ObjectivePeople living with HIV (PLWH) face multiple barriers to access treatments, experiencing ... more ObjectivePeople living with HIV (PLWH) face multiple barriers to access treatments, experiencing unmet medical and ancillary service needs. The purpose of this study was to determine the barriers t...
rate (nPCR) were obtained from chart; 24-hr dietary recalls were used to estimate daily dietary p... more rate (nPCR) were obtained from chart; 24-hr dietary recalls were used to estimate daily dietary protein intake (DPI) and dietary energy intake (DEI). Deaths were recorded for 12 months Results: Seventy-seven participants receiving HD were included, with a mean age of 63.2 ± 14.2 years; 71.2% were male, 58.4% had diabetes and the average time on dialysis was 6.2 ± 4.2 years. The Mean ± SD of nPCR was 0.9 ± 0.2, albumin was 3.8 ± 0.3, DEI was 1867.3 ± 367.9 kcal/kg and DPI was 80.0 ± 15.8 gm/kg. MIS ≥ 6 and SGA > 1 were used as cutoff values to detect malnourished participants; 46% were malnourished by MIS vs. 35% by SGA. Albumin, nPCR, DPI and DEI were all inversely correlated with both indices (P < 0.05).Ten patients (13%) died of cardiovascular disease. Well-nourished participants with MIS < 6 lived longer (11.8 months, CI 95%, 11.6-12.1) than malnourished with MIS ≥ 6 (10.9 months, CI 95%, 10.1-11.7) (Log Rank P = 0.04). MIS was a significant predictor of mortality, while SGA did not reach significance (P = 0.264). Conclusions: MIS was a more sensitive index to detect malnutrition than SGA among HD patients. Only MIS was a significant predictor of mortality. Both indices were strongly correlated to the examined nutrition parameters. Funding Sources: No funding sources.
The objective of this study is to assess the effectiveness of a 6-month nutrition intervention to... more The objective of this study is to assess the effectiveness of a 6-month nutrition intervention to improve glycemic parameters and inflammation in prediabetic PLWH on stable ART with undetectable HIV viral load. Methods: A 6-month randomized, controlled nutrition intervention was conducted in prediabetic PLWH. The study participants for the intervention were recruited from the Miami Adult Studies for HIV (MASH) cohort at the FIU-Borinquen Research Clinic. Upon their consent, the participants were randomized into the intervention group or the control group. Participants randomized in the intervention group met once a month for approximately 1 hour where they received medical nutrition therapy, nutrition counseling and nutrition education; participants randomized into the control group received educational material at baseline. Blood was drawn at baseline and at 6-month to measure fasting blood glucose (FBG) and high sensitivity C-reactive protein (hs-CRP). Results: A total of 38 participants were recruited and randomized into either the intervention group (n = 20) or the control group (n = 18). We found that the FBG for the 6-month follow-up for the intervention group was significantly lower than the baseline FBG values of the same study group (paired t-test; P = 0.031). No significant difference was found in the control group between the baseline and 6-month fasting blood glucose values (P = 0.068). Moreover, no significant difference was found in pre/post C-reactive protein (CRP) levels in the intervention or control group (paired t-test; P = 0.404 and P = 0.117 respectively). There was a significant difference in CRP levels at baseline (P = 0.028) between the study groups but no difference at the 6-month follow up (Mann Whitney U test: P = 0.430). Conclusions: The results from this intervention support the notion that a nutrition intervention is effective in prediabetic PLWH to lower diabetes risk by significantly lowering fasting blood glucose and may be implemented into larger scale interventions; however, no significant changes was seen in hs-CRP values between the 2 groups.
