JOINT EFFECTS OF OBESITY AND PHYSICAL INACTIVITY ON
CARDIOVASCULAR DISEASE RISK AMONG HISPANICS WITH TYPE 2 DIABETES
Ranjita Misra, Steve Riechman, Julio Guerrero, Roxana Valdes-Ramos, Sukho Lee, Linda Castillo,
Ivonne Vizcarra-Bordi, Martha Kaufer-Horwitz
 Obesity among individuals with type 2 diabetes leads to
cardiovascular disease (a macro-vascular complication of
diabetes). Obesity is a multifactorial disease requiring a
comprehensive preventive approach.
 26.9% of Americans are obese, including 29.3% of Hispanics
(CDC, 2009).
 Hispanics (15% of the U.S. population) are the largest and
fastest-growing ethnic minority group; 53% do not perform
the recommended amount of physical activity.
 Prevalence of diabetes (12.4%) is very high among MexicanAmericans (twice as much as non-Hispanic Whites).
Rationale/Purpose
 The purpose of this study was to investigate the joint
associations of physical inactivity and obesity with CVD risk
factors among Hispanic adults with diabetes
s
s
Introduction
Measures
 Demographics - age, gender, country of residence,
educational level, age of diabetes onset
Health Behaviors – smoking, diet, physical activity
Psychosocial Variables –
Social support
Depression
Acceptance of diabetes
Anthropometric measurements
height, weight, blood pressure, Body Mass Index
(BMI).
Clinical Variables – blood pressure, total cholesterol,
high- and low-density lipoproteins, triglycerides,
glycosylated hemoglobin (HbA1c).
Methods
The sample comprised of 259 Mexican and Mexican American
adults with type 2 diabetes.
Survey data were collected by trained and ethnically similar
interviewers on the following parameters.
Physical activity was measured by the Rapid Assessment
Physical Activity scale (English and Spanish). Obesity was
measured by the Body Mass Index.
Results
Physical inactivity and obesity had a strong and
independent association with CVD risk in both genders.
Non-obese active individuals had the lowest risk for
CVD (total cholesterol, triglyceride, high density
lipoprotein and low density lipoprotein, and systolic and
diastolic blood pressure) followed by obese active
individuals, non-obese inactive, and obese inactive
Hispanics.
Respondents were placed into four distinct obesity-physical
activity groups: non-obese active, non-obese inactive, obese
active, and obese inactive.
Regression analysis showed adjustment for the
obesity-related risk factors did not weaken the
associations between obesity/inactivity and CVD risk.
Social support was measured by the Multidimensional Scale
for Perceived Social Support. Depression was measured by the
Center for Epidemiologic Studies Depression Scale. Dietary
intake was measured by the nutrition subscale of the revised
Health Promotion Lifestyle Profile II. Acceptance of diabetes
was measured by the Revised Ideas About Diabetes scale.
Psychosocial factor [e.g., acceptance of diabetes],
nutrition behavior, education, blood pressure and
obesity/inactivity predicted CVD risk (total cholesterol)
in this sample [R2=.20; p<.01].
Data was analyzed using SPSS program (SPSS Inc., Chicago, IL).
Although obesity was higher among Mexican
Americans, Mexicans had poor glycemic control and
higher CVD risk than their counterparts in the United
States.
Variable
Nationality & Gender
Mexicans
male
female
Mexican-Americans
male
Female
Table 1: Demographics
Frequency
151
36
115
108
24
84
58.3%
23.8%
76.2%
41.7%
22.2%
77.8%
SD
± 16.8
± 21.5
Variable
Triglycerides (mg/dl)
Mexicans
Mexican-Americans
Non-obese
Active
49.7
48.7
42.5
75.3
83.5
Table 3: Clinical Measures
Mean
Low-density Lipoproteins (mg/dl)
Mexicans
Mexican-Americans
Total Cholesterol (mg/dl)
Mexicans
Mexican-Americans
HbA1c
Mexicans
Mexican-Americans
42.9
42.6
117.1
105.4
2.74
HDL
LDL
SBP
DBP
Total Cholesterol
HbA1c
269.75
237.96
227.13
200.97
194.96
183.53
139.23
137.50
178.90
137.46
124.91
133.04
83.95
SD
82.91
126.27
105.37
74.60
72.97
42.96
42.72
41.98
± 137.7
± 129.0
9.10
9.50
8.00
Obese Active
Non-obese Inactive
7.20
Non-obese Active
** Significant differences existed between the groups in their total cholesterol (p<.001), triglyceride (p=.038), HDL (non-sig), HbA1c
(p<.001), systolic blood pressure (p=.009), diastolic blood pressure (p<.001).
Figure 4: Psychosocial Factors
± 36.8
± 31.1
± 49.4
± 42.4
2.54
2.30
Figure 3: Cardiovascular Disease Risk Factors
Low Social Support
Not Depressed
95.00
199.4
182.6
3.80
3.72
104.67
± 12.0
± 9.5
Obese Inactive
4.68
** Significant differences existed between the groups in their acceptance of the disease (outlook – not significant, Inhibition, p=.050,
confidence, p=.005).
Obese Inactive
High-density Lipoproteins (mg/dl)
Mexicans
Mexican-Americans
Obese Active
Mexican Americans
Mexicans
45.70
220.4
196.1
Outlook
4.26
3.90 4.09
2.39
± 10.6
± 11.7
± 4.9
± 8.6
Confidence
Non-obese
Inactive
4.06
29.1
228.30
29.1
34.7
3.72
34.7
Triglycerides
(kg/m2)
Body Mass Index
Mexicans
Mexican-Americans
Inhibition
57.0
Table 2: Anthropometric Variables
Variable
Mean
Systolic Blood Pressure (mm HG)
Mexicans
125.1
Mexican-Americans
136.7
Diastolic Blood Pressure (mm HG)
Mexicans
Mexican-Americans
Percent
Figure 2: Acceptance of Diabetes as a Disease
Figure 1: Demographic Characteristics of
Mexicans and Mexican Americans
Age
Age of Diabetes Onset
BMI
High Social Support
Poor Dietary Habits
91.60
Clinically Depressed
Healty Dietary Behavior
100.00
90.30
85.70
75.20
71.40
90.30
89.10
70.10
68.80
63.10
8.5
7.5
± 2.5
± 1.7
36.90
31.30
28.60
Table 4: Psychosocial & Behavioral Measures
Variable
Mean
SD
Social Support
Mexicans
5.1
± 1.5
Mexican-Americans
5.7
± 1.1
Confidence (Acceptance of Diabetes)
Mexicans
Mexican-Americans
4.1
4.3
± 0.9
± 0.5
Inhibition (Acceptance of Diabetes)
Mexicans
Mexican-Americans
2.6
2.2
± 0.8
± 0.8
Nutrition Behavior
Mexicans
Mexican-Americans
2.5
1.7
± 0.5
± 0.5
Depression
Mexicans
Mexican-Americans
28.5
16.3
± 13.6
± 11.2
24.80
14.30
5.00
Obese Inactive
29.90
9.70
8.40
10.90
9.70
0.00
Obese Active
Non-obese Inactive
Non-obese Active
** Significant differences between the groups for dietary habits and social support is p <.001, and depression is p=.038
Discussion and Conclusion
Physical inactivity seems to have an independent effect on CVD risk.
Obesity increases the risk partly through the modification of other risk
factors.
The increasing Mexican-American population and high rates of obesity
and diabetes should motivate health professionals to focus on primary
prevention for this ethnic group.
This project was funded by la Programa de Investigacion en Migracion Y Salud (PIMSA) Grant