Supplemental Material can be found at: http://jn.nutrition.org/content/suppl/2015/05/06/jn.114.20639 1.DCSupplemental.html
The Journal of Nutrition Nutritional Epidemiology
A Healthy Lifestyle Score Is Associated with Cardiometabolic and Neuroendocrine Risk Factors among Puerto Rican Adults1–3 Mercedes Sotos-Prieto,4 Shilpa N Bhupathiraju,4 Luis M Falcon, ´ 5,6 Xiang Gao,8 Katherine L Tucker,5,7 4 and Josiemer Mattei * 4 Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; 5Center for Population Health and Health Disparities, 6College of Fine Arts, Humanities, and Social Sciences, and 7Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts, Lowell, MA; and 8Department of Nutritional Sciences, The Pennsylvania State University, State College, PA
Downloaded from jn.nutrition.org at CALIFORNIA STATE UNIV-FRESNO on July 15, 2015
Abstract Background: Although individual healthy lifestyle behaviors may reduce cardiovascular disease risk, few studies have analyzed the combined effect of multiple lifestyle components as one all-inclusive measure on such outcomes, much less in minority populations. Objective: We aimed to develop a Healthy Lifestyle Score (HLS) that included several lifestyle recommendations and to test its association with metabolic syndrome (MetS) and allostatic load (AL) and their cardiometabolic and neuroendocrine factors in Puerto Ricans. Methods: In a cross-sectional study in 787 Puerto Ricans living in Boston (aged 45–75 y), we developed an HLS that ranged from 0 to 190 (higher score indicative of healthier lifestyle) and included 5 components (diet, physical activity and sedentary behaviors, smoking, social support and network, and sleep). Multivariable-adjusted models were used to test associations between the HLS and biomarkers of dysregulation and odds of MetS and high AL ($4 out of 10 components). Results: The HLS showed adequate internal consistency (r = 0.31–0.69) and was inversely associated with urinary cortisol (b 6 SE = 20.22 6 0.11; P = 0.042), epinephrine (20.20 6 0.09; P = 0.017), and norepinephrine (20.26 6 0.11; P = 0.016); waist circumference (20.014 6 0.004; P = 0.003); and serum insulin (20.30 6 0.13; P = 0.028) and positively associated with plasma HDL cholesterol (0.007 6 0.003; P = 0.021) after adjustment for potential confounders. For each 20-unit increase in HLS, participants had 19% (95% CI: 2%, 33%) and 25% (11%, 36%) lower odds of MetS or AL, respectively. Healthier scores for social support and network and smoking components were associated with lower odds of high AL (P < 0.005). No significant associations were observed for other individual lifestyle components. Conclusions: Following an overall healthy lifestyle that comprises a combination of multiple behaviors may provide stronger protection against MetS and AL in Puerto Rican adults than individual components. The HLS may be a useful tool for examining health-related outcomes. This trial was registered at clinicaltrials.gov as NCT01231958. J Nutr 2015;145:1531–40.
Keywords:
lifestyle score, metabolic syndrome, allostatic load, lifestyle recommendations, Hispanics
Introduction Strong evidence exists for the role of healthy diet, physical activity, and smoking cessation to prevent cardiometabolic risk 1 Supported by NIH grants P01-AG023394, P50-HL105185, R01-AG027087, and ´ K01-HL120951. MS-P was supported by a research fellowship from Fundacion Alfonso Mart´ın Escudero (FAME), Spain. 2 ´ X Gao, KL Author disclosures: M Sotos-Prieto, SN Bhupathiraju, LM Falcon, Tucker, and J. Mattei, no conflicts of interest. 3 Supplemental Tables 1 and 2 are available from the ‘‘Online Supporting Material’’ link in the online posting of the article and from the same link in the online table of contents at http://jn.nutrition.org. * To whom correspondence should be addressed. E-mail: [email protected]. edu.
traits, including components of metabolic syndrome (MetS)9 (1–4), with further evidence of their effect on neuroendocrine markers of physiologic dysregulation or allostatic load (AL) (5– 8). In response, several agencies have put forth guidelines or recommendations for those behaviors to help the general population prevent cardiovascular disease (CVD) and related
9 Abbreviations used: ADLS, Activities of Daily Living Score; AL, allostatic load; BP, blood pressure; BPRHS, Boston Puerto Rican Health Study; CVD, cardiovascular disease; DHEA-S, dehydroepiandrosterone sulfate; Hb A1c, glycated hemoglobin; HLS, Healthy Lifestyle Score; MetS, metabolic syndrome; WC, waist circumference.
