Metabolic risk and health behaviors in minority youth at risk for type 2 diabetes.

Abstract

The purpose of this study was to determine the impact of sex and race/ethnicity on metabolic risk and health behaviors in minority youth.
A total of 173 seventh graders (46% male and 54% female; 49% Hispanic and 51% African American) with BMI ≥85th percentile and a family history of diabetes were assessed with weight, height, BMI, percent body fat, and waist circumference measures. Laboratory indexes included 2-h oral glucose tolerance tests with insulin levels at 0 and 2 h, fasting A1C, and lipids. Insulin resistance was estimated by homeostasis model assessment (HOMA-IR). Youth also completed questionnaires evaluating health behaviors.
Average BMI (31.6 ± 6.4 kg/m²) and percent body fat (39.5 ± 10.6%) were high. All participants demonstrated insulin resistance with elevated HOMA-IR values (8.5 ± 5.2). Compared with African American youth, Hispanic youth had higher triglycerides and lower HDL cholesterol despite similar BMI. Hispanic youth reported lower self-efficacy for diet, less physical activity, and higher total fat intake. Male youth had higher glucose (0 and 2 h) and reported more physical activity, more healthy food choices, and higher calcium intake than female youth.
Screening high-risk youth for insulin resistance and lipid abnormalities is recommended. Promoting acceptable physical activities and healthy food choices may be especially important for Hispanic and female youth.

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Metabolic Risk and Health Behaviors in
Minority Youth at Risk for Type 2 Diabetes
MARITA G. HOLL, PHD
SARAH S. JASER, PHD
JULIE A. WOMACK, PHD
VANESSA L. JEFFERSON, APRN
MARGARET GREY, DRPH
OBJECTIVE — The purpose of this study was to determine the impact of sex and race/
ethnicity on metabolic risk and health behaviors in minority youth.
RESEARCH DESIGN AND METHODS — A total of 173 seventh graders (46% male
and 54% female; 49% Hispanic and 51% African American) with BMI ?85th percentile and a
family history of diabetes were assessed with weight, height, BMI, percent body fat, and waist
circumference measures. Laboratory indexes included 2-h oral glucose tolerance tests with
insulinlevelsat0and2h,fastingA1C,andlipids.Insulinresistancewasestimatedbyhomeosta-
sis model assessment (HOMA-IR). Youth also completed questionnaires evaluating health
behaviors.
RESULTS — Average BMI (31.6 ? 6.4 kg/m2) and percent body fat (39.5 ? 10.6%) were
high. All participants demonstrated insulin resistance with elevated HOMA-IR values (8.5 ?
5.2).ComparedwithAfricanAmericanyouth,Hispanicyouthhadhighertriglyceridesandlower
HDL cholesterol despite similar BMI. Hispanic youth reported lower self-efficacy for diet, less
physical activity, and higher total fat intake. Male youth had higher glucose (0 and 2 h) and
reported more physical activity, more healthy food choices, and higher calcium intake than
female youth.
CONCLUSIONS — Screening high-risk youth for insulin resistance and lipid abnormalities
is recommended. Promoting acceptable physical activities and healthy food choices may be
especially important for Hispanic and female youth.
Diabetes Care 34:193–197, 2011
O
that rates of obesity have risen among ad-
olescents from 5% in 1970 to ?18% in
2008, and rates of overweight in adoles-
cents now exceed 34% (1). Further, rates
of obesity and overweight have increased
at even higher rates in minority youth;
Hispanic male and black female adoles-
cents are now significantly more likely to
havehighBMIthanwhiteadolescents(1).
Amonginnercityandminorityyouth,the
prevalenceofoverweightcanbeashighas
50% (2). Recent estimates from a popula-
tion-based study suggest that the preva-
lence of type 2 diabetes among
adolescents is 0.22 case/1,000 youth,
with significantly higher rates for His-
besity and overweight have in-
creased in youth at an alarming
rate. The latest statistics indicate
panic (0.48 case/1,000 youth) and black
adolescents (1.05 cases/1,000 youth),
and these rates are likely to continue to
increase with rising obesity rates (3).
Thus, there is a need to better understand
this high-risk population.
