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Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111
2To whom correspondence should be addressed. E-mail: Odilia.Bermudez{at}Tufts.edu.
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ABSTRACT |
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 TOP ABSTRACT SUBJECTS AND METHODSRESULTSDISCUSSIONLITERATURE CITED |
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-carotene, lutein + zeaxanthin, ß-carotene (from diet only), and total ß-carotene (diet and supplements) (P < 0.001). Hispanic women reported higher intakes of ß-cryptoxanthin and lycopene but lower intakes of lutein + zeaxanthin (P < 0.001) than non-Hispanic white women. The frequency of consumption of fruit and vegetables was higher among Hispanic women, relative to non-Hispanic white women (P < 0.05). Plasma concentrations of -carotene and lycopene were higher in Hispanic than in non-Hispanic white men and women. For both ethnic groups, higher intakes of carotenoids were associated with higher plasma concentrations of the respective carotenoids, except for lycopene (Hispanics) and lutein + zeaxanthin (non-Hispanic whites). Food sources contributing most to total intakes differed among the groups. The major sources of - and ß-carotene were carrots for non-Hispanic whites and winter squash for Hispanics. The major source of lycopene was cooked tomato products for Hispanics, and pasta dishes for non-Hispanic whites. Traditional foods such as beans and plantains were also important contributors of carotenoids for Hispanics. Because of the potential importance of carotenoids as protective factors against chronic diseases, more attention to food-related practices associated with carotenoid intake in differing population groups is warranted.
KEY WORDS: • carotenoids • elderly • Hispanic • Puerto Rican • Dominican
The Hispanic population in the United States is currently the largest minority group in the country (1), and there is evidence that their nutritional and health profiles are distinct from those of the non-Hispanic white population (2–6). We showed previously that Hispanic elders living in the U.S. Northeast, where the major groups are Puerto Rican and Dominican (1,7), are at higher risk for developing chronic conditions such as diabetes and disability than are non-Hispanic whites living in the same neighborhoods (7–10). Reliable dietary data are required for assessment of associations between diet and chronic diseases, but general FFQs are often not useful for subpopulations such as Hispanics with culturally specific eating patterns.
One class of phytochemicals, carotenoids, has been associated with a reduced risk of cardiovascular disease (11–14), some types of cancer (15–21), age-related macular degeneration (22,23), cataract (24), and cognitive impairment (25), although results remain inconclusive for many of these.
Data are needed to describe carotenoid profiles and food sources among Hispanic groups, particularly Caribbean Hispanics in the United States. In addition, carotenoids may be useful biomarkers of fruit and vegetable consumption among Hispanic elders, as shown in studies with other groups (26–28). Thus, we conducted this study 1) to assess the dietary intake and plasma concentrations of - and ß-carotene, ß-cryptoxanthin, lutein + zeaxanthin, and lycopene in Caribbean Hispanics (Puerto Rican and Dominican) and a comparison group of non-Hispanic whites living in the same neighborhoods in Massachusetts; 2) to evaluate associations between dietary intake measures and plasma concentrations; and 3) to identify the relative contributions of foods to carotenoid intakes assessed by FFQ in these groups.
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SUBJECTS AND METHODS |
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TOPABSTRACTSUBJECTS AND METHODSRESULTSDISCUSSIONLITERATURE CITED |
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Data collection.
Blood samples were collected from fasting (
12 h) subjects into tubes containing 0.15% EDTA and centrifuged at 1000 x g for 20 min at 4°C. Plasma was separated and frozen at –80°C until analyzed for carotenoids (-carotene, ß-carotene, lycopene, lutein, zeaxanthin, and ß-cryptoxanthin) by HPLC using a C30 carotenoid column (29). The intra-assay CV for ß-carotene was 4% and the mean percentage recovery of the internal standard (echinenone) was 97%. To prevent photodegradation of carotenoids, all plasma handling, preparation of standard compounds, and HPLC procedures were performed under dim red light. Plasma cholesterol was measured by enzymatic methods with an automated analyzer (CCX analyzer; Abbott Diagnostics Spectrum) and Abbott enzymatic reagents (30). Assays were performed in duplicate, and the CVs within and between runs were 2–5%.
