Boston Puerto Rican Health Study Research Articles

Associations among diabetes medication use, serum magnesium, and insulin resistance in a cohort of older Puerto Rican adults

BackgroundHypomagnesemia is commonly observed in individuals with diabetes, but how diabetes medications alter magnesium (Mg) status remains unclear. ObjectivesWe aimed to examine the association between diabetes medication and hypomagnesemia and evaluate whether serum Mg mediates the association between diabetes medication and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) in a prospective cohort. MethodsAdults from the Boston Puerto Rican Health Study were included (n = 1106). Multivariable logistic regression models were used to estimate odds ratio (OR) and 95% confidence interval (CI) for cross-sectional association between diabetes medication and hypomagnesemia (serum Mg <0.75 mmol/L). Longitudinal mediation analysis was performed to evaluate the direct and indirect (via serum Mg) associations between diabetes medication and 4-y HOMA-IR in 341 participants with baseline hemoglobin A1c (HbA1c) of ≥6.5%. ResultsMean age at baseline was 59.0 ± 7.6 y, with 28.0% male and 45.8% with hypomagnesemia. Use of metformin [OR (95% CI) = 3.72 (2.53, 5.48)], sulfonylureas [OR (95% CI) = 1.68 (1.00, 2.83)], and glitazones [OR (95% CI) = 2.09 (1.10, 3.95)], but not insulin, was associated with higher odds of hypomagnesemia. Use of multiple diabetes medications and longer duration of use were associated with higher odds of hypomagnesemia. Serum Mg partially mediated the association between metformin and HOMA-IR [indirect association: β (95% CI) = 1.11 (0.15, 2.07)], which weakened the direct association [β (95% CI) = -5.16 (-9.02, -1.30)] by 22% [total association: β (95% CI) = -4.05 (-7.59, -0.51)]. Similarly, serum Mg mediated 17% of the association between sulfonylureas and elevated HOMA-IR. However, the mediation by serum Mg was weak for insulin and glitazones. ConclusionsDiabetes medication, especially metformin, was associated with elevated odds of hypomagnesemia, which may weaken the association between metformin and lowering of HOMA-IR. The causal inference needs to be confirmed in further studies.

Metabolites and Cognitive Decline in a Puerto Rican Cohort.

Recent studies have identified plasma metabolites associated with cognitive decline and Alzheimer's disease; however, little research on this topic has been conducted in Latinos, especially Puerto Ricans. This study aims to add to the growing body of metabolomics research in Latinos to better understand and improve the health of this population. We assessed the association between plasma metabolites and global cognition over 12 years of follow-up in 736 participants of the Boston Puerto Rican Health Study (BPRHS). Metabolites were measured with untargeted metabolomic profiling (Metabolon, Inc) at baseline. We used covariable adjusted linear mixed models (LMM) with a metabolite * time interaction term to identify metabolites (of 621 measured) associated with ∼12 years cognitive trajectory. We observed strong inverse associations between medium-chain fatty acids, caproic acid, and the dicarboxylic acids, azelaic and sebacic acid, and global cognition. N-formylphenylalanine, a tyrosine pathway metabolite, was associated with improvement in cognitive trajectory. The metabolites identified in this study are generally consistent with prior literature and highlight a role medium chain fatty acid and tyrosine metabolism in cognitive decline.

Association of Gut Microbiota-Related Metabolites and Type 2 Diabetes in Two Puerto Rican Cohorts.

