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Purpose: This study examined the association of microalbuminuria (MAU), as determined by albumin-to-creatinine ratio (ACR), with hypertension (HTN) among Turkish immigrants with type 2 diabetes (T2D) living in deprived neighborhoods of The Hague, Netherlands. Methods: A total of 110 participants, physician-diagnosed with T2D, aged ≥ 30 years were recruited from multiple sources from The Hague, Netherlands in a cross-sectional design. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured using automated office blood pressure equipment. Urine albumin was measured by immunoturbidimetric assay. Urine creatinine was determined using the Jaffe method. MAU was defined as ACR ≥ 3.5 mg/mmol for females and/or ACR ≥ 2.5 mg/mmol for males. Results: MAU was present in 21% of Turkish immigrants with T2D. Adjusted logistic regression analysis indicated that the odds of having MAU were 6.6 times higher in hypertensive than those that were normotensive (p = 0.007; 95% confidence interval [CI]: 1.19, 36.4). Conclusion: These findings suggest that HTN and MAU may be assessed as a standard of care for T2D management for this population. Prospective studies of diabetes outcomes are recommended to further verify these findings.

Type 2 Diabetes mellitus (DM2) affects 9.3% of the U.S. population. Health disparities are evident in DM2, twice as many Hispanics as non-Hispanic Whites have DM2. The objective of this study was to pilot test the feasibility of implementing and evaluating trends of nutrition and exercise interventions to improve diabetes management and physical function in 29 disadvantaged older Hispanics with DM2. We delivered combined diet and exercise (n = 8) and diet-only (n = 6) interventions and compared the results to a control/no intervention group (n = 15). We cluster-randomized the participants into the three arms based on the senior center they attended. The interventions were delivered twice a week for 3 months (24 sessions) and assessments were conducted pre and post intervention. The results indicate the feasibility of implementing the interventions and slight improvements in both intervention groups compared to the control group. The diet-only group tended to have larger improvements on body composition measures (especially in muscle mass), while the diet + exercise group tended to have larger improvements on physical function (especially in chair stands). There was a high rate of attrition, especially in the diet + exercise group, but those who completed the intervention tended to have improvements in body composition and physical function.

OBJECTIVES: The prevalence of diet-related chronic diseases, such as obesity, hypertension and type 2 diabetes, among adults in the U.S. is of increasing import during the COVID-19 pandemic. These conditions are among the top risk factors associated with severe COVID-19 morbidity and mortality. The aim of this study was to assess the of diet-related diseases among a multi-racial/ethnic uninsured group in South Florida. METHODS: Electronic heath records of adult patients (N = 272) from a free clinic in South Florida, a 4-week pre COVID-19 pandemic de-identified dataset was analyzed. Presence of diet-related conditions for each patient was quantified. Numerical and categorical data were compared using independent t-test and Chi-Squared test, respectively. Spearman`s correlation, multi-linear regression, and binary regression models were used to assess the relationship between the variables. RESULTS: The sample included females (65%) and males (35%). The mean age was 49.08 ± 14.56 years. There were 26.5% Whites, 33.8% Blacks, 35.6% Asians/Asian-Indians, and 1.1% American Indians. About 24% were Hispanic/Latino. The mean BMI was 29.45 ± 6.76 kg/m² (n = 250). Overall, 87% of patients had at least one diet-related condition with overweight/obesity being the most observed (75.2%), followed by hypertension (39%), dyslipidemia (27.2%), and diabetes (23.9%). The inter-racial analysis revealed that BMI is a significant predictor of prevalence of hypertension among Whites (P = 0.008) and Blacks (P = 0.002), but not Asians/Asian-Indians (P = 0.536). BMI was a significant predictor of prevalence of dyslipidemia (P = 0.027) and type 2 diabetes (P = 0.006) among Hispanics/Latinos. Bivariate analysis showed a 70.8% co-incidence of hypertension and a 64.4% co-incidence of dyslipidemia among adults with type 2 diabetes. Co-incidence of hypertension among adults with dyslipidemia was at 73%. CONCLUSIONS: High rate of diet-related chronic diseases was found among the multi-ethnic group of uninsured adults in this study. This supports the need for increased patient-education regarding nutrition in free clinic settings. Nutrition programs tailored for low economic resources and culturally appropriate dietary recommendations could assist uninsured patients with management of their diet-related chronic diseases. FUNDING SOURCES: This research was supported by an NIH sub-award.

OBJECTIVES: To identify risk factors associated with the risk for overweight/obesity in preschool children ages 3 up to 5 years participating in the Broward County Special Supplementation Nutrition Program for Women, Infants, and Children (WIC). METHODS: Cross-sectional data were collected from all 7 Broward County Health Department WIC clinics over 4 months via a researcher-administered questionnaire. Additional data were extracted from the WIC data system. Children were classified into weight categories following the CDC's BMI-for-age percentiles, which were further combined into under/normal weight and overweight/obese. RESULTS: A total of 197 participants [90 boys (45.7%) and 107 girls (54.3%)] were included. From those, 68% were overweight/obese and 32% under/normal weight. Sugar sweetened beverage (SSB) intake was significantly greater in the overweight/obese group (7.45 ± 8.71 vs. 4.60 ± 6.64 oz/d, P = 0.024). Fruits were consumed daily by 67% of the children, and vegetables by 35%, with no significant association with weight category. Breakfast was skipped at least once/week by 16.5% of the children, independent of body weight. On average, children had 2.3 h/d of screen time and were physically active for 37.9 min/d. While screen time was not significantly different by weight category, children in the under/normal weight group were significantly more physically active when compared to their counterparts (41.9 ± 29.3 vs. 29.3 ± 27.0 min/d, P = 0.004). Only 15.2% of parents/guardians of overweight and 43.3% of obese children identified their child as being too big. Mean birth weight for overweight/obese children was significantly higher (7.41 ± 1.12 vs. 7.04 ± 1.17 lbs, P = 0.038). On a logistic regression model, SSB intake, physical activity, and birth weight were significant predictors of overweight/obesity. CONCLUSIONS: Physical activity was negatively correlated with the risk of overweight/obesity, while the intake of SSB and birth weight were positively correlated. In addition, most participants failed to perceive their overweight/obese child as such. This study points out important factors to be considered in obesity prevention interventions in this population. FUNDING SOURCES: AC was supported by a NIH/NIGMS R25 grant. The FIU Dietetics and Nutrition research foundation supported the study.

