Hypertension Prevalence and Related Risk Factors Among Mexican American Adults Are Increasing: National Health and Nutrition Examination Survey 1999 to 2018.

BACKGROUND: Acculturation affects hypertension prevalence among Hispanic people, but there have been no recent analyses specifically focused on Mexican American (MA) people. We sought to determine age-adjusted hypertension prevalence, abdominal obesity, and acculturation trends among MA adults and non-Hispanic White adults. METHODS AND RESULTS: Data from the NHANES (National Health and Nutrition Examination Survey) were analyzed in 2-year increments to observe trends in hypertension and risk factors (age, sex, body mass index, smoking status, abdominal obesity, waist-to-height ratio (WHtR), education, and income). Acculturation was based on three commonly used measures. The sample included 30 920 adults. Age-adjusted hypertension prevalence is higher in MA adults (52.7%) than White adults (48.3%). Hypertension risk factors-age, obesity prevalence, WHtR, acculturation-all significantly increased among MA adults, while smoking declined. Higher acculturation scores increased hypertension likelihood (odds ratio [OR], 1.44 [95% CI, 0.91-1.97]) for MA adults compared with those with lower acculturation scores. White adults with elevated WHtR >0.5 had a 40% higher risk of hypertension than those with WHtR <0.5, but among MA adults, elevated WHtR did not increase risk for hypertension. There was a significant increase in hypertension prevalence among MA adults from 2003 to 2018 at an average biennial rate of 2.23%. There was no change in hypertension prevalence among White adults from 1999 to 2018. CONCLUSIONS: Over 20 years of NHANES, more highly acculturated MA adults were at greater risk for hypertension, despite declines in smoking and controlling for age, sex, obesity status, education, and income. Finding ways to promote more traditional lifestyle and eating habits for MA adults could be a beneficial approach to reducing hypertension risk factors in this population.

Perceived Stress, Grit, and Self-Care Behaviors in First-Year Medical Students.

Medical students experience more stress than the general population, which over time can cause mental and physical disease, including burnout. Identifying factors impacting stress during early medical training could inform strategies to minimize its impacts throughout training and in clinical practice. This study surveyed 238 first-year osteopathic medical students to assess stress (Perceived Stress Scale; PSS), grit, sleep quality (Pittsburgh Sleep Quality Index; PSQI), physical activity (Godin-Shephard Leisure-Time Physical Activity Score; LTPA), and nutrition habits (Rapid Eating Assessment for Participants; REAP) within the first 2 weeks of starting medical school and again 10 weeks later. Incomplete responses were removed, leaving 204 study participants. We observed statistically significant decreases in grittiness (∆grit = -2.230%, P = .002) and physical activity (∆LTPA = -22.147%, P < .0001), while perceived stress (∆PSS = 34.548%, P < .0001) and poor sleep quality (∆PSQI% = 19.853, P < .0001) increased. Correlation analyses identified the strongest relationships were between ∆PSS vs ∆PSQI (r = .47, P < .0001) and ∆PSS vs ∆LTPA (r = -.20, P < .01). Multivariable linear regression analysis isolated ∆PSQI (P < .0001) and ∆LTPA (P = .012) as statistically significant predictors of ∆PSS. These results suggest early, repeated curricular interventions focused on physical activity and sleep hygiene may help students better manage stress during medical education.

Dietary goal attainment measures and psychosocial factors among Mexican Americans and non-Hispanic whites with type 2 diabetes.

Diabetes education programs need improved measures of goal setting for dietary control of diabetes. Additionally, measures of patient experiences with dietary goal setting are needed to better prepare patients for diabetes self-management. Measures of dietary goals and strategies were investigated via survey of 100 Mexican Americans and non-Hispanic whites with type 2 diabetes at a community clinic. Analyses tested novel goal measures as stages of change and goal attainment with a food plan compared to a traditional measure of food plan adherence. Ethnic groups varied in some reported experiences with goal setting education and goal attainment, but did not differ in most clinical characteristics of diabetes. Results indicated that different measures of goal setting vary in their psychosocial predictors, suggesting changes in how health care providers use and monitor goal setting for patients. At the time this research was conducted, Dr. Briggs Early was a doctoral candidate in the Department of Food Science and Human Nutrition at Washington State University. She is currently an Assistant Professor of Biochemistry and Nutrition at Pacific Northwest University of Health Sciences - College of Osteopathic Medicine, and a certified diabetes educator, and insulin pump trainer in Yakima, Washington.

Glycemic outcomes among rural patients in the type 1 diabetes T1D Exchange registry, January 2016-March 2018: a cross-sectional cohort study.

