Is Waist-to-Height Ratio a Better Obesity Risk-Factor Indicator for Puerto Rican Children than is BMI or Waist Circumference?

OBJECTIVE: Puerto Rican children could have a higher prevalence of obesity, compared to US children or even to US Hispanic children. Obese youths are more likely to have risk factors for cardiovascular conditions, such as hypertension. Although BMI provides a simple, convenient measurement of obesity, it does not measure body fat distribution, associated with mortality and morbidity. Waist circumference (WC) and waist-to-height ratio (WHtR) have been suggested to estimate obesity health risks. This study aimed to explore the association of a single blood pressure reading with 3 different obesity indicators (WC, BMI, and WHtR). METHODS: A representative sample of students (first to sixth grade) from public and private schools in Puerto Rico was selected. The sample size consisted of 249 students, representing a 63% response rate. According to the sex-specific BMIs, approximately 38.1% of the children were obese or overweight. The prevalence of obesity was slightly higher when determined using WHtR but lower when using WC as the overweight indicator. The prevalence of high blood pressure among students was 12.5%; an additional 11.3% of the students were classified as possible prehypertensive. RESULTS: Regardless of the weight indicator used, overweight children were shown to have a higher risk of pre-hypertension/hypertension (as defined by a single BP measure) than were non-overweight children. The odds for high blood pressure were almost 3 times higher using WHtR. Logistic regression showed a stronger relationship between WHtR and the risk of pre-hypertension/hypertension than that between the former and either BMI or WC. CONCLUSION: This study suggests the possibility of higher prevalence of high blood pressure in obese Puerto Rican children. The waist-to height ratio could be the best indicator to measure obesity and potential hypertension in Puerto Rican children.

Diet, interleukin-17, and childhood asthma in Puerto Ricans.

BACKGROUND: Dietary patterns might influence the pathogenesis of asthma in Puerto Ricans, the ethnic group most affected by this disease in the United States. OBJECTIVE: To examine the association among diet, T-helper cell type 17 cytokines, and asthma in Puerto Rican children. METHODS: As part of a case-control study of 678 Puerto Rican children 6 to 14 years old in San Juan, participants completed a 75-item questionnaire on the child's food consumption in the prior week. Foods were aggregated into 7 groups: fruits, vegetables, grains, protein foods, dairy, fats, and sweets. Logistic regression was used to evaluate consumption frequency of each group, plasma T-helper cell type 17 cytokine levels, and asthma. Based on this analysis, a food score (range -2 [unhealthy diet: high consumption of dairy products and sweets, low consumption of vegetables and grains] to +2 [healthy diet: high consumption of grains and vegetables, low consumption of dairy and sweets]) was created to identify dietary patterns. RESULTS: High consumption of grains was associated with lower odds of asthma (adjusted odds ratio [aOR] 0.52, 95% confidence interval [CI] 0.33-0.82), whereas frequent consumption of dairy products (aOR 1.93, 95% CI 1.32-2.84) or sweets (aOR 1.82, 95% CI 1.08-2.72) was associated with higher odds of asthma. A healthier diet (each 1-point increment in food score) was associated with lower levels of interleukin-17F (ß = -1.48 pg/mL, 95% CI -1.78 to -1.20) and with 36% decreased odds of asthma (aOR 0.64, 95% CI 0.53-0.77). CONCLUSION: A healthy diet, with frequent consumption of vegetables and grains and low consumption of dairy products and sweets, was associated with lower levels of interleulin-17F and decreased odds of childhood asthma in Puerto Ricans.

Dietary patterns and their association with sociodemographic characteristics and perceived academic stress of college students in Puerto Rico.

OBJECTIVE: University students face academic responsibilities that may produce stress, which may lead to changes in dietary patterns (DPs). These changed patterns can become dysfunctional, often resulting in a negative impact on the health of the stressed student. Little is known about DPs in college students in Puerto Rico (PR). The purpose of this study was to describe the DPs of college students in PR and the association of these patterns with socio-demographic characteristics and perceived academic stress. METHODS: This retrospective epidemiological study investigated self-reported DPs in a representative sample of 275 college students, in relation to socio-demographic characteristics, body composition (BC), and perceived academic stress; a Diet Quality Index was developed using the USDA Food Patterns for 2010 to determine whether their DPs were adequate or inadequate. RESULTS: Most of the participating students were female (67.6%), ranged from 21 to 30 years old (88%), lived in low household incomes (42.7%), and had healthy weights (56.4%). Most of the students perceived the stress levels as being moderate (60.7%). Most had diets that were below the dietary recommendations for grains, fruits, vegetables, dairy products, and protein, whereas fat consumption was adequate. Overall, most had inadequate DPs (62%). DP was significantly associated with age (p < 0.05); older students had better DPs than did younger students. In terms of the different schools (p < 0.05), those students from the School of Medicine and those from the School of Public Health had better DPs than did the students from the other schools. DP was not associated with income, gender, BMI, stress level, or course load. CONCLUSION: The majority of the students had inadequate DPs, which inadequacy was associated with both the age of the student and the school that he or she attended.

