The Effect of Vitamin D Supplementation on Blood Lipids in Minorities with Type 2 Diabetes.

INTRODUCTION: Vitamin D deficiency and type 2 diabetes are common among Hispanics and African Americans in the US. The aim of the study was to determine the effect of supplemental vitamin D intake (4000 IU/day or 6000 IU/day of vitamin D3 over a 6-month period) on blood lipids in a sample of African Americans and Hispanics with type 2 diabetes and vitamin D insufficiency. MATERIALS AND METHODS: Participants (n = 75) were recruited by community outreach. Participants in both groups were required to take either 4000 IU or 6000 IU of vitamin D (Cholecalciferol) per day given in the form of a pill in a single daily dose. Mixed model was used to compare treatment effects (4000 IU vs. 6000 IU) on the outcome variables. Bonferroni multiple comparison test was used to detect significant changes from baseline, 3 months, and 6 months. RESULTS: A significant decrease in total cholesterol (from 193.88 ± 41.03 to 180.48 ± 27.53 mg/dl, P = 0.040) and triglycerides (from 201.44 ± 91.35 to 172.92 ± 76.87 mg/dl, P = 0.037) was found for the 6000 IU group at 6 months. The significance was lost after adjusting for confounders. CONCLUSION: Our results suggest that the positive effect of vitamin D supplementation on lipid profile may be mediated by other cofactors related to vitamin D metabolism among Hispanic and African American participants with type 2 diabetes.

Validation of a Sun Exposure Questionnaire Among Subjects with Type 2 Diabetes Residing in South Florida.

To validate a sun exposure questionnaire against objective measures of change in skin color and to assess its validity in predicting 25(OH)D in a sample of African Americans and Hispanics with type 2 diabetes. Ninety subjects were enrolled. The sun exposure score was calculated by multiplying the time spent outdoors times the skin exposed score. Skin color was determined by reflectance colorimetry. The relationship between serum 25(OH)D, skin exposure score and stomach skin color was evaluated by a multi-linear regression model. The unadjusted model showed that skin exposure score (P = 0.037), and stomach skin color (P = 0.021) were associated with serum 25(OH)D. This relationship remained significant only for stomach skin color (P = 0.020) after controlling for covariates. It may be possible that the color of the skin is a better predictor of 25(OH)D in this particular population than sun exposure behaviors.

Lifestyle behaviors and self-rated health: the living for health program.

BACKGROUND: Lack of adherence to dietary and physical activity guidelines has been linked to an increase in chronic diseases in the United States (US). The aim of this study was to assess the association of lifestyle behaviors with self-rated health (SRH). METHODS: This cross-sectional study used self-reported data from Living for Health Program (N = 1,701) which was conducted from 2008 to 2012 in 190 health fair events in South Florida, US. RESULTS: Significantly higher percent of females as compared to males were classified as obese (35.4% versus 27.0%), reported poor/fair SRH (23.4% versus 15.0%), and were less physically active (33.9% versus 25.4%). Adjusted logistic regression models indicated that both females and males were more likely to report poor/fair SRH if they consumed ≤2 servings of fruits and vegetables per day (OR = 2.14, 95% CI 1.30-3.54; OR = 2.86, 95% CI 1.12-7.35, resp.) and consumed mostly high fat foods (OR = 1.58, 95% CI 1.03-2.43; OR = 3.37, 95% CI 1.67-2.43, resp.). The association of SRH with less physical activity was only significant in females (OR = 1.66, 95% CI 1.17-2.35). CONCLUSION: Gender differences in health behaviors should be considered in designing and monitoring lifestyle interventions to prevent cardiovascular diseases.

Ethnic Differences in Insulin Resistance, Adiponectin Levels and Abdominal Obesity: Haitian Americans and African Americans, with and without Type 2 Diabetes Mellitus.

