Comparing the influence of childhood and adult economic status on midlife obesity in Mexican American, white, and African American women.

Objective: To compare trends in the prevalence of metabolic syndrome (MetS) by race/ethnicity among US women ages 18-49 years between 1988 and 2016. Methods: Using data from the National Health and Nutrition Examination Survey (NHANES), we classified MetS according to AHA/NHLBI criteria and calculated age-standardized prevalence of MetS in the following periods: 1988-94, 1999-04, 2005-10, and 2011-16. Our sample included nonpregnant women 18-49 years of age who self-reported as non-Hispanic White, non-Hispanic Black, or Mexican American. For each period, we estimated relative (prevalence ratio, PR) and absolute (prevalence difference, PD) differences by race/ethnicity. We tested heterogeneity of these estimates using ANOVA to determine if the differences between groups significantly widened or narrowed over time. All analyses were stratified by gravidity (nulligravida vs. primi- and multigravida). Results: Between 1988-94 and 2011-16, the age-standardized prevalence of MetS for nulligravida and primi-/multigravida women increased from 10% to 19% and 16% to 28%, respectively. Among nulligravida women , the relative differences in MetS between NH Black and NH White women decreased (PR 1988-94 =1.6, PR 1999-04 =1.4, PR 2005-10 =1.4, PR 2011-16 =1.0), while the difference between Mexican American and NH White women declined in 1999-04, but increased after (PR 1988-94 =2.2, PR 1999-04 =1.0, PR 2005-10 =1.5, PR 2011-16 =1.7). Compared to NH White women, the absolute differences for NH Black (PD 1988-94 =5.8%, PD 1999-04 =9.2%, PD 2005-10 =7.5%, PD 2011-16 =-0.5%) and Mexican American women (PD 1988-94 =11.1%, PD 1999-04 =-0.2%, PD 2005-10 =9.3%, PD 2011-16 =11.9%) followed similar patterns. Moreover, and among primi-/multigravida women , the relative differences between NH Black and NH White women remained stable (PR 1988-94 =1.3, PR 1999-04 =1.3, PR 2005-10 =1.5, PR 2011-16 =1.3), while the differences between Mexican American and NH White women declined (PR 1988-94 =1.8, PR 1999-04 =1.6, PR 2005-10 =1.3, PR 2011-16 =1.3). Again, compared to NH White women, absolute differences for NH Black (PD 1988-94 =4.4, PD 1999-04 =8.5, PD 2005-10 =10.7, PD 2011-16 =7.0) and Mexican American women (PD 1988-94 =12.2, PD 1999-04 =15.4, PD 2005-10 =5.7, PD 2011-16 =7.1) were similar. We found no evidence of significant heterogeneity of PRs and PDs across time for any group. Conclusions: Since 1988, prevalence of MetS among US women ages 18-49 has nearly doubled. The increase in prevalence was similar across NH White, NH Black and Mexican American women. Among nulligravida women, those that self-reported as Mexican American had the highest burden of MetS, while among primi-/multigravida women, the prevalence of MetS was consistently higher among both Mexican American and non-Hispanic Blacks.

Serum and red blood cell folate concentrations, race, and education: findings from the third National Health and Nutrition Examination Survey