(1) Aims: Gut microbiota metabolites may play integral roles in human metabolism and disease progression. However, evidence for associations between metabolites and cardiometabolic risk factors is sparse, especially in high-risk Hispanic populations. We aimed to evaluate the cross-sectional and longitudinal relationships between gut microbiota related metabolites and measures of glycemia, dyslipidemia, adiposity, and incident type 2 diabetes in two Hispanic observational cohorts. (2) Methods: We included data from 670 participants of the Boston Puerto Rican Health Study (BPRHS) and 999 participants of the San Juan Overweight Adult Longitudinal Study (SOALS). Questionnaires and clinical examinations were conducted over 3 years of follow-up for SOALS and 6 years of follow-up for BPRHS. Plasma metabolites, including L-carnitine, betaine, choline, and trimethylamine N-oxide (TMAO), were measured at baseline in both studies. We used multivariable linear models to evaluate the associations between metabolites and cardiometabolic risk factors and multivariable logistic and Poisson regressions to assess associations with prevalent and incident type 2 diabetes, adjusted for potential confounding factors. Cohort-specific analyses were combined using a fixed-effects meta-analysis. (3) Results: Higher plasma betaine was prospectively associated with lower fasting glucose [-0.97 mg/dL (95% CI: -1.59, -0.34), p = 0.002], lower HbA1c [-0.02% (95% CI: -0.04, -0.01), p = 0.01], lower HOMA-IR [-0.14 (95% CI: -0.23, -0.05), p = 0.003], and lower fasting insulin [-0.27 mcU/mL (95% CI: -0.51, -0.03), p = 0.02]. Betaine was also associated with a 22% lower incidence of type 2 diabetes (IRR: 0.78, 95% CI: 0.65, 0.95). L-carnitine was associated with lower fasting glucose [-0.68 mg/dL (95% CI: -1.29, -0.07), p = 0.03] and lower HbA1c at follow-up [-0.03% (95% CI: -0.05, -0.01), p < 0.001], while TMAO was associated with higher fasting glucose [0.83 mg/dL (95% CI: 0.22, 1.44), p = 0.01] and higher triglycerides [3.52 mg/dL (95% CI: 1.83, 5.20), p < 0.0001]. Neither choline nor TMAO were associated with incident type 2 diabetes. (4) Conclusions: Higher plasma betaine showed consistent associations with a lower risk of glycemia, insulinemia, and type 2 diabetes. However, TMAO, a metabolite of betaine, was associated with higher glucose and lipid concentrations. These observations demonstrate the importance of gut microbiota metabolites for human cardiometabolic health.

Abstract P106: Omega-3 Fatty Acids in Erythrocyte Membranes Are Differentially Associated With Cardiometabolic Risk Factors in Brazilian and Puerto Rican Adults

Introduction: Intake of omega-3 fatty acids (ω–3) may protect against CVD, but this evidence was generated from studies with limited ethnic diversity, and thus, findings may not be generalizable to wider populations, especially those with low habitual intake of ω–3. This study aimed to investigate the association between ω–3 in erythrocyte membranes (a biomarker of ω–3 intake) and cardiometabolic risk factors in Brazilian and Puerto Rican adults. Hypothesis: We hypothesized that Brazilians and Puerto Ricans have different ω–3 erythrocyte membrane composition, but that the ω–3 index is inversely associated with cardiometabolic risk factors in both populations. Methods: This cross-sectional analysis included 367 Brazilians living in São Paulo, Brazil, and 1,293 Puerto Ricans living in Boston, USA, aged 45-75 years, from two population-based studies: The 2015 Health Survey of São Paulo and the Boston Puerto Rican Health Study. In both studies, fatty acids composition (as % of total fatty acids) was quantified in erythrocyte membranes from fasting blood samples using a gas chromatograph with a flame ionization detector (Shimadzu, CG-2010, Kyoto, Japan). The ω–3 index was calculated as the sum of EPA and DHA. Blood lipids, waist circumference, and insulin resistance (fasting plasma glucose and HOMA-IR) were measured from standardized protocols. Generalized linear models with gamma distribution and log link or ordinary least squares regression assessed the associations of the ω–3 index and cardiometabolic risk factors. Results: Puerto Ricans had worse indicators for cardiometabolic risk factors than Brazilians, except for total cholesterol, LDL-c, and non-HDL-c. The mean ω–3 index did not differ between the studies (4.43% for Puerto Ricans and 4.45% for Brazilians, P = 0.87). However, there were less total saturated (41.2% vs. 51.5%, P &lt; 0.001) and more total polyunsaturated fatty acids (41.8% vs. 31.3%, P &lt; 0.001) in Puerto Ricans than Brazilians. After adjusting for age, sex, BMI, physical activity, and diet quality (AHEI-2010 without the EPA+DHA component), the ω–3 index was inversely associated with fasting plasma glucose (β ± SE = -2.78 ± 1.37, P = 0.044), triglycerides (β = -0.05 ± 0.02, P = 0.004), VLDL-c (β = -1.22 ± 0.42, P = 0.003), and TG-HDL-ratio (β = -0.05 ± 0.02, P = 0.025) in Puerto Ricans, but positively associated with total cholesterol (β = 2.74 ± 1.30, P = 0.035), LDL-c (β = 2.48 ± 1.15, P = 0.031), and non-HDL-c (β = 2.81 ± 1.27, P = 0.028) in Brazilians. Conclusion: Despite similar ω–3 indices in Brazilian and Puerto Rican adults, there were differences in the magnitude, direction, and specific cardiometabolic risk factors with which it was associated. Variations in the dietary intake and cardiometabolic profile between the populations may explain the contrasting results. Assessing specific ω–3 in diverse populations is essential when studying their role in cardiometabolic health.