Obesity in adolescence is a strong
predictor of adult obesity (4), with in-
creased risks for type 2 diabetes and car-
diovascular disease, resulting in
significant morbidity and mortality (5).
Although the relationships between obe-
sity, insulin resistance, type 2 diabetes,
and other conditions have been well es-
tablished in adults, insulin resistance is
now becoming more prevalent in youth
(5). Obese youth exhibit hyperinsulin-
emia, increased adiposity, dyslipidemia,
and insulin resistance (6), and one study
showed that 70% of obese youth had at
leastoneriskfactorforcardiovasculardis-
ease (4).
In addition to health problems, obe-
sity in youth is associated with poor
health behaviors related to both nutrition
and physical activity (7). Studies of obese
youth suggest that their understanding of
basic nutrition is lacking, and overweight
youth consume lower levels of nutrients
than their healthy-weight peers (8). Fur-
ther, obese youth report lower self-
efficacy, the belief that they are capable of
performing the desired behaviors, for
physical activity (9). Ethnic minority
youth may have poorer health behaviors
thantheirwhitepeers.Whiteadolescents,
for example, have been shown to be more
physically active than minority adoles-
cents (10). In Latino youth, several stud-
ies have linked greater acculturation to
the majority culture with higher rates of
obesity related to poorer diet, including
lower intake of fruits and vegetables and
increased intake of sugar, and lower rates
of physical activity (11). Thus, the inves-
tigation of health behaviors in overweight
minority youth at risk for type 2 diabetes
is warranted.
The majority of previous studies in
obese minority youth were focused on ei-
ther metabolic risk or health behaviors
but not both. In this report, we explore
the anthropometric, metabolic, and
health behaviors associated with insulin
resistance and risk for type 2 diabetes in
Hispanic white and non-Hispanic African
American adolescents. Differences in sex
and race/ethnicity are investigated.
RESEARCH DESIGN AND
METHODS— The current study is a
secondary analysis of baseline data from a
randomized clinical trial of a school-
based intervention for youth at risk for
type 2 diabetes (12). Seventh grade youth
from six schools in a New England city
wereinvitedtoparticipateiftheyhadBMI
?85th percentile and a family member
with diabetes. Seventh graders were tar-
geted because of their increased risk for
type 2 diabetes at puberty. Youth were
excluded if they had an existing chronic
disease (other than asthma) or were in-
volved in another clinical trial. For inter-
ested students, parents were contacted to
● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●
From the Yale University School of Nursing, New Haven, Connecticut.
Corresponding author: Sarah S. Jaser, sarah.jaser@yale.edu.
Received 22 June 2010 and accepted 15 September 2010. Published ahead of print at http://care.
diabetesjournals.org on 20 September 2010. DOI: 10.2337/dc10-1197.
© 2011 by the American Diabetes Association. Readers may use this article as long as the work is properly
cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.
org/licenses/by-nc-nd/3.0/ for details.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby
marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
C a r d i o v a s c u l a r a n d M e t a b o l i c R i s k
O R I G I N A L A R T I C L E
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describe the study and obtain informed
consent in line with university institu-
tional review board requirements.
Between April 2004 and December
2006, 380 students were screened for el-
igibility, with 234 students meeting the
inclusion criteria and 28 families refusing
to enroll (the most common reason for
refusal was lack of interest). Of the 206
students who consented/assented to par-
ticipate, 4 students were later ineligible
because of low BMI, 1 was promoted to
eighth grade, 1 was expelled, 7 refused,
and 5 moved after consenting; these
youth were not statistically different in
sexandagefromparticipants.Dataforthe
remaining 188 participants were col-
lected by trained research staff in school-
based clinics. For purposes of these
analyses, data from 15 students who did
not self-categorize as either Hispanic or
African American were excluded before
analyses. Their representative groups
were white (n ? 5), more than one race
(n ? 5), other (n ? 1), and unspecified
(n?4).Dataanalyseswereperformedfor
the remaining 173 participants.