Objectives Snacks contribute to the diet quality in youth, which is often poor. Although the US Department of Agriculture (USDA) has guidelines for healthy snacks, this is lost in translation when youth are choosing snacks. To develop a user-friendly app to help identify healthy snacks based on the US Department of Agriculture guidelines and evaluate the app's feasibility, usability, satisfaction, and acceptability. Methods The ‘Snackability’ app was developed following the ADDIE (analysis, design, development, implementation, and evaluation) model. The app was pilot tested for 2 weeks among college-age students (18–24 years) using questionnaires and focus groups. Based on the feedback received, the app was improved, and pilot-tested again. Results The app had a simple score (−1 to 11) and feedback (the higher the score, the healthier the snack is). The 1st pilot test among 12 students showed that the app's feasibility and usability were >50% (p < 0.05). Participants reported that the app was a good way to help individuals select and consume healthy snacks and suggested improving the search process and including average score reports, a ‘consumed history’ tab, gamification, notifications, and the option to add snacks not found. These were incorporated into the 2nd version of the app, which was pilot tested among 8 students. Feasibility, usability, and acceptability of the 2nd version were >50% (p < 0.05). Additional suggestions were to include images for serving size, snack alternatives, and barcode scanning, which were incorporated into the 3rd version. Conclusions Snackability app was feasible, usable, satisfactory, and acceptable, and several features were improved as suggested by participants.

Objective: To assess the effectiveness of an eight-week nutrition and physical activity intervention, entitled: “My Healthy Habits”, at summer camps to prevent obesity, reduce screen time, promote healthy eating habits and physical activity among children. Material and Methods: Eight-week pretest-posttest: intervention versus a comparison group was conducted, in two comparable summer camps in Kuwait and randomized at the site level. Convenient sampling (n=79) included children aged 6-10, receiving 8 weeks of nutrition education: 2 days/week, 40 minutes/day and physical activity sessions: 4 days/week for 20 minutes/day. Outcomes included: the Modified Healthy Habits Survey (items about diet, physical activity and sedentary behavior) and anthropomorphic: Body mass index (BMI) for age and gender percentile and waist-to-height ratio (WHtR). Group changes were measured by independent t-test, and within group changes by the McNemar’s test (categorical data) and paired t-test (interval data). Results: Significant increases in nutrition knowledge scores (from 4.3±1.7 to 10.5±1.2) and in the total score of the major food groups (from 10.0±2.6 to 13.7±2.2) were observed from pretest to posttest. Healthy eating significantly increased (from 12.8±1.8 to 14.5±1.5) for the intervention group only; however, intake of French fries, chips (FF) and sugarsweetened beverages (SSB) remained the same for both groups. Physical activity increased and screen time decreased,only in the intervention group. The participants’ BMI and WHtR decreased significantly in the intervention group: p-value=0.001. Conclusion: Healthy food and physical activity increased, while screen time decreased. Consumption of unhealthy food (FF and SSB) remains an issue.

The purpose of this study was to present the challenges faced when implementing a diet and exercise intervention for low-income older Hispanics with type 2 diabetes with an observational study of recruitment, attendance, and characteristics of Hispanic adults with type 2 diabetes in a community congregate meal site pre and post administration of a diet and exercise intervention. This report evaluates retentions and diabetes self-management beliefs Hispanic adults ≥60 years with type 2 diabetes (n=17) at baseline, and completion of the six-month intervention in terms of the Health Belief Model. There was limited interest in controlling diabetes with diet and exercise. Major barriers included lack of perceived vulnerability to diabetes complications and a belief that medication alone is sufficient to stabilize blood glucose. Environmental barriers included lack of transportation, access to exercise groups, access grocery stores, and limited ability to pay for healthy foods. A lesson learned from this intervention was that the diet and exercise intervention given was insufficient as a cue to action for this population interventions to engage low-income, older Hispanics with diabetes in diet and exercise need to consider strategies to overcome barriers such as health beliefs, transportation issues, lack of access to nutritious food and group exercise classes.

OBJECTIVES: The adolescent period is crucial for optimizing future bone health because during these years bone accumulates rapidly accounting for up to half of adult peak bone mass (PBM). Calcium intake during this stage is critical for adequate bone mineralization but this essential nutrient, the major constituent of hydroxyapatite, is usually inadequate in the diets of US adolescents. A strategy to maximize bone mineralization is to increase calcium absorption. This could be achieved by soluble corn fiber (SCF) supplementation, which fermentation through bacteria in the lower intestine produces short-chain fatty acids and increase calcium absorption. However, there are no studies determining the long-term effects of SCF on bone mass in children. The main aim of the MetA-Bone Trial is to determine the effect of one-year SCF supplementation compared to placebo on bone mass in children with low habitual calcium intake. We hypothesize that SCF supplementation will result in a higher Bone Mineral Content. We will also determine the effects of SCF supplementation on bone biomarkers; we hypothesize that supplementation with SCF will result in higher levels of bone formation and lower bone resorption biomarkers. METHODS: A total of 240 healthy children (10–13 years), with usual low dietary calcium, will be randomized to four experimental groups for 1 year: (1) SCF (12 g/d); (2) SCF (12 g/d) + 600 mg/d of calcium; (3) Placebo (maltodextrin); and (4) Placebo + 600 mg/d of calcium. The supplements will be mixed with a flavored powder beverage to dilute in water and participants will be instructed to drink this twice per day. Bone mass will be measured using dual energy x-ray absorptiometry (DXA) at baseline, 6 and 12 months. Serum bone biomarkers will be measured at baseline and at 12 months. RESULTS: NA CONCLUSIONS: If supplementing diets with SCF lead to higher bone mass during adolescence, this could help achieve the genetic potential for PBM and to start adult life with stronger bones. Incorporating SCF into diets may be a cost-effective intervention for bone health than increasing dairy products consumption, particularly in adolescents. FUNDING SOURCES: Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health.

