Diabetes in Hispanic Americans

Genetic Risk Factors

A family history of diabetes increases the chance that people will develop diabetes. The San Antonio Heart Study showed that the prevalence of diabetes among Mexican Americans who have first-degree relatives (e.g., parents) with diabetes was twice as great as for those with no family history of diabetes.

Having American Indian or African genes (populations with a high prevalence of diabetes) is also thought to be a factor that causes the higher rates of diabetes in Hispanics. Hispanics, like all populations, inherit their susceptibility to diabetes from their ancestors. Hispanics have three groups of ancestors—Spaniards, American Indians, and Africans. Both American Indians and Africans have high rates of diabetes. Figure 2 shows the genetic origins of major Hispanic subgroups.¹⁰

In some people, the blood-glucose level is higher than normal, but not enough to be diagnosed as diabetes. These individuals are described as having prediabetes. People with prediabetes are at higher risk of developing type 2 diabetes than people with normal glucose tolerance. Rates of impaired glucose tolerance among adults ages 40 to 74 in the NHANES III survey were higher for Mexican Americans (19 percent) than for non-Hispanic white Americans (15 percent). ⁷

About 2 to 5 percent of pregnant women in the United States develop mild abnormalities in glucose levels, insulin secretion, and insulin resistance and are considered to have gestational diabetes. Although these women’s glucose and insulin levels often return to normal after pregnancy, as many as 50 percent may develop type 2 diabetes within 20 years of the pregnancy. Mexican American women may be at particularly high risk for developing type 2 diabetes. One study of 666 women with gestational diabetes in southern California found that each year an average of 12 percent developed type 2 diabetes after pregnancy.¹¹

Hyperinsulinemia (higher than normal levels of fasting insulin) and insulin resistance (an inability to use the body’s own insulin to properly control blood glucose) are both hallmarks of an increased risk for developing type 2 diabetes. Hyperinsulinemia often predates diabetes by several years. Among people in the NHANES III survey who did not have diabetes, insulin levels were higher in Mexican Americans than in non-Hispanic whites, indicating their greater predisposition for developing type 2 diabetes. Several other studies have also shown a higher rate of hyperinsulinemia in Hispanics than in non-Hispanics.¹²

Obesity is a major risk factor for type 2 diabetes. Many racial/ethnic groups in the United States have high rates of obesity, and surveys show that obesity is increasing. Hispanics are more likely than non-Hispanic whites to be overweight. Figure 3 shows that Mexican American adults, particularly women, have substantially higher rates of obesity than non-Hispanic white Americans, but rates that are similar to those of African Americans.^13,14

The degree to which obesity is a risk factor for diabetes depends not just on overall weight, but also on the location of the excess weight. Central or upper-body obesity is a stronger risk factor for type 2 diabetes than excess weight carried below the waist. Mexican Americans with upper body obesity have an increased risk of type 2 diabetes.¹²

Diabetes and Diet

College Station – According to 2002 figures from the American Diabetes Association, 18.2 million Americans, or 6.3 percent of the total population, have diabetes. Millions of these people with diabetes are African-Americans, Latino-Americans and Native Americans and Alaska Natives.

But thanks to nutritional advancements, people with diabetes – no matter what their cultural background or ethnicity – don’t have to give up their favorite foods, said Dr. Mickey Bielamowicz, Texas Cooperative Extension nutrition specialist. With a few nutritionally sound and common sense adjustments, nearly any recipe can be part of a diabetic eating plan.

The ADA describes diabetes as a serious illness that occurs when the body doesn’t produce insulin (type 1) or properly use insulin (type 2), a hormone needed to convert some foods into energy. Diabetes can be life-threatening, but it doesn’t have to be. Thanks to good medical care and management techniques that include diet and exercise, people with diabetes can live long, productive and healthy lives.

The first step, Bielamowicz said, is to seek professional advice. In addition to their regular health care providers, people with diabetes are encouraged to work with a licensed dietitian in order to establish a healthy food plan that’s right for them.

After that, it’s time to look at recipes. "The method of cooking and ingredients can be modified to maintain flavor," Bielamowicz said. For example, she said, there’s soul food. This style of cooking, perfected by generations of African-Americans, is hard to resist. Think of fried chicken and gravy, beaten biscuits dripping with butter, greens liberally seasoned with bacon fat, sweet potato pie.

"People of all different backgrounds and races enjoy the taste of soul food," Bielamowicz said. "However, traditional soul food has a tendency to be high in fat, cholesterol and sodium."

The same can be true of traditional Mexican-American dishes, she added. Although these foods are based on such healthy items as corn, beans and squash, they also tend to be made with lard and other fats.

"When a person’s diet consists of mainly fried foods, added fat and other high fat products, this could lead to obesity," she said. And in many cases, obesity is a contributing factor not only in developing diabetes, but high blood pressure and heart disease as well – or sometimes all of the above.

To overcome these dietary deficiencies and still enjoy some favorite foods from different cultures, she suggested:

• Season vegetables with skin-free smoked turkey necks, liquid smoke and/or
fat-free broth instead of fatback, ham hocks or bacon grease;

• Increase healthy carbohydrate and fiber consumption with whole grain breads,
pastas and cereals; non-starchy vegetables such as greens, cabbage and
summer squash; less starchy vegetables including potatoes;

• Cut back on salt consumption by eating less smoked, dried or salt-cured
meats, as well as salty seasonings such as meat tenderizer;

• Use corn tortillas instead of flour tortillas; if the tortillas are homemade, use
whole wheat flour and margarine made with unsaturated fats instead of lard or
regular shortening;

• Cut down on fat by eating less fried foods and high-fat meats such as chicken
wings, bologna and hot dogs, and sausage;

• Grill meats instead of frying;

• Use skim or low-fat milk instead of whole milk or cream;

• Drink water or diet sodas instead of high-sugar carbonated beverages;

• Substitute fresh fruits and vegetables for canned ones; and

• Include such favorites as beans, peas, rice, potatoes (both sweet and white)
and corn into healthy meals.

In fact, Bielamowicz added, substituting ingredients in recipes can lead to old familiar favorites with a healthier outlook. "Instead of having pork sausage, either buy the low-fat sausage or make your own with ground turkey, ground sage, black pepper and red pepper flakes," she said. And bake homemade tortilla chips instead of frying them.

When shopping for groceries, be sure to check the supermarket shelves for leaner products that are now available. "Reading the label can help people make the best choice," Bielamowicz said.

Source: Texas Cooperative Extension
Texas A & M University
Reprinted with permision.

v How Is NIDDK Addressing the Problem of Diabetes in Hispanic Americans?

Diabetes Prevention Program

Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
National Institutes of Health