Josiemer Mattei

• PhD, MPH
• Professor (Associate) at Harvard University

There is limited understanding of how dietary behaviors cluster together and influence cardiometabolic health at a population level in Puerto Rico. Data availability is scarce, particularly outside of urban areas, and is often limited to non-probability sample (NPS) data where sample inclusion mechanisms are unknown. In order to generalize results...

Background: High adherence to the Mediterranean Diet (MeDi) was associated with better cognitive performance and decreased memory decline among Hispanic or Latino adults. Objective: Investigate if higher adherence to the MeDi improves white matter (WM) integrity among Hispanic/Latino adults and if this effect is mediated by cardiovascular health (C...

Background Cardiovascular health (CVH) in young adulthood is associated with CVD in later life, yet CVH in young adults in the United States falls below ideal levels, with noticeable sex differences. Research on CVH in young adults in Puerto Rico is scarce. This study examined CVH and sex differences in CVH in a large cohort of young adults in Puer...

Food systems drive human and environmental change, reflect diverse cultural and ecological contexts, and, in their diversity, can bolster nutrition and planetary health. Ignoring structural inequities in food system transformations risks offsetting potential gains. We summarize current evidence on the context-dependent implications of EAT-Lancet go...

The effect of nonnutritive sweeteners (NNSs) on the body mass index [BMI (in kg/m 2)] of children and adolescents remains unclear despite rising consumption. Detailed systematic evaluations are warranted. We aimed to summarize evidence on NNS consumption and BMI sex-and age-specific absolute changes (kg/m 2) in pediatric populations, by NNS type, s...

Background Prospective associations between total and groups of ultra-processed foods (UPF) and cardiovascular disease (CVD) remained to be characterised. Our aim was to assess the association of total and group-specific UPF intakes with CVD, coronary heart disease (CHD), and stroke in three large prospective cohorts of US adults. Additionally, we...

Objective: Residents of Puerto Rico have recently experienced multiple adverse events, including hurricanes, earthquakes, and political unrest. Such adversity is associated with worse mental and physical health. Psychological resilience and effective coping may mitigate these relations by fostering positive health behaviors, like consuming a high-q...

The Puerto Rico (PR) Young Adults' Stress, Contextual, Behavioral & Cardiometabolic Risk Study (PR-OUTLOOK) is investigating overall and component-specific cardiovascular health (CVH) and cardiovascular disease (CVD) risk factors in a sample of young (age 18-29) Puerto Rican adults in PR (target n=3,000) and examining relationships between individu...

BACKGROUND Dietary acculturation, or adoption of dominant culture diet by migrant groups, influences human health. We aimed to examine dietary acculturation and its relationships with cardiovascular disease (CVD), gut microbiota, and blood metabolites among US Hispanic and Latino adults. METHODS In the HCHS/SOL (Hispanic Community Health Study/Stu...

Background Ethnicity, cultural background, and geographic location differ significantly within the United States Hispanic/Latino population. These variations can greatly define diet and its relationship with cardiometabolic disease, thus influencing generalizability of results. Objectives We aimed to examine nutrient-based food patterns (NBFPs) of...

Background Higher allostatic load (AL), a multi-system measure of physiological dysregulation considered a proxy for chronic stress exposure, is associated with poorer global cognition (GC) in older non-Hispanic white adults. However, evidence of these associations in middle-aged and older US-based Hispanic/Latino adults is limited. Objective To e...

Background Worksite-based health programs have shown positive impacts on employee health and have led to significant improvements in cardiovascular risk factor profiles. We aimed to determine the effect of cafeteria intervention on cardio-metabolic risk factors diet in a worksite setting (Dhulikhel Hospital) in Nepal. Methods In this one-arm pre-p...

Introduction Latinos report lower self-rated health (SRH) than non-Hispanic White persons. However, the association between SRH and medically diagnosed chronic diseases (MDCDs) remains understudied in Latino populations. This study assessed the relationship between a single-item SRH indicator and MDCD status among predominantly Latino adults in Pue...

