMID: 23371478
dairy; milk; yogurt; bone mineral density; hip fracture; dietary intake; bone health
10.  Syncytiotrophoblast Extracellular Vesicles from Pre-Eclampsia Placentas Differentially Affect Platelet Function 
PLoS ONE  2015;10(11):e0142538.
Pre-eclampsia (PE) complicates around 3% of all pregnancies and is one of the most common causes of maternal mortality worldwide. The pathophysiology of PE remains unclear however its underlying cause originates from the placenta and manifests as raised blood pressure, proteinuria, vascular or systemic inflammation and hypercoagulation in the mother. Women who develop PE are also at significantly higher risk of subsequently developing cardiovascular (CV) disease. In PE, the failing endoplasmic reticulum, oxidative and inflammatory stressed syncytiotrophoblast layer of the placenta sheds increased numbers of syncytiotrophoblast extracellular vesicles (STBEV) into the maternal circulation. Platelet reactivity, size and concentration are also known to be altered in some women who develop PE, although the underlying reasons for this have not been determined. In this study we show that STBEV from disease free placenta isolated ex vivo by dual placental perfusion associate rapidly with platelets. We provide evidence that STBEV isolated from normal placentas cause platelet activation and that this is increased with STBEV from PE pregnancies. Furthermore, treatment of platelets with aspirin, currently prescribed for women at high risk of PE to reduce platelet aggregation, also inhibits STBEV-induced reversible aggregation of washed platelets. Increased platelet reactivity as a result of exposure to PE placenta derived STBEVs correlates with increased thrombotic risk associated with PE. These observations establish a possible direct link between the clotting disturbances of PE and dysfunction of the placenta, as well as the known increased risk of thromboembolism associated with this condition.
doi:10.1371/journal.pone.0142538
PMCID: PMC4638362  PMID: 26551971
11.  Life Events Trajectories, Allostatic Load, and the Moderating Role of Age at Arrival from Puerto Rico to the US Mainland 
Our aim was to examine the effects of trajectories of stressful life events on allostatic load, measured over a two year time period, and to investigate the roles of language acculturation and age at migration in this association, in a sample of Puerto Rican migrants. We used data from the Boston Puerto Rican Health Study; a population-based prospective cohort of older Puerto Ricans recruited between the ages of 45 and 75 years. The Institutional Review Boards at Tufts Medical Center and Northeastern University approved the study. We used latent growth mixture modeling (LGMM) to identify different classes of two-year trajectories of stressful life events; analysis of variance to examine group differences by stress trajectory; and linear regression to test for the modifying effects of age at arrival on the association of stress trajectory with allostatic load at follow-up. In LGMM analysis, we identified three distinct stress trajectories; low, moderate ascending, and high. Unexpectedly, participants in the low stress group had the highest allostatic load at follow-up (F=4.4, p=0.01) relative to the other two groups. Age at arrival had a statistically significant moderating effect on the association. A reported two year period of moderate but repetitive and increasingly bad life events was associated with increases in allostatic load for participants who arrived to the U.S. mainland after the age of 5 years, and was particularly strong for those arriving between 6–11 years, but not for those arriving earlier or later. Results from this study highlight the complex effects of stress during the life course, and point to certain vulnerable periods for immigrant children that could modify long term effects of stress.
doi:10.1016/j.socscimed.2014.09.040
PMCID: PMC4256941  PMID: 25265208
Stressful life events; stress trajectories; age at arrival; migration related stress; allostatic load; Latinos/Hispanics; Puerto Rican migrants
12.  The Longitudinal Association of Vitamin D Serum Concentrations & Adiposity Phenotype 
Several cross-sectional studies have reported on the association between serum 25-hydroxy vitamin D concentrations (25(OH)D) and body mass index (BMI). We examined the longitudinal effect of BMI on serum 25(OH)D concentrations among 866 Puerto Rican adults living in the Greater Boston area: 246 men and 620 women, aged 45–75 years at baseline and 2 year. Our analyses showed negative correlations at two time points between BMI and serum 25(OH)D concentrations. The multivariate analysis showed that when predicting the change of serum 25(OH)D concentrations, baseline-BMI had significant inverse association (P<0.04) controlling for age, sex, and baseline-25 (OH)D). This association remained significant after adjusting for vitamin D supplement use, smoking, miles walking/day and alcohol intake (P<0.01). In conclusion, the major findings of the present study are obesity 1) was inversely associated with 25(OH)D at baseline; 2) with the change in serum 25(OH)D at 2-year in this population of older Puerto Rican adults living in the Boston area.