Dietary data were collected with a semiquantitative FFQ, especially adapted for the study population (31). Portion sizes were obtained with open-ended questions. This FFQ, which was interviewer-administered, has 118 items, with 13 fruit and 23 vegetable items, and includes foods used specifically by Hispanics (e.g., green and ripe plantains). Information about dietary supplements was also collected using an inventory on type, dosage, and frequency of use.
Dietary carotenoid analysis was conducted using the Nutrition Data System for Research (NDS-R) software version 4.06 (MN Food and Nutrient Database 34, released May, 2003, University of Minnesota), which contains a comprehensive carotenoid database. We assessed dietary intakes of - and ß-carotene, ß-cryptoxanthin, lutein + zeaxanthin, and lycopene. For ß-carotene, we also assessed the total intake from diet plus supplement use. In addition, we calculated the percentage contribution of each food item to the total intake of each carotenoid, and then ranked that contribution for the identification of the main food sources of carotenoids separately for the Hispanic and non-Hispanic white groups.
Statistical analysis.
Descriptive analyses were performed to examine ethnic differences between Hispanics and non-Hispanic whites, using general linear models with Bonferroni post hoc adjustments for continuous variables and logistic regression models for binomial variables. All -values were set at P < 0.05. To improve normality, dietary and plasma concentrations of carotenoids were log-transformed.
Multiple regression analyses were used to evaluate the association of plasma carotenoid concentration with ethnicity, dietary intake, and other known correlates. A basic model assessed the association with ethnicity adjusted for age, sex, and plasma cholesterol. Education and income:poverty threshold were added in a second model, and smoking and alcohol consumption to a third model. A fourth and final model included carotenoid and total energy intakes. We used SAS (version 8.0, SAS Institute) for statistical analysis.
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RESULTS |
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TOPABSTRACTSUBJECTS AND METHODSRESULTSDISCUSSIONLITERATURE CITED |
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-carotene (P < 0.05), lutein + zeaxanthin (P < 0.001), dietary ß-carotene (P < 0.05), and total ß-carotene (P < 0.01), but significantly higher intakes of lycopene (P < 0.01) (Table 2). Compared with non-Hispanic white women, Hispanic women also reported lower intakes of total ß-carotene (P < 0.01) and lutein + zeaxanthin (P < 0.001), but higher intakes of lycopene (P < 0.01) and ß-cryptoxanthin (P < 0.01).
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Plasma concentrations of -carotene, ß-carotene, lutein + zeaxanthin, and lycopene were strongly and positively associated with Hispanic ethnicity, after full adjustment for sociodemographic variables (Table 3). Plasma concentrations of total cholesterol were also positively associated with all plasma concentrations of carotenoids. As expected, intakes of the studied carotenoids were strong determinants of their respective plasma carotenoids. For Hispanics and non-Hispanic whites, correlations between intake and plasma concentrations, adjusted for age, sex, poverty, current smoking, plasma cholesterol, and energy intake were 0.28 and 0.25 for -carotene, 0.24 and 0.17 for dietary ß-carotene, 0.28 and 0.24 for total ß-carotene, 0.26 and 0.47 for ß-cryptoxanthin, 0.16 and 0.18 for lutein + zeaxanthin, and 0.03 and 0.31 for lycopene, respectively. With the exception of lycopene for Hispanics, all of these were significant (P < 0.05).
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-carotene and ß-carotene were seen across dietary intake quartiles among Hispanics (P < 0.05). Among non-Hispanic whites, plasma -carotene concentrations differed between the 4th and 1st and the 2nd quartiles of intake (P < 0.05). There was a weak trend (P = 0.12) toward higher plasma concentrations of ß-carotene at higher intakes. Plasma concentrations of ß-cryptoxanthin were consistently higher with higher intakes for both ethnic groups. Higher intakes of lutein + zeaxanthin resulted also in higher plasma concentrations of these carotenoids in Hispanics, but not in non-Hispanic whites. For Hispanics, we did not detect associations between intakes and plasma concentrations of lycopene. Among the non-Hispanic whites, we detected only a weak trend (P = 0.10) toward higher plasma lycopene concentrations at higher intakes between the 1st and the 2nd quartiles of lycopene intake.
