Type 2 diabetes, cardiovascular disease risk factors, carbohydrate nutrition, and acculturation in the Boston Puerto Rican Health Study

Background: Puerto Rican adults have high prevalence of type 2 diabetes (T2D). Impaired fasting glucose (IFG) increases risk of T2D and cardiovascular disease (CVD), but IFG has not been studied in Puerto Ricans. The American Diabetes Association (ADA) provides treatment goals for glycemic, blood pressure, and lipid control in those with T2D, but few US adults achieve all three goals. Dietary recommendations emphasize both carbohydrate quantity and quality, which includes dietary glycemic index (GI), glycemic load (GL), and fiber. Evidence suggests that Puerto Ricans have high carbohydrate intake, particularly those less acculturated. However, there remains sparse research in this population.;Objectives: (1) To compare lifestyle and CVD risk factors in Puerto Rican adults with normal fasting glucose (NFG), IFG, or T2D, and explore ADA goal achievement in those with T2D. (2) To investigate acculturation in relation to carbohydrate nutrition in this population. (3) To characterize carbohydrate nutrition in individuals with or without T2D, and measure associations with blood lipids.;Methods: Cross-sectional analyses were conducted in 1287 Puerto Ricans, aged 45-75 y, enrolled in the Boston Puerto Rican Health Study. Data on health status, dietary intake, and biological measures were collected in participants' homes. Participants were classified with IFG or T2D based on fasting glucose and diabetes medications.;Results: Prevalence of IFG and T2D was 24% and 39%, respectively. Prevalence of other CVD risk factors was: obesity (57%), central obesity (71%), low HDL-C (63%), and hypertension (68%). CVD risk increased from NFG to IFG and T2D. Only 4% of those with T2D achieved all three ADA goals. The sample's median acculturation score was 20.8%, indicating Spanish language preference. Less acculturated individuals had lower physical activity levels and cereal fiber intake, and higher dietary GI, starchy vegetable intake, and T2D prevalence. Individuals with T2D had lower carbohydrate intake, total sugars, and dietary GL, and greater cereal fiber intake than those without T2D. Important food sources were white rice, starchy vegetables, and legumes. Inverse associations were observed between HDL-C and both dietary carbohydrate and GL.;Conclusions: Boston Puerto Rican adults exhibit prevalent obesity and high CVD risk. Individuals with T2D reported some beneficial dietary changes, but few achieved ADA goals. Acculturation was associated with healthier lifestyle and diet; however, major food sources were refined grains. Dietary carbohydrate and GL showed negative effects on HDL-C. These results may help target future interventions for Puerto Ricans, aimed to reduce CVD risk in this understudied population.