Healthy lifestyle behaviors less likely in minority women

Alanna A. Morris

ANAHEIM, Calif. — Hispanic and black adults, particularly women, were less likely to partake in healthy lifestyle behaviors such as diet and physical activity compared with white adults, according to data presented at the American Heart Association Scientific Sessions.

Alanna A. Morris, MD, MSC, assistant professor of medicine in the division of cardiology at Emory University Clinical Cardiovascular Research Institute in Atlanta and a Cardiology Today Next Gen Innovator, and colleagues analyzed data from 12,351 participants (53% women) aged 40 to 79 years from the National Health and Nutrition Examination Survey from 2005 to 2014. Participants were non-Hispanic white (77.4%), non-Hispanic black (10.8%) or Hispanic (11.5%), and those with a history of MI, CHD or stroke were excluded.

Measurements that were reviewed included body weight, height, BP, HDL, LDL and total cholesterol. The information was used to estimate 10-year atherosclerotic CVD risk with the 2013 American College of Cardiology/American Heart Association Pooled Cohort Equation. Participants with an atherosclerotic CVD score greater than 7.5% were considered high risk.

Computer-assisted interviews were conducted to gather information on lifestyle behaviors, including weight-control practices, weight perception, diet quality and levels of physical activity.

White men were more likely to be told that they had a history of overweight (37%) compared with black (29.9%) and Hispanic (29.5%) men. Black women (50.8%) were more likely to be told that they had a history of being overweight vs. white (40.9%) or Hispanic women (45.7%).

Mean BMI in men was about 29 kg/m², and there was no difference by race or ethnicity. Black women had the highest mean BMI (32.7 kg/m²) compared with white (28.9 kg/m²) and Hispanic women (45.7 kg/m²). Obesity was seen in 56.5% of black women, 47.2% of Hispanic women and 36.9% of white women. Slight differences were seen in black men (39.7%), Hispanic men (36.9%) and white men (37%). Black men (14.2%) and black women (9.7%) were more likely to be high risk by the 10-year atherosclerotic CVD score compared with Hispanic and white participants.

White participants were more likely to perceive themselves as overweight and desire to weigh less compared with Hispanic and black participants. White (37.5%) and black men (37.8%) were more likely to have attempted to lose weight in the past year vs. Hispanic men (30.7%). After adjustment for education, income, marital status, atherosclerotic CVD risk score, BMI and self-perception as overweight, black women were less likely to try to lose weight in the past year compared with white women (OR = 0.8; 95% CI, 0.7-0.9). After adjustment, black men were more likely to attempt to lose weight compared with white men.

More white women (33%), Hispanic men (19.5%) and black men (28.9%) reported a healthy diet compared with the rest of the cohort. After adjustment, Hispanic men were about 30% less likely to report a healthy diet vs. white men (OR = 0.7; 95% CI, 0.6-0.9). Black and Hispanic women were about 40% less likely to report a healthy diet compared with white women after adjustment.

White participants were more likely to report physical activity compared with black and Hispanic participants. After adjustment, there were no differences in physical activity in men. However, Hispanic women were about 20% less likely to report physical activity (OR = 0.8; 95% CI, 0.6-0.9) vs. white women.

Participants who were overweight or obese with an elevated atherosclerotic CVD risk score had similar trends. However, in overweight or obese participants with elevated atherosclerotic CVD risk, there were no race or ethnic differences in the number of participants who attempted to lose weight in the past year.

The racial/ethnic disparities in healthy diet were more pronounced in women with atherosclerotic CVD risk greater than 7.5%, according to the researchers.

The strongest predictors of attempted weight loss were overweight and BMI. Physical activity and healthy diet were predicted by education and BMI in white and Hispanic participants, although BMI and overweight were the strongest predictors in black participants.

Compared with those at lower atherosclerotic CVD risk, those with higher risk were less likely to attempt weight loss (OR = 0.8; 95% CI, 0.7-0.9) or physical activity (OR = 0.8; 95% CI, 0.7-0.9) but more likely to report following a healthy diet (OR = 1.5; 95% CI, 1.3-1.7), Morris and colleagues found.

“The thing that’s important from these findings is the disparity in the prevalence of CV risk factors as well as the healthy lifestyle behaviors appears to be greatest in women,” Morris said. “There’s an urgency to continue to do important research that explores barriers implementing therapeutic lifestyle changes that are both culturally sensitive as well as gender specific.” – by Darlene Dobkowski

Reference:

Morris AA, et al. Ancel Keys Memorial Lecture: Lifestyle and Medical Therapy for CVD Prevention. Presented at: American Heart Association Scientific Sessions; Nov. 11-15, 2017; Anaheim, Calif.

Disclosures: The authors report no relevant financial disclosures.