title: A Healthy Lifestyle Score Is Associated with Cardiometabolic and Neuroendocrine Risk Factors among Puerto Rican Adults.
abstract: BACKGROUND
  Although individual healthy lifestyle behaviors may reduce cardiovascular disease risk, few studies have analyzed the combined effect of multiple lifestyle components as one all-inclusive measure on such outcomes, much less in minority populations.
  
  
  OBJECTIVE
  We aimed to develop a Healthy Lifestyle Score (HLS) that included several lifestyle recommendations and to test its association with metabolic syndrome (MetS) and allostatic load (AL) and their cardiometabolic and neuroendocrine factors in Puerto Ricans.
  
  
  METHODS
  In a cross-sectional study in 787 Puerto Ricans living in Boston (aged 45-75 y), we developed an HLS that ranged from 0 to 190 (higher score indicative of healthier lifestyle) and included 5 components (diet, physical activity and sedentary behaviors, smoking, social support and network, and sleep). Multivariable-adjusted models were used to test associations between the HLS and biomarkers of dysregulation and odds of MetS and high AL (≥4 out of 10 components).
  
  
  RESULTS
  The HLS showed adequate internal consistency (ρ = 0.31-0.69) and was inversely associated with urinary cortisol (β ± SE = -0.22 ± 0.11; P = 0.042), epinephrine (-0.20 ± 0.09; P = 0.017), and norepinephrine (-0.26 ± 0.11; P = 0.016); waist circumference (-0.014 ± 0.004; P = 0.003); and serum insulin (-0.30 ± 0.13; P = 0.028) and positively associated with plasma HDL cholesterol (0.007 ± 0.003; P = 0.021) after adjustment for potential confounders. For each 20-unit increase in HLS, participants had 19% (95% CI: 2%, 33%) and 25% (11%, 36%) lower odds of MetS or AL, respectively. Healthier scores for social support and network and smoking components were associated with lower odds of high AL (P < 0.005). No significant associations were observed for other individual lifestyle components.
  
  
  CONCLUSIONS
  Following an overall healthy lifestyle that comprises a combination of multiple behaviors may provide stronger protection against MetS and AL in Puerto Rican adults than individual components. The HLS may be a useful tool for examining health-related outcomes. This trial was registered at clinicaltrials.gov as NCT01231958.
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA;
authors.forename: Mercedes
authors.initials: M
authors.lastname: Sotos-Prieto
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA;
authors.forename: Shilpa N
authors.initials: SN
authors.lastname: Bhupathiraju
authors.affiliation: Center for Population Health and Health Disparities, College of Fine Arts, Humanities, and Social Sciences, and.
authors.forename: Luis M
authors.initials: LM
authors.lastname: Falcón
authors.affiliation: Department of Nutritional Sciences, The Pennsylvania State University, State College, PA.
authors.forename: Xiang
authors.initials: X
authors.lastname: Gao
authors.affiliation: Center for Population Health and Health Disparities, Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts, Lowell, MA; and.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Tucker
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; jmattei@hsph.harvard.edu.
authors.forename: Josiemer
authors.initials: J
authors.lastname: Mattei
mesh_terms: D000368:Aged; D052636:Allostasis; D001900:Boston; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005247:Feeding Behavior; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D024821:Metabolic Syndrome / Q000453:epidemiology*; D008875:Middle Aged; D009043:Motor Activity; D011647:Puerto Rico; D012307:Risk Factors; D012959:Socioeconomic Factors; D055105:Waist Circumference
keywords: Hispanics; allostatic load; lifestyle recommendations; lifestyle score; metabolic syndrome