Anthropometric measures
Weight in kilograms and percent body fat
were measured with a scale and body
composition analyzer (model BF-350;
Tanita Corporation of America, Arlington
Heights,IL).Theleg-to-legbioimpedance
method was used to determine percent
body fat. Height was measured using a
wall-mounted stadiometer, calibrated in
1⁄8-cm intervals. Waist circumference was
determined at the umbilicus at the end of
a normal expiration, and hip measures
weretakenatthewidestportionofthehip
using a Gulick tape measure.
Metabolic measures
Oral glucose tolerance tests (OGTTs)
were performed with a standard glucose
load (1.75 g glucose/kg body wt up to a
maximumof75g)(Trutol100;NERLDi-
agnostics, East Providence, RI). Insulin
resistance was estimated by homeostasis
model assessment (HOMA) of insulin re-
sistance (HOMA-IR) using the equation,
HOMA-IR ? fasting insulin (microunits
per milliliter) ? fasting glucose (milli-
moles per liter)/22.5. A value ?2.2 is in-
dicativeofinsulinresistance.FastingA1C
levels were determined using the DCA
2000 Analyzer (Bayer, Tarrytown, NY).
The normal range is ?6.5% (13). Lipids,
including total cholesterol, HDL choles-
terol, and triglycerides were measured
(Cholestech LDX system; Cholestech, Hay-
ward, CA). LDL cholesterol was calculated
using the formula, LDL cholesterol? (to-
tal cholesterol ? HDL cholesterol) ?
(triglycerides/5)(14).Thosewhohadlab-
oratory values within the prediabetes
range were referred to their primary care
providers for further evaluation and
follow-up.
Health behaviors
The Health Behavior Questionnaire (15)
was used to measure Dietary Intention
(13items,intentionstochoosefoodscon-
sidered heart healthful), Usual Food
Choices (14 items, usual food selections),
Perceived Support for Physical Activity
(18 items, social support for physical ac-
tivity among family members, teachers,
and friends), and Social Reinforcement
for Healthy Food Choices (7 items, social
support for heart-healthy food from fam-
ily members, teachers, and friends).
These scales use dichotomous forced-
choice formats among two foods or Yes/
No. Positive values indicate healthier
choices or greater support for healthy
choices, and negative values indicate
poorer choices or support. Internal con-
sistencyvaluesforthecurrentstudyareas
follows: Dietary Intent, ? ? 0.69; Usual
Food Choices, ? ? 0.68; Support for
Physical Activity, ? ? 0.60; and Social
Reinforcement for Healthy Food Choices,
? ? 0.87. In addition, the Dietary Self-
Efficacyscale(5items,e.g.,“Howsureare
you that you can eat a baked potato in-
stead of French fries?”) and Physical Self-
Efficacyscale(5items,e.g.,“Howsureare
you that you can choose to jog during
recess?”) were used to measure self-
efficacy.Thesescalesusea3-pointLikert-
type scale, with 1 ? not sure, 2 ? a little
sure, and 3 ? very sure. Internal consis-
tency for the current study was ? ? 0.85
for Dietary Self-Efficacy and ? ? 0.64 for
Physical Activity Self-Efficacy. Scores on
the self-efficacy scales range from ?15 to
15.
The Revised Godin-Shephard Activ-
itySurvey(16)measuresself-reportedac-
tivity.Subjectsreportthenumberoftimes
in an average week that they spent ?15
min in activities classified as mild (3
METs), moderate (5 METs), or strenuous
(9METs).TheMETisthestandardunitof
work measure used in exercise physiol-
ogy that involves the ratio of oxygen con-
sumption, body weight, and unit of time.
The number of times students engaged in
each activity is multiplied by the MET
level and summed to provide a weekly
total.
Dietary intake was estimated by aver-
aging two 24-h recalls (one weekend and
one weekday). Interviews were con-
ducted at school by a registered dietitian
or diet technician, and food models were
used to improve estimation of portion
sizes. Nutrient intake was analyzed using
Nutritionist Pro software (version 2.4.1;
First Data Bank, San Bruno, CA). Values
were compared with National Health and
Nutrition Examination Survey 2001–
2002 average intakes and dietary refer-
ence intakes for age and sex but not race/
ethnicity (17).