International Journal of Environmental Research and Public Health, Nov 8, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
adulthood [8,14]. Obesity has been cited as "a risk factor for CVD, ventricular dysfunction, cong... more adulthood [8,14]. Obesity has been cited as "a risk factor for CVD, ventricular dysfunction, congestive heart failure, stroke, and cardiac arrhythmias" [15]. According to Calderon et al. [16] "Persons with body mass index (BMI) >35 kg/m 2 are 2-3 times more likely than lean persons with lower BMI (18.5-24.9 kg/m 2) to die from CVD". Therefore, detection of the early signs of T2D and CVD is needed to help in the prevention of these and other related medical conditions. Similar to higher BMI, abdominal fat or central adiposity is closely associated with hyperinsulinemia and IR [17]. According to Ramachandran (2004), "visceral fat increases the risk of diabetes and hyperlipidemia by favoring insulin resistance." Studies on nondiabetic Indians revealed that IR was associated with subcutaneous fat. Other risk factors associated with central adiposity include glucose intolerance, hyperinsulinemia, hypertriglyceridemia, and hypertension [17]. These are also risk factors for CVD. Further support comes from Patel et al. [18] who indicated that "populations with low BMI such as
Objectives The relationship between dietary fiber intake and fasting plasma glucose (FPG) (mg/dl)... more Objectives The relationship between dietary fiber intake and fasting plasma glucose (FPG) (mg/dl) among U.S. adults aged 40 years and older were studied. 2017–2018 NHANES data (N = 3309) was used. Sex and ethnicity differences were studied. Methods Participants were included if they had data available for daily fiber intake during the first in-person interview and laboratory data for fasting plasma glucose levels. n = 1643 were males and n = 1666 were females. n = 402 were Mexican American, n = 308 were Other Hispanic, n = 1229 were Non- Hispanic White, n = 799 were Non- Hispanic Black, n = 416 were Non- Hispanic Asian, and n = 155 were other race- including Multi-Racial. The participants with diabetes, n = 409 were males, and n = 312 were females. Independent-Samples T test was used to compare means between dietary fiber intake and FPG levels by sex and ethnicity. Results Fiber intake was significantly different between sex and ethnic groups; Mexican American, Other Hispanic, Non- Hispanic White, Non- Hispanic Black, Non- Hispanic Asian, and other race- including Multi-Racial (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Males had significantly higher fiber intake than females…
Journal of the Academy of Nutrition and Dietetics, Sep 1, 2017
Background: Utilize Lean Management Principles and A3 thinking to assess current state and implem... more Background: Utilize Lean Management Principles and A3 thinking to assess current state and implement target state for meal selection process in the mental health unit of healthcare system. Method: Intra-disciplinary team conducted GEMBA Walk to determine current state in terms of: customer satisfaction, steps from start to finish, time from start to finish, compliance to diet prescribed, and number of people involved in process. Two rapid trials, seven days each with N¼15 patients, were conducted: meal selection via room-service call center and meal selection via diet tech and electronic device at bedside were evaluated. Patient and stakeholders interviews, time and motion studies, and meal accuracy checks were used to collect data pre-intervention (defining current status) and with each rapid trial. Results: KAPAWEES such as paper menu process was not patient centric, meal selections made by patients were not congruent with diet prescription, and shortfalls in patient education were identified. Post rapid trials there was a 50% increase in customer satisfaction, 42% reduction in start to finish steps, 47% decrease in start to finish time, 50% increase in diet compliance, and a 33% reduction in the number of people involved in the meal selection process.
The gut–liver axis has been recognized as a potential pathway in which dietary factors may contri... more The gut–liver axis has been recognized as a potential pathway in which dietary factors may contribute to liver disease in people living with HIV (PLWH). The objective of this study was to explore associations between dietary quality, the fecal microbiome, the metabolome, and liver health in PLWH from the Miami Adult Studies on HIV (MASH) cohort. We performed a cross-sectional analysis of 50 PLWH from the MASH cohort and utilized the USDA Healthy Eating Index (HEI)–2015 to measure diet quality. A Fibrosis-4 Index (FIB-4) score < 1.45 was used as a strong indication that advanced liver fibrosis was not present. Stool samples and fasting blood plasma samples were collected. Bacterial composition was characterized using 16S rRNA sequencing. Metabolomics in plasma were determined using gas and liquid chromatography/mass spectrometry. Statistical analyses included biomarker identification using linear discriminant analysis effect size. Compared to participants with FIB-4 ≥ 1.45, partic...
Background: Intestinal bacterial products such as lipopolysaccharide (LPS) are a marker of microb... more Background: Intestinal bacterial products such as lipopolysaccharide (LPS) are a marker of microbial translocation which causes chronic immune activation associated with HIV disease progression. Ex...