Screening mammography is associated with early detection of breast cancer (BC) and reduced BC mortality. To understand factors that influence screening mammography receipt in minority women with unrecognized risk factors for BC, this study examined BC screening behaviors among women with BC. Due to the BC survival disparities observed in African American (AA) and Mexican American (MA) women compared to whites, AA and MA women living in Texas and Arizona who were participants of the ELLA Binational Breast Cancer Study were selected for this study based on a diagnosis of BC. Data on socioeconomic status (SES), reproductive history, family history, insurance status, acculturation, and breast health history were collected via questionnaires and medical record abstraction. 601 women aged 40 years or older at time of BC diagnosis were included in this study, including 270 AA, 151 MA women classified as high-acculturation (MA-HA) and 180 MA women classified as low-acculturation (MA-LA). Logistic regression analysis was used to assess differences in mammography receipt in the last five years prior to BC diagnosis stratified by race/ethnicity and acculturation and for all groups combined. MA women in this study suffer a larger disparity than AA women with regards to screening mammography. Despite high rates of screening mammography among AA and MA women, 62% of BC was self-detected in the study population. AA women (OR=1.0) and MA-HA (OR=0.91; 95% CI: 0.57-1.48) women were more than twice as likely to receive screening mammography compared to MA-LA (OR=0.38; 95% CI: 0.25-0.59), adjusted for age. After adjusting for age, education, and insurance, there was no significant difference in screening mammography receipt between these three groups. Women who had a known family history of BC were more than twice as likely to receive screening mammography than women who had unknown or no family history (OR=2.02; 95% CI: 1.19-3.55). However, although AA and MA-HA women were twice as likely as MA-LA to report a family history of BC (20% vs. 23% vs. 12%, respectively), recognized family history did not account for the differences in screening mammography use between these groups. Thus, the differences observed in screening mammography receipt by race/ethnicity and acculturation among AA, MA-HA, and MA-LA are likely explained by SES variables, including education and insurance. Due to the large proportion of AA and MA women who reported self-detecting their BC, women must be educated about the importance of breast awareness and prompt reporting of findings to a health professional after noticing breast changes. In addition, cancer screening programs targeting underserved women should provide culturally appropriate messages about the importance of knowing their family history and the benefits of screening mammography. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2806.

2055 Differences in bone mineral density (BMD) between Caucasian and African American women have been well established, however few studies have investigated BMD differences within other ethnic minorities. PURPOSE: The purpose of this study was to investigate differences in BMD between premenopausal Mexican and Asian American women. METHODS: This study recruited 43 premenopausal Mexican American women and 33 Asian American women that live in Los Angeles County. BMD of spine, hip, and body composition were assessed by dual energy x-ray absorptiometry (DEXA). Heel BMD was obtained by a Sahara bone sonometer. Primary risk factors for osteoporosis, cardiovascular (CV) fitness and strength were obtained via a series of questionnaires and by exercise testing in the laboratory. These data were analyzed by independent sample t-test with the level of significance predetermined at p<0.05. RESULTS: Mean age for Mexican Americans and Asian Americans was 36.2 ± 5.0 and 38.7 ± 5.0 years respectively. Mexican Americans had significantly higher body weight (67.7 ± 13.2 kg vs. 56.2 ± 6 kg), lean body mass (43.6 ± 6 kg vs. 39 ± 3.8 kg), and percent body fat (33.2% vs. 27.9%) compared to Asian Americans. There were no significant differences in BMD or t-scores at all sites measured. In addition there were no differences in CV fitness or any of the strength measures. Asian America women reported greater frequency of smoking and drinking alcohol than Mexican American women as well as significantly higher income (p = 0.013), leisure walking index (p = 0.045), but significantly lower oral contraceptive use (p = 0.000) and number of children (p = 0.014). CONCLUSIONS: These data show that BMD of premenopausal Asian American women is similar to Mexican American women. However, lifestyle predictors of BMD were different providing some insight into differences in lifetime risk of osteoporosis. Supported by NIH Grant S06 GM 8101–28

Evidence exists that increased levels of physical activity decrease the population burden of cardiovascular disease (CVD). Although risk factors for CVD, including plasma lipids and lipoproteins, have been associated with physical activity, studies including a sizeable number of minority participants are lacking. Our purpose was to interrogate the longitudinal effect of physical activity on plasma lipids and lipoproteins in the African American and white participants of the Atherosclerosis Risk in Communities (ARIC) Study. Nine years of follow-up data on 8,764 individuals aged 45-64 years at baseline were used in linear mixed-effects models to estimate the association between increases in baseline physical activity on mean change in HDL, LDL, total cholesterol, and triglyceride levels. Increases in the level of activity were associated with increases in HDL in all strata and decreases in triglycerides among white participants. Physical activity was associated with LDL in all women, while the association with total cholesterol was limited to African American women. This study is one of the few to investigate the effect of physical activity on lipids and lipoproteins in a race- and sex-specific manner. Overall our results highlight the importance of physical activity on plasma lipid profiles and provide evidence for novel differential associations.