Statistical analysis
Analyses were performed with SAS (ver-
sion 9.1). The effects of sex and ethnicity
were examined on all available variables,
using?2testsfornoncontinuousvariables
and standard least-squares ANOVA mod-
elsforcontinuousvariables.Tocorrectfor
skewness, HOMA values were trans-
formed using the logarithm function.
RESULTS
Demographic, socioeconomic, and
health perception indicators
The 173 adolescents (80 male and 93 fe-
males) were 11–15 years old (12.9 ? 0.7
years). Of the total, 84 (49%) were His-
panic, and 89 (51%) were African Amer-
ican. We found significant differences
between racial/ethnic groups related to
guardians’ marital status (P ? 0.002), ed-
ucation(P?0.001),andself-ratedhealth
score (P ? 0.002), with Hispanic families
more likely to report marriage, a lower
level of education (i.e., less than high
school), and poorer self-rated health
(scores ranged from 1 ? poor to 4 ?
excellent).
Metabolic risk
As seen in Table 1, average BMI (31.6 ?
6.4 kg/m2) and percent body fat (39.5 ?
10.6%) were high. As shown in Table 2,
fastinginsulinlevels(37.9?21.3?U/ml)
were high, and 100% of the participants
had high HOMA-IR (8.5 ? 5.2). Glucose
(0-h), A1C, triglycerides, total choles-
terol, HDL cholesterol, and LDL choles-
terol were within normal ranges.
Prediabetes (glucose 100–125 mg/dl
[4.6–6.9 mmol/l]) was present in 15%
(26 participants) (18).
Health behaviors
As seen in Table 3, adolescents reported
fairly high support for physical activity
(9.6?5.4).However,theyreportedfairly
Health behaviors in minority youth
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low self-efficacy for physical activity
(2.4 ? 2.3) and perceived benefits for ac-
tivity (3.9 ? 0.70). Adolescents reported
fairlyhighself-efficacyfordiet(6.4?6.0)
and dietary knowledge (7.0 ? 5.8), but
they reported poor usual food choices
(?1.7 ? 5.6) and dietary intent (?1.5 ?
5.7).
Self-reportedenergyintakewaslower
than expected (Table 4); however, the
percentage of kilocalories from fat was
?30% for the entire sample. Participants
had lower intake than the recommended
average requirements for vitamin E, vita-
min K, calcium, potassium, fiber, and
magnesium (17). Dietary Reference In-
takes were met for iron, sodium, protein,
andcarbohydrate.Comparedwiththeav-
erageU.S.childaged9–13years,ourstu-
dents reported lower intake of all
nutrients except vitamins A and C (17).
Sex differences
As seen in Tables 1 and 2, age, height,
fasting glucose, and 2-h OGTT were sig-
nificantly higher in male than in female
participants (all P ? 0.01). As expected,
female participants had higher percent
body fat than male participants, but there
were no sex differences in the presence of
prediabetes. Table 3 indicates that male
participants reported greater physical ac-
tivity and healthier usual food choices
(both P ? 0.005). Although kilocalorie
intake was not significantly different be-
tween sexes (Table 4), male participants
had higher intake of potassium, calcium,
phosphorus, and magnesium than did fe-
male participants (all P ? 0.01). None of
the female participants met the Dietary
Reference Intake values for these nutri-
ents and male participants met only the
suggested levels for phosphorus (17).
Racial/ethnic differences
As seen in Tables 1 and 2, African Amer-
ican youth were significantly taller and
heavier than Hispanic youth, whereas
Hispanic youth had higher triglycerides
andlowerHDLcholesterol(allP?0.05).
There were no ethnic differences in the
prevalence of prediabetes. Hispanic
youth reported significantly less physical
activity and less diet self-efficacy than Af-
rican American youth (Table 3). Hispanic
youthreportedsignificantlyhigherintake
of total fat, monounsaturated fat, and
polyunsaturated fat than African Ameri-
can youth (Table 4).
With logHOMA as the dependent
variable, we fitted an ANCOVA model to
test for main effects and interactions, us-
ing a backward elimination algorithm to
arrive at the best model. The final model
(F1,144? 3.69, P ? 0.01, R2? 0.071)
included sex, BMI, and the sex ? BMI
interaction, with a steeper slope for girls
than for boys. These variables were
weakly but significantly related to log-
HOMA. Ethnicity was not retained in the
best model as a significant predictor for
insulin resistance.
