AND GOOD AFTERNOON.
WELCOME TO THE WEDNESDAY
AFTERNOON LECTURE SERIES.
I'M THE PROGRAM DIRECTOR AT NCI
AND I REPRESENT ASIAN AMERICAN
AND THE PACIFIC ISLANDER
INTEREST GROUP WHO NOMINATE THE
SPEAKER DR. ROSARIO ARANETA WHO
HAS INSIGHT INTO THE ALARMING
RISK OF THE TYPE 2 DIABETES
AMONG THE FILIPINO AND SOUTH
ASIAN.
BUT I HAVE TWO FOR THE
ANNOUNCEMENT FIRST.
FOR THOSE WATCHING REMOTELY WE
URGE YOU TO PARTICIPATE IN THE
Q&A.
CLICK ON THE BUTTON BELOW THE
VIDEOCAST WINDOW THAT SAYS SEND
LIVE FEEDBACK.
CLICK ON THAT AND TYPE IN YOUR
NAME AND QUESTION.
WE'LL RELATE THIS TO DR. ARANETA
AT THE END OF HER TALK.
YOU CAN SUBMIT A QUESTION ANY
TIME AND HOPE YOU DO SO.
FOR THOSE HERE IN THE AUDITORIUM
YOU CAN USE THE MIC TO YOUR LEFT
AND RIGHT.
ALSO WE ARE OFFERING THE
CONTINUING EDUCATION CREDIT FOR
THE PRESENTATION.
THE CME CODE IS 50126.
I WILL REPEAT THAT, 50126.
SO, OUR SPEAKER DR. ARANETA IS A
PROFESSOR IN THE DEPARTMENT OF
FAMILY MEDICINE AND PUBLIC
HEALTH.
DIVISION OF EPIDEMIOLOGY AT THE
UNIVERSITY OF CALIFORNIA SAN
DIEGO.
SHE HAS NUMEROUS ROLES AT UCSD.
SHE'S DEAN OF DIVERSITY
PARTNERSHIP OF THE USC SCHOOL OF
MEDICINE AND INVESTIGATOR IN
DIABETES PREVENTION PROGRAMS
OUTCOME STUDY WHERE UC SAN DIEGO
IS ONE OF THE 26 PARTICIPATING
SITES AND THE P.I. OF UCSD
HEALTH STUDY.
A LONGITUDINAL STUDY OF DIABETES
AND VASCULAR DISEASE AMONG MEN
AND WOMEN AND THE
CO-INVESTIGATOR OF A STUDY WHERE
SHE LEADS THE RESEARCH IN ETHNIC
HEALTH DISPARITIES AMONG
FILIPINO AND NATIVE AMERICAN.
HER INTEREST INCLUDES MATERNAL
AND PEDIATRIC HIV AIDS AND BIRTH
DEFECT AND LIVE COURSE EXPOSURE,
CARDIOVASCULAR DISEASE AND
METABOLIC STUDY.
IN HER EPIDEMIOLOGICAL RESEARCH,
DR. ARANETA HAS HELPED TO
IDENTIFY THE NOVEL RISK FACTOR
FOR DIABETES AMONG THE ASIAN
AMERICAN INCLUDING ACCESS TO
HEPATIC FAT ACCUMULATION SEL
SELECSEL
SELECTED CYTOKINES AND
GESTATIONAL DIABETES.
DR. ARANETA RECEIVED HER UNDER
GRADUATE DEGREE IN BIOLOGY FROM
UCSD AND HER Ph.D. IN
EPIDEMIOLOGY FROM THE YALE
UNIVERSITY.
SHE HAS RECEIVED SEVERAL AWARDS
FOR HER RESEARCH.
THIS INCLUDES VIV Y AN-FONSECA
AWEIRD AND SELECTION TO THE NIH
COUNCIL OF COUNCILS.
SHE ALSO IS THE RECIPIENT OF THE
NIH INVESTIGATOR TEAM AND LOOKED
AT CONNECTION BETWEEN DIABETES.
THE TITLE OF DR. ARANETA TALK IS
THE TYPE 2 DIABETES AMONG ASIAN
AMERICANS AND KNOWN FACTORS.
JOIN ME TO WELCOME DR. HAPPY
ARANETA.
