Associations Between Meal Program Participation and Protein Intake in People Over 65 (NHANES 2013-2018)

Protein plays a critical role in healthy aging. Little research exists regarding the association between meal program participation and protein consumption among individuals 65 and older. The objective of this research is to provide health professionals with a better understanding of how meal program participation through delivery services or congregate sites may relate to nutritional status. We analyzed cross-sectional data on 2845 individuals ≥65 years old who participated in the National Health and Nutrition Examination Survey (NHANES) during 2013-2018. Using linear regression models, we explored relationships between meal participation and covariates ( sex, race, marital status, income, and age) on protein intake. Protein intake did not differ significantly between individuals who participated in meal programs and those who did not. However, among individuals who answered whether or not they participated in meal programs, race was significantly associated with decreased protein intake. Non-Hispanic Blacks experienced a two-day average 8.82 grams lower [SE:1.48; p<.0001] that their white counterparts. Similarly, Hispanic/Latinos’ two-day protein average was 4.29 grams lower [SE:2.05; p=0.0426]. The association between earning an income of <$20,000 per year and protein intake was also statistically significant [β: -8.44. SE:2.4, p=0.0014]. Understanding protein intake among older adults who utilize meal programs is a gap in current literature. Results from this research may inform questions that health professionals should include in their assessments of older adults and provide guidance for nutrition policies and meal programs for people over 65.

Adapting the ADS Plus Program and Study for a Spanish Speaking Population

While Hispanic/Latinos are at increased risk for Alzheimer’s Disease, they are often cited as a “difficult-to-reach population” to engage in community-based research or clinical trials. One reason may be that many community-based supportive interventions for dementia caregivers are not adapted for Spanish-speaking populations. The purpose of this presentation is to describe the process of adapting the Adult Day Services Plus (ADS Plus) program for this population. In addition to translating ADS Plus into Spanish, staff, familiar with the program from four sites, which serve a predominantly Hispanic population, participated in a set of three focus groups that reviewed recruitment and intervention materials. Emerging themes included, Hispanic caregivers do not refer to themselves as caregivers but as the familial relationship (e.g. daughter, son, wife), and Hispanics often view research as a waste of resources. Future studies should consider these cultural elements towards caregiving in developing programs for Spanish-speaking dementia caregivers.

Demographic and sociocultural risk factors for adulthood weight gain in Hispanic/Latinos: results from the Hispanic Community Health Study / Study of Latinos (HCHS/SOL)

Background United States (US) Hispanic/Latinos experience a disproportionate burden of obesity, which may in part be related to demographic or sociocultural factors, including acculturation to an US diet or inactive lifestyle. Therefore, we sought to describe the association between adulthood weight histories and demographic and sociocultural factors in a large diverse community-based cohort of US Hispanic/Latinos. Methods We estimated the effect of several factors on weight gain across adulthood, using multivariable linear mixed models to leverage 38,759 self-reported current body weights and weight histories recalled for 21, 45 and 65 years of age, from 15,203 adults at least 21 years of age at the baseline visit of the Hispanic Community Health Study/Study of Latinos (2008–2011). Results The average rate of weight gain was nearly 10 kg per decade in early adulthood, but slowed to < 5 kg a decade among individuals 60+ years of age. Birth cohort, gender, nativity or age at immigration, Hispanic/Latino background, and study site each significantly modified the form of the predicted adulthood weight trajectory. Among immigrants, weight gain during the 5 years post-migration was on average 0.88 kg (95% CI: 0.04, 1.72) greater than the weight gain during the 5 years prior. The rate of weight gain appeared to slow after 15 years post-migration. Conclusions Using self-reported and weight history data in a diverse sample of US Hispanic/Latinos, we revealed that both demographic and sociocultural factors were associated with the patterning of adulthood weight gain in this sample. Given the steep rate of weight gain in this population and the fact that many Hispanic/Latinos living in the US immigrated as adults, efforts to promote weight maintenance across the life course, including after immigration, should be a top priority for promoting Hispanic/Latino health and addressing US health disparities more broadly.