Journal of Clinical and Translational Science, 2021
IMPACT: Understanding the needs and barriers or facilitators to participation in research, especi... more IMPACT: Understanding the needs and barriers or facilitators to participation in research, especially among minority communities is critical not only for COVID-19 research but also for future clinical and translational research and health disparities studies. OBJECTIVES/GOALS: The overall goal of this project is to enhance education, awareness, access, and inclusion of underserved communities across Florida in COVID-19 research, especially among Black and Hispanic minority groups that are disproportionately affected by COVID-19. METHODS/STUDY POPULATION: Through strategic partnership among five academic institutions and community-based organizations across the state of Florida, the FL-CEAL team will implement focus groups and surveys in minority communities in Florida to gauge the awareness and understanding of COVID-19, and the barriers and facilitators for participation in COVID-19 research studies. These communities include but are not limited to Latinx and Black populations in S...
We evaluated mental health and substance use during the COVID-19 pandemic in 196 participants fro... more We evaluated mental health and substance use during the COVID-19 pandemic in 196 participants from the Miami Adult Studies on HIV (MASH) Cohort. A survey was administered between July-August of 2020, including validated measures of resilience and anxiety, a scale to measure COVID-19-related worry, and self-reported substance use. Compared to HIVuninfected participants (n = 80), those living with HIV (n = 116) reported fewer anxiety symptoms, less COVID-19-related worry, and higher resilience. Those with more anxiety symptoms and lower resilience engaged in more frequent alcohol consumption, binge drinking, and cocaine use. Alcohol misuse was more common among HIV-uninfected participants. Cocaine use was reported by 21% fewer participants during the pandemic compared with 7.3 ± 1.5 months earlier. Possibly due to their experiences with HIV, PLWH responded with higher resilience and reduced worry and anxiety to the adversities brought by the COVID-19 pandemic.
Objectives Objective: To understand more about the impact of mindfulness training on perceived st... more Objectives Objective: To understand more about the impact of mindfulness training on perceived stress levels, dispositional mindfulness, intuitive eating, and psychological flexibility.in bariatric patients of Hispanic origin, 12–36 months post-bariatric surgery. Background: Mindfulness meditation has been proposed as an approach to reduce stress and increase awareness of physical sensations. The purpose of this study was to evaluate the impact of a six-session mindfulness-based training on dispositional mindfulness, perceived stress levels, intuitive eating, and psychological flexibility in bariatric patients of Hispanic origin 12–36 months post surgery. Methods The mindfulness group training was based on The Mindfulness Meditation/Acceptance Commitment Approach (MMACT) and focused on the following topics: mind body connection, stress management, intuitive eating, self-compassion, and acceptance & commitment. Participants were recruited from flyers posted in a private dietitian'...
Objectives Illicit drug use can lead to adverse cardiovascular events; it is an additional risk f... more Objectives Illicit drug use can lead to adverse cardiovascular events; it is an additional risk factor for cardiovascular disease. Thus, we sought to determine the association between CVD and drug use in people living with HIV (PLWH) using the FHS 10-year risk. Methods Participants were selected from the MASH cohort. Demographics, anthropometrics, bioimpedance analysis, and fasting blood samples were collected by trained personnel. HIV Viral Load (VL, copies/ml) was abstracted from medical charts. Urine toxicology was used to determine current illicit drug use. Descriptive statistics were used to analyze demographics, HIV status, and VL (undetectable VL < 50 copies/ml). CVD (10-year risk) score was calculated using a formula based on CVD risk factors. An independent sample t-test was used to compare the mean CVD risk score between drug users and non-users. Linear regression was used to find an association between drug users and CVD 10-year risk while controlling for sex and infec...