BACKGROUND: Metabolic outcomes of obesity and its associated disorders may not be equivalent across ethnicity and diabetes status. AIM: In this paper, we examined the association of abdominal obesity, by ethnicity and diabetes status, for indicators of glucose metabolism in Blacks. METHODS: A cross sectional study was conducted in Haitian Americans (n= 186) and African Americans (n= 148) with and without type 2 diabetes mellitus (T2DM). Student's t-test and Chi-squared test were used to assess differences in mean and proportion values between ethnicities with and without type 2 diabetes mellitus. Relationship between insulin resistance, ethnicity, diabetes status, abdominal obesity, and adiponectin levels were analyzed by analysis of covariance while controlling for confounding variables. RESULTS: Haitian American participants were older (P = .032), had higher fasting plasma glucose (P = .036), and A1C (P = .016), but had lower levels of Hs-CRP (P < .001), insulin and HOMA2-IR and lower abdominal obesity (P = .030), than African Americans. Haitian Americans had significantly lower HOMA2-IR (P = .008) than African Americans when comparing both ethnicities with T2DM, high abdominal obesity, and adiponectin levels lower than the median (<14.75 ng/mL). CONCLUSION: The clinical significance of observed differences in insulin resistance, abdominal obesity, and adiponectin levels between Haitian Americans and African Americans could assist in forming public health policies that are ethnic specific.

Use of Homeostatic Model Assessment Indexes for the Identification of Metabolic Syndrome and Insulin Resistance among Cuban-Americans: A Cross Sectional Study.

AIM: to determine cut off points for The Homeostatic Model Assessment Index 1 and 2 (HOMA-1 and HOMA-2) for identifying insulin resistance and metabolic syndrome among a Cuban-American population. STUDY DESIGN: Cross sectional. PLACE AND DURATION OF STUDY: Florida International University, Robert Stempel School of Public Health and Social Work, Department of Dietetics and Nutrition, Miami, FL from July 2010 to December 2011. METHODOLOGY: Subjects without diabetes residing in South Florida were enrolled (N=146, aged 37 to 83 years). The HOMA1-IR and HOMA2-IR 90th percentile in the healthy group (n=75) was used as the cut-off point for insulin resistance. A ROC curve was constructed to determine the cut-off point for metabolic syndrome. RESULTS: HOMA1-IR was associated with BMI, central obesity, and triglycerides (P<0.05). HOMA2-IR was associated with BMI, central obesity, total cholesterol, HDL-cholesterol and LDL-cholesterol (P<0.05). The cut-off points for insulin resistance for HOMA-1 and HOMA-2 were >3.95 and >2.20 and for metabolic syndrome were >2.98 (63.4% sensitivity and 73.3% specificity) and >1.55 (60.6% sensitivity and 66.7% specificity), respectively. CONCLUSION: HOMA cut-off points may be used as a screening tool to identify insulin resistance and metabolic syndrome among Cuban-Americans living in South Florida.

Skin Color and Self-reported Sun Exposure Scores are Associated with Serum 25-Hydroxyvitamin D Concentrations in a Multi-ethnic Population Living in South Florida.

AIMS: The aim was to investigate the association between serum 25-hydroxyvitamin D [25(OH)D], skin color and sun exposure score. STUDY DESIGN: Cross-sectional. PLACE AND DURATION OF STUDY: Florida International University, Robert Stempel College of Public Health and Social Work, Department of Dietetics and Nutrition, Miami, Florida from July 2012 to October 2012. METHODOLOGY: Seventy six adults, ages 18-36 years living in South Florida participated in the study. Skin color was quantified by a IMS Smart Probe 400 scanner and 25(OH)D was measured by ELISA. A sun exposure questionnaire was used to record the weekly sun exposure scores. A food frequency questionnaire was used to record daily vitamin D intake. RESULTS: Multiple-linear regression analysis indicated that sun exposure, forearm skin color and vitamin D intake were significant predictors of 25(OH)D (P=.004, P=.003 and P=.021 respectively). This association held after controlling for covariates (B=.371, P=.027 for forearm, B=.031, P=.005 for total sun exposure and B=.689, P=.003 for vitamin D intake). CONCLUSION: Skin color, sun exposure along with vitamin D intake may be used as an indirect non-invasive tools to estimate 25(OH)D levels in healthy individuals in South Florida.

