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COPE WEBINAR SERIES FOR HEALTH PROFESSIONALS FINDING SLIDES FOR TODAYS WEBINAR December 11, 2019 www.villanova.edu/COPE Pr evention of ASCVD in South Asians: Impac t of Diet Modific ation and Click on Geeta Sikand Physic al Ac tivity as

  1. COPE WEBINAR SERIES FOR HEALTH PROFESSIONALS FINDING SLIDES FOR TODAY’S WEBINAR December 11, 2019 www.villanova.edu/COPE Pr evention of ASCVD in South Asians: Impac t of Diet Modific ation and Click on Geeta Sikand Physic al Ac tivity as Pr imar y Inter vention webinar description page Moderator: Lisa Diewald, MS, RD, LDN Program Manager MacDonald Center for Obesity Prevention and Education M. Louise Fitzpatrick College of Nursing Nursing Education Continuing Education Programming Research Nursing Education Continuing Education Programming Research 1 2 DID YOU USE YOUR PHONE TO ACCESS THE WEBINAR? OBJECTIVES 1. Describe the impact of Western Acculturation on the dietary patterns of South Asians If you are calling in today rather than 2. Explain the impact of diet and lifestyle modification on using your computer to log on, and need ASCVD risk in South Asians CE credit, please email cope@villanova.edu and provide your 3. Review the South Asian diet and lifestyle goals and resources to help practitioners implement culturally tailored name so we can send your certificate. AHA/ACC recommended heart healthy dietary patterns. Nursing Education Continuing Education Programming Research Nursing Education Continuing Education Programming Research 3 4 CE DETAILS NUTRITION FUTURE FORWARD: ARE WE READY FOR OUT OF THE BOX Villanova University College of Nursing THINKING? is accredited as a provider of continuing nursing education by the March 6, 2020 American Nurses Credentialing Center 9 AM-4 PM Driscoll Hall Auditorium Commission on Accreditation Villanova University Villanova University College of Nursing Continuing Education/COPE is a RNs: 6 contact hours Continuing Professional Education RD/ RDN/ DTR: 6 CPEUs (CPE) Accredited Provider with the Villanova.edu/cope Commission on Dietetic Registration Nursing Education Continuing Education Programming Research 5 6 1

  2. Prevention of ASCVD in South Asians: CE CREDITS Impact of Diet Modification and Physical Activity as Primary Intervention • This webinar awards 1 contact hour for nurses and 1 CPEU for dietitians Geeta Sikand, MA, RDN, FAND, CDE, CLS, FNLA • Suggested CDR Learning Need Codes: 3020, Director of Nutrition 5160, 5370 and 6000 University of California Irvine Preventive Cardiology Program • Level 2 • CDR Performance Indicators: 8.2.1, 8.2.4, 8.3.1, 8.3.6 Nursing Education Continuing Education Programming Research 7 8 Prevention of ASCVD in South Asians I m pact of Diet Modification and DISCLOSURE Physical Activity in Prim ary Prevention The planners and presenter of this program have no conflicts of Geeta Sikand, MA, RDN, FAND, CDE, CLS, FNLA interest to disclose. Associate Clinical Professor of Medicine Accredited status does not imply endorsement by Villanova (Cardiology) University, COPE or the American Nurses Credentialing Center of any commercial products or medical/nutrition advice Director of Nutrition displayed in conjunction with an activity. Univ of Calif Irvine Preventive Cardiology Program University of California, Irvine 9 10 Disclosures Objectives  No financial relationships to disclose 1. Enumerate the impact of food acculturation on the dietary patterns of South Asians (SA) and associated ASCVD risk factors. 2. Explain the impact of diet and lifestyle modification on ASCVD risk factors. 3. Describe SA diet and lifestyle goals and resources to help practitioners implement culturally tailored AHA/ ACC recommended heart healthy dietary patterns. 11 12 2

  3. W ho are South Asians? W HO Facts: South Asians Countries of Birth  CHD strikes South Asians at an earlier age (almost 33% earlier) and with higher mortality rates than other demographics.  50% of all heart attacks in Indian men occur under 50 years of age and 25% of all heart 5% 1% attacks occur under 40 years of age. 1%  India accounts for approximately 60% of the world's heart disease burden, despite less than 84% 20% of the world's population. 3% Africa  India: World’s capital for diabetes e.g. in 2% U.S. 2% Fiji Hyderabad, India, 20% of the entire adult 2% other Diaspora population is diabetic. country 1% WHO, 2011; Chiu M et al., Diabetes Care, 2011 13 14 ACC/ AHA 2 0 1 8 Cholesterol Managem ent South Asian s: Background Guidelines: Risk-Enhancing Factors  Fam ily history of prem ature ASCVD  Relatively lower body weight (BMI)  Prim ary hypercholesterolem ia  More central abdominal obesity  Metabolic syndrom e  Higher diabetes rate  Chronic kidney disease  Higher risk of early heart disease  Chronic inflam m atory conditions  … little population-based U.S. data, and  Prem ature m enopause no longitudinal studies worldwide  High-risk race/ ethnicities ( e.g., South Asian ancestry)  Lipid/ biom arkers  Elevated high-sensitivity C-reactive protein  Elevated Lp( a) Grundy Circulation 2018, Vogelman Circulation 2018, Grundy et al. Circulation 2 0 1 8 Jacobson J Clin. Lipidol. 2015 15 16 I ntra-abdom inal fat vs. Subcutaneous ASCVD Risk Factors in South Asians Relative Accumulation of Intra-abdominal vs.  Relatively lower BMI but more Intra ‐ abdominal depot Subcutaneous Depot Subcutaneous central abdominal obesity. depot  The lower BMI cut-point for over weight in South Asians was lowered from 24.9 to 23.0 due to early insulin resistance.  High diabetes rate.  High risk of early heart disease. Caucasians Blacks Asians Grundy Circulation 2018, Vogelman Circulation 2018, Jacobson J Eastwood SV, Tillin T, Wright A, et al. PLoS One . 2013;8(9):e75085 . Clin. Lipidol. 2015 17 18 3