I wish to thank my committee members for their support during the preparation and compilation of ... more I wish to thank my committee members for their support during the preparation and compilation of this study. I appreciate their time, effort and guidance throughout the process. Special gratitude to Dr. Paulette Johnson for her help and patience with the statistical analyses, Dr. Adriana Campa, for her suggestions in methodology, Dr. Marcia Magnus and Dr. Dalip Ragoobirsingh for their scrutiny of the proposal. To my major professor, Dr. Fatma Huffman, thank you for your faith in my ability to complete this study. Her gentleness, encouragement, guidance, financial planning and assistance helped me to meet the deadlines and requirements for completion of this study. Thanks to the University Graduate School, FIU for awarding me the Dissertation Year Fellowship during my final year of the study. Special thanks to the workers of the Heart Foundation of Jamaica, the Diabetes Association of Jamaica, and the Central Medical Laboratory, who performed the blood analyses. To the Jamaican Ministry of Education and Ministry of Health officials who sanctioned the collection of data. To the principals and contact persons in all ten schools who accommodated us for the data collection. To the study subjects who willingly participated and made this project possible. To my family members here in the USA and in Jamaica who supported me during this challenging process. I am extremely grateful to my sisters, Cheryl and Heather Barrett in Jamaica who worked tirelessly to organize this study for me and made followup calls to ensure the smooth success of the project. To Francine White who assisted me throughout the data collection and to my nephews who took time out from their school activities to accompany me on data collection days. Your help is greatly appreciated.
Objectives Inflammation and oxidative stress are considered important factors in the development ... more Objectives Inflammation and oxidative stress are considered important factors in the development of non-communicable diseases with aging. We determined associations between body mass index (BMI), oxidative stress (OS), and inflammation in people living with HIV (PLWH) and un-infected substance users. Methods Overweight/obesity (OW/OB) was defined as BMI ≥ 25 and normal weight (NW) as BMI ≤ 24.9 in participants of the MASH cohort. Cocaine use was assessed with questionnaires and urine toxicology. Smoking was assessed with questionnaires. Blood was collected to assess inflammation (high sensitivity C-reactive protein [hsCRP] >3 m/L) by LabCorp, and OS with ARBOR ASSAYS (Ann Arbor, MI) glutathione colorimetric detection kit with %oxidized glutathione above median (>2.33%) as elevated. HIV viral load (VL) was obtained from medical charts. Regressions compared substance-abusing PLWH and un-infected people and controlled for age, sex, HIV status, and BMI. Results Mean age of the 605...
Objectives Distinct dietary components and microbiome metabolites may affect liver disease progre... more Objectives Distinct dietary components and microbiome metabolites may affect liver disease progression, a common comorbidity among people living with HIV (PLWH). Similarly, diet composition, including micronutrients, have been associated with markers of HIV disease progression (CD4 cell count). The objective of this study was to investigate the associations between dietary components, plasma metabolites, and liver fibrosis in PLWH. Methods A cross-sectional pilot study that enrolled 50 PLWH on antiretroviral therapy from the Miami Adult Studies on HIV (MASH) cohort. Diet quality was measured with the USDA Healthy Eating Index (HEI) and liver fibrosis was measured via the Fibrosis-4 Index (FIB-4). Microbiome metabolites were measured from plasma samples via metabolomics-non-targeted gas chromatography/mass spectrometry and liquid chromatography/mass spectrometry. Statistical analysis included T-test, Chi-square, Spearman correlation, and Partial Least Squares Discriminant Analysis (P...
Objectives Polyunsaturated fatty acids (PUFA) such as n-3 PUFA, eicosapentaenoic acid (EPA), doco... more Objectives Polyunsaturated fatty acids (PUFA) such as n-3 PUFA, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and n-6 PUFA, arachidonic acid (AA) may mediate inflammatory responses. Vitamin B6 deficiency has been shown to alter plasma PUFA levels. This perturbation of PUFA metabolism in vitamin B6 deficiency measured by pyridoxal-5’-phosphate (PLP) may contribute to inflammation. Thus, we aimed to examine the associations of 1) dietary EPA + DHA, and vitamin B6 with plasma ratio of AA/(EPA + DHA) by PLP level, 2) plasma AA/(EPA + DHA) and PLP with C-reactive protein (CRP), a marker for inflammation, and 3) dietary EPA + DHA, and vitamin B6 with CRP level, using NHANES. Methods NHANES datasets (2003–2004) with subjects ≥20 years were analyzed, accounting for survey design and sample weights (n = 4486). The significance level was P < 0.05. Covariates were age, gender, ethnicity, BMI, smoking, alcohol, total energy, dietary supplements, physical activity, and NSAIDs, depe...
