DIET AND VITAMIN STATUS, ALLOSTATIC LOAD, AND CVD RISK IN PUERTO RICAN ADULTS

项目总结(见说明)： 心血管疾病(CVD)是居住在美国的拉美裔人的主要死亡原因， 几乎每四例死亡中就有一例是由癌症引起的。大多数关于拉美裔的研究都集中在墨西哥人身上。 美国人和，但波多黎各心脏研究除外，该研究是在 波多黎各几十年前；很少有人探讨波多黎各人患心血管疾病的风险因素。重要的是， 波多黎各人在祖先遗传史和已知风险暴露方面有很大的不同 这些重要的流行疾病的因素来自其他Hispa：NIC组。不同的风险因素包括 独特的饮食摄入和体力活动模式以及社会、文化和环境结构 导致和影响心血管疾病风险的因素。高贫困率和大多数城市环境促成了 这些过程以未知的方式：因为这一群体既是美国快速增长的也是老龄化的子集 人口，了解发病率高得多的原因的重要性和 心血管危险因素在这一高危人群中的发生率至关重要。理由是这些 关联是复杂的，可能是迭代的，需要进行纵向分析才能理解因果关系 指导和全面实施多层次分析。我们这个项目的总体目标是前瞻性地 对波士顿波多黎各健康研究的参与者进行为期5年的跟踪调查，以衡量心血管疾病风险的进展 CVD的影响因素和亚临床标志物，以便我们可以明确病因的方向 联想。我们的目标是评估五年的前瞻性相互关系(3个时间点) 模式和维生素(叶酸、维生素B6、维生素B12、维生素D、总胡萝卜素)摄入量和血浆状态 和心血管危险因素(脉压、高血压和Framingham危险评分(FRS))的进展； 评估饮食摄入模式与心血管疾病三个时间点的维生素状况之间的关系 5年时间点的指标(ABI和IMT)；衡量不平衡负荷与FRS之间的关联 ABI和IMT为5年；测量社区环境测量之间的关联性 健康食物的可获得性和步行能力，包括饮食摄入模式、肥胖指标、不平衡负荷、心血管疾病 风险因素和心血管疾病指标。初步数据显示，波多黎各人的合并症患病率很高， 尤其是高血压、抑郁症和糖尿病。我们还记录了多个社会团体 和环境差异，以及这个民族独特的遗传背景。纵向研究， 正如所提议的那样，对于理清多种心血管疾病风险因素及其进展的复杂性至关重要 对健康结果的影响。我们建议的项目至关重要，因为了解独特的 疾病的贡献者和这一庞大的高危群体的需求将使有针对性的公共卫生行动成为可能 减少心血管疾病和改善这一人群的整体健康。我们的研究可能会提供洞察力和 作为其他弱势群体未来多学科方法的典范。

PROJECT SUMMARY (See instructions): Cardiovascular disease (CVD) is the leading cause of death among Hispanics residing in the U.S., contributing to nearly one of every four deaths. Most studies on Hispanics have focused on Mexican Americans and, with the exception of the Puerto Rico Heart Study, which was conducted on the island of Puerto Rico several decades ago; few have explored CVD risk factors in Puerto Ricans. Importantly, the Puerto Rican population differs considerably in ancestral genetic history, and in exposures to known risk factors for these important prevalent conditions from other Hispa:nic groups. Differing risk factors include unique dietary intake and physical activity patterns, as well as social, cultural and environmental structures that contribute to and affect CVD risk. The high poverty rates and majority urban environment contribute to these processes in unknown ways: As this group is both a rapidly growing and aging subset ofthe US population, the significance of understanding the reasons for the considerably higher prevalence and incidence of cardiovascular risk factors in this high risk population is critical. The rationale is that these associations are complex and likely iterative, requiring longitudinal analyses in order to understand causal direction and to fully implement multilevel analyses. Our overall aim for this project is to prospectively follow participants ofthe Boston Puerto Rican Health Study for 5 years to measure progression of CVD risk factors and of sub-clinical markers of CVD, so that we may clarify the causal direction of identified associations. We aim to assess five year prospective interrelationships (3 time points) between dietary pattern and vitamin (folate, vitamin B6, vitamin B12, vitamin D, total carotenoids) intake and plasma status and progression of CVD risk factors (pulse pressure, hypertension, and Framingham Risk score (FRS)); assess associations between dietary intake pattern and vitamin status across three time points with CVD indicators, (ABI and IMT) at the 5-year time point; measure associations between allostatic load and FRS with ABI and IMT at 5 years; measure associations between measures of neighborhood environment for healthy food availability and walkability with dietary intake pattern, obesity measures, allostatic load, CVD risk factors, and CVD indicators. Preliminary data show that Puerto Ricans have a high prevalence of comorbidities, particularly hypertension, depression and diabetes. We have also documented multiple social and environmental disparities and a unique genetic background for this ethnic group. Longitudinal studies, as proposed, are critical to untangle the complexities ofthe multiple CVD risk factors and their progression toward health outcomes. Our proposed project is of paramount importance, as understanding the unique contributors to disease and the needs of this large, high-risk group will allow for targeted public health action toward decreasing CVD and improving overall health in this population. Our study may provide insights and serve as a model for future multidisciplinary approaches in other vulnerable groups.