Genome-wide association study of osteoporosis identifies genetic risk and interactions with DASH diet and sugar sweetened beverages in a Hispanic cohort of older adults.

Osteoporosis (OP) and low bone mass can be debilitating and costly conditions if not acted on quickly. This disease is also difficult to diagnose as symptoms develop unnoticed until fracture occurs. Therefore, gaining understanding of the genetic risk associated with these conditions could be beneficial for healthcare professionals in early detection and prevention. The Boston Puerto Rican Osteoporosis (BPROS) study, an ancillary study to the Boston Puerto Rican Health Study (BPRHS), collected information regarding bone and bone health. All bone measurements were taken during regular BPROS visits using dual-energy x-ray absorptiometry. Osteoporosis was defined as T-score ≤ -2.5 (2.5 SD or more below peak bone mass). Dietary variables were collected at the second wave of the BPRHS via food frequency questionnaire. We conducted genome-wide associations with bone outcomes including bone mineral density (BMD) and OP for 978 participants. We also examined interactions with dietary quality on the relationships between genotype and bone outcomes. We further tested if candidate genetic variants described in previous GWAS on OP and BMD contribute to OP risk in this population. Four variants were associated with OP: rs114829316 (IQCJ), rs76603051, rs12214684 (MCHR2), and rs77303493 (RIN2), and two variants with BMD of lumbar spine (rs11855618, CGNL1) and hip (rs73480593, NTRK2), reaching the genome-wide significance threshold of P ≤ 5E-08. In a gene-diet interaction analysis, we found that one SNP showed a significant interaction with the overall DASH score, and 7 SNPs with sugar-sweeten beverages, a major contributor to the DASH score. This study identifies new genetic markers related to osteoporosis and BMD in older Hispanic adults. Additionally, we uncovered unique genetic markers that interact with dietary quality, specifically sugar-sweetened beverages, in relation to bone health. These findings may be useful to guide early detection and preventative care.

Association of Diabetes and Hypertension With Brain Structural Integrity and Cognition in the Boston Puerto Rican Health Study Cohort.

Association of Diabetes and Hypertension With Brain Structural Integrity and Cognition in the Boston Puerto Rican Health Study Cohort.