ObjectivePeople living with HIV (PLWH) face multiple barriers to access treatments, experiencing ... more ObjectivePeople living with HIV (PLWH) face multiple barriers to access treatments, experiencing unmet medical and ancillary service needs. The purpose of this study was to determine the barriers t...
rate (nPCR) were obtained from chart; 24-hr dietary recalls were used to estimate daily dietary p... more rate (nPCR) were obtained from chart; 24-hr dietary recalls were used to estimate daily dietary protein intake (DPI) and dietary energy intake (DEI). Deaths were recorded for 12 months Results: Seventy-seven participants receiving HD were included, with a mean age of 63.2 ± 14.2 years; 71.2% were male, 58.4% had diabetes and the average time on dialysis was 6.2 ± 4.2 years. The Mean ± SD of nPCR was 0.9 ± 0.2, albumin was 3.8 ± 0.3, DEI was 1867.3 ± 367.9 kcal/kg and DPI was 80.0 ± 15.8 gm/kg. MIS ≥ 6 and SGA > 1 were used as cutoff values to detect malnourished participants; 46% were malnourished by MIS vs. 35% by SGA. Albumin, nPCR, DPI and DEI were all inversely correlated with both indices (P < 0.05).Ten patients (13%) died of cardiovascular disease. Well-nourished participants with MIS < 6 lived longer (11.8 months, CI 95%, 11.6-12.1) than malnourished with MIS ≥ 6 (10.9 months, CI 95%, 10.1-11.7) (Log Rank P = 0.04). MIS was a significant predictor of mortality, while SGA did not reach significance (P = 0.264). Conclusions: MIS was a more sensitive index to detect malnutrition than SGA among HD patients. Only MIS was a significant predictor of mortality. Both indices were strongly correlated to the examined nutrition parameters. Funding Sources: No funding sources.
The objective of this study is to assess the effectiveness of a 6-month nutrition intervention to... more The objective of this study is to assess the effectiveness of a 6-month nutrition intervention to improve glycemic parameters and inflammation in prediabetic PLWH on stable ART with undetectable HIV viral load. Methods: A 6-month randomized, controlled nutrition intervention was conducted in prediabetic PLWH. The study participants for the intervention were recruited from the Miami Adult Studies for HIV (MASH) cohort at the FIU-Borinquen Research Clinic. Upon their consent, the participants were randomized into the intervention group or the control group. Participants randomized in the intervention group met once a month for approximately 1 hour where they received medical nutrition therapy, nutrition counseling and nutrition education; participants randomized into the control group received educational material at baseline. Blood was drawn at baseline and at 6-month to measure fasting blood glucose (FBG) and high sensitivity C-reactive protein (hs-CRP). Results: A total of 38 participants were recruited and randomized into either the intervention group (n = 20) or the control group (n = 18). We found that the FBG for the 6-month follow-up for the intervention group was significantly lower than the baseline FBG values of the same study group (paired t-test; P = 0.031). No significant difference was found in the control group between the baseline and 6-month fasting blood glucose values (P = 0.068). Moreover, no significant difference was found in pre/post C-reactive protein (CRP) levels in the intervention or control group (paired t-test; P = 0.404 and P = 0.117 respectively). There was a significant difference in CRP levels at baseline (P = 0.028) between the study groups but no difference at the 6-month follow up (Mann Whitney U test: P = 0.430). Conclusions: The results from this intervention support the notion that a nutrition intervention is effective in prediabetic PLWH to lower diabetes risk by significantly lowering fasting blood glucose and may be implemented into larger scale interventions; however, no significant changes was seen in hs-CRP values between the 2 groups.
