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INTERVENTION IS PREVENTION: For A Healthier Community

INTERVENTION IS PREVENTION: For A Healthier Community. Bronx County Medical Society 10 th Annual National Doctors Recognition Day March 20, 2013 Julie J Ramos, MD, MS Cardiologist/Nutritionist Montefiore-Einstein Center for Heart and Vascular Care. CAN YOUR PATIENT PINCH AN INCH??.

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INTERVENTION IS PREVENTION: For A Healthier Community

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  1. INTERVENTION IS PREVENTION:For A Healthier Community Bronx County Medical Society 10th Annual National Doctors Recognition Day March 20, 2013 Julie J Ramos, MD, MS Cardiologist/Nutritionist Montefiore-Einstein Center for Heart and Vascular Care

  2. CAN YOUR PATIENT PINCH AN INCH??

  3. Where Is The Weight? Where fat ends up influenced by factors such as: • Subcutaneous fat vs. Visceral fat

  4. VISCERAL FAT • Insulin resistance • Increase risk of CVD • Promotes low-level chronic inflammation (TNF & IL-6)

  5. IDEAL BODY WEIGHT

  6. Percent of Obese NYC Residents (BMI > 30), by Borough NYCDOH 2003

  7. Diabetes Prevalence in NYCBy Borough, 2002 Healthy People 2010 Goal: 2.5% NYCDOH 2003

  8. Metabolic Effects of Excess Weight • Abnormal Lipids • Insulin Resistance • Diabetes • Hypertension • Heart Failure

  9. INSULIN RESISTANCE

  10. SPECTRUM OF INSULIN RESISTANCE • Polycystic Ovary Disease • Dyslipidemia • Metabolic Syndrome

  11. MOUTH TO GUT PROCESS LIVER STORAGE ENERGY FAT

  12. FAT BEGETS MORE FAT: With the Help of Insulin

  13. METABOLIC SYNDROME • Blood pressure > 130/85mmHg • FastingBlood Sugar> 100 mg/dL • Waist Circumference : • Men - 40 inches or more • Women - 35 inches or more • Low HDL cholesterol: • Men - < 40 mg/dL • Women - < 50 mg/dL • Triglycerides> 150 mg/dL

  14. Jordan et al., Prev Chronic Diseases 2012;9

  15. METABOLIC SYNDROME SEQUELAE • Diabetes • Coronary Artery Disease • Liver Disease (fatty liver) • Stroke • Peripheral Vascular Disease

  16. WHAT CAN WE DO?

  17. Mosca et al, JACC Vol. 57, No. 12, 2011 AHA/ACC Prevention of CVD Guidelines- Update 2011 • 30 min/day of moderate exercise -or- • 15 min/day of vigorous exercise (Class I; Level of Evidence B)

  18. Mosca et al, JACC Vol. 57, No. 12, 2011 PHYSICAL ACTIVITY REQUIRED FOR WEIGHT LOSS • Minimum of 60 to 90 min of at least moderate-intensity physical activity almost everyday (Class I; Level of Evidence B).

  19. Let’s Talk Metabolism • Muscle uses glucose to function. • Body Fat produces factors that prevent weight loss.

  20. Exercise Increases Insulin Response in Glucose Transport to Muscle

  21. EXERCISE WORKS

  22. STRRIDE-AT/RT Study; Bateman et al., Am J Cardiol 2011;108:838-844

  23. FOOD

  24. American Diet: 1/3 Junk Food and Soft Drinks! Diseaseproof.com

  25. Heart Healthy Diet • Starts with unprocessed foods • Limit unhealthy fats and cholesterol. • Choose low-fat protein sources. • Eat more vegetables and fruits. • Low sodium diet.

  26. Mediterranean Bliss

  27. The Mediterranean Diet

  28. Lunch1 cup pasta with spinach and beans1 cup mixed greens with Parmigiano cheese1 cup grapesIce tea or water

  29. Healthy Eating Works

  30. Dietary Intervention and Metabolic Syndrome • Healthy Diet-Increased whole grain, fish, and berries • Whole Grain Enriched Diet-Added Whole grain • Refined Flour Diet (aka, American Diet)

  31. The Sysdimet Study Lankinen et al., PLoS ONE 6(8): e22646; Aug 2011

  32. FINAL WORDS SOCIAL Issues Intersect With The HEALTH and WELL Being of Our Community

  33. BRONX UES Community Issue of Availability

  34. Lets Do Less of This!

  35. Let’s Do More of This!

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