Our previous work has demonstrated that choline and folate are interrelated and that ethnicity is a determinant of folate status. Specifically, African American women have lower folate nutriture relative to Caucasian and Mexican American women under conditions of controlled folate intake. This study sought to examine the influence of ethnicity and controlled folate intake on choline status. Forty-two women of Mexican American (n=14), African American (n=14), and Caucasian (n=14) descent consumed a folate restricted diet (135 mcg DFE/d) for 7 weeks, followed by 7 weeks of folate treatment with either 400 or 800 mcg DFE/d. Total choline intake remained unchanged throughout the study at approximately 350 mg/d. Plasma choline and its derivatives were measured by LC-MS/MS at weeks 0, 7, and 14. Plasma betaine was modified by ethnicity and level of folate treatment (week x ethnicity x folate interaction; P=0.0392), and tended to decline for all subjects during folate restriction (week effect; P=0.0783). Also, plasma betaine tended to increase less in African Americans receiving treatment with 800 mcg DFE/d relative to other ethnic groups (ethnicity x folate interaction; P=0.052). Phosphatidylcholine declined during folate restriction (week effect; P<0.001) and tended to increase in Mexican American and Caucasian women and decline in African American women during folate treatment (week x ethnicity interaction; P=0.056). These data suggest that the lower folate status observed in African American women relative to Caucasian and Mexican American women is also associated with lower choline status. In turn, diseases that are linked to folate nutriture may also be linked to choline status. Supported by the NIH grant S06GM53933 and funds from the California Agricultural Research Initiative.

Lipoprotein profiles in Mexican American and non-Hispanic white women with polycystic ovary syndrome

The role of acculturation in explaining ethnic differences in the prenatal health-risk behaviors, mental health, and parenting beliefs of Mexican American and European American at-risk women

This study was initiated to test the hypothesis that older, healthy, nondiabetic Mexican American women would be relatively resistant to insulin-mediated glucose disposal, hyperinsulinemic, and dyslipidemic as compared to a matched group of non-Hispanic White (NHW) women. The study, cross-sectional in nature, involved 14 Mexican American and 19 NHW healthy, normotensive nondiabetic, postmenopausal women of similar age and body mass index. It took place in the General Clinical Research Center at Stanford Medical Center. Measurements were made of fasting plasma glucose, insulin and lipid concentrations, and plasma glucose and insulin concentrations following a 75 gram oral glucose challenge. Resistance to insulin-mediated glucose disposal was estimated by the steady-state plasma glucose (SSPG) concentration achieved at the end of a 3-hour constant infusion of glucose, insulin, and somatostatin. Mexican American women had significantly greater glucose (p < .001) and insulin (p < .001) responses to the oral glucose challenge than did the NHW women. Resistance to insulin-mediated glucose disposal was increased in Mexican American women (SSPG 195 +/- 25 mg/dl compared to 137 +/- 18 mg/dl in NHW; p < .001). While total cholesterol, low density lipoprotein (LDL)-cholesterol, and triglyceride concentrations were not significantly different in the two ethnic groups, high density lipoprotein (HDL)-cholesterol was significantly lower in the Mexican American women (51 mg/dl vs 61 mg/dl; p = .04). Older Mexican American women are more insulin resistant, glucose intolerant, and hyperinsulinemic, and have a lower HDL-cholesterol than a matched group of non-Hispanic White peers. These results were observed despite the exclusion of individuals with non-insulin dependent diabetes mellitus (NIDDM).