Metabolites and Brain Age in a Puerto Rican Cohor

AbstractBackgroundSeveral studies have examined metabolomic profiles in relation to Alzheimer’s disease and related dementia ADRD risk, however, few studies have focused on minorities, such as Latinos or examined MRI‐based outcomes.MethodsThis study examined the association between plasma metabolites and MRI‐derived AD/ADRD markers including brain age deviation and hippocampal volume in the Boston Puerto Rican Health Study (BPRHS). We used multiple linear regression, adjusted for covariates, to examine the association between metabolite concentration at baseline and brain age deviation in the Boston Puerto Rican health Stdy. Metabolites were measured with untargeted metabolomic profiling (Metabolon, Inc) at baseline. Brain age deviation was calculated as chronologic age minus MRI‐estimated brain age, representing the rate of biological brain aging relative to chronologic age. We further examined if metabolites associated with brain age were similarly associated with hippocampal volume.ResultsSeveral metabolites including isobutyrylcarnitine, propionylcarnitine (BCAA metabolism), phenylacetylglutamine, phenylacetylcarnitine (acetylated peptides), p‐cresol‐glucuronide*(tyrosine metabolism), and trimethylamine N‐oxide (TMAO) were inversely associated with brain age deviation. Taurocholate sulfate, a bile salt, was associated with better brain aging.ConclusionsThe metabolites identified in this study are generally consistent with prior literature and highlight a role of branched chain amino acids, TMAO and microbially derived in cognitive decline in cognitive decline.

Metabolites and 12‐Year Cognitive Measures Among a Cohort of Boston Area Puerto Ricans

AbstractBackgroundRecent studies have identified plasma metabolites associated with cognitive decline and Alzheimer’s disease; however, little research on this topic has been conducted in Latinos, especially Puerto Ricans. This study aims to add to the growing body of metabolomics research in Latinos to better understand and improve the health of this population.MethodWe assessed the association between plasma metabolites and global cognition, as well as memory and executive function component scores, over 12 y of follow‐up in 736 participants of the Boston Puerto Rican Health Study (BPRHS). Metabolites were measured with untargeted metabolomic profiling (Metabolon, Inc) at baseline. We used covariable adjusted linear mixed models (LMM) with a metabolite*time interaction term to identify metabolites (of 621 measured) associated with ∼12y cognitive trajectory.ResultWe observed strong inverse associations between medium‐chain fatty acids, caproic acid, and the dicarboxylic acids, azelaic and sebacic acid, with global cognition and memory. Metabolites on the tyrosine and tryptophan pathways as well as several phospholipids, were associated with improvement in cognitive trajectory. We also observed an association between glucose and taurocholate, a primary bile acid, and worse executive function trajectory.ConclusionThe metabolites identified in this study are generally consistent with prior literature and highlight a role for tryptophan, bile acid, branched chain amino acid, phospholipid and glucose metabolism in cognitive decline.

APOE4 allele-specific associations between diet, multimodal biomarkers, and cognition among Puerto Rican adults in Massachusetts.

Apolipoprotein E (APOE) is the strongest genetic risk factor for sporadic Alzheimer's Disease (AD), and the ε4 allele (APOE4) may interact with lifestyle factors that relate to brain structural changes, underlying the increased risk of AD. However, the exact role of APOE4 in mediating interactions between the peripheral circulatory system and the central nervous system, and how it may link to brain and cognitive aging requires further elucidation. In this analysis, we investigated the association between APOE4 carrier status and multimodal biomarkers (diet, blood markers, clinical diagnosis, brain structure, and cognition) in the context of gene-environment interactions. Participants were older adults from a longitudinal observational study, the Boston Puerto Rican Health Study (BPRHS), who self-identified as of Puerto Rican descent. Demographics, APOE genotype, diet, blood, and clinical data were collected at baseline and at approximately 12th year, with the addition of multimodal brain magnetic resonance imaging (MRI) (T1-weighted and diffusion) and cognitive testing acquired at 12-year. Measures were compared between APOE4 carriers and non-carriers, and associations between multimodal variables were examined using correlation and multivariate network analyses within each group. A total of 156 BPRHS participants (mean age at imaging = 68 years, 77% female, mean follow-up 12.7 years) with complete multimodal data were included in the current analysis. APOE4 carriers (n = 43) showed reduced medial temporal lobe (MTL) white matter (WM) microstructural integrity and lower mini-mental state examination (MMSE) score than non-carriers (n = 113). This pattern was consistent with an independent sample from the Alzheimer's Disease Neuroimaging Initiative (ADNI) of n = 283 non-Hispanic White adults without dementia (mean age = 75, 40% female). Within BPRHS, carriers showed distinct connectivity patterns between multimodal biomarkers, characterized by stronger direct network connections between baseline diet/blood markers with 12-year blood/clinical measures, and between blood markers (especially lipids and cytokines) and WM. Cardiovascular burden (i.e., hypertension and diabetes status) was associated with WM integrity for both carriers and non-carriers. APOE4 carrier status affects interactions between dietary factors, multimodal blood biomarkers, and MTL WM integrity across ~12 years of follow-up, which may reflect increased peripheral-central systems crosstalk following blood-brain barrier breakdown in carriers.