ã 2015 American Society for Nutrition. Manuscript received October 29, 2014. Initial review completed December 23, 2014. Revision accepted April 6, 2015. First published online May 6, 2015; doi:10.3945/jn.114.206391.
1531
Methods Participants. The Boston Puerto Rican Health Study (BPRHS) is a longitudinal cohort (baseline, 2- and 5-y follow-ups) with 1500 Puerto Rican adults from the greater Boston area (trial registry NCT01231958). For this analysis, baseline data were used except for sleeping information, which was collected in a subsequent ancillary study conducted close to the 2-y follow-up. The details on the design, methods, and recruitment strategies are described elsewhere (37). Briefly, baseline recruitment ran from 2004 to 2009 by using door-to-door enumeration based on the 2000 census with additional recruitment through community outreach and referrals. Eligible participants had to be able to answer interview questions in either English or Spanish, be of self-reported Puerto Rican descent, between the ages of 45 and 75 y, and living in the Boston area. Trained bilingual interviewers conducted all of the data collection. The study was approved by the Institutional Review Boards at Tufts Medical Center, Tufts University, and Northeastern University. Informed consent was obtained from all participants. Assessment of lifestyle behaviors. Dietary intake was assessed by using a semiquantitative FFQ specifically developed and validated for 1532
Sotos-Prieto et al.
this population (47). The FFQ included traditional Puerto Rican foods and was adjusted for usual portion sizes. Reported food intakes were converted into gram amounts. Food groups for fruit, vegetables, fish, and alcohol were created, and mixed dishes were disaggregated when necessary; intake amounts were added to the appropriate food group. Nutrient intakes were calculated from the Nutrition Data System for Research software (Nutrition Coordinating Center). For the current analyses, any participant from the entire study population reporting implausible energy intakes (#2510 or $20,083 kJ/d) or with invalid FFQs ($10 questions left blank) were excluded (n = 67). A comprehensive questionnaire asked participants about type and frequency of use of tobacco products. Smoking was categorized as never (
The Journal of Nutrition Nutritional Epidemiology
A Healthy Lifestyle Score Is Associated with Cardiometabolic and Neuroendocrine Risk Factors among Puerto Rican Adults1–3 Mercedes Sotos-Prieto,4 Shilpa N Bhupathiraju,4 Luis M Falcon, ´ 5,6 Xiang Gao,8 Katherine L Tucker,5,7 4 and Josiemer Mattei * 4 Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; 5Center for Population Health and Health Disparities, 6College of Fine Arts, Humanities, and Social Sciences, and 7Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts, Lowell, MA; and 8Department of Nutritional Sciences, The Pennsylvania State University, State College, PA
Downloaded from jn.nutrition.org at CALIFORNIA STATE UNIV-FRESNO on July 15, 2015
Abstract Background: Although individual healthy lifestyle behaviors may reduce cardiovascular disease risk, few studies have analyzed the combined effect of multiple lifestyle components as one all-inclusive measure on such outcomes, much less in minority populations. Objective: We aimed to develop a Healthy Lifestyle Score (HLS) that included several lifestyle recommendations and to test its association with metabolic syndrome (MetS) and allostatic load (AL) and their cardiometabolic and neuroendocrine factors in Puerto Ricans. Methods: In a cross-sectional study in 787 Puerto Ricans living in Boston (aged 45–75 y), we developed an HLS that ranged from 0 to 190 (higher score indicative of healthier lifestyle) and included 5 components (diet, physical activity and sedentary behaviors, smoking, social support and network, and sleep). Multivariable-adjusted models were used to test associations between the HLS and biomarkers of dysregulation and odds of MetS and high AL ($4 out of 10 components). Results: The HLS showed adequate internal consistency (r = 0.31–0.69) and was inversely associated with urinary cortisol (b 6 SE = 20.22 6 0.11; P = 0.042), epinephrine (20.20 6 0.09; P = 0.017), and norepinephrine (20.26 6 0.11; P = 0.016); waist circumference (20.014 6 0.004; P = 0.003); and serum insulin (20.30 6 0.13; P = 0.028) and positively associated with plasma HDL cholesterol (0.007 6 0.003; P = 0.021) after adjustment for potential confounders. For each 20-unit increase in HLS, participants had 19% (95% CI: 2%, 33%) and 25% (11%, 36%) lower odds of MetS or AL, respectively. Healthier scores for social support and network and smoking components were associated with lower odds of high AL (P < 0.005). No significant associations were observed for other individual lifestyle components. Conclusions: Following an overall healthy lifestyle that comprises a combination of multiple behaviors may provide stronger protection against MetS and AL in Puerto Rican adults than individual components. The HLS may be a useful tool for examining health-related outcomes. This trial was registered at clinicaltrials.gov as NCT01231958. J Nutr 2015;145:1531–40.