Prediabetes is a heterogenous metabolic state with various risks for development of type 2 diabetes (T2D). In this study, we used genetic data on 7,227 US Hispanic/Latino participants without diabetes from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and 400,149 non-Hispanic White participants without diabetes from the UK Biobank...

This study estimated the social and economic costs of body dissatisfaction and appearance-based discrimination (specifically, weight and skin-shade discrimination) in the United States (USA) in the 2019 calendar year. We used a prevalence-based approach and a cost-of-illness method to estimate the annual cost of harmful appearance ideals for cases...

Objectives To report the adaptation and implementation of LUCHA (Latinos United for a Culturally Healthy Alimentation), a pilot intervention to improve dietary quality and behaviors (primary outcomes) of Latinos in Massachusetts, US, and the lessons learned during the process, including disruptions during the COVID-19 pandemic, to help shape future...

Little is known about deep-structure (i.e., embedded) cultural attitudes toward healthy eating among Hispanics/Latinos in the United States. This study aimed to identify ethnic-specific dietary attitudes of Latino adults and evaluate their associations with self-rated diet and health. Participants (n = 200) were community-based Latinos (25–65 y/o)...

Hispanics of Mexican descent have disproportionate rates of non-alcoholic fatty liver disease (NAFLD). The purpose of this work is to investigate the association between the traditional Mexican diet score (tMexS) and hepatic steatosis and fibrosis, two NAFLD-related clinical endpoints, in Hispanic adults of Mexican descent. Data from 280 Hispanic a...

INTRODUCTION Few studies have examined the associations of psychosocial factors with cognitive change in Hispanics/Latinos. METHODS Data from the Hispanic Community Health Study/Study of Latinos‐Investigation of Neurocognitive Aging (HCHS/SOL INCA) and Sociocultural studies were used (n = 2,155; ages ≥45 years). Psychosocial exposures included int...

Creating nutritious and ecologically regenerative food cultures depends on the local knowledge of food system laborers. Food producers in small island developing states center socioecological interdependence in their livelihoods and, as such, conserve biocultural diversity. Amid burgeoning health, economic, and climate crises brought on by colonial...

Background: An increasingly industrialized food system has marginalized local, traditional food cultures in Puerto Rico (PR). Recent efforts to decolonize diets have promoted local food intake; however, how resulting dietary patterns may influence cardiometabolic disease remains unknown. Objectives: This study aimed to 1) identify dietary patter...

A diet high in quality is essential for prevention of chronic diseases. Specific healthy eating behaviors may modulate dietary intake. However, these behaviors have been seldomly studied, particularly in Puerto Rico (PR), a population with documented poor dietary quality and high burden of chronic diseases. This study aimed to document self-reporte...

Sexual and gender minorities have a higher risk for health and nutrition-related disparities across the life course, compared to the heterosexual or cisgender population. Experiences of stigmatization and discrimination are associated with diminished mental health quality and psychological distress, which are risk factors for developing various eat...

Objective: To examine the association between food insecurity and dysfunctional eating behaviors among adults in Puerto Rico. Methods: Data from 865 participants were obtained from baseline interviews from the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT) cohort. The association between foo...

Background. Ethnicity, cultural background, and geographic location differ significantly amongst the US Hispanic/Latino population. These characteristic differences can greatly define measured diet and its relationship with cardiometabolic disease, thus influencing generalizability of results. Objective. We aimed to examine dietary patterns of Hisp...

Background Sugar‐containing ultra‐processed (SUP) foods and beverages consumption has increased globally in recent years and contributes to the rising global trends of obesity and diet‐related chronic non‐communicable diseases. However, there are limited longitudinal studies of SUP foods and beverages intake and weight gain in children. Objectives...

Background: Considering the biological variation across subgroups during periods of growth, the role of non-nutritive sweeteners in weight-related outcomes among children and adolescents is unclear. We did a systematic review and meta-analysis to summarise the evidence on experimental and habitual consumption of non-nutritive sweeteners and prospe...

Introduction: Ultra-processed foods (UPF) are associated with cardiovascular disease (CVD) in European populations. Evidence is limited from U.S. populations, for specific UPF subgroups, and in the diet quality context. Hypothesis: We hypothesized that U.S. women with higher UPF intake have higher CVD risk and evaluated this association by UPF subg...

