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Latinos with diabetes need more fiber, less sodium in diet

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January 31, 2018

Sarah Casagrande
Sarah Casagrande

Latinos with diagnosed diabetes who completed two 24-hour dietary recalls had an average fiber intake well below U.S. dietary guideline recommendations, whereas all Hispanic participants had elevated sodium intake, according to findings published in BMJ Open Diabetes Research & Care.

“A healthy diet is important for diabetes prevention and control; thus, diet modification is often the first line of treatment before initiating pharmacological therapy,” Sarah S. Casagrande, PhD, senior research analyst at Social and Scientific Systems Inc. in Silver Spring, Maryland, and colleagues wrote in the study background. “Previous research from a U.S. health survey reported that, between 1982 and 2006, the percent of calories from total fat, saturated fat and protein among Mexican Americans decreased while carbohydrate and total energy intake increased. Other studies using U.S. data have shown that Hispanics have higher intakes of dietary fiber compared with other racial/ethnic groups, although consumption was still below recommendations.”

In a cross-sectional study, Casagrande and colleagues analyzed data from 13,089 self-identified Hispanic adults participating in the Hispanic Community Health Study/Study of Latinos (2008-2011). Participants completed a 24-hour dietary recall in a baseline interview followed by a second dietary recall by phone 30 days later. Researchers assessed total energy consumption; percent of calories from carbohydrates, protein, total fat, saturated fat, polyunsaturated fat and monounsaturated fat; and intake of fiber, cholesterol, alcohol, sodium, vitamin D, calcium, magnesium and potassium. The cohort was stratified by glycemic status, including diagnosed diabetes (n = 1,825), undiagnosed diabetes (n = 1,005), prediabetes (n = 5,261) and normal glucose tolerance (n = 4,998).

Among Hispanic adults with diagnosed diabetes, 35.9% were Mexican American; 21.8% identified as Puerto Rican and 20.2% indicated Cuban heritage.

The mean age- and sex-adjusted energy intake among all Hispanic adults with diagnosed diabetes was lower vs. Hispanic adults with normal glucose tolerance (1,665 kcal per day vs. 1,873 kcal per day), with 51.4% of calories from carbohydrates, 18.3% from protein and 31.3% from total fat, according to researchers. Compared with adults who had undiagnosed diabetes, prediabetes and normal glucose tolerance, those with diagnosed diabetes had a lower age- and sex-adjusted energy intake (P < .001), although macronutrient composition was similar across groups.

Fiber intake was higher among those with diagnosed diabetes vs. those with normal glycemic status (mean, 11.1 g/1,000 kcal vs. 10 g/1,000 kcal; P < .01), whereas sodium intake for those with diagnosed diabetes was lower vs. those with normal glucose tolerance (mean, 2,963 mg vs. 3,107 mg), but still higher than the recommended 2,300 mg per day. Alcohol intake was also lowest among those with diagnosed diabetes.

When assessing energy intake by Hispanic heritage, researchers found that those of Cuban heritage had the highest mean age- and sex-adjusted energy intake at 1,806 kcal per day vs. those of Dominican, Central American, Puerto Rican or South American heritage (P < .01); however, results did not persist after adjustment for education, years living in the United States, BMI and sedentary time.

Among those with diagnosed diabetes, age- and sex-adjusted mean fiber intake was lowest for adults of Cuban heritage (mean, 9.7 g/1,000 kcal) and highest for Mexican Americans (mean, 13.4 g/1,000 kcal; P < .01 for all), but differences did not persist after additional adjustment.

Researchers did not observe any between-group differences in intakes of vitamin D, calcium, magnesium or potassium supplementation.

“In large samples of Hispanic/Latinos living in the USA, those with diagnosed diabetes are generally adhering to the ADA’s dietary recommendations,” the researchers wrote. “However, fiber intake should increase and, among those with or at risk for cardiovascular disease, cholesterol intake should decrease.”

The researchers added that physicians and public health officials should consider these results when developing culturally specific nutrition programs. – by Regina Schaffer

Disclosures: The authors report no relevant financial disclosures.