Perceived stress and self-rated health of Haitian and African Americans with and without Type 2 diabetes.

BACKGROUND: Blacks have a higher incidence of diabetes and its related complications. Self-rated health (SRH) and perceived stress indicators are associated with chronic diseases. The aim of this study was to examine the associations between SRH, perceived stress and diabetes status among two Black ethnicities. MATERIALS AND METHODS: The cross-sectional study included 258 Haitian Americans and 249 African Americans with (n = 240) and without type 2 diabetes (n = 267) (n = 507). Recruitment was performed by community outreach. RESULTS: Haitian-Americans were less likely to report 'fair to poor' health as compared to African Americans [OR = 0.58 (95% CI: 0.35, 0.95), P = 0.032]; yet, Haitian Americans had greater perceived stress than African Americans (P = 0.002). Having diabetes was associated with 'fair to poor' SRH [OR = 3.14 (95% CI: 2.09, 4.72), P < 0.001] but not perceived stress (P = 0.072). Haitian-Americans (P = 0.023), females (P = 0.003) and those participants having 'poor or fair' SRH (P < 0.001) were positively associated with perceived stress (Nagelkerke R(2) = 0.151). CONCLUSION: Perceived stress associated with 'poor or fair' SRH suggests that screening for perceived stress should be considered part of routine medical care; albeit, further studies are required to confirm our results. The findings support the need for treatment plans that are patient-centered and culturally relevant and that address psychosocial issues.

Relationship of Omega-3 Fatty Acids on C-Reactive Protein and Homocysteine in Haitian and African Americans with and without Type 2 Diabetes.

BACKGROUND: Omega-3 fatty acids (n-3) may be protective of cardiovascular risk factors for vulnerable populations. The purpose of this study was to assess the association between n-3 with, C-reactive protein (CRP), and homocysteine (HCY) in Black minorities with and without type 2 diabetes. METHODS: A cross-sectional study was conducted with 406 participants: Haitian Americans (HA): n=238. African Americans (AA): n=172. Participants were recruited from a randomly generated mailing lists, local diabetes educators, community health practitioners and advertisements from 2008-2010. Sociodemographics and anthropometrics were collected and used to adjust analyses. All dietary variables were collected using the semi-quantitative food frequency questionnaire (FFQ) and used to quantify vitamin components. Blood was collected to measure CVD risk factors (blood lipids, HCY, and CRP). RESULTS: African Americans had higher waist circumferences and C-reactive protein and consumed more calories as compared to Haitian Americans. Omega 3 fatty acid intake per calorie did not differ between these ethnicities, yet African Americans with low n-3 intake were three times more likely to have high C-reactive protein as compared to their counterparts [OR=3. 32 (1. 11, 9. 26) p=0.031].Although homocysteine did not differ by ethnicity, African Americans with low omega 3 intake (<1 g/day) were four times as likely to have high homocysteine (>12 mg/L) as compared to their counterparts, adjusting for confounders [OR=4.63 (1.59, 12.0) p=0.004]. Consumption of n-3 by diabetes status was not associated with C-reactive protein or homocysteine levels. CONCLUSIONS: Consumption of n-3 may be protective of cardiovascular risk factors such as C-reactive protein and homocysteine for certain ethnicities. Prospective studies are needed to confirm these results.

The association of depression and perceived stress with beta cell function between African and Haitian Americans with and without type 2 diabetes.