Prolonged marginalization of traditional food cultures has diminished local food production and increased dependence on highly processed imports in Puerto Rico (PR), contributing to low-quality diets and cardiometabolic disease. Recent efforts have been made to decolonize diets by increasing local food intake; however, what dietary patterns (DPs) e...

Residents of Puerto Rico have repeatedly experienced adverse events over the past five years including Hurricanes Irma and Maria in 2017, earthquakes in 2019-2020, Hurricane Fiona in 2022, sociopolitical unrest, a deep economic crisis, and the COVID-19 pandemic (including strict lockdown protocols). Higher psychological resilience, or the ability t...

Background: It is still unclear if sustained intake of artificially sweetened beverages (ASB) in lieu of sugar-sweetened beverages (SSB) is associated with long-term weight reduction or maintenance. This study aimed to evaluate the long-term changes in weight and BMI in relation to changes in ASB intake, and to estimate the effects of replacing SSB...

Consuming foods away from home (FAFH) is prevalent in the United States and contributes to high food spending and daily energy intake. We recently showed that adults in Puerto Rico (PR) who frequently consume FAFH had lower diet quality and adherence to dietary recommendations. It remains unknown if these associations translate into poor cardiometa...

Background This study reports the outcomes of Communities for Healthy Living (CHL), a cluster randomized obesity prevention trial implemented in partnership with Head Start, a federally-funded preschool program for low-income families. Methods Using a stepped wedge design, Head Start programs (n = 16; Boston, MA, USA) were randomly assigned to one...

Objectives: To cluster participants with prediabetes with five type 2 diabetes (T2D)-related partitioned polygenetic risk scores (pPRSs) and examine the risk of incident diabetes and the benefit of adherence to healthy lifestyle across clusters. Design: Prospective cohort study Setting: Hispanic Community Health Study/Study of Latinos (HCHS/SOL), U...

Background Adhering to a Mediterranean Diet (MedDiet) is associated with a healthier cardiometabolic profile. However, there are limited studies on the MedDiet benefits for non-Mediterranean racial/ethnic minorities, for whom this diet may be unfamiliar and inaccessible and who have a high risk of chronic diseases. Objective To describe the study...

Introduction: The relation of dairy intake with cardiometabolic (CM) markers remains unclear due to a complex nutrient profile across dairy types. This study aimed to evaluate associations between dairy intake and CM markers among Puerto Rican adults with excessive CM burden. Methods: Baseline and 2-y follow-up data on diet and CM markers were avai...

Objective We examined links among dietary patterns (DPs), insulin resistance (IR), and diabetes risk by heritage in the Hispanic Community Health Study/Study of Latinos. Methods Hispanics/Latinos of Cuban, Dominican, Mexican, Puerto Rican, Central American, and South American heritage aged 18–74 years and diabetes-free completed two 24 h dietary r...

Objective: To identify the prevalence of weight dissatisfaction among adolescents aged 10-19 years and stratify the analysis by sex. Data source: A literature review of cross-sectional studies among healthy adolescents was performed. The U.S. National Library of Medicine/National Institutes of Health (PubMed), Ovid® (Wolters Kluwer), The Cumulat...

Precision nutrition is an emerging concept that aims to develop nutrition recommendations tailored to different people's circumstances and biological characteristics. Responses to dietary change and the resulting health outcomes from consuming different diets may vary significantly between people based on interactions between their genetic backgrou...

Objectives To evaluate the association between adverse experiences during Hurricane María and mental and emotional distress in Puerto Rico.Methods This cross-sectional study used baseline data from adult (30–75 years) participants of the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT). Enrolled...

Background & aims This study aimed to investigate the association of birth weight with developmental stages of Type 2 Diabetes among Chilean young adults. Methods A probabilistic sample of 1947 individuals (22–28 years) that belong to two birth cohorts (cohort 1: participants born in 1974–1978, cohort 2: participants born in 1988–1992). Multivaria...

Background Multiple dietary patterns haven been recommended by 2015–2020 Dietary Guidelines for Americans for the prevention of cardiovascular disease (CVD). The adherence to these patterns and its relationship with risk of CVD remain unclear in the US Hispanic/Latino population. Objectives We aimed to evaluate three healthy eating patterns measur...

