Changing Old Habits

 New Research Center Investigates Hispanic Nutrition

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Public Health Feature -- April 2004

By  Ken Ortolon
Senior Editor

Edinburg internist Linda Villarreal, MD, has seen firsthand the health problems poor nutrition causes in the Hispanic community. She daily sees diet-related illnesses such as diabetes, hypertension, and heart disease, even in her own family. Her mother had type 2 diabetes and, despite her warnings to family members to "shape up," two of her brothers developed the disease.

"In this population, we see a lot of [poor nutrition]," said Dr. Villarreal, president-elect of the Hidalgo-Starr County Medical Society. "Consequently, you end up with gallbladder disease or adult-onset diabetes, and that precipitates into arterial disease, which precipitates into hypertension, which precipitates into heart problems, and eventually evolves into stroke."

The role nutrition plays in our health has become painstaking clear. Poor diet and little or no exercise have lead to a staggering increase in the number of overweight and obese Americans and higher rates of nutrition-related illnesses such as diabetes and heart disease.

While proper nutrition is important for all Americans, it may be more so for Hispanics, who suffer disproportionately from diabetes and other chronic illnesses. The National Institutes of Health (NIH) says diabetes is two to three times more common among Mexican-American and Puerto Rican adults than among non-Hispanic whites. And NIH estimates that between 25 percent and 30 percent of Hispanics over age 50 have either diagnosed or undiagnosed diabetes.

Meanwhile, recent research shows a nutritional link to other diseases in the Hispanic community, including an increased risk of breast cancer among overweight Hispanic women.

Against that backdrop, researchers at The University of Texas Health Science Center at San Antonio's regional campus in the Lower Rio Grande Valley have launched the nation's first facility dedicated exclusively to studying the relationship between nutrition and health among Hispanic Americans. They hope the new U.S. Hispanic Nutrition Research and Education Center at the Regional Academic Health Center (RAHC) in Harlingen will help improve the health of Lower Rio Grande Valley residents, as well as Hispanics across America.

Planting the Seed

Leonel Vela, MD, MPH, the RACH's regional dean and professor, says the nutrition research center will be a long-term effort to understand how diet and nutrition -- combined with genetic, social, psychological, socioeconomic, cultural, and environmental factors -- affect the health and wellness of the U.S. Hispanic population.

"We want the center to be comprehensive in nature, given the fact that nutrition is not just about what you eat," said Dr. Vela, who will be the principal investigator at the new center. "Nutrition is so complex that we want to take a multidisciplinary approach to look at how nutrition interacts with lifestyles and genetics and psychological, socioeconomic, cultural, and other factors."

Bill McIntyre, PharmD, dean of the School of Health Sciences and Human Services at UT-Pan American in Edinburg, says focusing research on the Hispanic population is important because of recent health trends among that group.

"Among Hispanics in general, especially in the Valley, there's pretty good evidence that a much larger portion of the population are obese, and we're seeing a larger and larger percent of children with obesity issues," said Dr. McIntyre, who will serve as an advisor to the nutrition research center and facilitate collaboration between the center and researchers in UT-Pan American's health programs. "Obesity and poor nutrition lead to things like diabetes, heart disease, and just general health problems, so this population in the Valley probably deserves special attention to address those issues," he said.

Dr. Vela says a "confluence" of lifestyle and cultural issues is contributing to the nutrition and obesity problems in South Texas. Traditional Mexican foods such as beans, rice, tortillas, and other items that tend to be high in fat and cholesterol are still prevalent in the Hispanic diet. But as Hispanic immigrants assimilate to the American lifestyle, they add fast foods such as hamburgers and french fries to their diets.

Dr. Vela says focusing on Hispanics also is important because research on one population group cannot always be applied to others.

"Given the fact that there are cultural, genetic, socioeconomic, and environmental influences, we felt the interplay among all those factors was important. It's unique among population groups, and certainly it would be unique among the Hispanic population," he said.

Seed money for the research center was approved in 2003 when Congress appropriated $100,000 in start-up funds, thanks largely to the efforts of Sen. John Cornyn (R-Texas). In 2004, Congress appropriated an additional $994,000 in operating revenue.