Abstract 13302: Associations of Allostatic Load With Brain Macro-Morphology, Subclinical Cerebrovascular Disease, and Microstructural Integrity of White Matter Pathways: The Boston Puerto Rican Health Study

Introduction: Allostatic load (AL), a measure of overall body wear and tear, has been associated with structural and functional alterations of the brain, but the evidence remains scarce. We aimed to evaluate the prospective associations of AL with brain MRI measures in the Boston Puerto Rican Health Study (BPRHS). Research Questions: Whether AL is associated with 1) brain macro-morphology: brain age and volumes, 2) subclinical cerebrovascular disease: white matter hyperintensity (WMH) and brain infarcts, and 3) microstructural integrity of white matter (WM) pathways in Puerto Rican adults. Methods: Adults from the BPRHS cohort who provided blood and urine samples at baseline, 2-y, and 6-y visits and underwent MRI scans at 13-y visit were included in analyses (n=226). AL was evaluated as a composite score (0-11) of 11 physiological parameters in five body systems. An overall AL score was calculated by averaging the scores of the baseline, 2-y, and 6-y visits, with higher scores indicating greater dysregulation. We evaluated brain age and volumes using T1-weighted MRI, WMH and brain infarcts using T2-weighted MRI, and microstructural integrity of WM pathways using diffusion tensor imaging. Multivariable logistic regression models were used to examine the associations between AL and brain infarcts, and linear regression models were used for other MRI outcomes. Results: Mean age at baseline was 54.6 ± 6.6 y, with 79.2% female. Higher AL was associated with higher brain age z scores (β = 0.129, P = 0.031) and lower volumes of total WM, cerebral WM (especially parietal and temporal lobes), cerebellum, and brain stem. Higher AL was also associated with higher grades of WMH (β = 0.207, P = 0.024) and higher odds of small vessel infarcts [OR (95% CI) = 3.50 (1.56-7.87), P = 0.002], but not large vessel infarcts [OR (95% CI) = 1.33 (0.73-2.40), P = 0.348]. Diffusion tensor imaging parameters showed that participants with higher AL had more microstructural deterioration patterns in major WM pathways. Conclusions: Higher AL score was associated with brain macro- and microstructural disruptions and a higher risk of subclinical cerebrovascular disease, suggesting that AL may be a potential indicator of the need for early intervention in preventing neuronal damage in older adults.

Sociocultural factors associated with persistent prescription opioid use (PPOU) among Puerto Rican adults in Massachusetts.