doi:10.1016/j.jsbmb.2013.12.004
PMCID: PMC4055547  PMID: 24333795
vitamin D; serum 25(OH)D; obesity; BMI; Puerto Rican
13.  Plasma Phosphatidylcholine Concentrations of Polyunsaturated Fatty Acids Are Differentially Associated With Hip Bone Mineral Density and Hip Fracture in Older Adults: The Framingham Osteoporosis Study 
Polyunsaturated fatty acids (PUFAs) may influence bone health. The objective of this work was to examine associations between plasma phosphatidylcholine (PC) PUFA concentrations and hip measures: (1) femoral neck bone mineral density (FN-BMD) (n = 765); (2) 4-year change in FN-BMD (n = 556); and (3) hip fracture risk (n = 765) over 17-year follow-up among older adults in the Framingham Osteoporosis Study. BMD measures were regressed on quintile of plasma PC PUFAs (docosahexaenoic acid [DHA], linoleic acid [LA], and arachidonic acid [AA]), adjusted for covariates. Hazard ratios (HR) and 95% confidence interval (CI) for hip fracture were estimated by quintile of plasma PC PUFAs, adjusted for covariates. Higher concentrations of PC DHA were associated with loss of FN-BMD over 4 years in women (p-trend = 0.04), but was protective in men in the uppermost quintile compared to men grouped in the lower four quintiles, in post hoc analysis (p = 0.01). PC LA concentrations were inversely associated with baseline FN-BMD in women (p-trend = 0.02), and increased hip fracture risk in women and men (p-trend = 0.05), but body mass index (BMI) adjustment attenuated these associations (p-trend = 0.12 and p-trend = 0.14, respectively). A trend toward a protective association was observed between PC AA and baseline FN-BMD in men (p-trend = 0.06). Women and men with the highest PC AA concentrations had 51% lower hip fracture risk than those with the lowest (HR = 0.49, 95% CI = 0.24–1.00). Opposing effects of PC DHA on FN-BMD loss observed in women and men need further clarification. Bone loss associated with PC LA may be confounded by BMI. High PC AA concentrations may be associated with reduced hip fracture risk.
doi:10.1002/jbmr.1581
PMCID: PMC3565380  PMID: 22392875
DOCOSAHEXAENOIC ACID; LINOLEIC ACID; ARACHIDONIC ACID; BMD; FRACTURE
14.  Acculturation and Sociocultural Influences on Dietary Intake and Health Status among Puerto Rican Adults in Massachusetts 
Background
Previous studies have shown negative consequences of acculturation on lifestyle factors, health status, and dietary intake of Hispanic immigrants in the US. Despite prevalent type 2 diabetes and low socioeconomic status (SES) among Puerto Rican adults living on the US mainland, little is known about acculturation in this group.
Objective
We investigated associations among acculturation, lifestyle characteristics, health status, and carbohydrate nutrition in Puerto Rican adults. A secondary objective was to investigate possible confounding and/or effect modification on these associations by SES.
Design
Cross-sectional data from the Boston Puerto Rican Health Study, which included 1219 Puerto Ricans in the Boston area, aged 45–75 years.
Statistical analyses
Characteristics were compared using ANCOVA, linear trend and Pearson’s chi-square tests across quartiles of acculturation. Tests for interaction by poverty status were conducted. Proportional contributions of foods to intake of total carbohydrate and fiber were assessed using SAS RANK.
