Cultural and Lifestyle Determinants of Mexican American Adolescents’

Risk for Metabolic Syndrome

Rafael E. Ruiz, ScMDeborah E. Bender, PhD, MPH

Shoou-Yih D. Lee, PhD

Michelle Mayer, PhD, RN, MPH

This research was partially supported by a National Research Service Award (NRSA) Pre-doctoral Traineeship from AHRQ sponsored by the Cecil G. Sheps Center for Health Services

Research, University of North Carolina at Chapel Hill, Grant No. T32-HS000032

Introduction

“Latino/Hispanic” is used by CDC to generically describe Spanish speaking individuals The Latino population is young The majority are of Mexican descent

(~60%) and growing rapidly Acculturation is a socio-cultural

construct that captures the degree which a person integrates the social values, beliefs, and lifestyle of

the dominant culture

Introduction

Overweight and type-2 diabetes have both increased in adolescents

Metabolic syndrome affects adults (22%) and adolescents (4.2%)

Mexican Americans have been shown to have higher rates of metabolic syndrome

Conceptual Model

Type-2 Diabetes

CVD

MetabolicSyndrome

Overweight

Physical Activity

Diet

Acculturation

Specific Aims

1) Determine if metabolic syndrome, physical activity, and diet differ among racial/ethnic groups

2) Explore the association of physical activity and diet with metabolic syndrome

3) Examine the association of acculturation with metabolic syndrome, physical activity, and diet in Mexican Americans

Data

National Health and Nutrition Examination Survey (NHANES) 1999-2002 Pooled cross-section

Analytic dataset restrictions (N=2,002) adolescents, 12-19 years of age, with a

fasting plasma glucose level not taking insulin, oral hypoglycemic

agents, and not pregnant

Variables

In adolescents, three or more of the following traits define metabolic syndrome

Criterion Measurement

Elevated triglycerides 110 mg/dl

Low HDL 40 mg/dl

Increased waist circumference

90th percentile (cm)

Elevated fasting glucose 110 mg/dl

Elevated blood pressure 90th percentile (mm Hg)

Cook S, et al. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med 2003 Sep;157(8):821-827

Variables

Primary language was used to measure acculturation

read or spoken used as a child usually spoken at home usually used to think usually spoken with friends

Physical activity Discrete: None vs. any Continuous: Number, frequency,

duration, and intensity

Variables

Dietary measures Variability: number of foods eaten/day Frequency of eating out: number of

restaurants meals/wk Energy: total calories consumed Total macronutrients: protein (gm),

sugars (gm), cholesterol (mg), and fat (gm)

Statistical Methods

Bivariate associations Multivariate analysis

Logistic regression Dependent variable: having metabolic

syndrome Independent variable of interest: acculturation

OLS regression Dependent variables: Physical activity and

dietary measures Independent variable of interest:

acculturation

Prevalence of Metabolic Syndrome

Prevalence of metabolic syndrome was 4.8% Inactive (8.9%*) vs.

active (4.1%) Low variability in diet

(8.9%*) vs. higher variability (4.1%)

Males (6.6%*) vs. females (2.9%)

Overweight (25%**) vs. not-overweight (0.5%)

Metabolic syndrome traits in US adolescents with metabolic syndrome

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

ElevatedTriglycerides

Low HDL AbdominalAdiposity

ElevatedFastingPlasmaGlucose

ElevatedBlood

Pressure

Metabolic Syndrome Traits

Per

cent

of

Subj

ects

*-significant at 5% level, **-significant at 1% level

Differences among groups

Prevalence of metabolic syndrome in US adolescents by race/ ethnicity

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

Mexican American Caucasian African American

Race/ Ethnicity

Perc

ent o

f Sub

ject

s

Mexican Americans were more likely to... be inactive (19%*)

vs. non-Latinos (14%)

Be overweight (22%*) vs. non-Latinos (17%)

Mexican American males (25%*) were more likely than females (18%) to be overweight

*

*-significant at 5% level

Associations with metabolic syndrome

Inactivity increases risk of metabolic syndrome

(OR: 4.68, CI: 1.83-11.93) Greater dietary variability decreases

risk of metabolic syndrome (OR: 0.85, CI: 0.73-0.98) Acculturation does not directly

affect metabolic syndrome (OR: 1.52, CI: 0.78-2.97)

Acculturation, physical activity, diet

Higher levels of acculturation decrease inactivity [OR-0.65 (0.48-0.88)]

Higher levels of acculturation increase # of physical activities (+0.41/month**) energy (137 kcal/day*) carbohydrates (+25 gm/day**) saturated fat (+2 gm/day*) # of times at restaurant food (+0.3

times/week*)

Summary

Mexican American males are the most likely to develop metabolic syndrome Higher likelihood of overweight, less physical

activity, and fewer types of foods eaten

A higher level of acculturation increases overweight increases intake of calories, carbohydrates,

saturated fat, and more meals eaten outside the home

increases physical activity, BUT it seems to be a weak effect

Significance

Acculturation and metabolic syndrome have an indirect association It is a risk factor in Mexican American

adolescents Underscores the importance of

reducing adolescent overweight increasing physical activity promoting healthy dietary options

Considerations

There is no consensus on how to define metabolic syndrome in adolescents operationalize acculturation

Time in the U.S. was not a component of acculturation Primary language spoken has been shown to

be a good indicator of acculturation Language skills are acquired over time so they

are linked to the time spent in the U.S.