Abstract

1. Differences in Clinical and Non-Clinical Determinants of Diabetes and CVD Among Mexicans and Mexican-Americans Ranjita Misra1, Roxana Valdes-Ramos2, Gabriel Anzueto1, Linda Castillo1, Nilesh Chatterjee1, Martha Kaufer-Horwitz2, Victoria Caraveo2, John S Green1, John W Womack1 1 Department of Health and Kinesiology, Texas A&M University; 2 Universidad Autónoma del Estado de México • Sample size: Respondents comprised of a convenience sample of 207 Mexican Americans recruited through 3 health fairs in Bryan/College Station Texas and 182 Mexicans recruited in clinics and health fairs in Toluca Mexico. • Data Collection: Data collection was done through face-to-face interviews by ethnically similar interviewers. Survey information was supplemented by clinical data from fasting blood results. Respondents had to fast for 8-10 hours when they came for their blood tests. • Measures: • Clinical - Lipid profile (HDL, LDL, total cholesterol, serum triglycerides), Hemoglobin A1c (for individuals with type 2 diabetes), fasting glucose and insulin, and blood chemistry. • Non clinical – lifestyle (diet and physical activity), psychosocial factors (social support, social barriers, depression, quality of life), reinforcing factors (motivation and barriers for healthy diet and exercise), and knowledge of diabetes and CVD. All non-clinical measures were obtained using valid and reliable instruments (alpha ranged from 0.62 to 0.95 for the various constructs). • Participants were later given the lab results and advised to visit a physician if any exam showed abnormal results. Demographic and Socioeconomic Characteristics of Sample • Analysis: • Mexican Americans reported significantly higher quality of life, greater social support, and higher motivation to exercise. However, they had lower knowledge of diabetes as compared to their Mexican counterparts. Respondents did not meet the Food Guide Pyramid’s recommendation for intake of fruits, vegetables, and milk & milk products; Physical activity was very low and did not meet the recommended levels. Older age, gestational diabetes, and a higher fasting blood sugar were commonly missed risk factors for diabetes; older age, male gender, menopause, family history, and high levels of lipoprotein a were commonly lacked knowledge of CVD risk factors among the respondents. In general social support reported by both groups was good. Abstract Table 1. • This study examined clinical and non-clinical determinants of Type 2 diabetes (T2DM) and cardiovascular disease (CVD) among Mexicans in Mexico and Mexican-Americans (MAs) in the US.  Generally, respondents had high physical inactivity and poor knowledge of T2DM and CVD risk factors with MAs showing higher levels of risk factors. Introduction Metabolic Syndrome Determinants Table 4. • Compared to the general population, many minority groups including Hispanic Americans, have a poor health status. One of the many diseases and disorders that disproportionately affect the Hispanics is the metabolic syndrome. • Metabolic syndrome (MetS), also called insulin resistance syndrome (IRS), is an abnormality caused by a cluster of several disorders and indicates risk for diabetes and cardiovascular disease (CVD). • The majority of the 22 million Hispanics (64%) in the US are of Mexican origin. In the state of Texas, Mexican Americans constitutes one-third of the population and are increasing at a steady rate. • The prevalence and health burden of type 2 diabetes is 2-3 times higher in Mexican Americans compared to non-Hispanic Whites. • In Mexico, diabetes is the 3rd leading cause of death (prevalence = 9%) and a significant proportion of Mexicans are diagnosed with diabetes at younger (<40 years) age. • The 3rd report of the National Cholesterol Education Program Expert Panel (ATP III) guidelines are used to define MetS and one must meet three or more of the following criteria to have the disorder: • abdominal obesity: a waist circumference of 102 cm or more in men and 88 cm or more in women • hypertriglyceridemia [ >150 mg/dl (1.69 mmol/liter)] • low level of high density lipoprotein (HDL) cholesterol [<40 mg/dl (1.04 mmol/liter)in men and <50 mg/dl (1.29mmol/liter) in women • hypertension (>130/85 mm Hg) • elevated fasting glucose level [>110 mg/dl (>6.1 mmol/liter)] • Cross-national comparative studies are non existent for Mexican Americans that can allow the examination of multiple determinants for chronic diseases (e.g., diet, physical activity, health care access and utilization) while controlling for ethnic and genetic origin. Despite the higher age-adjusted diabetes and CVD rates among Mexican Americans, there is a paucity of metabolic & non-clinical data for this group that could provide a clear understanding of the Mexican Diaspora. Clinical Measures For Diabetes & CVD Table 2. Results Graph 1. Gender Demographics • Analysis: • Serum triglycerides, fasting blood sugar, and blood pressure among male respondents and serum triglycerides, fasting blood sugar, blood pressure, and central obesity among female respondents had greater risk factors for metabolic syndrome in both groups. The prevalence of metabolic syndrome (at least three of five characteristics) was significantly higher among Mexican Americans (44.6%) than Mexicans (37.6%), didn’t vary by gender in Mexico but increased with age in both groups (not shown in table). • Analysis: • Mean fasting blood glucose levels indicated both Mexicans and Mexican Americans were in the pre-diabetes category (FBS 100-125 mg/dl). However, mean A1c levels (blood glucose control over the past 3 months) for Mexicans was over 8.0 indicating poor control as compared to Mexican Americans in the US. Serum triglyceride levels were significantly higher among Mexicans Americans as compared to the Mexicans, and much higher than the recommended level of 150 mg/dl. No significant difference was noted in total cholesterol and its subcomponents between the two groups. Graph 2. Discussion and Conclusions Education Level of Participants • Mexicans and Mexican Americans are a high risk group for T2DM and CVD. • The prevalence of metabolic syndrome was significantly higher among Mexican Americans than Mexicans. • Clinical determinants showed respondents had mean levels much higher than recommended levels, placing them at risk for developing diabetes and cardiovascular disease in the future. Mexican Americans have greater risk ratios than Mexicans; Mexican American females had the greatest central obesity. • Dietary intake and physical activity did not meet the Food Guide Pyramid or Surgeon General’s recommendation. • Non-clinical measures that differed significantly between Mexicans and Mexican Americans included knowledge of diabetes, quality of life, social support and motivation to exercise. • Increasing population demographic along with higher clinical/non-clinical risk factors necessitates the development of culturally oriented prevention programs for this high-risk group. Non-Clinical Measures for Diabetes and CVD Table 3. Purpose Graph 3. Number of Determinants of MS in Study Population • This study is the first comprehensive study to examine both clinical and non-clinical determinants of metabolic syndrome among natives in Mexico (non-acculturated) with Mexican-Americans (with different degrees of acculturation) for a better understanding of the determinants, outcomes, and burden. Percent Prevalence US- 44.4% Percent Prevalence Mexico- 37.6% Future Direction Methods The data from this study can be used in various ways helping to prevent MS in Mexicans and Mexican-Americans. More tailored programs in preventing/managing hypertension and obesity in females need to be developed as they are the two out of the five causes of MS with the highest percentage of affected individuals for both study sites. • Sample Design: The proposed study design is a cross-sectional and cross-cultural study of healthy, pre-diabetic, and diabetic Mexicans and Mexican Americans, matched for age, gender, and body mass index (BMI). Funded by a grant from CONACYT, TAMU