CONCLUSIONS — In this study, we
describedmetabolicindicatorsandhealth
behaviorsinasampleofAfricanAmerican
and Hispanic youth at high risk for type 2
diabetes by virtue of BMI and family his-
tory. The average adolescent in our study
manifested insulin resistance, while
maintaining normal glucose levels, but
without the elevated lipids associated
with metabolic syndrome (19). As ex-
pected, higher BMI was related to higher
insulin resistance (19). In addition, the
relationship between BMI and insulin re-
sistance was stronger for girls than for
boys. Although our participants were se-
lected for being at high risk for type 2
diabetes, the prevalence of insulin resis-
Table 1—Anthropometric measures: total and by ethnicity and sex
Measure Total Hispanic African American
P value Male Female
P value
n
Age (years)
Height (cm)
Weight (kg)
BMI (kg/m2)
Body fat (%)
Waist circumference (cm)
Hip circumference (cm)
Data are means ? SD.
173 84 898093
12.9 ? 0.7
159.3 ? 10.6
77.6 ? 17.9
31.6 ? 6.4
39.5 ? 10.6
94.6 ? 14.7
107.0 ? 12.0
12.9 ? 0.7
157.0 ? 13.3
74.5 ? 15.5
31.2 ? 13.4
38.4 ? 9.8
93.1 ? 13.5
105.1 ? 9.7
12.9 ? 0.7
161.4 ? 6.8
80.4 ? 19.5
30.7 ? 6.7
40.4 ? 11.2
95.9 ? 15.6
108.7 ? 13.5
0.74
0.006
0.03
0.73
0.20
0.22
0.053
13.1 ? 0.8
161.5 ? 13.8
79.0 ? 18.7
31.2 ? 13.6
36.8 ? 12.7
95.6 ? 15.9
106.7 ? 11.9
12.7 ? 0.6
157.5 ? 5.8
76.4 ? 17.2
30.7 ? 6.1
41.9 ? 7.4
93.7 ? 13.5
107.3 ? 12.2
0.01
0.01
0.36
0.73
0.002
0.40
0.73
Table 2—Metabolic measures: total and by ethnicity and sex
MeasureTotal HispanicAfrican American
P valueMaleFemale
P value
n
Glucose, 0-h (mg/dl)
Insulin, 0-h (?U/ml)
A1C (%)
Triglycerides (mg/dl)
Total cholesterol (mg/dl)
HDL cholesterol (mg/dl)
LDL cholesterol (mg/dl)
Glucose, 2-h (mg/dl)
Insulin, 2-h (mg/dl)
HOMA-IR
Data are means ? SD.
17384 898093
90.6 ? 11.0
37.9 ? 21.3
5.3 ? 0.3
91.0 ? 56.7
151.9 ? 29.7
40.2 ? 11.7
93.1 ? 29.0
103.2 ? 20.0
126.4 ? 92.3
8.5 ? 5.2
90.3 ? 11.3
37.3 ? 21.2
5.2 ? 0.3
112.7 ? 71.9
154.8 ? 28.4
37.6 ? 11.0
94.2 ? 28.1
104.8 ? 23.2
130.1 ? 100.8
8.2 ? 5.7
90.9 ? 10.8
38.5 ? 21.6
5.3 ? 0.4
72.1 ? 27.7
149.3 ? 30.7
42.5 ? 11.9
92.1 ? 29.8
101.8 ? 16.7
123.0 ? 84.9
8.6 ? 5.4
0.76
0.71
0.10
?0.001
0.31
0.008
0.67
0.30
0.66
0.59
93.3 ? 12.0
38.4 ? 23.0
5.2 ? 0.4
91.5 ? 56.3
155.9 ? 30.9
40.5 ? 13.0
96.6 ? 32.1
108.0 ? 21.2
113.6 ? 79.9
8.9 ? 6.1
88.3 ? 9.6
37.5 ? 19.9
5.3 ? 0.3
90.6 ? 57.3
148.5 ? 28.4
39.9 ? 10.6
90.0 ? 25.8
99.2 ? 18.1
136.6 ? 100.5
8.1 ? 4.3
0.004
0.83
0.61
0.92
0.15
0.76
0.16
0.005
0.12
0.66
Holl and Associates
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tance at 100% is surprising and differs
from a previous study of overweight
youth, in which the prevalence of insulin
resistance was only 25% (20). However,
our sample may have been at higher risk
because of a family history of diabetes,
which was not a requirement in other
studies. The high percentage of Hispanic
youth in our population may have also
influencedtheincreasedprevalenceofin-
sulin resistance, because a genetic predis-
position to diabetes has been reported in
some Hispanic populations (3).