BACKGROUND: Diabetes and diabetes-related complications are major causes of morbidity and mortality in the United States. Depressive symptoms and perceived stress have been identified as possible risk factors for beta cell dysfunction and diabetes. The purpose of this study was to assess associations between depression symptoms and perceived stress with beta cell function between African and Haitian Americans with and without type 2 diabetes. PARTICIPANTS AND METHODS: Informed consent and data were available for 462 participants (231 African Americans and 231 Haitian Americans) for this cross-sectional study. A demographic questionnaire developed by the Primary Investigator was used to collect information regarding age, gender, smoking, and ethnicity. Diabetes status was determined by self-report and confirmed by fasting blood glucose. Anthropometrics (weight, and height and waist circumference) and vital signs (blood pressure) were taken. Blood samples were drawn after 8 - 10 hours over-night fasting to measure lipid panel, fasting plasma glucose and serum insulin concentrations. The homeostatic model assessment, version 2 (HOMA2) computer model was used to calculate beta cell function. Depression was assessed using the Beck Depression Inventory-II (BDI-II) and stress levels were assessed using the Perceived Stress Scale (PSS). RESULTS: Moderate to severe depressive symptoms were more likely for persons with diabetes (p = 0.030). There were no differences in perceived stress between ethnicity and diabetes status (p = 0.283). General linear models for participants with and without type 2 diabetes using beta cell function as the dependent variable showed no association with depressive symptoms and perceived stress; however, Haitian Americans had significantly lower beta cell function than African Americans both with and without diabetes and adjusting for age, gender, waist circumference and smoking. Further research is needed to compare these risk factors in other race/ethnic groups.

Use of hemoglobin A1C to detect Haitian-Americans with undiagnosed Type 2 diabetes.

OBJECTIVE: To evaluate the validity of hemoglobin A1C (A1C) as a diagnostic tool for type 2 diabetes and to determine the most appropriate A1C cutoff point for diagnosis in a sample of Haitian-Americans. SUBJECTS AND METHODS: Subjects (n = 128) were recruited from Miami-Dade and Broward counties, FL. Receiver operating characteristics (ROC) analysis was run in order to measure sensitivity and specificity of A1C for detecting diabetes at different cutoff points. RESULTS: The area under the ROC curve was 0.86 using fasting plasma glucose ≥ 7.0 mmol/L as the gold standard. An A1C cutoff point of 6.26% had sensitivity of 80% and specificity of 74%, whereas an A1C cutoff point of 6.50% (recommended by the American Diabetes Association - ADA) had sensitivity of 73% and specificity of 89%. CONCLUSIONS: A1C is a reliable alternative to fasting plasma glucose in detecting diabetes in this sample of Haitian-Americans. A cutoff point of 6.26% was the optimum value to detect type 2 diabetes.

Use of hemoglobin A1C to detect Haitian-Americans with undiagnosed Type 2 diabetes / Utilização de hemoglobina A1C no rastreamento de haitianos americanos com diabetes tipo 2 não diagnosticado

OBJECTIVE: To evaluate the validity of hemoglobin A1C (A1C) as a diagnostic tool for type 2 diabetes and to determine the most appropriate A1C cutoff point for diagnosis in a sample of Haitian-Americans. SUBJECTS AND METHODS: Subjects (n = 128) were recruited from Miami-Dade and Broward counties, FL. Receiver operating characteristics (ROC) analysis was run in order to measure sensitivity and specificity of A1C for detecting diabetes at different cutoff points. RESULTS: The area under the ROC curve was 0.86 using fasting plasma glucose ≥ 7.0 mmol/L as the gold standard. An A1C cutoff point of 6.26% had sensitivity of 80% and specificity of 74%, whereas an A1C cutoff point of 6.50% (recommended by the American Diabetes Association - ADA) had sensitivity of 73% and specificity of 89%. CONCLUSIONS: A1C is a reliable alternative to fasting plasma glucose in detecting diabetes in this sample of Haitian-Americans. A cutoff point of 6.26% was the optimum value to detect type 2 diabetes.

