REVIEW Hispanic Americans living in the United States and their risk for obesity, diabetes and kidney disease: Genetic and environmental considerations Joseph M. Yracheta* 1 , Javier Alfonso* 2 , Miguel A. Lanaspa 2,3 , Carlos Roncal-Jimenez 2,3 , Sarah B Johnson 2 , Laura G Sánchez-Lozada 3,4 and Richard J Johnson 2,3 1 Department of Pharmaceutics, School of Pharmacy, University of Washington, Seattle, WA, USA, 2 Division of Renal Diseases and Hypertension, University of Colorado, Aurora, CO, USA, 3 Colorado Research Partners LLC, Aurora, CO, USA, and 4 Laboratory of Renal Physiopathology and Depart- ment of Nephrology, INC Ignacio Chavez, Mexico City, Mexico Abstract The Hispanic American, the largest minority population in the United States, is at increased risk for obesity, diabetes and end-stage renal disease. Here we review genetic and environmental fac- tors that might account for their increased risk for these conditions. Whereas many environmen- tal and genetic factors have important roles in driving the increased risk for obesity and kidney disease in this population, a case is made that excessive intake of sugary beverages is a contribu- tory cause. Studies focusing on decreasing intake of sugary beverages among the Hispanic Amer- ican could potentially reduce renal and cardiovascular complications in this population. Keywords Hispanic American, diabetes, obesity, meta- bolic syndrome, chronic kidney disease, health disparities, sugar, fructose History Received 11 November 2014 Accepted 17 February 2015 Published online 7 March 2015 Hispanic Americans are an ethnicity defined as Americans of Mexican, Cuban, Puerto Rican, Central American, or South- ern American culture or origin. Hispanic Americans consti- tute the largest minority (16%) in the United States and are projected to account for one in three Americans by 2050 [1-4]. Hispanic Americans have some of the highest preva- lence rates of obesity and diabetes in the United States, as well as increased frequency of chronic kidney disease (CKD), but interestingly have less coronary artery disease events and cardiovascular mortality [5-7]. Regional diversity is also present among Hispanic Americans based on origins (Cuban, Mexican, Puerto Rican, etc.) or environment that can lead to some variation in the frequency of diabetes and car- diovascular diseases [7-9]. Here we review the metabolic and cardiorenal status of the Hispanic American and discuss potential environmental and genetic mechanisms to account for these findings, with a special emphasis on the role of sugar intake. Increased prevalence of obesity and diabetes yet lower prevalence of cardiovascular disease: The Hispanic paradox The Hispanic American is currently at increased risk for obe- sity and metabolic syndrome compared to non-Hispanic Whites (Table 1) [5,6,10-14]. Obesity is especially prevalent in female Hispanic Americans with 44% obese compared to 32% in non-Hispanic Whites. This is accompanied by an increased prevalence rate for metabolic syndrome [13], fatty liver [14], and diabetes [10]. Obesity and diabetes are com- mon in Hispanic Americans in adolescence [14,15], with type 2 diabetes occurring four times more in Hispanic American adolescents compared to non-Hispanic Whites [16]. Diabetes is almost twice as common (12%) in adults as compared to the non-Hispanic White (7%), and is especially common in Mexican Americans where it occurs at an earlier age than in non-Hispanic Whites [15]. Interestingly, Cuban Americans have a lower frequency of diabetes compared to Mexican or Puerto Rican Americans [17]. Despite the higher prevalence of obesity and metabolic syndrome, the prevalence of hypertension tends to be equiva- lent or slightly lower to that observed in the non-Hispanic White [18-20]. An exception is the Caribbean Hispanic, who has a greater prevalence of hypertension [21,22], possibly related to the greater African heritage compared to Mexican Americans [23]. Despite similar rates of hypertension, the incidence of stroke is greater in the Hispanic Americans, especially in those under the age of 60 [24]. Nevertheless, stroke mortality is lower in Hispanic Americans (although these differences do not appear in some regions) [25,26]. Furthermore, the incidence of cardiovascular events (myo- cardial infarction) and prevalence of heart failure, as well as Correspondence: Richard J Johnson, MD, Division of Renal Diseases and Hypertension, University of Colorado, 12700 East 19th Ave, Room 7015, Aurora, CO 80045, USA. E-mail: richard.johnson@ucdenver.edu *These authors contributed equally to this work. Ó 2015 Informa UK Ltd. http://informahealthcare.com/pgm ISSN: 0032-5481 (print), 1941-9260 (electronic) Postgrad Med, 2015; Early Online: 1–8 DOI: 10.1080/00325481.2015.1021234 Postgraduate Medicine Downloaded from informahealthcare.com by 97.118.167.7 on 03/08/15 For personal use only.