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- and ß-carotene came from the intake of carrots and mixed vegetables (which usually contained carrots) (Table 4). For Hispanics, although these were also sources, a more important source was winter squash (frequently included in the preparation of beans). Plantains were also important contributors for Hispanics, providing 10% of -carotene and 7% of ß-carotene, respectively; 7% of total ß-carotene intake was obtained from dietary supplements by non-Hispanic whites, whereas Hispanics obtained <5% of this carotenoid from supplements.
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Of total lycopene consumption among Hispanics, >50% came from cooked tomatoes, primarily from canned tomato sauce used in the preparation of beans and mixed rice dishes. Pasta dishes provided most of the lycopene intake of non-Hispanic whites. Other important contributors of lycopene for Hispanics included watermelon, and for non-Hispanic whites, these included vegetable and tomato soups, and raw tomatoes.
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DISCUSSION |
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TOPABSTRACTSUBJECTS AND METHODSRESULTSDISCUSSIONLITERATURE CITED |
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-carotene, total ß-carotene, and lutein + zeaxanthin by Hispanic men, these Hispanic elders of Caribbean origin did not have lower plasma concentrations of these carotenoids relative to non-Hispanic whites. Furthermore, plasma -carotene concentrations were significantly higher for the Hispanics compared with those of non-Hispanic whites. Hispanics had significantly higher intakes and plasma concentrations of lycopene. We observed a higher frequency of consumption of fruit and vegetables by the Hispanics relative to the non-Hispanic whites, which influenced the carotenoid intakes. Higher intakes of carotenoids were reported for Mexican Americans compared with non-Hispanic whites (32). Hispanic groups, including Mexican Americans and those of Caribbean origin, include a wide array of starchy vegetables in their dietary patterns and tomato-based dishes in their daily food consumption. Those products are important sources of carotenoids.
In addition to the usual rich food sources of - and ß-carotene and ß-cryptoxanthin, traditional Hispanic foods and dishes, including winter squash, plantains, beans, and homemade soups, were important sources of these carotenoids. Relative to the non-Hispanic whites, Hispanic elders reported a higher intake of ß-cryptoxanthin (women), and lower total ß-carotene (men and women). However, these differences in intake were not reflected in the respective plasma concentrations because the differences by ethnicity were not significant, after age adjustment. In a national sample, lower intakes of carotenoids were associated with being white (vs. black), younger (adults 18–39 y vs. 40–69 y), and having less education (33).
Absorption of dietary carotenoids is enhanced with the addition of dietary fats (34). A recent study reported that - and ß-carotenes in plasma chylomicrons were negligible after study subjects ingested fresh vegetable salads with fat-free dressing, but were high when served with reduced-fat dressing, and higher still with full-fat salad dressing (35). We reported that Hispanics, relative to non-Hispanic whites, consumed less total, monounsaturated, and saturated fatty acids (as a percentage of energy) as well as less cholesterol, but more polyunsaturated fat (10). The last-mentioned, in the form of vegetable oil, is used regularly in the preparation of beans and soups that contain vegetables. There were stronger associations between plasma total cholesterol and plasma carotenoid concentrations among Hispanic women, relative to non-Hispanic white women.
Lutein + zeaxanthin may protect against the development of cataract and macular degeneration, common age-related diseases among older population groups (23,36). Data from the NHANES III showed that, among subjects aged 60–79 y, intakes of lutein + zeaxanthin were higher among non-Hispanic blacks compared with Mexican Americans and non-Hispanic whites (37). In our study, Hispanics reported lower intakes of these carotenoids relative to non-Hispanic white elders. Although total intakes of lutein + zeaxanthin were significantly lower for Hispanics than for non-Hispanic whites, plasma concentrations of these carotenoids did not differ between these 2 ethnic groups. Despite lower intakes of these carotenoids by the Hispanic elders, it is possible that some protective factors, including methods of preparation, may enhance carotenoid absorption in this ethnic group.