Our data suggest that, despite lower
percent body fat, male youth had higher
blood glucose levels at fasting and after a
glucose load than did female youth. Fe-
male youth reported poorer food choices
and lower intake of calcium, similar to
other studies (21), suggesting that they
engage in less healthy eating behaviors
than male youth. It is important to note,
however, that underreporting of total
kilocalories consumed is common, par-
ticularly among overweight adolescent
girls (22). In addition, female youth re-
ported engaging in less physical activity
than male youth, in line with studies
showingasexdifferenceinphysicalactiv-
ity within ethnic groups and across ages
(10). Specifically, a precipitous decline in
activity levels has been reported in girls
between ages 9 and 19 (23). Because in-
activityisrelatedtooverweight,programs
to improve girls’ knowledge and attitudes
about the benefits of activity and finding
sex-acceptable ways to increase high-
intensity activity among girls should be
priorities.
In our sample, Hispanic youth had
poorer lipid profiles than African Ameri-
can youth, including higher triglyceride
and lower HDL cholesterol levels. This
finding is similar to a recent study, in
whichHispanicyouthhadtwicetheprev-
alence of metabolic syndrome than non-
Hispanic white youth, with significantly
higher levels of triglycerides and lower
HDL cholesterol (24). It is possible that
the difference in lipid profile is related to
diet; Hispanic youth in our study re-
ported a higher fat intake than African
American youth, and it has been shown
that Hispanic youth with greater Anglo
acculturationhavedietshigherinfat(11).
In addition, Hispanic youth reported
lower diet self-efficacy and less physical
activity than African American youth.
Few studies have examined activity
levels in overweight minority groups, but
there is evidence that Hispanic and Afri-
can American girls have the lowest levels
of moderate to vigorous activity com-
pared with those of other racial/ethnic
groups (10). Higher dietary fat intake and
lower levels of physical activity reported
by the Hispanic youth in our sample sug-
gest that they have poorer health behav-
iors related to weight and cardiovascular
health than African American youth. Fur-
ther research is needed to determine the
effects of acculturation on nutrition, ac-
tivity, and behavioral and metabolic pa-
rameters in high-risk youth.
This study has important limitations.
Nutrition, activity, and health behavior
measures were based on self-report and
may be subject to socially desirable re-
sponses. The sample was self-selected to
participate in an intervention trial and
was obtained from a population with a
high prevalence of overweight (3). There-
fore, relationships among metabolic pa-
rameters and health behaviors may not
generalize to other populations. In addi-
tion, despite reminders, it is possible that
some participants were not fasting for
blood draws, resulting in higher rates of
prediabetes and HOMA-IR. Last, we did
not measure acculturation, which may
Table 3—Health behaviors: total and by ethnicity and sex
MeasureTotalHispanic African American P valueMale Female
P value
n
Support for Physical Activity
Physical Activity Self-Efficacy
Physical activity reported (MET)
Dietary Intention
Usual Food Choice
Dietary habits
Social Reinforcement for Healthy
Food Choices
Diet Self-Efficacy
Data are means ? SD.