>> THANK YOU, GOOD AFTERNOON
THANK YOU FOR THE GENEROUS
INTRODUCTION AND ESTEEMED
INVITATION TO BE A WAL SELECTOR
ESPECIALLY IN RECOGNITION OF
PACIFIC ISLANDER MONTH AND WE
WANT TO ACKNOWLEDGE THE
PARTICIPANTS IN THE THREE
STUDIES I'M GOING TO FEATURE
TODAY.
SINCE 2016, ASIAN IMMIGRANTS
EXCEEDED THE NUMBER OF LATINO
IMMIGRANT THE PROJECTED NUMBER
OF THE ASIAN AMERICAN POPULATION
IS EXPECTED TO CLIMB TO 35
MILLION IN THE NEXT 15 YEARS AND
46 MILLION BY 2060.
24 MILLION ASIAN AMERICANS
COMPRISE 7% OF THE
U.S. POPULATION.
THE LARGEST ARE CHINESE, INDIAN,
FILIPINOS AND VIETNAMESE AND
RECENT IMMIGRANTS FROM OTHER
LOCATIONS ARE SMALLER GROUPS BUT
IMPORTANT TO ACKNOWLEDGE THE
GROUPS REPRESENT OVER 100
LANGUAGES WHICH MADE IT
CHALLENGING TO PROVIDE
TRANSLATION SERVICES AT THE PEAK
OF THE PANDEMIC AND THERE'S
DISPARITIES IN SOCIAL ECONOMIC
BACKGROUND OF THE DIVERSE ASIAN
AMERICAN POPULATIONS VARYING IN
COLLEGE ATTAINMENT AS WELL AS
INCOME.
THERE'S BEEN LIMITED COHORTS OF
ASIAN AMERICANS AND A LOT OF THE
PREVALENCE DATA HAVE COME FROM
ELECTRONIC HEALTH RECORDS.
THIS PAPER PUBLISHED BY ANDY
CARTER IN 2013 SHOCKED THE
MEDICAL COMMUNITY.
IT WAS BASED ON 2 MILLION
MEMBERS OF KAISER, NORTHERN
CALIFORNIA PERMANENTE MEMBERS
GENERALLY REPRESENTATIVE OF
CALIFORNIA'S POPULATION AND
WHENEVER I ASK OUR MEDICAL
STUDENTS NAME THE THREE RACIAL
ETHNIC GROUPS WITH THE HIGHEST
PREVALENCE OF TYPE 2 DIABETES
THEY USUALLY RESPOND WITH
LATINOS, AFRICAN AMERICANS AND
NATIVE AMERICANS WHEN IN
CALIFORNIA IT'S PACIFIC
ISLANDERS AND THIRD ARE SOUTH
ASIANS COMING FROM INDIA,
PAKISTAN, BANGLADESH AND NEPPAL
IF YOU LOOK AT SOUTH EACH
ASIAIANS FROM CAM BONE --
CAMBODIA AND CHINESE AND
JAPANESE THEY HAVE ELEVATED
DIABETES COMPARED TO WHITES.
IN THE ORANGE LINE YOU SEE THE
BMI OF 30 OR THE DEFINITION OF
CLINICAL OBESITY AMONG BLACKS,
WHITES AND NATIVE AMERICANS AND
PACIFIC ISLANDER AND INCIDENTS
OF DIABETES OR PREVALENT
DIABETES IN THE WHITE BAR,
THEY'RE ALL EXCEEDING A BMI OF
30 KILOGRAMS PER METER SQUARED
BUT NOT SO AMONG CHINESE,
JAPANESE AND FILIPINOS AND SOUTH
ASIANS WHO ARE BMIs LESS THAN
30.
AROUND THEN SIX YEARS AFTER THE
PAPER WAS PUBLISHED KAISER DID
THE ANALYSIS AGAIN AMONG ADULTS
OVER THE AGE OF 45 AND FOUND
SIMILAR TREND WITH NATIVE
HAWAIIANS AND PACIFIC ISLANDERS
AND FILIPINOS AND SOUTH ASIANS
HAVING HIGHER PREVALENCE AND
AMONG NATIVE HAWAIIANS AND
PACIFIC ISLANDERS WE'RE ALREADY
THERE AND JAPANESE AND CHINESE
THEY'RE DIABETES PREVALENCE
EXCEEDS THAT OF WHITES DESPITE
LOW BMIs AND THE ABSENCE OF
GENERAL OBESITY.