Results
Levels of acculturation were low, despite young age at first arrival to the US mainland (25.4 ± 12.3 y) and long length of stay (34.2 ± 12.2 y). Greater English language use was associated with higher SES, alcohol consumption, physical activity, better perceived health, and less central obesity. Acculturation was associated with lower legume fiber and greater cereal fiber intake. Among those above the poverty threshold, acculturation was associated with lower dietary glycemic index and starch intake, and greater fruit and non-starchy vegetable intake.
Conclusions
In contrast to studies with Mexican Americans, the association of acculturation with dietary quality in these Puerto Rican adults was mixed, but tended toward better carbohydrate quality. Dietary recommendations should include maintenance of traditional, healthful dietary practices including consumption of legumes, but also reduction in refined grains, and greater inclusion of fruit, non-starchy vegetables, and whole grains. Interventions to improve access to better quality carbohydrate sources are necessary for this group disproportionately affected by diabetes.
doi:10.1016/j.jada.2011.08.049
PMCID: PMC3289968  PMID: 22389874
acculturation; glycemic index; dietary fiber; Puerto Rican
15.  Food-Insecure Dietary Patterns Are Associated With Poor Longitudinal Glycemic Control in Diabetes: Results From the Boston Puerto Rican Health Study 
Diabetes Care  2014;37(9):2587-2592.
OBJECTIVE
To determine whether dietary patterns associated with food insecurity are associated with poor longitudinal glycemic control.
RESEARCH DESIGN AND METHODS
In a prospective, population-based, longitudinal cohort study, we ascertained food security (Food Security Survey Module), dietary pattern (Healthy Eating Index–2005 [HEI 2005]), and hemoglobin A1c (HbA1c) in Puerto Rican adults aged 45–75 years with diabetes at baseline (2004–2009) and HbA1c at ∼2 years follow-up (2006–2012). We determined associations between food insecurity and dietary pattern and assessed whether those dietary patterns were associated with poorer HbA1c concentration over time, using multivariable-adjusted repeated subjects mixed-effects models.
RESULTS
There were 584 participants with diabetes at baseline and 516 at follow-up. Food-insecure participants reported lower overall dietary quality and lower intake of fruit and vegetables. A food insecurity*HEI 2005 interaction (P < 0.001) suggested that better diet quality was more strongly associated with lower HbA1c in food-insecure than food-secure participants. In adjusted models, lower follow-up HbA1c was associated with greater HEI 2005 score (β = −0.01 HbA1c % per HEI 2005 point, per year, P = 0.003) and with subscores of total vegetables (β = −0.09, P = 0.04) and dark green and orange vegetables and legumes (β = −0.06, P = 0.048). Compared with the minimum total vegetable score, a participant with the maximum score showed relative improvements of HbA1c of 0.5% per year.
CONCLUSIONS
Food insecurity was associated with lower overall dietary quality and lower consumption of plant-based foods, which was associated with poor longitudinal glycemic control.
doi:10.2337/dc14-0753
PMCID: PMC4140162  PMID: 24969578
16.  A meat, processed meat, and french fries dietary pattern is associated with high allostatic load in Puerto Rican older adults 
doi:10.1016/j.jada.2011.07.006
PMCID: PMC3185297  PMID: 21963016
dietary pattern; allostatic load; Puerto Ricans
17.  The folate hydrolase 1561 C>T polymorphism is associated with depressive symptoms in Puerto Rican adults 
Psychosomatic medicine  2011;73(5):385-392.
Objective
To examine associations between variants of genes involved in the uptake, retention and metabolism of folate and depressive symptoms, and whether such associations are direct or through mediation by folate or homocysteine.
Methods
We performed a cross-sectional analysis of data from 976 Puerto Rican adults, aged 45-75 years, residing in the greater Boston area, Massachusetts. Twelve single nucleotide polymorphisms (SNPs) in genes involved in folate uptake, retention and metabolism were investigated. These include folate hydrolase (FOLH1), folate polyglutamate synthase (FPGS), r-glutamyl hydrolase (GGH), methylene tetrahydrofolate reductase (MTHFR), methionine synthase (MTR), proton-coupled folate transporter (PCFT), and reduced folate carrier (RFC1). The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure depressive symptoms.