There are few studies of ethnic differences in cardiovascular disease (CVD) risk factors in older populations. To examine the association of ethnicity on CVD risk factors, after accounting for socioeconomic status (SES), and to examine health behaviors among those with CVD risk factors. Third National Health and Nutrition Examination Survey, 1988-1994. Eighty-nine mobile examination centers. 700 black, 628 Mexican-American, and 2192 white women and men age 65 to 84 years. Ethnicity in relation to type II diabetes mellitus, physical inactivity, abdominal obesity, hypertension, cigarette smoking and non-high-density lipoprotein cholesterol (non-HDL-C). After accounting for age and SES, both black and Mexican-American women had significantly higher prevalences of type II diabetes than white women. In addition, black women were significantly more likely to have abdominal obesity and hypertension and to be physically inactive than white women. Black men had significantly higher prevalences of hypertension and physical inactivity than white men. However, black men had lower prevalences of abdominal obesity than white men, and black women had lower prevalences of high non-HDL-C than white women. Among those with CVD risk factors, health behaviors were in need of improvement, especially among Mexican-American women whose primary language was Spanish. In this national sample of older women and men, black and Mexican American women and black men were at the greatest risk for CVD. These findings parallel the heightened risk of CVD among younger ethnic minority populations and argue for appropriate primary and secondary prevention programs, modified for the language, cultural, and medical needs of older ethnic minorities.

Polycystic ovarian syndrome and insulin resistance in white and Mexican American women: A comparison of two distinct populations

Objective: We previously demonstrated that choline and folate are interrelated and that African American women have lower folate nutriture than Caucasian and Mexican American women under conditions of controlled folate intake. The present study sought to examine the influences of ethnicity and controlled folate intake on choline status.Methods: Forty-two women of Mexican American (n = 14), African American (n = 14), and Caucasian American (n = 14) descent consumed a folate restricted diet (135 μg DFE/d) for 7 weeks, followed by 7 weeks of folate treatment with either 400 or 800 μg DFE/d. Total choline intake remained unchanged throughout the study at approximately 350 mg/d. Plasma choline and its derivatives were measured by LC-MS/MS at weeks 0, 7, and 14.Results: Plasma phosphatidylcholine declined during folate restriction (P < 0.001) and tended to increase in response to 800 μg DFE/d (week × folate, P = 0.099) in Mexican American and Caucasian women. For African American women, however, phosphatidylcholine continued to decline (week × race, P = 0.056). Plasma betaine was modified by ethnicity and level of folate intake (week × race × folate, P = 0.039) however no clear patterns emerged.Conclusions: The phosphatidylcholine data suggest that the lower folate status observed in African American women may also be associated with lower choline status. In turn, diseases linked to folate may also be linked to choline.

Preventive and health promoting behaviors in pregnant minority women can be used to develop approaches to encourage healthy lifestyle and optimal utilization of health services, and to obtain better outcomes of pregnancy. Using the Health Promotion Model as a theoretical framework, this study employed a cross-sectional survey design to investigate factors that related to health behaviors of low-income pregnant Mexican American and African American women in selected sites in the southeast portion of the state of Texas. Results showed that Mexican American women had a significantly higher mean on the Powerful Others Locus of Control measure than the African American women. For African American subjects, the strongest effect was exerted by the social support variable, which had a negative effect on the health behavior variable. Findings suggest that more studies are needed to identify specific determinants of health promoting activities during pregnancy in ethnic minority groups. Designing programs that would motivate early involvement of low-income pregnant minority women in health care should be a top priority for professionals in maternity practice.

A Cross-Cultural Consumer-Based Decision Aid for Screening Mammography

Predicted contribution of folic acid fortification of corn masa flour to the usual folic acid intake for the US population: National Health and Nutrition Examination Survey 2001–2004