INTRODUCTION: Does rural status influence glycemic outcomes among participants in the type 1 diabetes T1D Exchange clinic registry? RESEARCH DESIGN AND METHODS: Data from the T1D Exchange clinic registry between January 2016 and March 2018 were identified by rural-urban status and stratified by age and hemoglobin A1c (HbA1c). Multivariable regression modeling was performed to isolate HbA1c differences. A full model including all significant (p<0.05 via two-sided testing) differential factors was determined with an additional indicator for rural status, and adjusted for duration of diabetes, use of continuous glucose monitoring device, age, race/ethnicity, and private insurance status. The model was reduced using backwards elimination stepwise procedures until only significant factors remained. RESULTS: Mean HbA1c levels for all rural participants were significantly higher (8.71%; 72 mmol/mol) compared with the urban group (8.48%; 69 mmol/mol), p<0.001. For youth under 13 years of age, rural participants had a higher mean HbA1c (8.65%; 71 mmol/mol) compared with urban (8.45% 69 mmol/mol), p=0.022. Rural youth (13-<18 years) had a higher mean HbA1c (9.39%; 79 mmol/mol) than urban youth (9.14%; 76 mmol/mol), p<0.001. Rural young adults (18-<26 years) had a higher mean HbA1c (9.07%; 76 mmol/mol) than urban young adults (8.88%; 74 mmol/mol), p=0.042. Rural adults (≥26 years; n=589) were the only group that did not have a higher mean HbA1c (7.76%, 61.3 mmol) than urban adults (n=4770; 7.72%, 60.9 mmol/mol), p=0.503. Rural locale was highly significant (beta=0.175, p<0.001) despite controlling for potentially confounding differences between rural and urban groups. CONCLUSIONS: Among this T1D Exchange cohort, there is a pattern of higher mean HbA1c being associated with rural status, even after adjustment for characteristic differences, most strikingly among those under 26 years of age. This disparity and contributing factors need to be more thoroughly studied to provide effective solutions.

The Impact of RDNs on Non-Communicable Diseases: Proceedings from The State of Food and Nutrition Series Forum.

In the United States, nutrition-related morbidities are rising steadily at rates corresponding to increasing overweight and obesity in the population. Such morbidities take huge tolls on personal health and impose high costs on health care systems. In 2019, the Academy of Nutrition and Dietetics (Academy) and the Academy of Nutrition and Dietetics Foundation (Academy Foundation) embarked on a new project titled "The State of Food and Nutrition Series" to demonstrate the value of nutrition interventions led by registered dietitian nutritionists for individuals with the following 3 high-priority non-communicable diseases that affect many in the United States and globally: type 2 diabetes mellitus, chronic kidney disease, and hypertension. Poor nutritional status contributes to disease onset and progression in these non-communicable diseases, and appropriate medical nutrition therapy can prevent or delay worsening and ameliorate poor health outcomes. However, many people who have these conditions do not have access to an registered dietitian nutritionist, and consequently do not receive the nutrition care they need. On February 19-20, 2020 in Arlington, VA, as the first stage in The State of Food and Nutrition Series, the Academy and the Academy Foundation gathered health care policymakers, clinicians, and researchers from across the country for the State of Food and Nutrition Series Forum, where Academy leaders sought input to build a comprehensive research strategy that will quantify the impact of patient access to registered dietitian nutritionist-led nutrition interventions for type 2 diabetes mellitus, chronic kidney disease, and hypertension. This article summarizes the findings of that forum.

Pilot evaluation of obesity-specific health-related quality of life following a 12-week non-randomized lifestyle intervention in youth.

BACKGROUND: Health-related quality of life (HRQOL), a multifaceted construct for understanding health and healthcare outcomes, is comprised of eight domains of well-being and functioning over time and has become an essential factor in assessing outcomes for youth with obesity. AIMS: To evaluate the effect of a community based, lifestyle intervention, on obesity-specific HRQOL using the Sizing Me Up (SMU) in this group of Latino and White youth. MATERIALS AND METHODS: For this 12-week family and community-based intervention (ACT; Actively Changing Together), HRQOL was measured before and after the intervention concluded using the obesity-specific HRQOL tool, SMU. This study enrolled 68 youth (10.9 ± 2 years; 54% male; 50% non-Hispanic white). Paired t-tests were used to examine the Sizing Me Up sub-scales: Emotion, Physical, Social Avoidance, Positive Attributes, Teasing, and the total score. A greater change score indicated a larger increase in quality of life sub-scale. RESULTS: Significant improvements from baseline to follow-up were found in the total SMU (mean change = 5.27, SD 10.76, p = 0.00) and for the sub-scores of: emotion (mean change = 8.06, SD 16.85, p ≤ 0.00), teasing (mean change = 5.65, SD 16.79, p = 0.01), and social avoidance (mean change = 3.92, SD 11.21, p = 0.01). CONCLUSIONS: Sizing Me Up provided a clinically meaningful tool for this research study to evaluate obesity-specific HRQOL among Hispanic and non-Hispanic White youth with obesity.

