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Hispanic ethnicity as a moderator of the effects of aerobic and resistance exercise in survivors of breast cancer.
Dieli-Conwright, CM, Sweeney, FC, Courneya, KS, Tripathy, D, Sami, N, Lee, K, Buchanan, TA, Spicer, D, Bernstein, L, Mortimer, JE, et al
Cancer. 2019;(6):910-920
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Abstract
BACKGROUND Metabolic syndrome (MSY) is associated with an increased risk of cardiovascular disease, type 2 diabetes, and recurrence in breast cancer survivors (BCS). MSY is 1.5 times more common in Hispanic women compared with non-Hispanic women. Although exercise mitigates MSY in BCS, to the best of the authors' knowledge, few studies to date have focused on minorities. This secondary analysis examined ethnicity as a moderator of the effects of a 16-week aerobic and resistance exercise intervention on MSY, sarcopenic obesity, and serum biomarkers in BCS. METHODS A total of 100 eligible BCS were randomized to exercise (50 BCS) or usual care (50 BCS). The exercise intervention promoted moderate to vigorous aerobic and resistance exercise 3 times a week for 16 weeks. MSY z scores, sarcopenic obesity, and serum biomarkers were measured at baseline, after the intervention, and at the 28-week follow-up (exercise group only). Linear mixed models adjusted for baseline values of the outcome, age, disease stage, adjuvant treatment, and recent physical activity were used to evaluate effect modification by ethnicity. RESULTS The study sample was 57% Hispanic BCS (HBCS) and 43% non-Hispanic BCS (NHBCS). HBCS were younger, of greater adiposity, and had been diagnosed with more advanced cancers compared with NHBCS (P<.001). Ethnicity was found to moderate the mean differences in exercise training on triglycerides (-36.4 mg/dL; 95% confidence interval [95% CI],-64.1 to -18.8 mg/dL), glucose (-8.6 mg/dL; 95% CI, -19.1 to -3.0 mg/dL), and C-reactive protein (-3.3 mg/L; 95% CI, -7.3 to -0.9 mg/L). CONCLUSIONS HBCS appear to have poorer metabolic profiles and therefore may derive relatively larger metabolic changes from exercise compared with NHBCS. Clinical exercise interventions may attenuate existing health disparities across diverse groups of BCS.
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Females, Hispanics and older individuals are at greatest risk of developing metabolic syndrome in the U.S.
Campbell, B, Aguilar, M, Bhuket, T, Torres, S, Liu, B, Wong, RJ
Diabetes & metabolic syndrome. 2016;(4):230-233
Abstract
BACKGROUND The increasing prevalence of metabolic syndrome (MetS) and MetS related complications in the U.S. poses a serious public health burden. We aim to identify high risk groups at greatest risk of developing MetS in the U.S. METHODS Using data from the 2001-2012 National Health and Nutrition Examination Survey (NHANES), MetS prevalence among adults (age≥18) was stratified by sex, race/ethnicity and age to identify groups at greatest risk of MetS. Mutlivariate logistic regression models evaluated for predictors of MetS. RESULTS Overall, the prevalence of MetS in the U.S. was 78 million during the study period. There was a greater prevalence of MetS in females compared to males (34.4% vs. 29.6%, p<0.001). Females had a 25% higher risk of MetS compared to males (OR, 1.25; 95% CI, 1.18-1.32, p<0.001). Hispanics had a higher risk of MetS when compared to non-Hispanic whites (OR, 1.13; 95% CI, 1.04-1.23, p<0.01). The prevalence of MetS increased with increasing age (age <40: 17.5% vs. age 40-49: 29.7% vs. age 50-59: 37.5% vs. age 60-69: 44.4% vs. age ≥70: 47.0%, p<0.001), and individuals age 70 and over were more than 5 times more likely to have MetS than those less than age 40 (OR, 5.12, 4.71-5.57, p<0.001) CONCLUSIONS The high prevalence of MetS in the U.S. affects females, Hispanics, and older individuals the greatest. The aging population and increasing Hispanic population further highlight the huge burden of disease MetS will place on the healthcare system in the U.S.
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Ethnicity and genetics are more important than diabetes mellitus and hypertension in producing cardiovascular events in patients with the metabolic syndrome: emphasis in the Puerto Rico population.