Background In Latin America and the Caribbean, historical shifts away from traditional, plant-sourced food production and consumption patterns may undermine both nutritional status and environmental sustainability. Although agricultural intensification and increasingly animal-centric dietary preferences in the region are well-documented, their infl...

Importance: The Mediterranean diet may reduce the burden of Alzheimer disease and other associated dementias in Hispanic or Latino people. Objective: To investigate the association of a Mediterranean diet with cognitive performance among community-dwelling Hispanic or Latino adults. Design, setting, and participants: This cohort study analyzed...

Dietary patterns (DPs) synthesize multiple related dietary components in one or more combined variables. A drawback of DPs is their limited reproducibility across subpopulations, especially adopting a posteriori DPs, derived using standard multivariate methods [e.g., factor analysis (FA)]. Standard approaches assessing reproducibility of FA-based D...

Objectives This study aimed to document the perspectives of past participants of a text- and website-based ethnic-specific healthy eating program delivered in 2019–2021 for 76 ethnically-diverse Latinos in Boston, MA. Following a healthy diet may help prevent excessive burden of disease; however, current programs fail to address distinctions by eth...

Objectives To examine associations between access to drinking water, beverage intake, and abdominal obesity among adults in Puerto Rico (PR). Methods Cross-sectional data from 856 adults (30–75 y) of the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT) were used. Participants indicated the type...

Objectives Parental feeding styles (PFS) influence children's diet and weight; we aimed to evaluate this relationship in adolescents. Methods Cross-sectional study in 686 Costa Rican adolescents (13–18y). Parents responded to a questionnaire from which four validated PFS scores were derived: promotion (verbal encouragement of healthy eating); verb...

Climate change is a threat to food system stability, with small islands particularly vulnerable to extreme weather events. In Puerto Rico, a diminished agricultural sector and resulting food import dependence have been implicated in reduced diet quality, rural impoverishment, and periodic food insecurity during natural disasters. In contrast, small...

Prediabetes is a heterogenous metabolic condition. We calculated 5 pathway-based partitioned polygenetic risk scores (pPRS: beta-cell, proinsulin, obesity, lipodystrophy and liver/lipid scores) based on 94 type 2 diabetes (T2D) -associated variants in 3677 individuals with prediabetes from the Hispanic Community Health Study/Study of Latinos. Based...

We examined links among dietary patterns (DPs) , insulin resistance (IR) , and diabetes risk by heritage (Cuban, Dominican, Mexican, Puerto Rican, and Central and South American) in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) . HCHS/SOL is a population-based cohort of 16,415 Hispanics/Latinos aged 18-74 y living in 4 US cities....

Background Consuming foods-away-from-home (FAFH) is ubiquitous; yet, it is unclear how it influences diet in diverse populations. Objective The study aimed to evaluate the association between frequency and type of consumption of foods away from home (FAFH) and diet quality. Design The study had a cross-sectional design. Participants self-reported...

Objective: The internet is a primary source of nutrition information in the US. Minorities and non-English speakers face a digital divide when accessing such information. We aimed to report on the reach of social media dissemination of the cultural adaptation of the evidence-based Kid's Healthy Eating Plate to Spanish-speaking Latinos and of previ...

Background: Whereas parental feeding styles (PFS) influence children's diet, less is known about this relationship in adolescents. Methods: A cross-sectional study in 686 Costa Rican adolescents (13-18 years) evaluated 4 validated PFS scores: healthy eating verbal encouragement; scolding; directly controlling diet; instrumental/emotional. Diet w...

Evidence consistently suggests that plant-based diets promote human and planetary health. Reducing large-scale animal-based food production generates environmental benefits, as the entire livestock agriculture chain plays an outsized role in greenhouse gas emissions, land change and degradation, and scarcity-weighted water use. However, substitutin...

Introduction: Poor sleep quality is associated with negative emotions and may modulate emotional eating (EE). However, this has not been studied among US Latinx adults, a group experiencing sleep disparities. Objective: To examine the association between sleep quality and EE in Latinx adults and explore the mediating role of negative emotions....