OBJETIVO: Avaliar a validade da hemoglobina A1C (A1C) como ferramenta para o diagnóstico de diabetes tipo 2 e determinar o ponto de corte mais apropriado para a A1C no diagnóstico de uma amostra de haitianos americanos. SUJEITOS E MÉTODOS: Os sujeitos (n = 128) foram recrutados dos condados de Miami-Dade e Broward na Flórida. A análise ROC (Receiver operating characteristics) foi feita de forma a medir a sensibilidade e especificidade de A1C para a detecção do diabetes em diferentes pontos de corte. RESULTADOS: A área sob a curva ROC foi 0,86 usando a glicemia de jejum ≥ 7,0 mmol/L como padrão-ouro. O ponto de corte de 6,26% para a A1C apresentou sensibilidade de 80% e especificidade de 74%, enquanto o ponto de corte de 6,50% (recomendado pela American Diabetes Association - ADA) apresentou uma sensibilidade de 73% e especificidade de 89%. CONCLUSÕES: A A1C foi uma alternativa confiável para a glicemia de jejum na detecção do diabetes nesta amostra de haitianos americanos. Um ponto de corte de 6,26% foi o valor ótimo para a detecção do diabetes tipo 2.

Television watching, diet quality, and physical activity and diabetes among three ethnicities in the United States.

Diabetes is a world-wide epidemic associated with multiple environmental factors. Prolonged television viewing (TV) time has been related to increased risk of obesity and type 2 diabetes in several studies. TV viewing has been positively associated with cardiovascular disease risk factors, lower energy expenditure, over-eating high-calorie and high-fat foods. The objective of this study was to assess the associations of hours of TV viewing with dietary quality, obesity and physical activity for three ethnic minorities with and without type 2 diabetes. Diet quality and physical activity were inversely related to prolonged TV viewing. African Americans and participants with type 2 diabetes were more likely to watch more than 4 hours of TV per day as compared to their counterparts. Diet quality was inversely associated with physical activity level. Future studies are needed to establish the risk factors of prolonged TV watching in adult populations for the development of diabetes or diabetes-related complications. Although strategies to reduce TV watching have been proven effective among children, few trials have been conducted in adults. Intervention trials aimed at reducing TV viewing targeting people with type 2 diabetes may be beneficial to improve dietary quality and physical activity, which may reduce diabetes complications.

Serum vitamin D insufficiency and diabetes status in three ethnic minority groups.

The purpose of this study was to investigate the association between 25-hydroxyvitamin D [25(OH)D] levels and diabetes status in three ethnicities. This cross sectional study included Cuban Americans (n = 199), Haitian Americans (n = 253) and African Americans (n = 248) with and without type 2 diabetes (T2D) from Florida, U.S. Recruitment of participants was through mailing lists (Cuban Americans and African Americans) and community based sources (Haitian Americans). Adjusted logistic regression analysis indicated significant differences in the odds of having insufficient 25(OH)D levels by ethnicity [P < 0.001], diabetes status [P < 0.001], and their interaction [P < 0.001]. Holm's modified Bonferroni method showed that only Cuban Americans without T2D had significantly lower odds of having insufficient 25(OH)D compared to all other groups. Haitian American and African American participants and participants having T2D had the greatest risk of 25(OH)D insufficiency. Future studies should focus on the role of vitamin D supplementation and diabetes outcomes across ethnic groups.

Healthy Eating Index scores associated with symptoms of depression in Cuban-Americans with and without type 2 diabetes: a cross sectional study.

BACKGROUND: Low diet quality and depression symptoms are independently associated with poor glycemic control in subjects with type 2 diabetes (T2D); however, the relationship between them is unclear. The aim of this study was to determine the association between diet quality and symptoms of depression among Cuban-Americans with and without T2D living in South Florida. METHODS: Subjects (n = 356) were recruited from randomly selected mailing list. Diet quality was determined using the Healthy Eating Index-2005 (HEI-05) score. Symptoms of depression were assessed using the Beck Depression Inventory (BDI). Both linear and logistic regression analyses were run to determine whether or not these two variables were related. Symptoms of depression was the dependent variable and independent variables included HEI-05, gender, age, marital status, BMI, education level, A1C, employment status, depression medication, duration of diabetes, and diabetes status. Analysis of covariance was used to test for interactions among variables. RESULTS: An interaction between diabetes status, gender and HEI-05 was found (P = 0.011). Among males with a HEI-05 score ≤ 55.6, those with T2D had a higher mean BDI score than those without T2D (11.6 vs. 6.6 respectively, P = 0.028). Among males and females with a HEI-05 score ≤ 55.6, females without T2D had a higher mean BDI score compared to males without T2D (11.0 vs. 6.6 respectively, P = 0.012) CONCLUSIONS: Differences in symptoms of depression according to diabetes status and gender are found in Cuban-Americans with low diet quality.

