Diabetes-Specific Food Insecurity Is Associated with Impaired Heart Rate Variability Independent of Glycemic Control: Exploratory Findings among Latinos with Type 2 Diabetes.
Diabetes-Specific Food Insecurity Is Associated with Impaired Heart Rate Variability Independent of Glycemic Control: Exploratory Findings among Latinos with Type 2 Diabetes.
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DOI：
10.3945/cdn.117.000521
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发表时间：
2017-05
影响因子：
4.8
通讯作者：
Wagner JA
中科院分区：
文献类型：
--
作者：
Bermúdez-Millán A;Pérez-Escamilla R;Lampert R;Segura-Pérez S;Damio G;Chhabra J;Wagner JA
背景：食品不安全(FI)、糖尿病流行和糟糕的糖尿病结果都不成比例地影响着美国的拉丁裔。心率变异性(HRV)反映自主神经张力，与血糖控制相关，并预测2型糖尿病的死亡率。目前尚不清楚FI是否与HRV有关，如果是，血糖控制是否与这种联系有关。目的：这项探索性横断面研究考察了患有2型糖尿病的拉美裔美国人的FI和HRV。方法：参与者报告人口学特征、社会经济状况和FI，包括6项美国农业部食品安全模块和1项糖尿病特定食品安全措施。受试者佩戴24小时动态心电监护仪。在时间域，用R-R间期标准差(SDNN)评估心率变异性。在频域中，将功率谱积分到极低频(VLF)、低频(LF)和高频(HF)3个频段，然后进行自然对数变换。根据年龄、性别、糖化血红蛋白(HbA1c)和社会经济状况指标调整后的未经调整的ANOVA和ANCOVA在HRV上比较了食品安全组。结果：受试者平均±SD年龄为59.7±10.9岁，其中73%为女性。在94名参与者中，63人根据美国农业部食品安全模块报告了FI，46人根据糖尿病特定指标报告了FI。平均±SD HbA1c为8.6%±1.7%，在那些报告糖尿病特有FI的人中略高于那些报告糖尿病特有食物安全的人。报告糖尿病特异性FI的参与者具有较低的SDNN、VLF、LF和HF HRV，其影响范围在小到中等范围内。即使在控制了年龄、性别、社会经济困难和糖化血红蛋白之后，差异仍然显著。美国农业部的6项食品安全模块与HRV无关。结论：糖尿病特有的FI可能是导致拉美裔美国人健康状况不佳的独特危险因素。解决FI的努力可能有利于糖尿病的结果。
Background: Food insecurity (FI), diabetes prevalence, and poor diabetes outcomes all disproportionately affect Latinos in the United States. Heart rate variability (HRV) reflects autonomic tone, is associated with glycemic control, and predicts mortality in type 2 diabetes. It is unknown whether FI is related to HRV and, if so, whether glycemic control accounts for this association. Objective: This exploratory cross-sectional study examined FI and HRV among US Latinos with type 2 diabetes. Methods: Participants reported demographic characteristics, socioeconomic status, and FI, including the 6-item USDA food security module and a 1-item measure of diabetes-specific food security. Participants wore an ambulatory electrocardiogram monitor for 24 h. In the time domain, HRV was assessed with the SD of the R-R interval (SDNN). In the frequency domain, the power spectrum was integrated over 3 frequency bands—very low frequency (VLF), low frequency (LF), and high frequency (HF)—and then natural log transformed. Unadjusted ANOVA and ANCOVA adjusted for age, sex, glycated hemoglobin (HbA1c), and indicators of socioeconomic status compared food security groups on HRV. Results: Participants' mean ± SD age was 59.7 ± 10.9 y, and 73% were women. Of the 94 participants, 63 reported FI according to the USDA food security module and 46 reported FI according to the diabetes-specific measure. Mean ± SD HbA1c was 8.6% ± 1.7% and was marginally higher among those reporting diabetes-specific FI than those reporting diabetes-specific food security. Participants who reported diabetes-specific FI had lower SDNN, VLF, LF, and HF HRV with effect sizes in the small-to-medium range. Differences remained significant even after controlling for age, sex, socioeconomic hardship, and HbA1c. The 6-item USDA food security module was not associated with HRV. Conclusions: Diabetes-specific FI may be a unique risk factor for poor health outcomes among US Latinos. Efforts to address FI could benefit diabetes outcomes.