Physical activity and its associations with sociodemographic characteristics, dietary patterns, and perceived academic stress in students attending college in Puerto Rico.

OBJECTIVE: The academic environment usually generates stress in students. Increasing physical activity (PA) is one of the stress-coping strategies for students; however, students usually reduce their PA while enrolled in college. OBJECTIVE: To determine the association between PA, self-perceived academic load and stress, and dietary patterns in students attending college in Puerto Rico. METHODS: A proportional stratified sample of 275 students from UPR-MSC completed a self-administered questionnaire on socioeconomic status, academic load and stress, body composition, dietary patterns, and PA. Chi2 was used to assess the association between variables. RESULTS: Most of the participants were female (68%), were aged 21 to 30 years (88%), and had low annual household incomes ($0-$24,999) (43%). Women reported higher levels of stress (p < 0.001) than did men. Overweight and obesity was found in 35.4%, while most students reported a light PA level (46.5%), which was higher among women (p < 0.001). During periods of greater stress, most students increased sedentary activities (68%), and -30% reported a decrease in moderate and vigorous activities; however, 60% reported that PA was an effective coping strategy and 66% would use it again. There was a negative association between PA and stress: those with higher levels of stress had lower PA levels (p = 0.06). No significant associations were found between PA and the others variables studied (p > 0.05). CONCLUSION: Most students reported sedentary lifestyles during periods of greater stress. High level of stress were positively associated with a light PA level.

Alcohol consumption and smoking and their associations with socio-demographic characteristics, dietary patterns, and perceived academic stress in Puerto Rican college students.

OBJECTIVE: College students often use different strategies, such as consuming alcohol and smoking, to cope with stress. We examined the associations between self-perceived academic stress, alcohol consumption, smoking, and dietary patterns in graduate students. METHODS: A representative stratified sample of 275 students from each school of the Medical Science Campus of the University of Puerto Rico (UPR-MSC) completed a 48-item questionnaire that solicited the following: socio-demographic data, estimates of self-perceived stress, estimates of the frequency of alcohol consumption and the type(s) of alcohol consumed, details regarding smoking habits, and information associated with diet (i.e., dietary patterns). Fisher's exact test and the Chi2 test were used to assess the associations between the different study variables. RESULTS: Only 3% were considered smokers (defined as > 1 cigarettes per day), with the greatest number of smokers among those aged 21-30 y (p<0.05). Smoking habits was not associated with academic load/stress or with dietary pattern. Most smokers reported that their main reason for using cigarettes was to cope with stress. About 70% of the students were considered drinkers (defined as > 0 drink/day), with a higher proportion found among women (63.5%), among those aged 21-30 years (90.6%), and among those with a low or moderate household income (p<0.05). Alcohol intake was significantly associated with academic stress, with a greater proportion of drinkers reporting experiencing moderate levels of academic stress (p<0.05), but it was not associated with dietary patterns or academic load (p>0.05). Most subjects classified as drinkers reported that alcohol consumption was not (in their experience) an effective strategy for the management of stress (81%). CONCLUSION: Alcohol consumption was only associated with academic stress. No associations were found between smoking habits and academic stress/load and dietary patterns.

Caffeinated-beverage consumption and its association with socio-demographic characteristics and self-perceived academic stress in first and second year students at the University of Puerto Rico Medical Sciences Campus (UPR-MSC).

OBJECTIVE: To determine the association between caffeinated-beverage consumption, self-perceived academic load, and self-perceived stress levels in first and second year students at UPR-MSC. METHODS: A descriptive epidemiological study was performed using a self-administered anonymous questionnaire given to a representative stratified sample of 275 students. Questions included information regarding socio-demographic characteristics, academic load and stress indicators, and caffeinated-beverage consumption. Chi2 was used to assess the associations between these variables. RESULTS: Most participants were women (68%), aged 21-30 years (88%), with low annual household incomes (43%). Most perceived their academic loads as being heavy (68%), and most perceived their academic stress levels as being moderate (37%). Academic load was significantly correlated with stress level (p<0.001). About 88% of the participants reported consuming caffeinated beverages; of those, 87% drank soft drinks, 83% drank coffee, 56% drank hot chocolate, 40% drank tea, and 29% drank energy drinks, all of which were--according to the participants (54%)--used mainly to stay awake. Soft drinks and coffee intake increased in periods of high stress, and many (49%) reported that these beverages were useful for coping with stress. Energy drinks, in particular, were consumed more often by men compared to women (p<0.05). None of these beverages were significantly associated with academic stress or load. CONCLUSION: Consuming caffeinated beverages is a popular practice among participants in this sample, with soft drinks and coffee being the ones that are the most frequently consumed. No associations were found between the consumption of caffeinated beverages and academic stress or load.