The first $100,000 did not arrive in the hands of RAHC officials until last fall, so preliminary planning for the center and its research still are ongoing, Dr. Vela says. One of their first steps was to visit other nutrition research centers around the country to see what research they were conducting. Currently, a regional advisory committee is being established to help the RAHC define what its research goals will be.

"One of the things we don't want to do with this funding is duplicate anything that's going on already," Dr. Vela said. "We want to be able to determine the current state of affairs in terms of research, in terms of knowledge, and put together a very specific plan that fills in the existing gaps."

Assessing the Valley Menu

Once research activities begin, the center will focus on three main areas, Dr. Vela says. First, researchers will conduct an epidemiologic survey of the Hispanic population in the Lower Rio Grande Valley to establish baseline data on food choices, consumption habits, and general nutritional status.

The second focus will be on basic science and clinical research. "We want to specifically look at the role of diet and susceptibility in diseases that disproportionately affect the Hispanic population, like diabetes and infectious diseases such as TB and hepatitis," Dr. Vela said. "We will look at it from the level of micronutrients in Hispanic diets and their health effects and the role of phytonutrients in Hispanic diets in preventing disease."

Micronutrients are substances such as vitamins and minerals. Phytonutrients are plant compounds with health-promoting qualities, such as carotenoids, flavonoids, and phytoestrogens.

The third focus will be on educating the Hispanic population about the impact their nutritional habits have on their health and helping them make better food choices.

"We hope through this knowledge base to make some headway in preventing the major contributors to morbidity and mortality in the Hispanic population that have a nutrition base," Dr. Vela said. "We want to take what we learn in the laboratory and what we're going to learn in the field in terms of the epidemiologic work and translate it into actual clinical applications, translate it in a way that affects lifestyles and leads to preventing nutrition-related diseases."

Dr. McIntyre says influencing eating habits is a tough task because of several factors, including cultural issues, such as the types of foods Hispanics traditionally eat and how the foods are prepared.

"With nutrition, a lot comes into food preparation, and a lot of cultural issues have to be addressed," said Dr. McIntyre . "You just can't tell people they shouldn't eat high-fat foods. You have to work with them to look at their diet, look at the way they prepare foods, and work within the culture to be able to change that."

Dr. McIntyre says targeting education at patients with nutrition-related diseases is not enough. "The male head of the household may have adult-onset diabetes and, therefore, may need to adjust his diet, but the person who is preparing the food for the family may actually have the greatest impact on making that successful. Educational programs have to be aimed at both, and they have to be culture specific."

Dr. Vela says the challenge for those interested in improving Hispanic health is to figure out how to "maintain the beneficial effects of traditional Hispanic diets and complement that with the right mix of the American diet that's acquired during their acculturation." The nutrition research center will look specifically at how to craft educational messages to get that point across to the Hispanic community, he says.

Looking to the Future

As of February, the nutrition research center had not hired faculty or staff and did not have a permanent home. Dr. Vela planned to hire a research coordinator and then bring in researchers and faculty with specific expertise or interests based on specific research areas recommended by the advisory panel.

For now, Dr. Vela says the new research center will be housed in existing facilities at the RAHC. Eventually he hopes to build a separate home for the center. "Our long-range goal is to integrate nutrition research and education as an important component of the research mission that our health science center has here in the Rio Grande Valley," he said.

RAHC officials also plan to seek additional funding sources, both public and private.

While there does not seem to be a great deal of awareness of the nutrition research center yet among Lower Rio Grande Valley physicians, Dr. McIntyre says he believes the medical community will support it.

"The medical community, in general, is pretty well aware of the issues, and many people are involved with different programs trying to address these issues," he said. "If we don't address the nutrition issue in the Valley, we're going to see a lot of diseases occurring in younger and younger males and females that will cost us a lot down the road."

Dr. Villarreal says the center is an excellent idea. "If the initial research is going to be as it applies to Hispanics and their nutritional needs, or lack thereof, it's an excellent way to get started. And it's the best place to start because of the high incidence of diabetes and chronic diseases that are preventable. If we had the availability of resources or areas of study and research that could really stimulate the population to participate, then we could certainly make a dent in what evolves into a chronic disease state and untimely or, perhaps, premature death."

Ken Ortolon can be reached at (800) 880-1300, ext. 1392, or (512) 370-1392; or by email at Ken Ortolon.

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