Results
The FOLH1 rs61886492 C>T (or 1561C>T) polymorphism was significantly associated with lower CES-D score (p = .0025), after adjusting for age, sex, population admixture, smoking, and educational attainment. Individuals with the TT and TC genotypes were 49% less likely (odds ratio (OR): 95% confidence interval [CI]: 0.51: 0.29, 0.89) to report mild depressive symptoms (CES-D score ≥16 & ≤26) and 64% less likely (OR: 95% CI: 0.36: 0.18, 0.69) to report moderate to severe depressive symptoms (CES-D score >26), compared to those with the CC genotype. No significant mediation effects by plasma folate or homocysteine on the associations between this SNP and CES-D score were observed.
Conclusions
The FOLH1 1561C>T polymorphism may be associated with risk of depressive symptoms.
doi:10.1097/PSY.0b013e31821a1ab4
PMCID: PMC3110520  PMID: 21597034
Depressive symptoms; genetics; polymorphisms; folate; folate hydrolase; glutamate carboxypeptidase II
18.  Protective association of milk intake on the risk of hip fracture: Results from the Framingham Original Cohort 
Dairy foods are rich in bone beneficial nutrients, yet the role of dairy foods in hip fracture prevention remains controversial. The objective was to evaluate the association of milk, yogurt, cheese, cream and milk+yogurt intakes with incident hip fracture. 830 men and women from the Framingham Original Cohort, a prospective cohort study, completed a food frequency questionnaire (1988–89) and were followed for hip fracture until 2008. In this population-based study, Cox-proportional hazards regression was used to estimate Hazard Ratios (HR) by categories of energy-adjusted dairy intake (servings/week) adjusting for standard confounders. The exposure was energy adjusted intakes of milk, yogurt, cheese, cream and milk+yogurt (servings/wk). Risk of hip fracture over the follow-up was the primary outcome; the hypothesis being tested was formulated after data collection. The mean age at baseline was 77y (SD:4.9, range: 68–96). 97 hip fractures occurred over the mean follow-up time of 11.6y (range: 0.04–21.9y). The mean±SD (servings/wk) of dairy intakes at baseline were: milk=6.0±6.4, yogurt=0.4±1.3, cheese=2.6±3.1; cream=3.4±5.5. Participants with medium (>1 and <7serv/wk) or higher (≥7serv/wk) milk intake tended to have lower hip fracture risk than those with low (≤1serv/wk) intake [HR(95%CI): high vs low intake: 0.58 (0.31–1.06), P=0.078; medium vs. low intake: 0.61 (0.36–1.08), P=0.071; P trend: 0.178]. There appeared to be a threshold for milk, with 40% lower risk of hip fracture among those with medium/high milk intake, compared to those with low intake (P=0.061). A similar threshold was observed for milk+yogurt intake (P=0.104). These associations were further attenuated after adjustment for femoral neck bone mineral density. No significant associations were seen for other dairy foods (P range, 0.117–0.746). These results suggest that greater intakes of milk and milk+yogurt may lower risk for hip fracture in older adults through mechanisms that are partially, but not entirely, due to effects on bone mineral density.
doi:10.1002/jbmr.2219
PMCID: PMC4381539  PMID: 24760749
Dairy; milk; hip fracture; cohort study
19.  Proyecto Mamá: a lifestyle intervention in overweight and obese Hispanic women: a randomised controlled trial – study protocol 
Background
The proportion of women entering pregnancy overweight or obese has been rising and, in turn, is associated with adverse maternal and fetal outcomes. Gestational weight gain (GWG) exceeding Institute of Medicine (IOM) guidelines further increases health risks and has been independently associated with postpartum weight retention. Hispanic women are disproportionately affected by overweight and obesity, but have had limited access to interventions that promote healthy lifestyles due to cultural, socioeconomic, and language barriers. Therefore, the overall goal of this randomized controlled trial is to test the efficacy of a culturally and linguistically modified, individually-tailored lifestyle intervention to reduce excess GWG, increase postpartum weight loss, and improve maternal metabolic status among overweight/obese Hispanic women.