Altieri, PI, Marcial, JM, Banchs, H, Escobales, N, Crespo, M
Boletin de la Asociacion Medica de Puerto Rico. 2013;(3):56-63
Abstract
Metabolic syndrome is a cluster of risk factors for cardiovascular disease that affects an estimated 50 million Americans. The present article reviews the metabolic syndrome with respect to its definition, epidemiology, pathophysiology and management. A primary focus in research has been to elucidate the processes determined to cause insulin resistance, the fundamental mechanism underlying the metabolic syndrome. Namely, the incidence, component characteristics and complications of the metabolic syndrome in the island of Puerto Rico are described alongside the fact that the metabolic syndrome may be milder in Puerto Rico than in the mainland United States because it is characterized by less aggressive coronary disease and a relatively normal lipid profile. This suggests that the cardiovascular complications are more influenced by genetics and culture than diabetes mellitus and hypertension.
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The moderating impact of ethnicity on metabolic outcomes during treatment with olanzapine and aripiprazole in patients with schizophrenia.
Meyer, JM, Rosenblatt, LC, Kim, E, Baker, RA, Whitehead, R
The Journal of clinical psychiatry. 2009;(3):318-25
Abstract
OBJECTIVE Race is strongly associated with risk for metabolic dysfunction, but there is limited prospective data concerning the impact of race on antipsychotic metabolic outcomes among patients with schizophrenia. METHOD This study is a post hoc analysis of data from a 26-week, double-blind, randomized trial of aripiprazole (N = 155) and olanzapine (N = 159) conducted from April 2000 through June 2001 in patients aged >or= 18 years with acute schizophrenia according to DSM-IV criteria. The data were analyzed on the basis of racial breakdown: white and black/Hispanic. Between-drug and within-drug outcomes were analyzed separately for each racial cohort across weight, lipid, and glucose parameters. RESULTS For white subjects (N = 167), olanzapine significantly worsened all metabolic parameters except high-density lipoprotein (HDL) cholesterol and fasting glucose, and this was significantly different than aripiprazole for every outcome except fasting glucose. In the black/Hispanic cohort (N = 137), olanzapine treatment resulted in adverse metabolic outcomes, and these changes were significantly different from aripiprazole for adiposity, total cholesterol, and non-HDL cholesterol. Aripiprazole decreased the odds of endpoint metabolic syndrome compared with olanzapine for all subjects (OR = 0.33, 95% CI = 0.19 to 0.55), the white cohort (OR = 0.20, 95% CI = 0.10 to 0.41), and black/Hispanic subjects (OR = 0.53, 95% CI = 0.25 to 1.12), but the black/Hispanic result was not statistically significant (p = .096). Within the aripiprazole group, white subjects had significantly lower risk for metabolic syndrome, but there was no significant difference in metabolic syndrome between white and black/Hispanic subjects exposed to olanzapine. CONCLUSIONS Race may be an important moderator of metabolic risk during atypical antipsychotic therapy. Olanzapine treatment is associated with greater effects on adiposity and lipids than aripiprazole in both white and black/Hispanic subjects, suggesting that antipsychotic choice and intensive monitoring are important in minimizing metabolic risk, especially in nonwhite patients.
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Type 2 diabetes in the Hispanic or Latino population: challenges and opportunities.
Caballero, AE
Current opinion in endocrinology, diabetes, and obesity. 2007;(2):151-7
Abstract
PURPOSE OF REVIEW To describe how type 2 diabetes affects the Latino or Hispanic population in the United States, and identify the multiple challenges and opportunities to improve diabetes care in this rapidly growing group. RECENT FINDINGS Three compelling reasons justify the work in this area. First, this group has become the largest minority in the country, representing 13.7% of the total population. Based on current growth rates, one in four individuals will be of Hispanic origin by the year 2050. Second, this population suffers from very high rates of type 2 diabetes, obesity, the metabolic syndrome and their multiple vascular complications. A genetic tendency to develop insulin resistance and abdominal obesity, along with multiple nutritional, lifestyle, socio-economic and cultural factors, influence the development and course of type 2 diabetes among Latinos. Third, Hispanics have lagged behind in their diabetes care when compared with the predominant non-Hispanic White population. SUMMARY Understanding the challenges and opportunities in Latinos with diabetes is necessary to develop and implement comprehensive culturally oriented diabetes care, education, outreach and research programs. Some of these strategies may also be beneficial for other groups and can contribute to better integrate our societies.