Social support and its association with sociodemographic characteristics, dietary patterns, and perceived academic stress among college students in Puerto Rico.

OBJECTIVE: The objective of the present study was to determine the association between social support, dietary pattern, and academic stress among college students in Puerto Rico, based on their socio-demographic characteristics. METHODS: This was a retrospective, descriptive, epidemiological study that used a stratified sample of 275 college students. The data collection was done by means of a self-administered instrument. RESULTS: Most of the participating students were female (67.6%), ranged in age from 21 to 30 years (88%), and had health weights (56.4%); a large minority, 42.7%, lived in homes having low annual incomes. Most of the participating students perceived their academic loads as being heavy (68.2%) and their total academic stress levels as being moderate (60.7%). Most of the students had moderate levels of social support (61.5%). Social support was significantly associated with age (p = 0.04), in that young students had high levels of social support; with the school being attended (p = 0.01), in that students from the School of Dental Medicine had high levels of social support' and with perceived academic load (p = 0.02). Social support was significantly associated with age (p = 0.04), in that the younger students had higher levels of social support than did their older counterparts; with the school being attended (p = 0.01), in that students from the School of Medicine had higher levels of social support than did the students from the other schools; and with perceived academic load (p = 0.02). CONCLUSION: There were associations between social support and age, school, and perceived academic load, but there were no such associations between social support and either level of academic stress or dietary pattern.

Prevalence of childhood obesity in a representative sample of elementary school children in Puerto Rico by socio-demographic characteristics, 2008.

OBJECTIVE: Childhood obesity is a worldwide epidemic; its prevalence has quadrupled in the US among children from 6-11 y/o. In the US, Hispanic children have a higher prevalence of obesity compared to non-Hispanic whites. No representative data was available for Puerto Rican children from first to sixth grades in Puerto Rico or the US. The aim of this study was to measure the prevalence of childhood obesity among Puerto Rican children from first to sixth grade by different socio-demographic characteristics in a sub-urban municipality in Puerto Rico. METHODS: A two-stage stratified cluster sampling design was used (n = 250). Weights and heights were measured twice to the nearest 0.1 kg and 0.1 cm, respectively. Weight status of children was determined based on the CDC criteria. Chi-square and Fisher tests were used to compare proportions. Simple logistic regressions were used to assess associations with socio-demographic variables. RESULTS: Nearly half of the students (51.0%) were boys; mean age was 9.5 + 1.9 years. Almost 40% of the children had family monthly incomes under $1,000. Overall childhood obesity prevalence (BMI > 95th percentile) was 26.8%. Prevalence of having some type of overweight (BMI for age > 85%) was statistically similar by gender and school grade. Low family-income children had 76% higher odds of having some type of overweight compared with those with higher income. CONCLUSION: This study documents a high prevalence of Puerto Rican childhood obesity among first to sixth grade regardless of grade level and gender, which is higher than the prevalence among Hispanics in the US. A higher probability of overweight was seen among the poorer children. This is the first study conducted among first to sixth graders. Thus, it calls for attention towards Puerto Rican children in the island and the US.

Childhood obesity among Puerto Rican children: discrepancies between child's and parent's perception of weight status.

Public concern about childhood obesity and associated health problems calls for the identification of modifiable factors that could halt this epidemic. Parental perceptions of their children's weight status could be associated to how parents influence children's eating patterns. We aimed to identify the perceptions Puerto Rican parents have of their children's weight and children's own perceptions of weight status as compared to real weight. A cross sectional survey was performed in a representative sample of 1st-6th grade students. Only half of the children correctly identified their weight, and only 62.4% of the parents correctly classified their children's weight. Most obese/overweight children did not perceive themselves as such. Almost half of obese/overweight children were identified by the parents as normal weight while over half of the underweight children were perceived by their parents at normal weight. More girls than boys perceived themselves as obese/overweight and more parents of girls than of boys perceived them as such. Higher-educated parents were better at recognizing overweight/obesity among their children compared to less-educated parents. This study suggests an influence of parents' SES characteristics on their perceptions of children's weight status as well as on children's own perceptions of their weight status.