Calcium intake is critical for adequate bone mineralization in adolescence, but it is usually inadequate in US adolescents. A strategy to maximize bone mineralization is to increase calcium absorption, which could be achieved by soluble corn fiber (SCF). There are no studies determining the long-term effects of SCF on bone mass in children. Objectives To determine the effect of one-year SCF supplementation compared to placebo on bone mass and bone biomarkers in children with low habitual calcium intake. We hypothesize that SCF supplementation will result in a higher bone mineral content and higher levels of bone formation and lower bone resorption biomarkers. Methods 240 healthy children (10–13 years), with usual low calcium intake, will be randomized to four experimental groups for 1 year: (1) SCF (12 g/d); (2) SCF (12 g/d) + 600 mg/d of calcium; (3) Placebo (maltodextrin); and (4) Placebo +600 mg/d of calcium. The supplements have been pre-mixed with a flavored powder beverage and participants will only need to dilute it in water and drink this twice per day. Bone will be measured using dual energy x-ray absorptiometry (DXA) at baseline, 6 and 12 months. Serum bone biomarkers will be measured at baseline and at 12 months. Conclusions If supplementing diets with SCF lead to higher bone mass during adolescence, this could help achieve the genetic potential for PBM and to start adult life with stronger bones. If successful, SCF can be incorporated into diets for promoting bone health in adolescents.

OBJECTIVES: The objective was to measure food insecurity and determine whether food insecurity may be associated with nutrition knowledge, English adequacy and education of Syrian women from the households participating in this study. METHODS: One-on-one interview questionnaires were administered to Syrian refugee households residing in Florida, N = 80, n = 43 in rural area, n = 37 in urban area. The main outcomes were food insecurity, nutrition knowledge, English adequacy, and women's education. RESULTS: Among the total households, 80% were food insecure, and food insecurity was greater in rural area (60.9%) than in urban area (39.1%). The majority (57.5%) of participants scored fair nutrition knowledge. One-way frequency analysis showed that 75% of households had inadequate English and 25% had adequate English. Twenty three point seven percent of Syrian refugee women had high school diploma or higher, when 76.3% did not complete their high school education. The Chi square test showed a significant difference in nutrition knowledge in urban and rural areas, P = 0.04. It also showed significant differences in women's education in rural and urban areas, P = 0.03. The result of multivariate logistic regression model indicated that types of residence had an inverse significant effect on food security after controlling for our variables. Syrian refugees in rural areas had 79.9 greater odds of being food insecure compared with urban areas, odds ratio = 0.201, 95% CI: 0.053–0.758, P = 0.01. CONCLUSIONS: Nutrition knowledge, English adequacy and women's education may be less important than types of residence. The types of residence is a contributing factor to food insecurity in Syrian refugees residing in Florida. A larger sample size would allow clearer understanding of the relation of our variables with food insecurity. FUNDING SOURCES: Self funded

Vitamin D and its association with cardiovascular disease (CVD) are currently a topic of investigation. The objective of this study was to explore the association between vitamin D status (serum 25-hydroxyvitamin D (25(OH)D)) and a cardiometabolic risk score (CMRS) derived from markers of cardiac autonomic nervous system activity, vascular dynamics, and body composition, using an innovative non-invasive technology. We found that individuals who were vitamin D sufficient ((25(OH)D) ≥ 30 ng/ml, n = 51), compared to those who were vitamin D insufficient (

This study examined sex by race/ethnicity differences in medical advice received for diet and exercise with corresponding health behaviors of a U.S. representative sample of adults with type 2 diabetes ( N = 1,269). Data from the National Health and Nutrition Examination Surveys for 2011-2014 for 185 Mexican Americans, 123 Other Hispanics, 392 non-Hispanic Blacks, 140 non-Hispanic Asians, and 429 non-Hispanic Whites were analyzed using logistic regression analyses. Reporting being given dietary and exercise advice was positively associated with reporting following the behavior. There were differences in sex and sex by race/ethnicity for reporting receiving medical advice and performing the advised health behavior. These results suggest the importance of physicians having patient-centered communication skills and cultural competency when discussing diabetes management.

Background: Diabetes and diabetes-related complications are major causes of morbidity and mortality in the United States. Depressive symptoms and perceived stress have been identified as possible risk factors for beta cell dysfunction and diabetes. The purpose of this study was to assess associations between depression symptoms and perceived stress with beta cell function between African and Haitian Americans with and without type 2 diabetes. Participants and Methods: Informed consent and data were available for 462 participants (231 African Americans and 231 Haitian Americans) for this cross-sectional study. A demographic questionnaire developed by the Primary Investigator was used to collect information regarding age, gender, smoking, and ethnicity. Diabetes status was determined by self-report and confirmed by fasting blood glucose. Anthropometrics (weight, and height and waist circumference) and vital signs (blood pressure) were taken. Blood samples were drawn after 8 - 10 hours over-night fasting to measure lipid panel, fasting plasma glucose and serum insulin concentrations. The homeostatic model assessment, version 2 (HOMA2) computer model was used to calculate beta cell function. Depression was assessed using the Beck Depression Inventory-II (BDI-II) and stress levels were assessed using the Perceived Stress Scale (PSS). Results: Moderate to severe depressive symptoms were more likely for persons with diabetes (p = 0.030). There were no differences in perceived stress between ethnicity and diabetes status (p = 0.283). General linear models for participants with and without type 2 diabetes using beta cell function as the dependent variable showed no association with depressive symptoms and perceived stress; however, Haitian Americans had significantly lower beta cell function than African Americans both with and without diabetes and adjusting for age, gender, waist circumference and smoking. Further research is needed to compare these risk factors in other race/ethnic groups.

Background: Omega-3 fatty acids (n-3) may be protective of cardiovascular risk factors for vulnerable populations. The purpose of this study was to assess the association between n-3 with, C-reactive protein (CRP), and homocysteine (HCY) in Black minorities with and without type 2 diabetes. Methods: A cross-sectional study was conducted with 406 participants: Haitian Americans (HA): n=238. African Americans (AA): n=172. Participants were recruited from a randomly generated mailing lists, local diabetes educators, community health practitioners and advertisements from 2008-2010. Sociodemographics and anthropometrics were collected and used to adjust analyses. All dietary variables were collected using the semi-quantitative food frequency questionnaire (FFQ) and used to quantify vitamin components. Blood was collected to measure CVD risk factors (blood lipids, HCY, and CRP). Results: African Americans had higher waist circumferences and C-reactive protein and consumed more calories as compared to Haitian Americans. Omega 3 fatty acid intake per calorie did not differ between these ethnicities, yet African Americans with low n-3 intake were three times more likely to have high C-reactive protein as compared to their counterparts [OR=3. 32 (1. 11, 9. 26) p=0.031]. Although homocysteine did not differ by ethnicity, African Americans with low omega 3 intake (12 mg/L) as compared to their counterparts, adjusting for confounders [OR=4.63 (1.59, 12.0) p=0.004]. Consumption of n-3 by diabetes status was not associated with C-reactive protein or homocysteine levels. Conclusions: Consumption of n-3 may be protective of cardiovascular risk factors such as C-reactive protein and homocysteine for certain ethnicities. Prospective studies are needed to confirm these results.

