Cultural and Lifestyle Determinants
of Mexican American Adolescents’
Risk for Metabolic Syndrome
Rafael E. Ruiz, ScM
Deborah E. Bender, PhD, MPH
Shoou-Yih D. Lee, PhD
Michelle Mayer, PhD, RN, MPH
This research was partially supported by a National Research Service Award (NRSA) Predoctoral Traineeship from AHRQ sponsored by the Cecil G. Sheps Center for Health
Services Research, University of North Carolina at Chapel Hill, Grant No. T32-HS000032
Introduction

“Latino/Hispanic” is used by CDC to
generically describe Spanish
speaking individuals



The Latino population is young
The majority are of Mexican descent
(~60%) and growing rapidly
Acculturation is a socio-cultural
construct that captures the degree
which a person integrates the

social values, beliefs, and lifestyle of
the dominant culture
Introduction



Overweight and type-2 diabetes
have both increased in adolescents
Metabolic syndrome affects adults
(22%) and adolescents (4.2%)
Mexican Americans have been
shown to have higher rates of
metabolic syndrome
Conceptual Model
Physical
Activity
Metabolic
Syndrome
Acculturation
Diet
Overweight
Type-2
Diabetes
CVD
Specific Aims
1) Determine if metabolic syndrome,
physical activity, and diet differ among
racial/ethnic groups
2) Explore the association of physical
activity and diet with metabolic syndrome
3) Examine the association of acculturation
with metabolic syndrome, physical activity,
and diet in Mexican Americans
Data

National Health and Nutrition
Examination Survey (NHANES)
1999-2002


Pooled cross-section
Analytic dataset restrictions
(N=2,002)


adolescents, 12-19 years of age, with a
fasting plasma glucose level
not taking insulin, oral hypoglycemic
agents, and not pregnant
Variables

In adolescents, three or more of the
following traits define metabolic syndrome
Criterion
Measurement
Elevated triglycerides
110 mg/dl
Low HDL
40 mg/dl
Increased waist circumference 90th percentile (cm)
Elevated fasting glucose
110 mg/dl
Elevated blood pressure
90th percentile (mm Hg)
Cook S, et al. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination
Survey, 1988-1994. Arch Pediatr Adolesc Med 2003 Sep;157(8):821-827
Variables

Primary language was used to
measure acculturation
read or spoken
 used as a child
 usually spoken at home
 usually used to think
 usually spoken with friends


Physical activity


Discrete: None vs. any
Continuous: Number, frequency,
duration, and intensity
Variables

Dietary measures




Variability: number of foods eaten/day
Frequency of eating out: number of
restaurants meals/wk
Energy: total calories consumed
Total macronutrients: protein (gm),
sugars (gm), cholesterol (mg), and fat
(gm)
Statistical Methods


Bivariate associations
Multivariate analysis


Logistic regression
 Dependent variable: having metabolic
syndrome
 Independent variable of interest: acculturation
OLS regression
 Dependent variables: Physical activity and
dietary measures
 Independent variable of interest:
acculturation
Prevalence of Metabolic Syndrome
50.0

Metabolic syndrome traits in US adolescents with
metabolic syndrome
Percent of Subjects
45.0
40.0
Prevalence of
metabolic syndrome
was 4.8%

35.0
30.0
25.0

20.0
15.0
10.0

5.0
0.0
Elevated
Triglycerides
Low HDL
Abdominal
Adiposity
Elevated
Fasting
Plasma
Glucose
Metabolic Syndrome Traits
Elevated
Blood
Pressure

Inactive (8.9%*) vs.
active (4.1%)
Low variability in diet
(8.9%*) vs. higher
variability (4.1%)
Males (6.6%*) vs.
females (2.9%)
Overweight (25%**)
vs. not-overweight
(0.5%)
*-significant at 5% level, **-significant at 1% level
Differences among groups
Prevalence of metabolic syndrome in US adolescents by
race/ethnicity
9.0
Percent of Subjects
8.0
*

Mexican Americans
were more likely
to...

7.0
6.0

5.0
4.0
3.0

2.0
1.0
0.0
Mexican American
Caucasian
Race/Ethnicity
African American
be inactive (19%*)
vs. non-Latinos
(14%)
Be overweight
(22%*) vs. nonLatinos (17%)
Mexican American
males (25%*) were
more likely than
females (18%) to be
overweight
*-significant at 5% level
Associations with metabolic syndrome
Inactivity increases risk of
metabolic syndrome
(OR: 4.68, CI: 1.83-11.93)
 Greater dietary variability decreases
risk of metabolic syndrome
(OR: 0.85, CI: 0.73-0.98)
 Acculturation does not directly
affect metabolic syndrome
(OR: 1.52, CI: 0.78-2.97)

Acculturation, physical activity, diet

Higher levels of acculturation decrease


inactivity [OR-0.65 (0.48-0.88)]
Higher levels of acculturation increase





# of physical activities (+0.41/month**)
energy (137 kcal/day*)
carbohydrates (+25 gm/day**)
saturated fat (+2 gm/day*)
# of times at restaurant food (+0.3
times/week*)
Summary

Mexican American males are the most
likely to develop metabolic syndrome


Higher likelihood of overweight, less physical
activity, and fewer types of foods eaten
A higher level of acculturation



increases overweight
increases intake of calories, carbohydrates,
saturated fat, and more meals eaten outside
the home
increases physical activity, BUT it seems to be
a weak effect
Significance

Acculturation and metabolic
syndrome have an indirect
association


It is a risk factor in Mexican American
adolescents
Underscores the importance of



reducing adolescent overweight
increasing physical activity
promoting healthy dietary options
Considerations

There is no consensus on how to



define metabolic syndrome in adolescents
operationalize acculturation
Time in the U.S. was not a component of
acculturation


Primary language spoken has been shown to
be a good indicator of acculturation
Language skills are acquired over time so they
are linked to the time spent in the U.S.