The Mediating Role Of Dietary Patterns On The Relation Between Acculturation, Psychosocial Factors, And Cardiovascular Disease Risk Factors In The U.S. - Mexico Border

Chronic diseases affect both, developed and developing countries around the world. In the U.S., cardiovascular diseases (CVD) are the leading cause of death for all groups including Hispanics (Heron, 2009). Hispanics are disproportionally affected by CVD and experience risk factors at higher rates than non-Hispanic whites (Swenson, 2002). Although CVD are among the most expensive and widespread health problems, they are among the most preventable. Evidence shows that diet plays a very important role in the development of chronic diseases; current dietary changes are partially responsible for the increasing epidemic of chronic diseases worldwide. It is well established that the consumption of a healthy diet can help prevent and control morbidity and mortality (Diet, nutrition and the prevention of chronic diseases.2003). The study of dietary patterns is a useful method to assess dietary intake focusing on the total intake (Kerver, 2003). Dietary patterns reflect the complexity of the diet providing a more practical way for researchers to evaluate the associations between diet and health outcomes and to evaluate health effects of current dietary guidelines. In addition, the public can better understand and implement research results from the dietary pattern studies. The overall aim of this study is to examine dietary patterns, psychosocial factors, and dietary heart-healthy behaviors as mediators of CVD risk factors among Hispanics adults participating in the H.E.A.R.T. study. Two studies are proposed. Specific aim for Study 1 was to identify and characterize dietary patterns using factor analysis and to examine its associations with demographic characteristics and CVD risk factors. Specific aim for Study 2 was to examine the associations between acculturation, psychosocial factors with dietary patterns and CVD risk factors among Hispanic adults. Five dietary patterns were identified by factor analysis; the Western, Prudent, Mexican, Juice, and Sweets. The Western pattern was predominantly consumed by younger adults, males, and by participant born in the U. S. The Prudent pattern was predominantly consumed by older adults, females, and participants being born in Mexico. The Prudent pattern was negatively and significantly associated with reduced CVD risk Index, whereas the Western was positively and significantly associated with waist circumference only. The Juice pattern was the only pattern to be negatively and significantly associated with most CVD risk factors. Results from the mediational analysis showed that only the Prudent and Juice patterns mediated the association between gender, age, and education with two CVD risk factors, BMI and CVD risk Index. Acculturation levels were positively associated with consumption of the Western pattern and lower consumption of the Mexican pattern. Significant indirect effects indicate that the Prudent pattern has a mediating role between acculturation and CVD risk index. Lastly, four SEM models were tested to identify the effects of several psychosocial factors on two CVD risk factors, obesity and CVD risk Index. Results showed that the Prudent pattern was the only significant mediator in the association between psychosocial factors and CVD risk Index. In addition, lower perceived barriers to eat healthy were the strongest predictor of increased consumption of Prudent pattern, followed by higher self-efficacy and higher perceived benefits. Self-efficacy, followed by perceived barriers predicted the Western pattern. Moreover, perceived barriers were the only factor to have a direct effect on both, obesity and CVD risk Index. In conclusion, the models had an acceptable fit of the data in describing factors associated with CVD risk factors among Hispanics in El Paso, TX. Overall, high homogeneity of the study sample may have limited the strength of many relationships, particularly those between dietary patterns and cardiovascular risk factors