Introduction Vitamin D deficiency and type 2 diabetes are common among Hispanics and African Americans in the US. The aim of the study was to determine the effect of supplemental vitamin D intake (4000 IU/day or 6000 IU/day of vitamin D3 over a 6-month period) on blood lipids in a sample of African Americans and Hispanics with type 2 diabetes and vitamin D insufficiency. Materials and methods Participants (n = 75) were recruited by community outreach. Participants in both groups were required to take either 4000 IU or 6000 IU of vitamin D (Cholecalciferol) per day given in the form of a pill in a single daily dose. Mixed model was used to compare treatment effects (4000 IU vs. 6000 IU) on the outcome variables. Bonferroni multiple comparison test was used to detect significant changes from baseline, 3 months, and 6 months. Results A significant decrease in total cholesterol (from 193.88 ± 41.03 to 180.48 ± 27.53 mg/dl, P = 0.040) and triglycerides (from 201.44 ± 91.35 to 172.92 ± 76.87 mg/dl, P = 0.037) was found for the 6000 IU group at 6 months. The significance was lost after adjusting for confounders. Conclusion Our results suggest that the positive effect of vitamin D supplementation on lipid profile may be mediated by other cofactors related to vitamin D metabolism among Hispanic and African American participants with type 2 diabetes.

OBJECTIVES: Evaluate the association between the hemodialysis (HD) patient's diet components and all-cause mortality in a 12-month prospective analysis. METHODS: The diet components of 77 HD participants were examined using 24-hr recalls administered on dialysis and non-dialysis days, participant's demographics were obtained from the chart and all-cause mortality was registered for 12 months. RESULTS: The mean age ± SD was 63.2 ± 15.7 years; 28.8% were female, 58.4% of the patients had DM and 13% died of cardiovascular disease. When comparing dietary energy intake (DEI) and dietary protein intake (DPI) with the National Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines (30–35 kcal/kg; 1.2 g/kg daily) only 59.5% of the participants met energy recommendations and 25.2% met protein recommendations. Survivors had a greater protein and energy intake when compared to non-survivors; DEI (1917 ± 400 vs 1615 ± 321, P = 0.026) DPI (81 ± 16 vs 66 ± 11, P = 0.06); greater intake of fruit servings (2.4 ± 0.99 vs 1.5 ± 0.85, P = 0.09); greater intake of cereal-fiber grams (11.6 ± 4.5 vs 7.4 ± 4.4, P = 0.07). The intake of at least two fruit servings per day, decreased four-fold the mortality risk (HR:0.246; 95.0%, C.I. 0.069–0.880) P = 0.031; and the intake of at least 7 grams of cereal-fiber per day, decreased five-fold the mortality risk (HR:0.187; 95.0%, C.I. 0.050–0.693, P = 0.012); when adjusted by age, gender and diabetes the relationships remained significant (P 0.05). CONCLUSIONS: Hemodialysis patients should be encouraged to use various food sources to meet their energy and protein requirements as well as satisfy at least two servings of fruits and 7 grams of cereal-fiber per day to prevent cardiovascular mortality. FUNDING SOURCES: No funding resources. This study is part of a PhD dissertation thesis.

OBJECTIVES: HIV infection has previously been associated with malnutrition and wasting; however, with the initiation of antiretroviral therapy (ART), a growing number of people living with HIV (PLWH) are becoming centrally obese, with disproportionate weight accumulation around the abdominal area and fat losses in the rest of their body (periphery face, arms and legs), indicative of lipodystrophy. As a result, some PLWH may struggle simultaneously with central fat accumulation and peripheral losses, trying to balance these 2 opposite effects. METHODS: PB is a 62-year-old, African-American male infected with HIV for 12 years, receiving an NRTI regimen. Participating in the Miami Adult Studies in HIV (MASH) Cohort, PB started a 6-month nutrition intervention targeted to lower diabetes risk in prediabetic PLWH. Baseline body mass index (BMI) was 24.1 kg/m(2) and waist circumference (WC) was 36.5 inches. Despite having the initial intention to lose weight, PB gained ∼12.4 lbs just a month after initiation. When questioned about the weight gain, PB revealed that he had started taking an appetite stimulant (Megace) to address the wasting on his periphery, claiming that he looked “sickly”. PB stopped taking Megace after he gained >20 lbs (12.3% Wt∆) in 4 months. BMI at this time was 26.3 kg/m(2) and WC was 45.5 inches, reflecting a substantially increased risk for metabolic complications. With WC increasing 9 inches and hip circumference increasing only 2 inches, it is evident that a considerable amount of the weight accumulation occurred around the waist. As can be seen, he among others in his situation, are struggling with conflicting goals by simultaneously trying to reduce central obesity and prevent peripheral losses and wasting, something that may be unique to PLWH. RESULTS: Despite the participant's difficulties in weight management, his fasting blood glucose (FBG) improved after the 6-month nutrition intervention, with a −14 mg/dL improvement, lowering associated risk for diabetes and cardiometabolic complications. CONCLUSIONS: This improvement in FBG levels suggests that despite the difficulty of effective weight management in these patients, proper glucose values may still be achieved with nutrition counseling and education, thus lowering risk for diabetes and associated complications. FUNDING SOURCES: NIGMS-RISE funding, National Institute on Drug Abuse 5U01DA040381-03 and FIU-Dissertation Funding.