Increasing numbers of opioid-overdose deaths have been witnessed among Hispanics and other underserved populations in Massachusetts. Puerto Rican adults (PRs) have a disproportionately higher prevalence of chronic diseases than non-Hispanic White adults-conditions linked to increased prescription opioid use and misuse. Stress indicators, including low acculturation, low social support, and perceived discrimination, have been recognized as correlates of chronic diseases. However, little research has been undertaken on how these socio-cultural factors relate to persistent prescription opioid use among PRs. This study evaluated the prevalence of prescription opioid use and socio-cultural factors associated with persistent prescription opioid use among PRs. Data from the prospective population-based Boston Puerto Rican Health Study, at baseline, ~2-year, and ~ 6-year follow-up, were used to estimate prescription opioid use prevalence and its associations with acculturation, social support, and perceived discrimination. Analyses were conducted using multivariable binary logistic regression modeling. The study sample was comprised of 798 PRs (age 56.5 ± 7.5y) with data at all three-time points. A high prevalence of prescription opioid use was observed and was associated with lower household income. PRs with experiences of perceived discrimination had higher odds of persistent prescription opioid use (y/n; OR = 2.85, 95% CI: 1.46-5.58). No significant associations were found between acculturation, social support, and persistent prescription opioid use. Our study reported a high prevalence of prescription opioid use in PRs, with persistent prescription opioid use significantly associated with perceived discrimination. Future programs to limit discrimination practices may reduce persistent prescription opioid use and opioid-related complications among PRs.

P03-014-23 Differences in Gut Microbiome Composition by Bowel Movement Frequency and Proton Pump Inhibitor Use: The Boston Puerto Rican Health Study

P03-014-23 Differences in Gut Microbiome Composition by Bowel Movement Frequency and Proton Pump Inhibitor Use: The Boston Puerto Rican Health Study

P29-031-23 Dietary and Lifestyle Inflammation Scores: The Boston Puerto Rican Health Study

P29-031-23 Dietary and Lifestyle Inflammation Scores: The Boston Puerto Rican Health Study

P19-030-23 Associations of Dairy Foods and Cardiometabolic Markers Differ by Food Type, Fat Content and Dietary Pattern: The Boston Puerto Rican Health Study

P19-030-23 Associations of Dairy Foods and Cardiometabolic Markers Differ by Food Type, Fat Content and Dietary Pattern: The Boston Puerto Rican Health Study

Longitudinal Associations Between Sleep and Cognitive Function in a Cohort of Older Puerto Rican Adults: Sex and Age Interactions.

Evidence on sleep duration or quality and cognitive function in diverse older adults is limited. We examined prospective associations between subjective sleep measures and cognitive function, with modifying effects of sex and age (<65 vs ≥65 years). Data are from the longitudinal Boston Puerto Rican Health Study, Waves 2 (n = 943) and 4 (n = 444), with mean follow-up of 10.5 years (range 7.2-12.8). Subjective measures of sleep duration (short <7, ref. 7, or long ≥8 hours) and insomnia symptoms (sum of difficulty falling asleep, waking up at night, and early morning awakening), were assessed at Wave 2. Linear regression models were used to assess changes in global cognition, executive function, memory, and Mini-Mental State Examination, and tested for modifying roles of sex and age. Significant 3-way interaction (sex × age × cognition) in fully adjusted models showed greater decline in global cognitive function in older men with short (β [95% confidence interval]: -0.67 [-1.24, -0.10]) or long sleep duration (-0.92 [-1.55, -0.30]), compared to women, younger men, and older men with 7 hours of sleep. Insomnia symptoms were associated with a greater decline in memory (-0.54, [-0.85, -0.22]) among older men, compared to women and younger men. Sleep duration showed a U-shaped association with cognitive decline, and insomnia symptoms were associated with memory decline in fully adjusted models. Older men, versus women and younger men, were at relatively greater risk for cognitive decline associated with sleep factors. These findings are important for personalizing sleep interventions to support cognitive health.