1738489 8093
9.6 ? 5.4
2.4 ? 2.3
996.9 ? 417.3 907.5 ? 434.6
?1.5 ? 5.7
?1.7 ? 5.6
1.6 ? 2.5
8.7 ? 5.9
2.3 ? 2.5
10.5 ? 4.7
2.5 ? 2.1
1,078.1 ? 385.7
?1.8 ? 5.4
?2.1 ? 5.1
1.5 ? 2.3
0.05
0.69
0.006
0.44
0.33
0.63
10.3 ? 4.9
2.6 ? 2.4
1,131.7 ? 406.1 888.0 ? 392.9 ?0.001
?0.8 ? 5.7
?2.1. ? 5.6
?0.5 ? 5.8
?2.8 ? 5.2
1.8 ? 2.5 1.4 ? 2.5
9.0 ? 5.8
2.2 ? 2.3
0.21
0.37
?1.1 ? 6.1
?1.3 ? 6.1
1.7 ? 3.6
0.13
0.009
0.31
?2.1 ? 10.1
6.4 ? 6.0
?3.3 ? 9.5
5.2 ? 6.8
?1.0 ? 10.6
7.5 ? 5.5
0.14
0.013
?3.3 ? 10.3
6.6 ? 5.9
?1.0 ? 9.9
6.2 ? 6.5
0.14
0.68
Table 4—Nutrient intake: total and by ethnicity and sex
MeasureTotalHispanic African American
P valueMale Female
P value
n
Energy (kcal)
Fat (g)
Monounsaturated fat (g)
Polyunsaturated fat (g)
Potassium (mg)
Calcium (mg)
Phosphorus (mg)
Magnesium (mg)
Data are means ? SD.
17384 898093
1,827.3 ? 569.5
65.3 ? 26.0
20.5 ? 8.9
11.0 ? 5.9
1,922.2 ? 648.9
679.5 ? 299.6
976.1 ? 318.9
174.1 ? 61.6
1,858.6 ? 531.4
69.6 ? 25.5
22.0 ? 8.9
12.1 ? 6.3
1,914.3 ? 619.6
655.5 ? 285.0
960.3 ? 307.9
169.4 ? 58.4
1,791.7 ? 611.5
60.4 ? 25.8
18.7 ? 8.5
9.7 ? 5.0
1,931.2 ? 684.7
707.0 ? 314.9
994.1 ? 332.1
179.5 ? 65.1
0.46
0.02
0.02
0.006
0.84
0.24
0.46
0.27
1,859.6 ? 453.6
66.1 ? 20.8
21.3 ? 7.1
10.7 ? 4.2
2,071.7 ? 591.3
754.5 ? 321.2
1,058.8 ? 297.2
186.6 ? 56.3
1,799.7 ? 654.0
64.7 ? 29.8
19.8 ? 10.1
11.2 ? 7.0
1,794.0 ? 671.5
615.3 ? 265.1
905.3 ? 321.4
163.4 ? 64.3
0.50
0.73
0.28
0.50
0.005
0.002
0.002
0.01
Health behaviors in minority youth
196
DIABETES CARE, VOLUME 34, NUMBER 1, JANUARY 2011care.diabetesjournals.org

Page 5

help to explain some results for the His-
panic youth.
Despite these limitations, our find-
ingssuggesttheneedtodevelopstrategies
to identify insulin resistance, such as pe-
riodic screening with an OGTT, in high-
riskyouth,especiallyHispanicandfemale
youth. Few affordable and accessible
child-focused programs are available or
have proven to be very successful. Re-
searchers and practitioners, therefore,
have the responsibility to develop inter-
ventions to prevent and treat overweight,
insulin resistance, prediabetes, type 2 di-
abetes, and their consequences in this
population. It is not yet clear whether
family involvement is necessary for re-
ducing adolescent obesity, but previous
studies have shown that in younger chil-
dren, promoting family reinforcement of
healthybehaviorsandincreasingphysical
activitiesthatareattractivetospecificeth-
nic and sex groups is important (25).
Acknowledgments— This work was sup-
ported by the National Institutes of Health
(NIH) (grant 1R01-NR-008244) and in part
by the NIH National Center for Research Re-
sources/Clinical and Translational Science
Awards Program (grant 1UL1-RR-024139-01
awarded to Yale University School of
Medicine).
No potential conflicts of interest relevant to
this article were reported.
M.G.H. researched data and wrote the
manuscript. S.S.J. wrote the manuscript.
J.A.W. researched data and conducted data
analyses. V.L.J. researched data and contrib-
uted to the introduction. M.G. designed the
study, contributed to discussion, and re-
viewed/edited the manuscript.
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