International Journal of Environmental Research and Public Health, Nov 8, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
adulthood [8,14]. Obesity has been cited as "a risk factor for CVD, ventricular dysfunction, cong... more adulthood [8,14]. Obesity has been cited as "a risk factor for CVD, ventricular dysfunction, congestive heart failure, stroke, and cardiac arrhythmias" [15]. According to Calderon et al. [16] "Persons with body mass index (BMI) >35 kg/m 2 are 2-3 times more likely than lean persons with lower BMI (18.5-24.9 kg/m 2) to die from CVD". Therefore, detection of the early signs of T2D and CVD is needed to help in the prevention of these and other related medical conditions. Similar to higher BMI, abdominal fat or central adiposity is closely associated with hyperinsulinemia and IR [17]. According to Ramachandran (2004), "visceral fat increases the risk of diabetes and hyperlipidemia by favoring insulin resistance." Studies on nondiabetic Indians revealed that IR was associated with subcutaneous fat. Other risk factors associated with central adiposity include glucose intolerance, hyperinsulinemia, hypertriglyceridemia, and hypertension [17]. These are also risk factors for CVD. Further support comes from Patel et al. [18] who indicated that "populations with low BMI such as
Objectives The relationship between dietary fiber intake and fasting plasma glucose (FPG) (mg/dl)... more Objectives The relationship between dietary fiber intake and fasting plasma glucose (FPG) (mg/dl) among U.S. adults aged 40 years and older were studied. 2017–2018 NHANES data (N = 3309) was used. Sex and ethnicity differences were studied. Methods Participants were included if they had data available for daily fiber intake during the first in-person interview and laboratory data for fasting plasma glucose levels. n = 1643 were males and n = 1666 were females. n = 402 were Mexican American, n = 308 were Other Hispanic, n = 1229 were Non- Hispanic White, n = 799 were Non- Hispanic Black, n = 416 were Non- Hispanic Asian, and n = 155 were other race- including Multi-Racial. The participants with diabetes, n = 409 were males, and n = 312 were females. Independent-Samples T test was used to compare means between dietary fiber intake and FPG levels by sex and ethnicity. Results Fiber intake was significantly different between sex and ethnic groups; Mexican American, Other Hispanic, Non- Hispanic White, Non- Hispanic Black, Non- Hispanic Asian, and other race- including Multi-Racial (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Males had significantly higher fiber intake than females…
Journal of the Academy of Nutrition and Dietetics, Sep 1, 2017
Background: Utilize Lean Management Principles and A3 thinking to assess current state and implem... more Background: Utilize Lean Management Principles and A3 thinking to assess current state and implement target state for meal selection process in the mental health unit of healthcare system. Method: Intra-disciplinary team conducted GEMBA Walk to determine current state in terms of: customer satisfaction, steps from start to finish, time from start to finish, compliance to diet prescribed, and number of people involved in process. Two rapid trials, seven days each with N¼15 patients, were conducted: meal selection via room-service call center and meal selection via diet tech and electronic device at bedside were evaluated. Patient and stakeholders interviews, time and motion studies, and meal accuracy checks were used to collect data pre-intervention (defining current status) and with each rapid trial. Results: KAPAWEES such as paper menu process was not patient centric, meal selections made by patients were not congruent with diet prescription, and shortfalls in patient education were identified. Post rapid trials there was a 50% increase in customer satisfaction, 42% reduction in start to finish steps, 47% decrease in start to finish time, 50% increase in diet compliance, and a 33% reduction in the number of people involved in the meal selection process.
The gut–liver axis has been recognized as a potential pathway in which dietary factors may contri... more The gut–liver axis has been recognized as a potential pathway in which dietary factors may contribute to liver disease in people living with HIV (PLWH). The objective of this study was to explore associations between dietary quality, the fecal microbiome, the metabolome, and liver health in PLWH from the Miami Adult Studies on HIV (MASH) cohort. We performed a cross-sectional analysis of 50 PLWH from the MASH cohort and utilized the USDA Healthy Eating Index (HEI)–2015 to measure diet quality. A Fibrosis-4 Index (FIB-4) score < 1.45 was used as a strong indication that advanced liver fibrosis was not present. Stool samples and fasting blood plasma samples were collected. Bacterial composition was characterized using 16S rRNA sequencing. Metabolomics in plasma were determined using gas and liquid chromatography/mass spectrometry. Statistical analyses included biomarker identification using linear discriminant analysis effect size. Compared to participants with FIB-4 ≥ 1.45, partic...
Background: Intestinal bacterial products such as lipopolysaccharide (LPS) are a marker of microb... more Background: Intestinal bacterial products such as lipopolysaccharide (LPS) are a marker of microbial translocation which causes chronic immune activation associated with HIV disease progression. Ex...