  4. MASALA and MESA on Pooled I m pact of Acculturation on I ncident CVD in South Asians Risk Equation  Discordance between 10-year 2- to 3-fold higher risk of incident CVD in cardiovascular risk estimates using the non-adherers to heart healthy behaviors e.g. ACC/ AHA 2013 estimator and coronary • Fewer fruits and vegetables artery calcium in SA individuals was noted • Sedentary lifestyle when compared with 5 racial/ ethnic groups • Smokers when Comparing MASALA and MESA studies • Excessive alcohol use Parackal et al. Curr. Diabetes Rev. 2017 Al Rifai, M., Atherosclerosis, https://doi.org/10.1016/j.atherosclerosis.2018.09.015 19 20 I m pact of Acculturation in SA Dietary Patterns vary by Region South Asians’ dietary patterns and and Religion ASCVD Risk However, all consume high amounts of saturated  Increased intake of animal protein, fried fat & refined carbs: snacks, sweets & high-fat dairy: Increased • Ghee, butter, whole milk, cream insulin resistance and reduced HDL-C. • Shortening, fried foods, coconut oil • Potatoes, white rice, pizza  Adhere to a traditional plus western dietary pattern: Increased obesity and hypertension. • Repeat use of cooking oil in deep fried savory snacks • Sugar sweetened beverages  Adhere to a western dietary pattern: Increased risk for MetS. Parackal Curr. Diabetes Rev. 2017 Eriksen et al. PLoS One . 2015 21 22 Vegetarian vs. Non-Vegetarians Dietary I s there a single SA dietary pattern? Patterns Vegetarians ( Lacto) Non-vegetarians  Obesity  Dyslipidemia  Dyslipidemia  Overweight  ASCVD Consume excessive Consume excessive animal products. calories, refined carbs, saturated fats from high fat dairy (ghee, butter, whole milk, cream) and coconut oil. Eriksen et al. PLoSOne . 2015 23 24 4

  5. MASALA Study Design The Mediators of Atherosclerosis in Kanaya et al. 2 0 1 4 South Asians Living in Am erica MASALA MESA ( MASALA) Study — Ages 40-84 — Ages 45-84 years years — N = 900 — N = 6,500  Kanaya et al. Acculturation & Subclinical — Only South — 4 ethnic Atherosclerosis among U.S. South Asians: Asians groups Findings from the MASALA study. J Clin Exp — Two sites (UCSF — 6 sites Res Cardiol 2014. and NWU) (Columbia, Hopkins, NWU, — Pilot study Minnesota, (n= 150; 2006- UCLA, Wake 2007) Forest) — Oct 2010-March — Started in 2013 2000: — Exam 5, 2010- 2012 25 26 Much Low er Exercise in SA Major Lifestyle Contributors to ASCVD in SA Kanaya et al. 2 0 1 4 2 0 1 4 MASALA Study Findings  Atherogenic diet  Lack of physical activity  Overweight: 75% of SA  Diabetes prevalence: 23% (twice that of age MET-min/week and adiposity matched Chinese Americans * (13% ) and quadruple of Non Hispanic Whites (6% ) Kanaya et al. Acculturation & Subclinical Atherosclerosis among U.S. South Asians: Findings from the MASALA study. J Clin Exp Res Cardiol 2014. 27 28 2 0 1 4 MASALA Study Findings Three m ajor dietary patterns Were linked with 2 A. Traditional Veg diet: 1. High animal  Higher BMI The high animal Fried snacks, sweets, high fat protein  Higher waist- dairy. protein diet 2 B. Mixed pattern= traditional 2 A plus cir pattern and the W estern diet: high fat dairy, pizza,  Higher total-C fried snacks, potatoes, fast foods, sw eetened sweets & high-fat  Higher LDL-C beverages. dairy diet  Lower HDL-C 3 . Fruits, vegetables, nuts, and patterns  Higher insulin legumes pattern. resistance 29 30 5

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