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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 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
Where Is The Weight? Where fat ends up influenced by factors such as: • Subcutaneous fat vs. Visceral fat
VISCERAL FAT • Insulin resistance • Increase risk of CVD • Promotes low-level chronic inflammation (TNF & IL-6)
Percent of Obese NYC Residents (BMI > 30), by Borough NYCDOH 2003
Diabetes Prevalence in NYCBy Borough, 2002 Healthy People 2010 Goal: 2.5% NYCDOH 2003
Metabolic Effects of Excess Weight • Abnormal Lipids • Insulin Resistance • Diabetes • Hypertension • Heart Failure
SPECTRUM OF INSULIN RESISTANCE • Polycystic Ovary Disease • Dyslipidemia • Metabolic Syndrome
MOUTH TO GUT PROCESS LIVER STORAGE ENERGY FAT
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
METABOLIC SYNDROME SEQUELAE • Diabetes • Coronary Artery Disease • Liver Disease (fatty liver) • Stroke • Peripheral Vascular Disease
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)
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).
Let’s Talk Metabolism • Muscle uses glucose to function. • Body Fat produces factors that prevent weight loss.
Exercise Increases Insulin Response in Glucose Transport to Muscle
STRRIDE-AT/RT Study; Bateman et al., Am J Cardiol 2011;108:838-844
American Diet: 1/3 Junk Food and Soft Drinks! Diseaseproof.com
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.
Lunch1 cup pasta with spinach and beans1 cup mixed greens with Parmigiano cheese1 cup grapesIce tea or water
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)
The Sysdimet Study Lankinen et al., PLoS ONE 6(8): e22646; Aug 2011
FINAL WORDS SOCIAL Issues Intersect With The HEALTH and WELL Being of Our Community
BRONX UES Community Issue of Availability