SO THAT'S CALIFORNIA.
ONE-THIRD OF ALL ASIAN AMERICANS
RESIDE IN CALIFORNIA.
WHAT DOES DIABETES PREVALENCE
LOOK LIKE IN OTHER PARTS OF THE
COUNTRY?
WE USED NHANES DATA FROM 2011 TO
2016 AND THE DARKER BARS
REPRESENT KNOWN OR PREVIOUSLY
DIAGNOSED DIABETES AND THE
LIGHTER SHADES REPRESENT
UNDIAGNOSED ABOUT THE OR
UNDIAGNOSED AT THE TIME OF THE
NHANES VISIT.
YOU'LL SEE HISPANICS,
NON-HISPANIC BLACKS AND THE
NUMBER THREE, ASIANS HAVE THIS
FIRST, SECOND AND THIRD HIGHEST
PREVALENCE BUT WHEN YOU
DISAGGREGATED THE GROUPS INTO
EAST ASIAN, KOREAN AND JAPANESE
AND THEN HAVE THE SOUTH ASIANS
AND SOUTHEAST ASIANS
PREDOMINANTLY FILIPINO IN THIS
GROUP THEIR DIABETES PREVALENCE
EXCEEDS THAT OF LATINOS AND
BLACKS AND IF YOU ADJUST FOR NET
JUST AGE AND SEX BUT BMI ALSO,
SOUTHEAST ASIANS HAVE HIGHER
DIABETES PREVALENCE THAN GROUPS
THAT ARE TRADITIONALLY PERCEIVED
TO BE AT HIGHEST RISK.
SO THIS IS AN OPPORTUNITY TO
EMPHASIZE THE IMPORTANCE OF
DISAGGREGATING ASIAN SUB GROUPS.
GLOBALLY THE INTERNATIONAL
DIABETES FOUNDATION PUBLISHED
THE DATA FOR 2021 AND THE BURDEN
OF DIABETES IS IN THE WESTERN
PACIFIC REGION THAT INCLUDES
ASIA AS WELL AS OCEANA WITH OVER
206 MILLION CASES.
THESE ARE ALSO SOME OF THE MOST
POPULOUS COUNTRIES FOLLOWED BY
INDIA AND SOUTHEAST ASIAN WITH
90 MILLION CASES.
IS THIS A NEW OBSERVATION?
THIS IS ACTUALLY RECOGNIZED 60
YEARS AGO.
WE LOOKED BACK AT THE LITERATURE
AND THIS PAPER IN HAWAI'I BASED
ON 38,000 MIGRANTS TO HAWAI'I
BEFORE THE CURRENT OBESITY
EPIDEMIC, 7 PER 1,000 CAUCASIANS
HAD TYPE 2 DIABETES AND THE RATE
WAS TWICE THAT AMONG CHINESE IN
BLUE AND THREE TIMES THAT AMONG
KOREANS, FILIPINOS AND JAPANESE
AND OVER SEVEN FOLD AMONG NATIVE
HAWAIIANS.
AND 50 YEARS LATER THE STUDY IN
THE BIG ISLAND OF HAWAI'I LOOKED
AT A DOOR TO DOOR SAMPLE.
IT WAS GENERALIZABLE TO THE
POPULATION.
YOU'LL NOTICE THE BMI OF WHITES
IN BEIGE AND JAPANESE IN GREEN
AND FILIPINOS IN ORANGE AND THE
MIXED ASIANS WAS AT THE
DEFINITION OF OVERWEIGHT AND THE
BMI OF NATIVE HAWAIIANS WAS AT
CLINICAL OBESITY BEYOND 30 AND
YOU'D EXPECT DIABETES PREVALENCE
TO BE SIMILAR AMONG WHITES,
JAPANESE AND FILIPINOS BUT
FOLLOWING THE TRENDS FROM 50
YEARS EARLIER, IT WAS AT LEAST
FOUR TIMES HIGHER IN JAPANESE
AND FILIPINOS AND OTHER MIXED
ASIANS AS WELL AS NATIVE
HAWAIIANS COMPARED TO WHITES.