OBJECTIVES: Type 2 diabetes (T2D) is a complex and chronic metabolic disorder that involves complex interaction between environmental factors and genetic predisposition. TCF7L2 gene recently emerged as top candidate gene for T2D. Our study is aimed to assess six TCTL2 common polymorphisms: rs7903146, rs12255372, rs11196205, rs7901695, rs7895340 and rs4506565, in relation to T2D and related phenotypes in Cuban Americans who lived in Miami-Dade county, Florida. METHODS: We conducted a case-control study with 341 Cuban Americans (172 without T2D/169 with T2D). Unconditional logistic regression method was used to assess the association between six TCF7L2 SNPs and the risk of T2D in the additive genetic model, and further adjusted by potential confounding factors such as age, sex, BMI, physical activities and calorie intake. Student's t-tests on continuous values of T2D related quantitative traits were compared between risk allele carriers and non-carriers in control subjects. In addition, linkage disequilibrium and haplotype analysis were performed using Haploview 4.2. RESULTS: Four TCF7L2 SNPs (rs7901695, rs4506565, rs7903146 and rs11225537) were significantly associated with the risk of T2D in a Cuban American population after multivariable adjustment. Among non-diabetic control subjects, risk minor allele carriers of three TCF7L2 SNPs (rs7901695 (T > C), rs4506565 (A > T) and rs7903146 (C > T)) had significantly higher fasting glucose level and marginally higher level of glycated hemoglobin (A1C), compared to non-risk allele carriers. Consistently, results from haplotype analysis showed that two haplotypes TAC and CTT, formed by aforementioned three TCF7L2 SNPs (rs7901695, rs450565 and rs7903146), were significantly associated with the risk of T2D (P = 0.0094, and P = 0.0044, respectively), with the frequency of TAC significantly lower and CTT significantly higher in subjects with T2D, compared to subjects without T2D. CONCLUSIONS: The results of this study provide convincing evidence that variation in TCF7L2 genes confers strong susceptibility to T2D in the population studied. FUNDING SOURCES: Funding for this research was provided through an NIH/NIDDK sponsored grant. SUPPORTING TABLES, IMAGES AND/OR GRAPHS

OBJECTIVES: Food insecurity, nutrition knowledge, and perceived stress were assessed among Syrian refugees in urban and/or rural areas in Florida. The relationship between food insecurity and nutrition knowledge was determined as well. METHODS: A comprehensive 228-question questionnaire was administered to 80 households (n = 80, 43 in rural area, 37 in urban area). Families with children and couple families with children and additional individuals living in the same household were interviewed (87.5% families with children, 12.5% families with children and additional individuals). Interviewees included women and men (63 women, 17 men) of households with duration of stay in US of >24 months (mean ± SD) (26.4 ± 6.8). RESULTS: Food insecurity scale showed that refugees in urban and rural areas are moderately food insecure without hunger (4.5 ± 2.8, 4.9 ± 2.4 respectively). The mean of nutrition knowledge score was 42.0 ± 13.6 among all of the refugees; refugees in urban scored 41.5 ± 10.9 and in rural areas was 42.7 ± 16.3. It was estimated that Syrian refugees have fair nutrition knowledge. There might be a positive but not significant correlation between food insecurity and nutrition knowledge (r = 0.07 and P > 0.05). Perceived stress scale (20.9 ± 9.0) indicated a low level of stress. However, refugees residing in urban areas had moderate perceived stress scale (24.6 ± 6.1) compared to refugees residing in rural areas (17.8 ± 9.1). A significant (P 0.05). CONCLUSIONS: Syrian refugees have fair nutrition knowledge. Refugees in urban areas experience greater perceived stress compared to refugees in rural areas. Low power might be contributed to our findings. Increasing sample size may be recommended. FUNDING SOURCES: N/A.

OBJECTIVES: To compare the value of Subjective Global Assessment (SGA) and Malnutrition-Inflammation Score (MIS) for the prediction of mortality and examine their relationship with other nutritional parameters. METHODS: Nutrition status was assessed at baseline by SGA and MIS; albumin, protein catabolic rate (nPCR) were obtained from chart; 24-hr dietary recalls were used to estimate daily dietary protein intake (DPI) and dietary energy intake (DEI). Deaths were recorded for 12 months RESULTS: Seventy-seven participants receiving HD were included, with a mean age of 63.2 ± 14.2 years; 71.2% were male, 58.4% had diabetes and the average time on dialysis was 6.2 ± 4.2 years. The Mean ± SD of nPCR was 0.9 ± 0.2, albumin was 3.8 ± 0.3, DEI was 1867.3 ± 367.9 kcal/kg and DPI was 80.0 ± 15.8 gm/kg. MIS ≥ 6 and SGA > 1 were used as cut-off values to detect malnourished participants; 46% were malnourished by MIS vs. 35% by SGA. Albumin, nPCR, DPI and DEI were all inversely correlated with both indices (P

OBJECTIVES: Nutrition plays a critical role in systemic inflammation regulation and the risk of developing inflammatory diseases such as type 2 diabetes (T2D). The Dietary Inflammatory Index (DII) is a non-invasive comprehensive literature-derived tool that evaluates the inflammatory potential of each individual's diet. The aim of this study was to assess the relationship between DII and biomarker of inflammation (CRP), DNA/RNA oxidative stress (8OHdG), glycemic control [HbA1c, glycated albumin (GA) and insulin], and blood pressure (BP) among individuals with T2D and hypovitaminosis D. METHODS: Sixty-eight participants were recruited by community outreach. DII for each individual was calculated based on the values obtained from the Willett food frequency questionnaire. DII score was categorized into quartiles (Q1-Q4) ranged from −5.214 (maximally anti-inflammatory) to +3.999 (maximally pro-inflammatory). CRP, 8OHdG, HbA1c and GA were measured by enzymatic assays. Linear regression analysis was performed to test for the linear trend between DII and CRP, 8-OHdG, HbA1c, GA, insulin, and BP. RESULTS: Mean age was 54.94 ± 7.93 with 60.3% of participants being female. Participants in the DII Q4 were less likely to be female and had higher 8OHdG, HbA1c and GA levels. A significant inverse association was observed between DII Q3-Q4 and insulin level (P = 0.006 and P = 0.030, respectively). After adjusting for covariates, the model remained significant for both Q3 and Q4 (P = 0.040 and P = 0.049, respectively). There was a significant association between systolic BP and DII in Q4 (P = 0.029). However, after adjusting the model for the covariates the model lost significance. There was no statistically significant relationship between the overall DII, CRP, 8OHdG, HbA1c and GA. CONCLUSIONS: A pro-inflammatory diet may be associated with increased risk of hypo-insulinemia and incidence of higher systolic BP among individuals with T2D and vitamin D deficiency/insufficiency. To our knowledge, this was the first study assessing the relationship between DII, 8-OHdG, HbA1c, GA, insulin, and SBP among individuals with type 2 diabetes and hypovitaminosis D. The results of this study may serve as a basis for future nutrition interventions to improve health status of individuals with type 2 diabetes. FUNDING SOURCES: Funding for this research was provided through an NIH/NIDDK sponsored grant.