Association between Acid-Lowering Agents, Metformin, and Vitamin B12 among Boston-Area Puerto Ricans

BackgroundVitamin B12 involves several physiological functions, and malabsorption is reported with medication use. ObjectivesStudies have reported an inverse association between the use of metformin or acid-lowering agents (ALAs), such as proton pump inhibitors, histamine 2 receptor antagonists, and blood vitamin B12 concentration, because of malabsorption. The concomitant use of these medications is underreported. We sought to examine these associations in a cohort of Boston-area Puerto Rican adults. MethodsThis analysis was conducted within the Boston Puerto Rican Health Study (BPRHS), an ongoing longitudinal cohort that enrolled 1499 Puerto Rican adults aged 45–75 y at baseline. Our study comprised 1428, 1155, and 782 participants at baseline, wave2 (2.2 y from baseline), and wave3 (6.2 y from baseline), respectively. Covariate-adjusted linear and logistic regression was used to examine the association between baseline medication use and vitamin B12 concentration or deficiency (vitamin B12 <148 pmol/L or methylmalonic acid >271 nmol/L), and long-term medication use (continuous use for ∼6.2 y) and wave3 vitamin B12 concentration and deficiency. Sensitivity analyses were done to examine these associations in vitamin B12 supplement users. ResultsAt baseline, we observed an association between metformin use (β = –0.069; P = 0.03) and concomitant ALA and metformin use (β = –0.112; P = 0.02) and vitamin B12 concentration, but not a deficiency. We did not observe associations between ALA, proton pump inhibitors, or histamine 2 receptor antagonists, individually, with vitamin B12 concentration or deficiency. ConclusionsThese results suggest an inverse relationship between metformin, concomitant ALA, metformin use, and serum vitamin B12 concentration.

The Longitudinal Impact of the SARS-CoV-2 Pandemic on Participants From the Boston Puerto Rican Health Study

to investigate the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on older Hispanic adults. A total of 522 participants (or their family member, if deceased) from the Boston Puerto Rican Health Study were asked whether they had been diagnosed with SARS-CoV-2, across 2 survey phases. In phase 1 (May - Aug 2020, n=497), participants answered survey questions related to SARS-CoV-2 exposure, diagnosis, and transmission and 5 family members reported deaths. In phase 2, participants were again surveyed (January - June 2021; n=420, and 2 family members reported deaths). SARS-CoV-2 diagnosis and/or death apparently from SARS-CoV-2 was self-reported. In 2020, 5.2% reported that they had been SARS-CoV-2 positive; by June 2021, a cumulative 11.0% reported having been SARS-CoV-2 positive (including cases and deaths in the first survey). A total of 7 participants (1.3%) reportedly died from SARS-CoV-2. Language acculturation was significantly lower among participants with SARS-CoV-2 (13.7 ± 17.9) vs. without SARS-CoV-2 (20.0 ± 21.4; P = 0.049). Mean length of return to usual health was 28 ± 38 days (range: 0-210 days; median = 15 days). Depressive symptomatology was significantly lower during the pandemic (CES-D score: 13.4 ± 11.6) compared to the same participants pre-pandemic (17.8 ± 11.7; P = 0.001). Compared to the months before the pandemic, 32% (n=135) of participants reported greater communication with friends and family, and 41% (n=172) reported no change. Public health models should be personalized to communities, considering their unique structures and cultural beliefs. Social resiliency may be key for future programmatic responses to pandemics to reduce the mental health burden.

Abstract P211: Associations of the Mediterranean and MIND Diets With Brain Volume in the Boston Puerto Rican Health Study