Keywords:
lifestyle score, metabolic syndrome, allostatic load, lifestyle recommendations, Hispanics
Introduction Strong evidence exists for the role of healthy diet, physical activity, and smoking cessation to prevent cardiometabolic risk 1 Supported by NIH grants P01-AG023394, P50-HL105185, R01-AG027087, and ´ K01-HL120951. MS-P was supported by a research fellowship from Fundacion Alfonso Mart´ın Escudero (FAME), Spain. 2 ´ X Gao, KL Author disclosures: M Sotos-Prieto, SN Bhupathiraju, LM Falcon, Tucker, and J. Mattei, no conflicts of interest. 3 Supplemental Tables 1 and 2 are available from the ‘‘Online Supporting Material’’ link in the online posting of the article and from the same link in the online table of contents at http://jn.nutrition.org. * To whom correspondence should be addressed. E-mail: [email protected]. edu.
traits, including components of metabolic syndrome (MetS)9 (1–4), with further evidence of their effect on neuroendocrine markers of physiologic dysregulation or allostatic load (AL) (5– 8). In response, several agencies have put forth guidelines or recommendations for those behaviors to help the general population prevent cardiovascular disease (CVD) and related
9 Abbreviations used: ADLS, Activities of Daily Living Score; AL, allostatic load; BP, blood pressure; BPRHS, Boston Puerto Rican Health Study; CVD, cardiovascular disease; DHEA-S, dehydroepiandrosterone sulfate; Hb A1c, glycated hemoglobin; HLS, Healthy Lifestyle Score; MetS, metabolic syndrome; WC, waist circumference.
ã 2015 American Society for Nutrition. Manuscript received October 29, 2014. Initial review completed December 23, 2014. Revision accepted April 6, 2015. First published online May 6, 2015; doi:10.3945/jn.114.206391.
1531
Methods Participants. The Boston Puerto Rican Health Study (BPRHS) is a longitudinal cohort (baseline, 2- and 5-y follow-ups) with 1500 Puerto Rican adults from the greater Boston area (trial registry NCT01231958). For this analysis, baseline data were used except for sleeping information, which was collected in a subsequent ancillary study conducted close to the 2-y follow-up. The details on the design, methods, and recruitment strategies are described elsewhere (37). Briefly, baseline recruitment ran from 2004 to 2009 by using door-to-door enumeration based on the 2000 census with additional recruitment through community outreach and referrals. Eligible participants had to be able to answer interview questions in either English or Spanish, be of self-reported Puerto Rican descent, between the ages of 45 and 75 y, and living in the Boston area. Trained bilingual interviewers conducted all of the data collection. The study was approved by the Institutional Review Boards at Tufts Medical Center, Tufts University, and Northeastern University. Informed consent was obtained from all participants. Assessment of lifestyle behaviors. Dietary intake was assessed by using a semiquantitative FFQ specifically developed and validated for 1532
Sotos-Prieto et al.
this population (47). The FFQ included traditional Puerto Rican foods and was adjusted for usual portion sizes. Reported food intakes were converted into gram amounts. Food groups for fruit, vegetables, fish, and alcohol were created, and mixed dishes were disaggregated when necessary; intake amounts were added to the appropriate food group. Nutrient intakes were calculated from the Nutrition Data System for Research software (Nutrition Coordinating Center). For the current analyses, any participant from the entire study population reporting implausible energy intakes (#2510 or $20,083 kJ/d) or with invalid FFQs ($10 questions left blank) were excluded (n = 67). A comprehensive questionnaire asked participants about type and frequency of use of tobacco products. Smoking was categorized as never (