OBJECTIVES: The objective of this study is to assess the effectiveness of a 6-month nutrition intervention to improve glycemic parameters and inflammation in prediabetic PLWH on stable ART with undetectable HIV viral load. METHODS: A 6-month randomized, controlled nutrition intervention was conducted in prediabetic PLWH. The study participants for the intervention were recruited from the Miami Adult Studies for HIV (MASH) cohort at the FIU-Borinquen Research Clinic. Upon their consent, the participants were randomized into the intervention group or the control group. Participants randomized in the intervention group met once a month for approximately 1 hour where they received medical nutrition therapy, nutrition counseling and nutrition education; participants randomized into the control group received educational material at baseline. Blood was drawn at baseline and at 6-month to measure fasting blood glucose (FBG) and high sensitivity C-reactive protein (hs-CRP). RESULTS: A total of 38 participants were recruited and randomized into either the intervention group (n = 20) or the control group (n = 18). We found that the FBG for the 6-month follow-up for the intervention group was significantly lower than the baseline FBG values of the same study group (paired t-test; P = 0.031). No significant difference was found in the control group between the baseline and 6-month fasting blood glucose values (P = 0.068). Moreover, no significant difference was found in pre/post C-reactive protein (CRP) levels in the intervention or control group (paired t-test; P = 0.404 and P = 0.117 respectively). There was a significant difference in CRP levels at baseline (P = 0.028) between the study groups but no difference at the 6-month follow up (Mann Whitney U test: P = 0.430). CONCLUSIONS: The results from this intervention support the notion that a nutrition intervention is effective in prediabetic PLWH to lower diabetes risk by significantly lowering fasting blood glucose and may be implemented into larger scale interventions; however, no significant changes was seen in hs-CRP values between the 2 groups. FUNDING SOURCES: National Institute of General Medical Sciences (NIGMS): Research Initiative for Scientific Enhancement (RISE), Biomedical Research Initiative (BRI) Grant, National Institute on Drug Abuse 5U01DA040381-03 and FIU-Dissertation Funding.

OBJECTIVES: The purpose of this study was to assess the feasibility of using the Miami Adult Studies on HIV (MASH) cohort to conduct research on markers of gut integrity, MT, immune-activation and inflammation and their relationship to Vitamin D status in this cohort. We hypothesize that drug users infected with HIV, who have vitamin D deficiency or insufficiency, will have higher levels of MT, immune-activation, inflammation and deterioration of the gut integrity than drug users infected with HIV with sufficient Vitamin D levels. METHODS: Ninety HIV-infected drug users and HIV-infected drug non-users were identified from the MASH cohort with IRB approval. Data for this study will be collected at baseline, 6-months and 12-months. Laboratory analyses will include: determination of Lipopolysaccharide for MT, Soluble CD14, Interleukin 6, and Tumor Necrosis Factor alpha to assess immune-activation and inflammation; 25(OH)D levels for Vitamin D status, and Intestinal Fatty Acid Binding Protein as a gut integrity marker. All laboratory analyses will be completed using plasma samples and determined by enzyme-linked immunosorbent assays in the laboratories of the MASH cohort. Dietary and anthropometric data, disease progression and medical history will be collected. The MASH cohort assesses drug use with questionnaires, urine toxicology, and cocaine metabolites. RESULTS: We hypothesize that drug users infected with HIV, who have vitamin D deficiency or insufficiency, will have higher levels of MT, immune-activation, inflammation and deterioration of the gut integrity than drug users infected with HIV with sufficient Vitamin D levels. CONCLUSIONS: The MASH cohort participants are well-characterized and followed longitudinally enabling access to the participants and their information. This study will provide information to develop adjunct therapies for the management of HIV, gut health and nutrition. FUNDING SOURCES: The National Institute of Drug Abuse provides funding for the MASH cohort.

Given the prevalence and consequences of childhood obesity, efforts are being made to identify risk factors and design evidence-based interventions to reduce its impact. Food and beverage consumption habits are established early in life, making preschool-age children an important group to focus on. This cross-sectional study explored beverage intake and its association with body weight status among low-income preschool-age children enrolled in the Special Supplementation Nutrition Program for Women, Infants, and Children (WIC). Authorized representatives for children between the ages of 3 and 4.9 years were interviewed at WIC clinics in Broward County, Florida. Anthropometric data were collected from the WIC data system. The intake of sugar-sweetened beverages (SSB), particularly fruit drinks, was significantly higher in overweight/obese children when compared with their under/normal weight counterparts. Independent of body weight status, the preschool-age children were consuming on average over twice as much as the recommended intake of 100% fruit juice per day for that age group. Close to 80% of the overweight/obese children consumed low-fat or fat-free milk most often than any other type of milk. The intake of SSB was positively correlated with both the intakes of 100% fruit juice and milk, and negatively correlated with the intake of water. When body weight status, race/ethnicity, and intake of other beverages were held constant, SSB intake was positively associated with milk intake and negatively associated with water intake. Results from this study support the need to encourage water intake and discourage SSB intake in an effort to reduce the risk for overweight and obesity in WIC-participating preschool-age children. Emphasizing the need to follow the recommendation to limit 100% fruit juice intake to 4 to 6 oz. per day is important when counseling families with young children. Efforts to increase awareness of the health consequences associated with consuming high-fat milk should continue.