Objectives: Although few studies are available, some evidence suggests that greater adherence to the MeD (Mediterranean Diet) and MIND (Mediterranean-Dietary Approaches to Reduce Hypertension Intervention for Neurocognitive Delay) dietary patterns may benefit cognitive function among Hispanic/Latino adults. Greater regional and total brain volumetric measures are associated with an increased risk of dementia, but whether the MeD and MIND dietary patterns relate to brain volume among Hispanic/Latino adults remains unclear. The objective of the current study was to quantify the associations of these dietary patterns with brain volume among Hispanic/Latino adults. Methods: Data are from the Boston Puerto Rican Health Study, which recruited 1500 older Puerto Rican adults residing in the Boston Metro Area. Approximately 13 years from baseline, a subsample of participants (n=240) were invited to a follow-up visit where brain scans were conducted using a 3T MRI scanner. Diet was estimated using the mean intake from a validated food frequency questionnaire administered at baseline, ~2, and ~6 years. The MeD score has 6 adequacy and 3 moderation components, whereas MIND has 10 and 5 components, respectively. Component scores were summed to get a total dietary score, where a higher value indicates greater adherence to the pattern. Total scores range from 0-9 for MeD and 0-15 for MIND. Outcomes included hippocampal, amygdalar, and total gray matter volumes. The residual method was used to adjust brain volumes for differences in intracranial volume and values were z score transformed prior to analyses. Multiple linear regression models were adjusted for age, sex, total energy, the time between the baseline and 13-year visits, education, physical activity, BMI, and smoking status. After exclusions for missing data, the sample size was n=225. Results: The mean age of the participants was 55±7 years and was primarily female [79%, (178 of 225)]. On average, the time between the baseline and MRI visits was 12.8±1.1 years. Higher MeD score was significantly associated with greater hippocampal [β (95% CI), 0.19 (0.053, 0.32), amygdalar [0.16 (0.03, 0.29)], and total grey matter volumes [0.14 (0.01, 0.26)] ( P &lt;0.05 for all). Similarly, positive associations were observed between the MIND score and hippocampal [0.18 (0.05, 0.31), amygdalar [0.14 (0.01, 0.27)], and total grey matter volumes [0.14 (0.01, 0.27)] ( P &lt;0.05 for all). Conclusion: Our findings suggest that the observed beneficial associations of the MeD and MIND dietary patterns with cognitive function among Hispanic/Latino adults, may in part be through impacts on regional and total brain volume. These results provide evidence that can inform tailored dietary recommendations and interventions targeting brain health among older Puerto Rican adults. Funding Sources: This study was supported by NIH grants R01AG055948, P50 HL105185, and P01 AG023394.

Editors' Note: Association of Diabetes and Hypertension With Brain Structural Integrity and Cognition in the Boston Puerto Rican Health Study Cohort.

In the research article entitled “Association of Diabetes and Hypertension With Brain Structural Integrity and Cognition in the Boston Puerto Rican Health Study Cohort,” Guan et al. reported that comorbid diabetes and hypertension is associated with a greater degree of brain structural disruptions than hypertension alone. Kawada commented that comorbid diabetes and hypertension was not associated with a greater degree of structural or functional impairment than diabetes or hypertension alone in a study by Newby et al. Koo and Guan responded that the relationship between diabetes and hypertension and brain structural integrity and cognition may vary across cohorts due to modification by social determinants of health. Kawada also noted that there is a bidirectional relationship between diabetes and dementia that should be considered when interpreting results of the study conducted by Guan et al., to which Koo and Guan replied that while they do not have data on β-amyloid and dementia for this cohort, this could be a future research direction. In the research article entitled “Association of Diabetes and Hypertension With Brain Structural Integrity and Cognition in the Boston Puerto Rican Health Study Cohort,” Guan et al. reported that comorbid diabetes and hypertension is associated with a greater degree of brain structural disruptions than hypertension alone. Kawada commented that comorbid diabetes and hypertension was not associated with a greater degree of structural or functional impairment than diabetes or hypertension alone in a study by Newby et al. Koo and Guan responded that the relationship between diabetes and hypertension and brain structural integrity and cognition may vary across cohorts due to modification by social determinants of health. Kawada also noted that there is a bidirectional relationship between diabetes and dementia that should be considered when interpreting results of the study conducted by Guan et al., to which Koo and Guan replied that while they do not have data on β-amyloid and dementia for this cohort, this could be a future research direction.

Reader Response: Association of Diabetes and Hypertension With Brain Structural Integrity and Cognition in the Boston Puerto Rican Health Study Cohort.

The research by Guan et al.1 reports that older patients with type 2 diabetes (T2D) and hypertension (HTN) comorbidity presented with increased brain structural change and advanced cognitive impairment. I have a few comments.