A Cross-Sectional Pilot Survey of Rural Clinic Attitudes and Proficiency with Insulin Pumps and Continuous Glucose Monitoring Devices.

Purpose: To examine the perceptions, proficiencies, and barriers of diabetes device use among rural clinic providers. Methods: A total of 210 surveys were sent through e-mail and/or U.S. Postal Service to rural clinics throughout Alaska, Idaho, Montana, Oregon, Washington, and Utah based on discussions with rural clinic network leadership in the states. Responses were included if the participant was 18 years of age and older, and worked at a rural clinic as a physician, physician assistant, nurse, nurse practitioner, allied health worker, or clinic manager. Results: Respondents included clinic management (13%), midlevel providers (physician assistants and nurse practitioners) and allied health workers (pharmacists, dietitians, and social workers, 30.8%), nurses (30.8%), and physicians (23.1%). We had a low response rate (20%; n = 41), but of those who said they work with patients who have diabetes, only 47.4% indicated that they use diabetes devices as part of their patients' treatment. The most common barrier reported among respondents suggested that additional medical team expertise is needed in their community or clinic to adopt insulin pumps and/or continuous glucose monitoring for qualified patients (75.9% and 80.8%, respectively). Conclusion: Lack of provider experience and having patients managed by out-of-area experts were the biggest reasons for providers not seeing or managing patients using these devices. Lack of provider access, patient satisfaction with current diabetes regimens, unsupportive health care team, patient literacy, and patient fear showed limited to negligible endorsements from survey respondents. A variety of potential solutions to this problem of limited provider experience and training are also offered.

Position of the Academy of Nutrition and Dietetics: The Role of Medical Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and Treatment of Prediabetes and Type 2 Diabetes.

It is the position of the Academy of Nutrition and Dietetics that for adults with prediabetes or type 2 diabetes, medical nutrition therapy (MNT) provided by registered dietitian nutritionists (RDNs) is effective in improving medical outcomes and quality of life, and is cost-effective. MNT provided by RDNs is also successful and essential to preventing progression of prediabetes and obesity to type 2 diabetes. It is essential that MNT provided by RDNs be integrated into health care systems and public health programs and be adequately reimbursed. The Academy's evidence-based nutrition practice guidelines for the prevention of diabetes and the management of diabetes document strong evidence supporting the clinical effectiveness of MNT provided by RDNs. Cost-effectiveness has also been documented. The nutrition practice guidelines recommend that as part of evidence-based health care, providers caring for individuals with prediabetes or type 2 diabetes should be referred to an RDN for individualized MNT upon diagnosis and at regular intervals throughout the lifespan as part of their treatment regimen. Standards of care for three levels of diabetes practice have been published by the Diabetes Care and Education Practice Group. RDNs are also qualified to provide additional services beyond MNT in diabetes care and management. Unfortunately, barriers to accessing RDN services exist. Reimbursement for services is essential. Major medical and health organizations have provided support for the essential role of MNT and RDNs for the prevention and treatment of type 2 diabetes.

Quality of care in rural youth with type 1 diabetes: a cross-sectional pilot assessment.

BACKGROUND: Type 1 diabetes mellitus (T1DM) presents a significant health burden for patients and families. The quality of care (QOC) among those living in rural communities is thought to be subpar compared with those in urban communities; however, little data exist to reflect this, especially in pediatric diabetes. OBJECTIVE: The purpose of this pilot study was to investigate diabetes QOC among families living in rural versus urban areas. 6 QOC markers were used to compare youth with T1DM: appointment adherence, patient-provider communication, diabetes education during clinic visit, congruency with diabetes standards of care, diabetes self-management behaviors, and diabetes-related hospitalizations. RESEARCH DESIGN AND METHODS: Participants were rural or urban adult caregivers of youth ages 2-18 with ≥10-month history of T1DM receiving treatment at Seattle Children's Hospital, USA. Participants were from rural areas of central Washington, or urban areas of western Washington. Caregivers completed a 26-item survey pertaining to the 6 QOC markers. The 6 QOC markers were compared across 61 participants (34 rural, 27 urban), to determine how diabetes care quality and experiences differed. Data were collected over 12 months. Groups were compared using t-tests and χ2 tests, as appropriate. RESULTS: Compared with urban families, rural families reported significantly lower income and a 4-fold greater usage of public insurance. Among the QOC measures, rural participants were significantly worse off in the appointment adherence, patient-provider communication, and hospitalizations categories. Congruence with diabetes standards of care (foot care only) was also significantly poorer in rural participants. CONCLUSIONS: The burden of travel in conjunction with the lack of resources in this rural population of families with T1DM youth is cause for concern and warrants further research.