Environmental factors, preventive medical care, and behaviors play a role in childhood obesity. This study used the National Survey of Children’s Health, 2011-2012, for 42,828 children, ages 10–17 years. Greater percent of children in the overweight/obese category performed no moderate-to-vigorous physical activity: 11.9 (10.6, 13.3) as compared to children in the underweight/normal weight category: 9.7 (8.9 10.6). No moderate-to-vigorous physical activity was associated with no preventive medical care, inadequate or no health care, parents reporting higher percent of no parks or playgrounds, and unsafe and unsupportive neighborhoods. Odds ratios of overweight/obesity were higher for males [OR = 2.06 (1.64, 2.60)], Hispanics [OR = 1.49 (1.17, 1.90)], non-Hispanic Black females [OR = 1.59 (1.20, 2.08)], younger females [OR10–12 yrs. = 1.35 (1.03, 1.79) and OR13–15 yrs. = 1.4. (1.06, 1.89) vs. OR = 1.0016-17 yrs.], children with high television viewing [OR0-1 hr./day = 0.72 (0.61, 0.86); OR>1 to 0.84 (0.72, 0.99) = vs. OR = 1.00≥ 4 hrs./day,] and lower categories of physical activity [OR 0 days/wk. = 1.38 (1.13, 1.62); OR1–3 days/wk. = 1.14 (1.22, 1.62) vs. OR7 days/wk. = 1.00], higher poverty, smoke exposure, and parental perception of their neighborhood as unsupportive. Promoting preventive medical care and neighborhood cooperation may have potential to lower childhood obesity.

Objective To explore the relationships among ethnicity/race, gender, demographics, age-group and dietary health in a nationally representative sample of older adults.

An obesity paradox has been proposed in many conditions including HIV. Studies conducted to investigate obesity and its effect on HIV disease progression have been inconclusive and are lacking for African settings. This study investigated the relationship between overweight/obesity (BMI≥25 kg/m2) and HIV disease progression in HIV+ asymptomatic adults not on antiretroviral treatment (ART) in Botswana over 18 months. A cohort study in asymptomatic, ART-naïve, HIV+ adults included 217 participants, 139 with BMI of 18·0–24·9 kg/m2 and seventy-eight participants with BMI≥25 kg/m2. The primary outcome was time to event (≥25 % decrease in cluster of differentiation 4 (CD4) cell count) during 18 months of follow-up; secondary outcomes were time to event of CD4 cell countP=0·011). Higher fat mass at baseline was also significantly associated with decreased risk of AIDS-defining conditions during the follow-up (HR 0·855; 95 % CI 0·741, 0·987; P=0·033) and the combined outcome of having CD4 cell count≤250/µl and AIDS-defining conditions, whichever occurred earlier (HR 0·918; 95 % CI 0·847, 0·994; P=0·036). All models were adjusted for covariates. Higher BMI and fat mass among the HIV-infected, ART-naïve participants were associated with slower disease progression. Mechanistic research is needed to evaluate the association between BMI, fat mass and HIV disease progression.

OBJECTIVES: Albumin is the most abundant protein in serum with half-life of 2–3 weeks. Several studies suggested glycated albumin (GA) may provide a more accurate measure of extracellular glycation status, compared to hemoglobin A1C. Low serum vitamin D level [25(OH)D3] has been linked to diabetes. The aim of this study was to investigate the effect of different doses of vitamin D3 supplementation for 3 and 6 months on serum glycated albumin (GA) in individuals with type 2 diabetes (T2D) and hypovitaminosis D. METHODS: In this clinical trial, we assessed the effect of daily supplementation with 4000 and 6000 IU of vitamin D3 over 6 months on GA among 68 adults with T2D and hypovitaminosis D. Measurements of variables were conducted at baseline, 3 months and 6 months. Mixed model was used to compare treatment groups. Covariates in the adjusted model included age, gender, body mass index (BMI), sun exposure, fasting plasma glucose, insulin and C-reactive protein (CRP). RESULTS: After testing for normal distribution of variables, 65 participants, females (n = 40) and males (n = 25), were included in the analysis. Mean age was 54.52 ± 7.86 years. Mean serum 25(OH)D3 at baseline, 3 months and 6 months were 22.4 ± 6.77, 40.4 ± 13.68, and 40.57 ± 14.55, respectively. Mean GA at baseline, 3 months and 6 months were 4.69 ± 1.7, 4.13 ± 1.09, and 4.42 ± 1.23, respectively. Mixed model analysis controlling for interactions between 4000 IU and 6000 IU/day doses and outcome variables showed no differences between 2 treatment groups. Unadjusted pairwise comparisons between GA were a statistically significant from baseline to 3 months (P = 0.015), and from 3 months to 6 months (P = 0.039), but not from baseline to 6 months (P = 0.488). After adjusting for covariates, the model remained statistically significant for baseline and 3 months (P = 0.018) but not for 3 months to 6 month (P = 0.069), nor for baseline and 6 months (P = 0.471). CONCLUSIONS: GA may be a more sensitive biomarker for oxidative/glycemic changes in individuals with T2D and hypovitaminosis D and daily supplementation with higher doses of vitamin D3 may have beneficial effects on their health status. Larger studies with longer durations among different racial and ethnic groups may help to confirm these findings. FUNDING SOURCES: Funding for this research was provided through an NIH/NIDDK sponsored grant.

OBJECTIVES: As a recently arrived vulnerable population, food insecurity might be associated with types of residence and nutrition knowledge among Syrian refugees residing in the State of Florida. We assessed the relationship between food insecurity status, types of residence and nutrition knowledge among Syrian refugees in Florida. METHODS: In one-on-one sessions, the assessments of nutrition knowledge and food insecurity were completed in 80 households (n = 80, 43 in rural area, 37 in urban area). The outcome measures included demographics, types of residence, food insecurity status, the levels of food insecurity, and nutrition knowledge. RESULTS: Of the 80 households, 20% were food secure while 80% of households experienced food insecurity at different levels. Fisher's exact test showed significant differences between the levels of food insecurity in rural and urban areas, P = 0.02. The mean nutrition knowledge score (42.0 ± 13.6) indicated that Syrian refugees had fair nutrition knowledge. Fisher's exact test showed marginal differences between the levels of food insecurity in households with different nutrition knowledge, P = 0.08. The results of our multivariate logistic regression model showed that types of residence had an inverse significant effect on food security, which remained significant after controlling for nutrition knowledge. Syrian refugees in rural areas had 78.4 greater odds of being food insecure compared with urban areas, odds ratio = 0.216, 95% CI: 0.06–0.777, P = 0.02. CONCLUSIONS: Food insecurity was experienced by 80% of our participants. It was estimated that Syrian refugees had fair nutrition knowledge. Geographical location, types of residence, is a determinant for food insecurity status; Syrian refugees residing in rural areas are more likely to be food insecure compared with urban areas. Greater nutrition knowledge might increase the likelihood of food security among Syrian refugee households. Increasing sample size may be recommended to support our findings. FUNDING SOURCES: Personal funding.