Journal of Clinical and Translational Science, 2021
IMPACT: Understanding the needs and barriers or facilitators to participation in research, especi... more IMPACT: Understanding the needs and barriers or facilitators to participation in research, especially among minority communities is critical not only for COVID-19 research but also for future clinical and translational research and health disparities studies. OBJECTIVES/GOALS: The overall goal of this project is to enhance education, awareness, access, and inclusion of underserved communities across Florida in COVID-19 research, especially among Black and Hispanic minority groups that are disproportionately affected by COVID-19. METHODS/STUDY POPULATION: Through strategic partnership among five academic institutions and community-based organizations across the state of Florida, the FL-CEAL team will implement focus groups and surveys in minority communities in Florida to gauge the awareness and understanding of COVID-19, and the barriers and facilitators for participation in COVID-19 research studies. These communities include but are not limited to Latinx and Black populations in S...
We evaluated mental health and substance use during the COVID-19 pandemic in 196 participants fro... more We evaluated mental health and substance use during the COVID-19 pandemic in 196 participants from the Miami Adult Studies on HIV (MASH) Cohort. A survey was administered between July-August of 2020, including validated measures of resilience and anxiety, a scale to measure COVID-19-related worry, and self-reported substance use. Compared to HIVuninfected participants (n = 80), those living with HIV (n = 116) reported fewer anxiety symptoms, less COVID-19-related worry, and higher resilience. Those with more anxiety symptoms and lower resilience engaged in more frequent alcohol consumption, binge drinking, and cocaine use. Alcohol misuse was more common among HIV-uninfected participants. Cocaine use was reported by 21% fewer participants during the pandemic compared with 7.3 ± 1.5 months earlier. Possibly due to their experiences with HIV, PLWH responded with higher resilience and reduced worry and anxiety to the adversities brought by the COVID-19 pandemic.
Objectives Objective: To understand more about the impact of mindfulness training on perceived st... more Objectives Objective: To understand more about the impact of mindfulness training on perceived stress levels, dispositional mindfulness, intuitive eating, and psychological flexibility.in bariatric patients of Hispanic origin, 12–36 months post-bariatric surgery. Background: Mindfulness meditation has been proposed as an approach to reduce stress and increase awareness of physical sensations. The purpose of this study was to evaluate the impact of a six-session mindfulness-based training on dispositional mindfulness, perceived stress levels, intuitive eating, and psychological flexibility in bariatric patients of Hispanic origin 12–36 months post surgery. Methods The mindfulness group training was based on The Mindfulness Meditation/Acceptance Commitment Approach (MMACT) and focused on the following topics: mind body connection, stress management, intuitive eating, self-compassion, and acceptance & commitment. Participants were recruited from flyers posted in a private dietitian'...
Objectives Illicit drug use can lead to adverse cardiovascular events; it is an additional risk f... more Objectives Illicit drug use can lead to adverse cardiovascular events; it is an additional risk factor for cardiovascular disease. Thus, we sought to determine the association between CVD and drug use in people living with HIV (PLWH) using the FHS 10-year risk. Methods Participants were selected from the MASH cohort. Demographics, anthropometrics, bioimpedance analysis, and fasting blood samples were collected by trained personnel. HIV Viral Load (VL, copies/ml) was abstracted from medical charts. Urine toxicology was used to determine current illicit drug use. Descriptive statistics were used to analyze demographics, HIV status, and VL (undetectable VL < 50 copies/ml). CVD (10-year risk) score was calculated using a formula based on CVD risk factors. An independent sample t-test was used to compare the mean CVD risk score between drug users and non-users. Linear regression was used to find an association between drug users and CVD 10-year risk while controlling for sex and infec...