Background Color groups of fruits and vegetables (FV) are part of a healthy diet, but evidence for an association with cardiometabolic outcomes is inconsistent. Objective To examine the association between intake of FV of different colors with incident diabetes and cardiometabolic risk biomarkers among U.S. Hispanics/Latinos. Subjects/methods We...

Aims/hypothesis We aimed to evaluate associations of multiple recommended dietary patterns (i.e. the alternate Mediterranean diet [aMED], the Healthy Eating Index [HEI]-2015 and the healthful Plant-based Diet Index [hPDI]) with serum metabolite profile, and to examine dietary-pattern-associated metabolites in relation to incident diabetes. Methods...

Objectives: Refugees and immigrants often experience challenges pre- and post-settlement that expose them to risk factors of cardiovascular disease (CVD). Literature on CVD among the growing population of African refugees and immigrants in the United States (US) is scant. This narrative review aimed to evaluate existing studies reporting on CVD an...

OBJECTIVES Hispanic/Latino youth bear a disproportionate burden of food insecurity and poor metabolic outcomes, but research linking the two in this diverse population is lacking. We evaluated whether lower household and child food security (FS) were adversely associated with a metabolic syndrome (MetS) composite variable and clinically measured ca...

Background: Brown rice consumption reduces the risk of diabetes. The prevalence of diabetes is increasing in Nepal; however, dietary preference remains for white rice. This study aimed to understand the perception, enablers, barriers, and facilitators of acceptance brown rice at a worksite cafeteria. Methods: We conducted a mixed-method qualitat...

Childhood food insufficiency negatively influences physical and psychosocial health in children, but less is known about long-term health implications. This study aimed to elucidate the association of childhood food insufficiency with older adulthood cardiometabolic conditions. We conducted cross-sectional analyses using data from the Puerto Rican...

Legumes are a traditional healthy staple food in Latin America, with great potential for use in diet-related chronic disease prevention interventions. This study aimed to investigate attitudes about legume consumption and associations with dietary intake. Adult participants from the Puerto Rico Assessment of Diet, Lifestyle, and Diseases, who compl...

Introduction: Multiple healthy eating patterns have been recommended by the Dietary Guidelines for Americans (2015-2020) for the prevention of cardiovascular disease (CVD). However, adherence to these dietary patterns and its relationship with risk of CVD remains unclear among US Hispanic/Latinos. Hypothesis: We aimed to evaluate three healthy eati...

Background: Following a healthy diet may help prevent excessive burden of disease; however, current programs fail to address distinctions by ethnicity, which may affect their acceptability, efficacy, and sustainability. Formative research with community partners showed that the Latino community warranted deeply tailored dietary programs. In 2019-20...

Purpose: Over-the-counter diet pills are target-marketed to Latinx communities, raising concerns about youth use of these harmful products. Methods: Multivariable logistic models estimated odds ratios (ORs) of diet-pill use in a representative sample of US Latinx and White students (2009-2013; N = 33,824). Results: Latinx students had 30%-40%...

Small island developing states face challenges in cultivating healthy food systems and are currently bearing substantial burdens of obesity and type 2 diabetes. Local food production—rooted in collective local and Indigenous traditions, self-sufficiency, and climate-adaptive agricultural practices—has long emphasised a fibre-rich, plant-based diet;...

Introduction Parent health-related empowerment is defined as the process by which parents realize control over their life situation and take action to promote a healthier lifestyle. For decades, researchers have described the theoretical potential of empowerment in health promotion efforts, though few have empirically examined this hypothesized rel...

Objectives: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal program that improves the health of low-income women (pregnant and postpartum) and children up to 5 years of age in the United States. However, participation is suboptimal. We explored reasons for incomplete redemption of benefits and early d...

Importance As public health emergencies become more prevalent, it is crucial to identify adverse physical and mental health conditions that may be triggered by natural disasters. There is a lack of data on whether Hurricane Maria in 2017 influenced the disease burden of adults in Puerto Rico. Objective To estimate the prevalence of chronic disease...