AND SO THAT'S PREVALENCE DATA.
WHAT ARE THE IMPLICATIONS WHEN
IT COMES TO CARDIOVASCULAR AND
ALL-CAUSE MORTALITY?
IN CHART A YOU'LL SEE DIABETES
RELATED ALL-CAUSE MORTALITY WAS
HIGHEST AMONG FILIPINOS.
SECOND HIGHEST AMONG HISPANICS
AND THEN WAS ALSO HIGH AMONG THE
ASIAN SUBGROUPS THAT ARE
VIETNAMESE OR ASIAN INDIAN.
AMONG MALES ALL CAUSE MORTALITY
RELATED TO DIABETES AGAIN WAS
HIGHEST AMONG FILIPINOS FOLLOWED
BY ASIAN INDIANS.
CARDIOVASCULAR DISEASE MORTALITY
IN CHART B YOU'LL SEE AGAIN
FILIPINOS AND ASIAN INDIANS HAVE
THE HIGHEST CVD MORTALITY AND
AMONG HISPANIC AND NON-HISPANIC
BLACKS IT'S SIMILAR DESPITE
RECENT RECOGNITION OF VIETNAMESE
BEING AT HIGH RISK FOR TYPE 2
DIABETES.
AND THEN AMONG MEN, DIABETES
RELATED CARDIOVASCULAR DISEASE
MORTALITY WAS HIGHEST AGAIN
AMONG FILIPINOS AND ASIAN
INDIANS.
THE KAISER PAPER THAT WAS
PUBLISHED IN 2013 PROMPTED THE
AMERICAN DIABETES ASSOCIATION TO
REACH OUT TO FOUR GROUPS THAT
HAD LONGITUDINAL COHORTS TO
EVALUATE THE BMI SCREENING CUT
POINTS FOR DIABETES WHICH WAS
PREVIOUSLY AT A BMI OF 25
KILOGRAMS PER METER SQUARED.
THE ONLY LONGITUDINAL STUDY, THE
FIRST STARTED IN 1979 THE PILOT
STUDY LED BY THE UNIVERSITY OF
WASHINGTON IN SEATTLE AND
BETWEEN 1983 AND 1991 HE
ENROLLED 420 U.S.-BORN SECOND
GENERATION JAPANESE AMERICANS AS
WELL AS THIRD-GENERATION
JAPANESE AMERICANS YET THESE
ELEGANT STUDIES COMPARING
DIABETES PREVALENCE AMONG
JAPANESE AMERICANS COMPARED TO
THOSE IN JAPAN AND THOSE IN
BRAZIL AND FOUND HIGHER DIABETES
PREVALENCE AMONG THE IMMIGRANT
OR U.S.-BORN POPULATIONS.
SO 1979 THIS WAS 45 YEARS AGO
THE RECOGNITION OF EXCESS RISK
IN THIS GROUP OF ASIAN AMERICANS
WAS FIRST RECOGNIZED.
THEY HAD THEIR CLINICAL BASELINE
VISIT WITH FOLLOW UP AFTER FIVE
AND 10 YEARS.
I WAS A NEW CLINICAL INSTRUCTOR
NOT YET ASSISTANT PROFESSOR WHEN
I HAD THE PRIVILEGE OF RUNNING
INTO ELIZABETH BARRETT-CONNOR AT
A CONFERENCE AND NOT KNOWING MY
ETHNICITY SHE MENTIONED WE
NOTICED AT THE VETERANS
ADMINISTRATION HOSPITAL THE
MAJORITY OF PATIENTS IN THE
DIALYSIS UNITS ARE THIN FILIPINO
MEN.
THEY HAVE ACCESS TO CARE AND IN
THE NAVY AND EXERCISE FREQUENTLY
AND MAINTAIN LOW BMIs.
WERE THEY JUST DIAGNOSED LATE OR
IS THERE SOMETHING DIFFERENT IN
THE PATHOPHYSIOLOGY OF TYPE 2
DIABETES IN ASIANS.
WE'D LIKE TO START A COHORT.
THAT'S HOW I WAS ABLE TO JOIN UC
SAN DIEGO.