Methods/Design
Overweight/obese Hispanic women are recruited in early pregnancy and randomly assigned to a Lifestyle Intervention (n = 150) or a Comparison Health and Wellness (control) intervention (n = 150). Multimodal contacts (i.e., in-person, telephone counseling, and mailed print-based materials) are used to deliver the intervention from early pregnancy (12 weeks gestation) to 6 months postpartum, with follow-up to 1 year postpartum. Targets of the intervention are to achieve IOM Guidelines for GWG and postpartum weight loss; American Congress of Obstetrician and Gynecologist guidelines for physical activity; and American Diabetes Association guidelines for diet. The intervention draws from Social Cognitive Theory and the Transtheoretical Model and includes strategies to address the specific social, cultural, and economic challenges faced by low-income Hispanic women. Assessments are conducted at baseline (~10 weeks gestation), mid pregnancy (24–28 weeks gestation), late pregnancy (32–34 weeks gestation) and postpartum at 6-weeks, 6-months, and 12-months by bicultural and bilingual personnel blinded to the intervention arm. Efficacy is assessed via GWG, postpartum weight loss, and biomarkers of glycemic control, insulin resistance, and cardiovascular disease risk factors. Changes in physical activity and diet are measured via 7-day accelerometer data and 24-h dietary recalls at each assessment time period.
Discussion
Hispanic women are the fastest growing minority group in the U.S. and are disproportionately affected by overweight and obesity. This randomised trial uses a high-reach, low-cost strategy that can readily be translated into clinical practice in underserved and minority populations.
Trial registration
NCT01868230 May 29, 2013
doi:10.1186/s12884-015-0575-3
PMCID: PMC4520196
Lifestyle intervention; Randomised controlled trial; Healthy eating; Prevention; Diet; Latina; Physical activity; Postpartum; Pregnancy; Gestational diabetes mellitus; Overweight; Obesity
20.  Association between Sleep Duration, Insomnia Symptoms and Bone Mineral Density in Older Boston Puerto Rican Adults 
PLoS ONE  2015;10(7):e0132342.
Objective
To examine the association between sleep patterns (sleep duration and insomnia symptoms) and total and regional bone mineral density (BMD) among older Boston Puerto Rican adults.
Materials/Methods
We conducted a cross-sectional study including 750 Puerto Rican adults, aged 47–79 y living in Massachusetts. BMD at 3 hip sites and the lumbar spine were measured using dual-energy X-ray absorptiometry. Sleep duration (≤5 h, 6 h, 7 h, 8 h, or ≥9 h/d) and insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awaking, and non-restorative sleep) were assessed by a questionnaire. Multivariable regression was used to examine sex-specific associations between sleep duration, insomnia symptoms and BMD adjusting for standard confounders and covariates.
Results
Men who slept ≥9h/d had significantly lower femoral neck BMD, relative to those reporting 8 h/d sleep, after adjusting for age, education level, smoking, physical activity, depressive symptomatology, comorbidity and serum vitamin D concentration. This association was attenuated and lost significance after further adjustment for urinary cortisol and serum inflammation biomarkers. In contrast, the association between sleep duration and BMD was not significant in women. Further, we did not find any significant associations between insomnia symptoms and BMD in men or women.
Conclusions
Our study does not support the hypothesis that shorter sleep duration and insomnia symptoms are associated with lower BMD levels in older adults. However, our results should be interpreted with caution. Future studies with larger sample size, objective assessment of sleep pattern, and prospective design are needed before a conclusion regarding sleep and BMD can be reached.
doi:10.1371/journal.pone.0132342
PMCID: PMC4493039  PMID: 26147647
21.  Dietary intake of vitamin B6, plasma pyridoxal 5′-phosphate and homocysteine in Puerto Rican adults 
Background
Vitamin B6 is an important cofactor in many metabolic processes. However, vitamin B6 intake and plasma status have not been well studied in the Puerto Rican population, a group with documented health disparities.
Objective
To assess dietary intake of vitamin B6, food sources, and plasma status of pyridoxal 5′-phosphate (PLP), and their associations with plasma homocysteine in 1236 Puerto Rican adults, aged 45–75 years, living in the greater Boston area.