Leptin promotes satiety and modulates energy balance and weight. Diet-induced obesity leads to leptin resistance, exacerbating overeating. We reviewed the literature on the relationship between diet and leptin, which suggests that addressing leptin resistance through dietary interventions can contribute counteracting obesity. Albeit some limitation...

Introduction: Dietary macronutrient balance and reduced sodium intake are key modifiable risk factors for prevention of cardiovascular disease. Pre-heart failure (HF) (evidence of structural heart disease or abnormal cardiac function) is an independent risk factor for incident clinical HF development. We assessed associations of macronutrient and s...

Weight stigma is a pressing issue that affects individuals across the weight distribution. The role of social media in both alleviating and exacerbating weight bias has received growing attention. On one hand, biased algorithms on social media platforms may filter out posts from individuals in stigmatized groups and concentrate exposure to content...

Context The interrelationships among the gut microbiome, the MedDiet and a clinical endpoint of diabetes is unknown. Objectives To identify gut microbial features of a MedDiet and examine whether the association between MedDiet and diabetes varies across individuals with different gut microbial profiles. Methods This study included 543 diabetes,...

Low diet quality is a significant public health problem in the United States, especially among low-income populations. The food environment influences dietary choices. When applied to eating behavior, behavioral economics (BE) recognizes that decision biases instigated by a food environment saturated with unhealthy foods may lead people to purchase...

Background Diabetes mellitus and consumption of sugar-sweetened beverages is high in the Hispanic/Latino population in the United States. The associations between consumption of sugar-sweetened beverages, artificially sweetened beverages, and 100% fruit juice with prediabetes and glucose metabolism markers in the diverse Hispanic/Latino population...

Objective: Despite evidence on allostatic load (AL) as a model explaining associations between stress and disease, there is no consensus on its operationalization. This study aimed to contrast various AL constructs and their longitudinal associations with disease and disability. Methods: Baseline and 5-year follow-up data from 738 adults partici...

Purpose The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal program that improves the health of low-income children up to 5 years of age. However, participation is suboptimal. We aimed to explore reasons for incomplete redemption of benefits and dropping out of WIC early. Methods In 2020-2021, we conduct...

Our objective was to quantify the cross-sectional associations between dietary fatty acid (DFA) patterns and cognitive function among Hispanic/Latino adults. This study included data from 8,942 participants of the Hispanic Community Health Study/Study of Latinos, a population-based cohort study (weighted age 56.2 y and proportion female 55.2%). The...

Background: Widespread vaccination against COVID-19 is essential to control the pandemic. Estimates of unwillingness and uncertainty toward COVID-19 vaccination and factors associated with it remain unclear among adults in Puerto Rico (PR). Objective: To examine factors associated with uncertainty and unwillingness of COVID-19 vaccination among adu...

Traditional diet indices may capture diet quality according to local food culture. Higher adherence to traditional diet scores may help prevent disease, yet evidence in adolescents is limited. This cross-sectional study aimed to develop and validate a Traditional Costa Rica Adolescents Diet Score (TCRAD) and determine its association with sociodemo...

Objective: Using a difference-in-difference approach, the current study is among the first to assess the relationship between the process of increasing parental empowerment and acquiring healthier weight parenting practices (i.e., change in parental empowerment by change in parenting practices). Background: In child health, parental empowerment is...

Background Previous diet findings in Hispanics/Latinos rarely reflect differences in commonly consumed and culturally relevant foods across heritage groups and by years lived in the United States. Objectives We aimed to identify and compare a posteriori heritage-specific dietary patterns (DPs) and evaluate their associations with “healthfulness” [...

Objective: Growing research suggests that skin tone may be a health risk indicator for Hispanics. Black and darker-skinned Hispanics have worse mental and physical outcomes than white and lighter-skinned Hispanics. Discrimination exposure has been implicated as a risk factor that may explain the association between skin tone and health. However, th...

The public health measures instituted by governments to combat the coronavirus disease 2019 (COVID-19) may cause developmental and educational losses to adolescents. The impacts of the COVID-19 pandemic and its mitigation strategies on adolescents in sub-Saharan Africa are unclear. This study aimed to examine adolescents’ knowledge, perceptions, an...