I wish to thank my committee members for their support during the preparation and compilation of ... more I wish to thank my committee members for their support during the preparation and compilation of this study. I appreciate their time, effort and guidance throughout the process. Special gratitude to Dr. Paulette Johnson for her help and patience with the statistical analyses, Dr. Adriana Campa, for her suggestions in methodology, Dr. Marcia Magnus and Dr. Dalip Ragoobirsingh for their scrutiny of the proposal. To my major professor, Dr. Fatma Huffman, thank you for your faith in my ability to complete this study. Her gentleness, encouragement, guidance, financial planning and assistance helped me to meet the deadlines and requirements for completion of this study. Thanks to the University Graduate School, FIU for awarding me the Dissertation Year Fellowship during my final year of the study. Special thanks to the workers of the Heart Foundation of Jamaica, the Diabetes Association of Jamaica, and the Central Medical Laboratory, who performed the blood analyses. To the Jamaican Ministry of Education and Ministry of Health officials who sanctioned the collection of data. To the principals and contact persons in all ten schools who accommodated us for the data collection. To the study subjects who willingly participated and made this project possible. To my family members here in the USA and in Jamaica who supported me during this challenging process. I am extremely grateful to my sisters, Cheryl and Heather Barrett in Jamaica who worked tirelessly to organize this study for me and made followup calls to ensure the smooth success of the project. To Francine White who assisted me throughout the data collection and to my nephews who took time out from their school activities to accompany me on data collection days. Your help is greatly appreciated.
Objectives Inflammation and oxidative stress are considered important factors in the development ... more Objectives Inflammation and oxidative stress are considered important factors in the development of non-communicable diseases with aging. We determined associations between body mass index (BMI), oxidative stress (OS), and inflammation in people living with HIV (PLWH) and un-infected substance users. Methods Overweight/obesity (OW/OB) was defined as BMI ≥ 25 and normal weight (NW) as BMI ≤ 24.9 in participants of the MASH cohort. Cocaine use was assessed with questionnaires and urine toxicology. Smoking was assessed with questionnaires. Blood was collected to assess inflammation (high sensitivity C-reactive protein [hsCRP] >3 m/L) by LabCorp, and OS with ARBOR ASSAYS (Ann Arbor, MI) glutathione colorimetric detection kit with %oxidized glutathione above median (>2.33%) as elevated. HIV viral load (VL) was obtained from medical charts. Regressions compared substance-abusing PLWH and un-infected people and controlled for age, sex, HIV status, and BMI. Results Mean age of the 605...
Objectives Distinct dietary components and microbiome metabolites may affect liver disease progre... more Objectives Distinct dietary components and microbiome metabolites may affect liver disease progression, a common comorbidity among people living with HIV (PLWH). Similarly, diet composition, including micronutrients, have been associated with markers of HIV disease progression (CD4 cell count). The objective of this study was to investigate the associations between dietary components, plasma metabolites, and liver fibrosis in PLWH. Methods A cross-sectional pilot study that enrolled 50 PLWH on antiretroviral therapy from the Miami Adult Studies on HIV (MASH) cohort. Diet quality was measured with the USDA Healthy Eating Index (HEI) and liver fibrosis was measured via the Fibrosis-4 Index (FIB-4). Microbiome metabolites were measured from plasma samples via metabolomics-non-targeted gas chromatography/mass spectrometry and liquid chromatography/mass spectrometry. Statistical analysis included T-test, Chi-square, Spearman correlation, and Partial Least Squares Discriminant Analysis (P...
Objectives Polyunsaturated fatty acids (PUFA) such as n-3 PUFA, eicosapentaenoic acid (EPA), doco... more Objectives Polyunsaturated fatty acids (PUFA) such as n-3 PUFA, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and n-6 PUFA, arachidonic acid (AA) may mediate inflammatory responses. Vitamin B6 deficiency has been shown to alter plasma PUFA levels. This perturbation of PUFA metabolism in vitamin B6 deficiency measured by pyridoxal-5’-phosphate (PLP) may contribute to inflammation. Thus, we aimed to examine the associations of 1) dietary EPA + DHA, and vitamin B6 with plasma ratio of AA/(EPA + DHA) by PLP level, 2) plasma AA/(EPA + DHA) and PLP with C-reactive protein (CRP), a marker for inflammation, and 3) dietary EPA + DHA, and vitamin B6 with CRP level, using NHANES. Methods NHANES datasets (2003–2004) with subjects ≥20 years were analyzed, accounting for survey design and sample weights (n = 4486). The significance level was P < 0.05. Covariates were age, gender, ethnicity, BMI, smoking, alcohol, total energy, dietary supplements, physical activity, and NSAIDs, depe...
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