WE ENROLLED 453 WOMEN FIRST WITH
A BASELINE VISIT FOLLOWED FIVE
YEARS AND 10 YEARS LATER AND
BASELINE VISIT OF 107 FILIPINO
MEN.
AND THE THIRD LONGITUDINAL
COHORT IS THE MA SA LA IT STAND
FOR MEDIATORS OF ATHEROSCLEROSIS
AND HAVE SOUTH ASIANS IN THE SAN
FRANCISCO AND CHICAGO AND
EXPANDED TO ENROLL A LARGE
POPULATION OF BANGLADESHI TAXI
DRIVERS.
SO TO INFORM THE AMERICAN
DIABETES ASSOCIATION GUIDELINES
WE ALSO COLLECTED DATA FROM THE
STUDY LED BY DR. CHANG FROM THE
UNIVERSITY OF HAWAI'I AT MEN
OWA.
THE CRITERIA WAS THEY HAD TO BE
OVER THE AGE OF 45, NO PRIOR
DIAGNOSIS OF TYPE 2 DIABETES
WITH INCOMBINANT MEASURES OF BMI
GLYCOSYLATED LEVELS AND A
GLUCOSE TOLERANCE TEST.
IF SCREENING WAS LIMITED TO
PARTICIPANTS WITH A BMI LESS
THAN 25, 37% OF ASIAN AMERICANS
WOULD BE MISSED INCLUDING A
WOMAN WITH A BMI OF 16 NEWLY
DIAGNOSED DURING OUR CLINIC
VISIT.
SHE WAS 5'4" AND 96 POUNDS.
WE WERE GLAD TO BE ABLE TO
INFLUENCE THE SCREENING
GUIDELINES TO ASIAN AMERICANS
WITH THE BMI OF 23 OR GREATER
AND HAVE THESE RISK FACTORS
SHOULD BE TESTED.
WE DON'T KNOW ABOUT THE
IMPLEMENTATION OF THIS IN
CLINICAL CENTERS AND WE PREDICT
THERE'S OVER HALF A MILLION
ASIAN AMERICANS UNDIAGNOSED
MOVING THE SCREENING GUIDELINES
JUST TWO BMI UNITS WOULD HELP
IDENTIFIED AT LEAST 300,000
ASIAN AMERICANS WITH DIABETES.
ANOTHER IMPORTANT OBSERVATION IS
THE IMPORTANCE OF THE TWO HOUR
GLUCOSE TOLERANCE TEST.
USING THE THREE TESTS WE FOUND
DIABETES PREVALENCE WAS 18%.
IF YOU LIMIT SCREENING JUST TO
GLYCOSYLATED HEMO GLOBIN
MEASURES YOU'LL ONLY CAPTURE 9%.
IF YOU RELY ON A FASTING GLUCOSE
MEASURE HYPERGLYCEMIA WILL ONLY
BE 5%.
IF SCREENING IS LIMITED TO A
FASTING GLUCOSE MEASURE ALMOST
HALF OF ASIAN AMERICANS WITH
DIABETES MIGHT REMAIN
UNDIAGNOSED.
THIS IS PARTICULARLY RELEVANT TO
JAPANESE AND FILIPINO
COMMUNITIES.
THIS IS FROM THE MASALA STUDIES
WITH COMPARISONS TO THE MESA
STUDY WITH 800 CHINESE AMERICANS
MOSTLY FROM LOS ANGELES.
AND THE MECHANISMS INCLUDE FOR
SOUTH ASIANS MORE INSULIN RE
RESISTANCE AND LOWER BETA CELL
FUNCTION THOUGH THE GLYCOSYLATED
HEMOGLOBIN TEST DON'T REQUIRE
FAST WE WANTED TO LOOK AT
SPECIFICITY AND HOW MANY ASIAN
AMERICANS WOULD BE MISSED BY
RELYING ON THE CUT POINT OF 6.5%
COMPARED TO AN ORAL GLUCOSE
TOLERANCE REST TO 2.6% IN
JAPANESE HOWEVER, WHEN YOU
ADMINISTER AN OGTT THE
PERCENTAGE OF JAPANESE TRIPLES.