Carotenoid intakes, as measured by the FFQ, were significantly associated with plasma carotenoids, with the exception of lycopene among Hispanics. These results validate the ability of our FFQ to capture usual carotenoid intake of both Hispanic and non-Hispanic white elders. Our group showed previously that the Willett FFQ (38,39) provided acceptable rankings of carotenoid profiles among participants in the Framingham Heart Study (40). Adjusted correlations between carotenoid intake and plasma concentrations for men and women in that study were 0.25–0.23 for -carotene, 0.25–0.27 for ß-carotene, 0.16–0.19 for ß-cryptoxanthin, 0.14–0.16 for lutein + zeaxanthin, and 0.17–0.19 for lycopene. With the exception of a lower correlation for lycopene in Hispanics, our correlations for Hispanic and non-Hispanic white elders are similar to the Framingham results. Yong and collaborators (41) reported similar findings for a FFQ used in a cross-sectional study by the National Cancer Institute, with positive correlations between dietary and plasma concentrations for -carotene (0.49), ß-carotene (0.49), ß-cryptoxanthin (0.36), lutein + zeaxanthin (0.37), and lycopene (0.26). When 2 different carotenoid databases were used to assess intakes of carotenoids collected by FFQ, different estimations of intake were obtained, but they were found to rank individuals similarly (42). Other FFQs have been used to assess carotenoid intakes with positive results (40,43).
Similar to findings from another study with healthy subjects (ages 26–82 y) (44), we noted an inverse association of plasma lycopene with age and no association with smoking. However, Re et al. (45) recently reported a significant inverse association between lycopene and the number of cigarettes smoked. Lycopene intake has been associated with reductions in risk for prostate cancer (44), a probable reduction in rectal cancer risk in women (44), and decreased risk of cardiovascular disease (8). Lycopene is a stronger antioxidant than - or ß-carotene (44), protecting lipids, lipoproteins, proteins, and DNA from oxidative processes, and thus having potential anticarcinogenic and antiatherogenic effects (44). Furthermore, LDL oxidizability decreases after consumption of tomato products (44). The relatively high lycopene plasma concentrations in our Hispanic sample may provide some protection against these conditions, a benefit that should be investigated further.
Lycopene is more bioavailable in cooked (vs. raw) tomato products because heat, and the addition of fat, releases it from cells and changes its isomeric form to one that may be more bioavailable (46–49). In the Caribbean Hispanic cuisine, canned tomato sauce, along with cooking oil, is added liberally to stews, beans, soups, rice, pasta, and other starchy dishes. The frequent use of cooked and processed tomatoes by Hispanic elders resulted in significantly higher intake and plasma concentrations of lycopene relative to non-Hispanic white elders. However, we did not detect a significant association between dietary and plasma values for this carotenoid among Hispanics. Among non-Hispanic whites, with more distinct sources of lycopene and greater variation in intake of those sources, we detected weak associations between dietary intake and plasma concentrations.
We do not have a conclusive explanation for the lack of association between dietary and plasma lycopene among Hispanic elders. In a study conducted in men with prostate adenocarcinoma, short-term supplementation with tomato paste increased both prostate and serum lycopene levels from baseline. However, the increases in the tissue levels were substantially greater than those in serum (50). Results from a study on the bioavailability of lycopene also suggested that serum levels may reach a plateau at an intake of 20 mg/d (51). Furthermore, Diwadkar-Navsariwala et al. (52) reported that the percentage of lycopene absorption among healthy men was higher (34%) when low (10 µg) doses were given in the form of a tomato beverage relative to higher doses (30–120 µg). They also reported that, independent of dose, 80% of subjects absorbed 6 mg of lycopene, suggesting the possible saturation of absorptive mechanisms (52). From our results, we infer that a relatively constant intake of lycopene sources, for extended periods of time, may have induced Hispanic elders to reach saturation levels in their plasma lycopene, at which point there was no longer a direct relation between intake and plasma concentrations of this carotenoid. It is also possible that a variation in actual use of tomato sauce was obscured by assumptions about recipes used in the preparation of the Hispanic dishes included in the FFQ.
In summary, and in contrast to expectation, plasma concentrations of -carotene and lycopene were higher in Hispanics than in non-Hispanic whites. The FFQ used to assess dietary intake appears to be a valid instrument for assessment of carotenoid intakes, for both Hispanic and non-Hispanic white elders. The importance of carotenoids as protective factors against chronic and degenerative diseases and their relevance in the prevention of those diseases underline the need to focus more on the identification of food-related practices of diverse population groups.
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ACKNOWLEDGMENTS |
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FOOTNOTES |
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Manuscript received 25 October 2004. Initial review completed 12 November 2004. Revision accepted 8 March 2005.
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TOPABSTRACTSUBJECTS AND METHODSRESULTSDISCUSSIONLITERATURE CITED |
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