Design
Baseline data were analyzed cross-sectionally.
Method
Questionnaire data were collected by home interview. Dietary intake was assessed with a semi-quantitative food frequency questionnaire. Plasma PLP and homocysteine were assayed from blood samples collected in the home.
Results
The mean daily intake of vitamin B6 was 2.90 ± 1.28 mg (mean ± SD) for men and 2.61 ± 1.29 mg for women (P <0.001). Approximately 11% were deficient (PLP <20 nmol/L) and another 17 % insufficient (PLP ≥20 but <30 nmol/L). Household income below the poverty threshold, physical inactivity and current smoking were significantly associated with lower plasma PLP (P <0.05). Food groups contributing most to vitamin B6 intake included ready-to-eat cereals, poultry, rice, potatoes and dried beans. However, only intake of ready-to-eat cereals and use of supplements with vitamin B6 were significantly associated with plasma PLP sufficiency (≥30 vs. <30 nmol/L, P <0.01). Both vitamin B6 intake and PLP were significantly associated with plasma total homocysteine (P < 0.001). The association between PLP and homocysteine remained statistically significant after further adjustment for plasma vitamin B12 and folate (P = 0.028).
Conclusion
Given the known importance of vitamin B6 to health, the high prevalence of low vitamin B6 status in this Puerto Rican population is of concern. Further work is needed to clarify the potential role that insufficient vitamin B6 may have in relation to the observed health disparities in this population.
doi:10.1016/j.jada.2010.08.006
PMCID: PMC2989853  PMID: 21034879
vitamin B6; pyridoxal 5′-phosphate; homocysteine; Puerto Rican
22.  Variants of the CD36 Gene and Metabolic Syndrome in Boston Puerto Rican Adults 
Atherosclerosis  2010;211(1):210-215.
Objective
Puerto Ricans experience a high prevalence of several chronic conditions, including metabolic syndrome. Genetic variants of the CD36 gene have been associated with metabolic syndrome. We aimed to determine the association between 6 single nucleotide polymorphisms (SNPs) for CD36 and metabolic syndrome and its components in Puerto Ricans (45-75 y) living in the Greater Boston area.
Methods
Associations between each SNP, metabolic syndrome and its components were examined using multivariate logistic regression models. Haplotype trend regression analysis was used to determine associations between haplotypes and metabolic syndrome.
Results
For two SNPs of CD36 (rs1049673 and rs3211931), homozygous subjects of the minor allele (G and T, respectively) were associated with a higher likelihood of metabolic syndrome (odd ratio (OR) (95% confidence interval (CI): 1.89 (1.0, 3.5) and 1.77 (1.0, 3.1), respectively) relative to carriers of the major allele. Although CD36 haplotypes were not significantly associated with metabolic syndrome overall (global significance, P=0.23), one haplotype (G-C-C vs. C-C-C (reference haplotype) was marginally associated (P=0.049).
Conclusion
SNPs of CD36 were associated with metabolic syndrome in Puerto Ricans. Prospective studies should further explore the role of CD36 variants in the development of this condition.
doi:10.1016/j.atherosclerosis.2010.02.009
PMCID: PMC2923842  PMID: 20223461
Puerto Rican; Hispanic; CD36; metabolic syndrome
23.  Insulin receptor substrate 1 (IRS1) variants confer risk of diabetes in the Boston Puerto Rican Health Study 
Objective
Published data concerning associations between IRS1 variants and type 2 diabetes and related traits have been inconsistent. We examined the relationship between common variants in IRS1, type 2 diabetes, and related traits including insulin resistance, hyperglycemia and DNA damage in the Boston Puerto Rican Health Study.
Methods
We genotyped six common IRS1 variants in an adult Puerto Rican population (n=1132) and tested for association with risk of type 2 diabetes and related traits.