Phenotypes of Obstructive Sleep Apnea in the Hispanic Community Health Study/Study of Latinos

Study Objectives Recent work on US Whites from clinical samples used obstructive sleep apnea (OSA) symptoms to generate phenotypes for individuals with moderate-severe OSA which suggested 3 to 5 symptom classes. However, it is unknown whether similar classes generalize to diverse Hispanics/Latino adults. Therefore, we sought to fill this gap by empirically deriving sleep phenotypes among a large sample of diverse Hispanics/Latinos. Methods We used data from The Hispanic Community Health Study/Study of Latinos (HCHS/SOL; 2008-2011), a prospective cohort study designed using a multisite multistage probability sample of adults 18-74 years old. The subpopulation of interest included participants with moderate-severe OSA symptoms (≥15 respiratory event index (REI) events per hour; n=1,605). We performed latent class analysis for complex survey data using 15 common OSA symptoms (e.g. Epworth Sleepiness Scale) and four comorbidities to identify phenotype classes. Results Average age was 52.4 ± 13.9 years and 34.0% were female. Mean respiratory event index was 33.8 ± 22.5 events per hour. Fit statistics and clinical significance suggested that a three-class solution provided best fit to the data. The three phenotypes were: 1) Minimally Symptomatic (47.7%), 2) Excessive sleepiness (37.1%), and (3) Disturbed Sleep (15.2%). Sensitivity models were consistent with main proposed solution. Conclusions Derived sleep phenotypes among diverse Hispanic/Latinos were consistent with recent findings from the Sleep Apnea Global Interdisciplinary Consortium, but we found notable differences in class prevalence relative to Whites. Further research is needed to link derived sleep phenotypes to health comorbidities in diverse populations.

Using a daily diary approach to examine the early effects of COVID-19 on daily physical activity bouts and contexts among residents of Colorado and California

COVID-19 restrictions may prevent adults from achieving sufficient physical activity (PA) and may affect PA context. This study examined the early effects of COVID-19 on daily PA bouts and contexts during April–June 2020 using a daily diary approach. Adults (N = 390) completed daily diary surveys for 28 days assessing number of PA bouts and social (e.g., alone), locational (i.e., home, neighborhood, recreational space), and technology (e.g., using streaming videos) contexts of PA. Mixed-effects models examined the effects of days since the pandemic started (on 3/13/2020), state residence, and demographics on number of daily PA bouts. Models examined demographic and temporal effects on PA context. Participants were 18–77 years, 15% Hispanic/Latino, and 80% female. PA bouts per day decreased significantly over time among Californians versus Coloradans (bsimple = −0.01, p &lt; .001) and Hispanics/Latinos (vs. non-Hispanic Latinos) did fewer PA bouts per day (b = −0.17, p = .04). Most PA bouts occurred while alone (56.7%), at home (43.4%), or in any neighborhood (40.5%). Older (60+ years) versus younger (&lt;40 years) adults were less likely to do PA with others (odds ratio [OR] = 0.40, 95% confidence interval [CI]: 0.18–0.90). PA bouts in recreational spaces were more common on weekends versus weekdays (OR = 1.59, 95% CI: 1.32–1.92) and were less common among California versus Colorado residents (OR = 0.23, 95% CI: 0.12–0.42). PA bouts decreased from April to June 2020, and these changes disparately affected subgroups. Resources are needed to counteract the negative effects of COVID-19 restrictions intended to slow disease spread on PA.

Who identifies as “Latinx”? An examination of the determinants of the use of Latinx among Hispanic-Latinos in the United States

“Latinx”—a gender neutral variation of “Latino/a”—is increasingly used to describe the Latin American diaspora. Despite expanded use of the term, the 2019 National Survey of Latinos found that just 3% of Hispanic-Latinos have ever used “Latinx” to describe themselves. Drawing on these data, we address three interrelated questions: 1) what factors explain Hispanic-Latinos having heard of the term? 2) What factors are associated with having ever used the term to identify oneself? 3) What explains individuals believing the term should be used to describe the Hispanic-Latino population? We find that sharing a sense of linked fate with other Hispanic-Latinos, greater discrimination experiences, Democratic partisan affiliation, being younger, and having at least some college experience all increase the likelihood of respondents exhibiting greater awareness of the term. However, having ever used Latinx to identify oneself is only associated with personal experiences of discrimination, identifying as Afro-Latino, and being female. Believing the term should be used as a panethnic label is associated with the same factors as those that explain awareness of the term, with the exception of greater education. These findings suggest that while university and college campuses may represent critical sites for raising awareness of the term, this knowledge is not necessarily leading to its active use.