OBJECTIVES: To understand the influence of eating frequency and snack quality on body weight of preschool children ages 3 up to 5 years participating in the Broward County Special Supplementation Nutrition Program for Women, Infants, and Children (WIC). METHODS: Cross-sectional data were collected from all 7 Broward County Health Department WIC clinics over 4 months via a researcher-administered questionnaire. Additional data were extracted from the WIC data system. Centers for Disease Control and Prevention's BMI-for-age percentiles were used to classify children into weight categories that were combined into under/normal weight and overweight/obese. Snacks were categorized into nutrient-based food groups and assigned a quality score. RESULTS: A total of 197 participants [90 boys (45.7%) and 107 girls (54.3%)] were included. From those, 3.6% were underweight, 64.4% normal weight, 16.8% overweight and 15.2% were obese. Most children consumed 3 meals (97.5%) and between 2 (33%) to 3 (37.1%) snacks on average per day. Mean number of snacks on the weekend was significantly higher than on weekdays (2.78 ± 1.20 vs. 2.67 ± 1.08, P = 0.001). We found a tendency for a lower prevalence of overweight/obesity as the number of eating events increased, although it was not significant. The most frequently consumed snacks were milk, 100% fruit juice, and fresh fruits, consumed daily by more than 75% of the children, irrespective of weight category. There was an overall higher consumption of more nutritious snacks when compared to nutrient-poor snacks (66% vs. 33.5%), with under/normal weight children consuming nutritious snacks more frequently than overweight/obese children (P = 0.09). CONCLUSIONS: Most children included in this study engaged in frequent eating events with a higher intake of the more nutritious snacks, which were both associated with a lower prevalence of overweight/obesity. Our findings suggest that in this age range, participation in the WIC program may foster positive eating behaviors. FUNDING SOURCES: A.C. was supported by a NIH/NIGMS R25 grant. Support to conduct the study was provided by the FIU Dietetics and Nutrition research foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

OBJECTIVES: Diabetes related complications include kidney, eye, heart diseases and amputations. Advanced Glycation End Products, (AGEs) are biomarkers of T2D. AGEs are covalent adducts formed from reactions between sugars and proteins or lipids. Vitamin D deficiency, prevalent with T2D, increases oxidative stress and inflammation that promotes the formation of AGEs. This study assessed the effect of 4000 IU vitamin D supplements on AGEs in adults with T2D and vitamin D deficiency/insufficiency. METHODS: We assessed changes in serum AGEs of 41 African Americans and Hispanics with T2D and hypovitaminosis D who were supplemented with 4000 IU of vitamin D3 for 6 months. Total AGEs were assessed using commercially available kits (Biotang Inc/TSZ Elisa, Waltham, MA, USA). RESULTS: The mean age of study participants was 54 ± 8 years. AGEs significantly increased at 3 months compared to baseline (Mean Difference = −13.70 ng/ml, P = 0.007). The mean level of AGEs decreased significantly at 6 months of supplementation (Mean Difference = 9.79 ng/ml, P = 0.020). Additionally, the mean serum levels of AGEs were significantly higher at 3 months compared to 6 months among study participants (Mean Difference = 24.52 ng/ml, P

Osteoporosis, a chronic disease that results in low bone mass with an increased risk of fragility fractures, is prevalent in older adults. Diet can prevent or lessen the severity of osteoporosis. The purpose of this cross-sectional study was to assess differences in diet, quality of life, self-rated health, and physical function between congregate meal participants with and without osteoporosis. Data were from telephone survey, 10th Annual National Survey of Older American Act Participants, a representative sample of congregate meal attendees across the United States. (N = 888). Osteoporosis was present in 20% of this population. Participants with, as compared to without, osteoporosis reported that their physical health limited moderate activities (31.5% vs. 18.9%, p = 0.026), stair climbing (32.2% vs. 22.8%, p = 0.032), and shopping (27.4 vs. 15.3, p = 0.018). More than half of the participants consumed less than the recommended servings of dairy, meat, grains, and fruits/vegetables regardless of osteoporosis status. Participants with osteoporosis had lower self-rated health and more physical limitations than people without osteoporosis. Although congregate meals are a way to improve nutritional intake, additional methods to improve nutrition (including education) may be of benefit, since undernutrition is a concern in this population.

Background To report the association of serum 25-hydroxyvitamin D [25(OH)D] and its association with adipokines and cardiometabolic risk factors in Haitian Americans (HA) and African Americans (AA) by ethnicity and type 2 diabetes (T2D) status. Methods A cross-sectional study in 197 HA (92 with T2D and 102 without T2D) and 200 AA (97 with T2D and 103 without T2D) recruited in South Florida. Serum 25(OH)D concentrations and adipokines were analyzed by ELISA and cardiometabolic risk factors were indexed by obesity, glycemic control, insulin sensitivity, lipid profile, and blood pressure. Results Controlling for age, BMI, energy intake, smoking status and HOMA2-IR in multivariate linear regression analyses, serum 25(OH)D concentrations were significantly associated with WC (R2 = 0.760, B = − 0.092, P = 0.027), HbA1C (R2 = 0.142, B = − 0.012, P = 0.010), and TG (R2 = 0.159, B = − 1.192, P = 0.003) in only HA without T2D. While serum 25(OH)D concentrations were significantly associated with TC (R2 = 0.168, B = − 0.329, P = 0.040), log leptin (R2 = 0.544, B = − 0.007, P = 0.021), and adiponectin (R2 = 0.144, B = 0.111, P = 0.033), but slightly associated with LDL-c (R2 = 0.133, B = − 0.278, P = 0.064) in only AA without T2D. Among individuals with T2D, serum 25(OH)D concentrations were marginally associated with IL-6 (R2 = 0.109, B = 0.076, P = 0.085) in HA with T2D, and there was a trend toward significance with log leptin (R2 = 0.393, B = − 0.006, P = 0.075) in AA with T2D in regression analysis. Conclusions The findings that the associations of serum 25(OH)D concentrations with adipokines and cardiometabolic factors differ between HA and AA has clinical and public implications to guide design of T2D preventive strategies that are culturally specific even within the same ethnicity. Electronic supplementary material The online version of this article (10.1186/s40795-018-0259-2) contains supplementary material, which is available to authorized users.