Results
SNPs rs934167 and rs1801123 showed significant association with fasting glucose concentrations (p = 0.005 and p = 0.016, respectively) and rs934167 showed significant association with plasma insulin levels (p = 0.005). Carriers of the rs934167 minor allele had significantly higher HOMA-IR and lower QUICKI (p = 0.001 and p = 0.001, respectively), and a 40% and 58% greater likelihood of being hyperglycaemic or hyperinsulinemic (OR = 1.40 and 1.58; p = 0.013 and 0.002, respectively). However, they exhibited only a marginally significant trend towards having type 2 diabetes (OR=1.27, p = 0.077). Furthermore, carriers of the haplotype C-T of the rs934167 and rs1801123 minor alleles showed consistent patterns of associations after correction for multiple testing. In addition, the G972R (rs1801278) minor allele was significantly associated with higher urinary 8-OHdG concentrations (p = 0.020) and plasma CRP levels (p = 0.035).
Conclusions
Our results support IRS1 variants associated with type 2 diabetes risk in adult Puerto Ricans. Moreover, we report the novel finding that IRS1 variant G972R (rs1801278) may contribute to oxidative DNA damage and inflammation.
PMCID: PMC4428925  PMID: 23353623
genetic association; IRS1; type 2 diabetes; insulin resistance; DNA damage
24.  Prevalence of Cardiovascular Disease Risk Factors Among Older Puerto Rican Adults Living in Massachusetts 
There remains limited research on cardiovascular disease (CVD) risk factors in Puerto Rican adults. We compared lifestyle and CVD risk factors in Puerto Rican men and women with normal fasting glucose (NFG), impaired fasting glucose (IFG), or type 2 diabetes (T2D), and investigated achievement of American Diabetes Association (ADA) treatment goals in those with T2D. Baseline data from the Boston Puerto Rican Health Study were analyzed, which included 1,287 adults aged 45–75 years. Obesity, hyperglycemia, and dyslipidemia were prevalent and increased from NFG to IFG and T2D. In individuals without T2D, fasting insulin correlated significantly with body mass index. Achievement of ADA goals was poor; LDL cholesterol was most achieved (59.4%), followed by blood pressure (27.2%) and glycosylated hemoglobin (27.0%). Poverty, female sex, current alcohol use, and diabetes or anti-hypertensive medication use were associated with not meeting goals. Puerto Rican adults living in the Boston area showed several metabolic abnormalities and high CVD risk, likely due to pervasive obesity and socio-economic disparities.
doi:10.1007/s10903-011-9448-7
PMCID: PMC4428926  PMID: 21298483
Cardiovascular disease risk factors; Type 2 diabetes; Impaired fasting glucose; Hispanics; Puerto Ricans
25.  Protective effect of total and supplemental vitamin C intake on the risk of hip fracture - A 17-year follow-up from the Framingham Osteoporosis Study 
Introduction
Dietary antioxidants such as vitamin C may play a role in bone health. We evaluated associations of vitamin C intake (total, dietary and supplemental) with incident hip fracture and non-vertebral osteoporotic fracture, over a 15 to 17-y follow-up, in the Framingham Osteoporosis Study.
Methods
366 men and 592 women (mean age 75 yr ± 5) completed a food frequency questionnaire (FFQ) in 1988–89 and were followed for non-vertebral fracture until 2003 and hip fracture until 2005. Tertiles of vitamin C intake were created from estimates obtained using the Willett FFQ, after adjusting for total energy (residual method). Hazard Ratios were estimated using Cox-proportional hazards regression, adjusting for covariates.
Results
Over follow-up 100 hip fractures occurred. Subjects in the highest tertile of total vitamin C intake had significantly fewer hip fractures (P trend=0.04) and non-vertebral fractures (P trend=0.05) compared to subjects in the lowest tertile of intake. Subjects in the highest category of supplemental vitamin C intake had significantly fewer hip fractures (P trend=0.02) and non-vertebral fractures (P trend=0.07) compared to non-supplement users. Dietary vitamin C intake was not associated with fracture risk (all P>0.22).
Conclusion
These results suggest a possible protective effect of vitamin C on bone health in older adults.
doi:10.1007/s00198-009-0897-y
PMCID: PMC2766028  PMID: 19347239
ageing; bone; fracture; nutrition; population studies; vitamin C

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