Common genetic variants associated with obesity in an African-American and Hispanic/Latino population

Introduction Over 35% of all adults in the world are currently obese and risk of obesity in racial or ethnic minority groups exist in the US, but the causes of these differences are not all known. As obesity is a leading cause of cardiovascular disease, an improved understanding of risk factors across racial and ethnic groups may improve outcomes. Objective The objective of this study was to determine if susceptibility to obesity is associated with genetic variation in candidate single nucleotide polymorphisms (SNPs) in African Americans and Hispanic/Latinos. Materials and methods We examined data from 534 African Americans and 557 Hispanic/Latinos participants from the UIC Cohort of Patients, Family and Friends. Participants were genotyped for the top 26 obesity-associated SNPs within FTO, MC4R, TUB, APOA2, APOA5, ADIPOQ, ARL15, CDH13, KNG1, LEPR, leptin, and SCG3 genes. Results The mean (SD) age of participants was 49±13 years, 55% were female, and mean body mass index (BMI) was 31±7.5 kg/m2. After adjusting for age and sex, we found that rs8050136 in FTO (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.1–1.8; P = 0.01) among African Americans and rs2272383 in TUB (OR 1.34, 95% CI 1.04–1.71; P = 0.02) among Hispanic/Latinos were associated with obesity. However, none of the SNPs in multivariable analysis of either AA or H/L cohorts were significant when adjusted for multiple correction. Conclusions We show that candidate SNPs in the FTO and TUB genes are associated with obesity in African Americans and Hispanic/Latinos individuals respectively. While the underlying pathophysiological mechanisms by which common genetic variants cause obesity remain unclear, we have identified novel therapeutic targets across racial and ethnic groups.

Survival advantage of Asian metastatic prostate cancer patients treated with external beam radiotherapy over other races/ethnicities

Purpose To assess the effect of race/ethnicity in cancer-specific mortality (CSM) adjusted for other-cause mortality (OCM) in metastatic prostate cancer patients (mPCa) treated with external beam radiotherapy (EBRT) to the prostate. Methods We relied on the Surveillance, Epidemiology, and End Results (SEER) database to identify Caucasian, African-American, Hispanic/Latino and Asian mPCa patients treated by EBRT between 2004 and 2016. Cumulative incidence plots displayed CSM after adjustment for OCM according to race/ethnicity. Propensity score matching accounted for patient age, prostate-specific antigen, clinical T and N stages, Gleason Grade Groups and M1 substages. OCM adjusted multivariable analyses tested for differences in CSM in African-Americans, Hispanic/Latinos and Asians relative to Cauacasians. Results After 3:1 propensity score matching and OCM adjustment, Asians exhibited lower CSM at 60 and 120 months (48.2 and 60.0%, respectively) compared to Caucasians (66.7 and 79.4%, respectively, p < 0.001). In OCM adjusted multivariable analyses, Asian race/ethnicity was associated with lower CSM (HR 0.66, CI 0.52–0.83, p < 0.001). Conversely, African-American and Hispanic/Latino race/ethnicity did not affect CSM. OCM rates were comparable between examined races/ethnicities. Conclusion In the setting of mPCa treated with EBRT, Asians exhibit lower CSM than Caucasians, African-Americans and Hispanic/Latinos. This observation may warrant consideration in prognostic stratification schemes for newly diagnosed mPCa patients.

Disparities in Early-Onset Colorectal Cancer

The incidence and mortality of early-onset colorectal cancer (CRC) are increasing in the United States (US) and worldwide. In the US, there are notable disparities in early-onset CRC burden by race/ethnicity and geography. African Americans, Hispanic/Latinos, and populations residing in specific regions of the Southern U.S. are disproportionately affected with CRC diagnosed at younger ages, while less is known about disparities in other countries. Reasons for these disparities are likely multi-factorial and potentially implicate differences in health determinants including biology/genetics, diet/environment, individual health behaviors, and access to high-quality health services, as well as social and policy factors. This review summarizes current understanding of early-onset CRC disparities and identifies specific research areas that will inform evidence-based interventions at individual, practice, and policy levels to reduce the global burden of this disease.