Healthy Eating Index and Alternate Healthy Eating Index among Haitian Americans and African Americans with and without Type 2 Diabetes.

Ethnicities within Black populations have not been distinguished in most nutrition studies. We sought to examine dietary differences between African Americans (AA) and Haitian Americans (HA) with and without type 2 diabetes using the Healthy Eating Index, 2005 (HEI-05), and the Alternate Healthy Eating Index (AHEI). The design was cross-sectional N = 471 (225 AA, 246 HA) and recruitment was by community outreach. The eating indices were calculated from data collected with the Harvard food-frequency questionnaire. African Americans had lower HEI-05 scores ß = -10.9 (-8.67, 13.1); SE = 1.12, P < .001 than HA. Haitian American females and AA males had higher AHEI than AA females and HA males, respectively, (P = .006) adjusting for age and education. Participants with diabetes had higher adherence to the HEI-05 ß = 3.90 (1.78, 6.01), SE = 1.08, P < .001 and lower adherence to the AHEI ß = -9.73 (16.3, -3.19), SE = 3.33, P = .004, than participants without diabetes. The findings underscore the importance of disaggregating ethnicities and disease state when assessing diet.

Hypertension, poor glycemic control, and microalbuminuria in Cuban Americans with type 2 diabetes.

PURPOSE: To investigate to what degree the presence of hypertension (HTN) and poor glycemic control (GC) influences the likelihood of having microalbuminuria (MAU) among Cuban Americans with type 2 diabetes (T2D). METHODS: A cross-sectional study conducted in Cuban Americans (n = 179) with T2D. Participants were recruited from a randomly generated mailing list purchased from Knowledge-Base Marketing, Inc. Blood pressure (BP) was measured twice and averaged using an adult size cuff. Glycosylated hemoglobin (A1c) levels were measured from whole blood samples with the Roche Tina-quant method. First morning urine samples were collected from each participant to determine MAU by a semiquantitative assay (ImmunoDip). RESULTS: MAU was present in 26% of Cuban Americans with T2D. A significantly higher percentage of subjects with MA had HTN (P = 0.038) and elevated A1C (P = 0.002) than those with normoalbuminuria. Logistic regression analysis showed that after controlling for covariates, subjects with poor GC were 6.76 times more likely to have MAU if they had hypertension compared with those without hypertension (P = 0.004; 95% confidence interval [CI]: 1.83, 23.05). CONCLUSION: The clinical significance of these findings emphasizes the early detection of MAU in this Hispanic subgroup combined with BP and good GC, which are fundamentals in preventing and treating diabetes complications and improving individuals' renal and cardiovascular outcomes.

Use of HbA(1c) in screening for Cuban-Americans with undiagnosed type 2 diabetes.

This study evaluated the use of HbA(1c) as a screening tool for undiagnosed type 2 diabetes (fasting plasma glucose ≥7.0 mmol/l) in a sample of Cuban-Americans aged ≥ 30 years old. Subjects were randomly recruited from Miami-Dade and Broward counties, FL. Fasting plasma glucose was measured by hexokinase enzymatic method. HbA(1c) was measured by the DCA2000 + system using the monoclonal antibody method. HbA(1c) demonstrated a high predictive value in detecting undiagnosed diabetes. The area under the receiver operating characteristics (ROC) curve was 0.87. Also, HbA(1c) had high sensitivity and specificity when using a cut off value of 6.37 (71 and 86%, respectively). Moderate sensitivity and very high specificity were shown with a cut off value of 6.84 (57 and 96%, respectively). HbA(1c) is a reliable alternative to fasting plasma glucose in screening for undiagnosed diabetes in Cuban-Americans.