THE IMPLICATIONS ARE LIMITING
DIABETES DIAGNOSIS TO JUST A1C
MEASURES ALONE COULD MISS
DIABETES DIAGNOSIS AMONG
ONE-THIRD OF FILIPINO AMERICANS,
HALF OF NATIVE HAWAIIANS AND
TWO-THIRDS OF JAPANESE
AMERICANS.
WE CONDUCTED PHOTOGRAPHS AND
FOUND THAT AN A1C CUT POINT OF
5.8% MIGHT IMPROVE THE
SENSITIVITY DIAGNOSED DIABETES
VERSUS THE CURRENT GUIDELINES OF
AN A 1C CUT POINT AND IT WAS
USEFUL IN IDENTIFYING
PARTICIPANTS WITH A RETINOPATHY
AND ALSO IN THE KAISER
POPULATION MEMBERS WHO DID NOT
HAVE CARDIOVASCULAR DISEASE,
WHITES AND SOUTH ASIAN
INDIVIDUALS HAD THRESHOLDS FOR
CARDIOVASCULAR CONVENIENT LESS
THAN THE TREATMENT GOALS OF 7%.
WHAT'S CAUSING THIS DIFFERENCE?
THIS PAPER WAS PUBLISHED 20
YEARS AGO AND AN EXAMPLE OF A
EUROPEAN MAN WITH GLASSES AND
SOUTH ASIAN MAN WITH A BEARD
WITH LOW BMIs AND SCANS WERE
USED TO ESTIMATE THEIR PERCENT
BODY FAT.
THE SOUTH ASIAN MAN HAS TWICE AS
MUCH BODY FAT AS THE EUROPEAN
MAN THOUGH THEY BOTH HAVE VERY
LOW BMIs.
SO THERE ARE SO BODY COMPOSITION
INCLUDING EXCESS FAT IN THE
VISCERAL ADIPOSE TISSUE, FATTY
LIVER, INTRAMUSCULAR FAT AND
PERICARDIAL FAT ALSO SEEM TO THE
RISK FOR DIABETES.
SO WE WERE INTERESTED IN
QUANTIFYING VISCERAL ADIPOSITY
AND WE CONDUCTED CT SCANS IN
ABOUT 200 IN EACH GROUP.
WOMEN WHO DID NOT HAVE
CARDIOVASCULAR DISEASE.
YOU'LL SEE THE FILIPINO WOMEN
WERE SLIGHTLY YOUNGER, THEY HAD
HIGHER COLLEGE ATTAINMENT
CONSISTENT WITH NATIONAL DATA,
WERE LESS LIKELY TO HAVE EVER
SMOKED.
DON'T DRINK ALCOHOL AND THEIR
EXERCISE FREQUENCY WAS SIMILAR
TO WHITES SO YOU'D EXPECT THEM
TO HAVE OPTIMAL OUTCOMES.
WE LOOKED AT ANTHROPOMETRIC
MEASURES AND BLACK WOMEN HAD THE
LARGEST BMI AND WAIST GIRTH AND
TRUNKAL FAT AND LOOK AT DIABETES
PREVALENCE WAS HIGHEST AMONG
FILIPINAS ONE OUT OF THREE
INTERMEDIATE AND LOWEST IN BLACK
WOMEN AND MEASURED ADIPOSE
TISSUE AND HIGHER AMONG
FILIPINAS WHERE IN BLACK WOMEN
THE EXCESS WAS IN SUB CUTANEOUS
FATS.
HERE'S MEASURES.
ON THE LEFT WAS A MILLIMETER
SLICE BETWEEN THE L4 AND L5
VERTEBRAE BELONGING TO A
65-YEAR-OLD BLACK WOMEN AND A'
5'7", 160 POUND AND COMPARED TO
A FILIPINA 5'4", 115 POUNDS AND
HAD MORE THAN THREE TIMES THE
VOLUME OF VISCERAL ADIPOSE
TISSUE COMPARED TO THE BLACK
WOMAN.
THIS PERSISTED AT EVERY LEVEL OF
WAIST GIRTH.
THIS IS ADIPOSE TISSUE AMONG
WOMEN DEFINED WITH A BMI LESS
THAN 23 IN PHILIPFIPHILIPPINE'S
BLACK WOMEN AT EVERY WAIST
CIRCUMFERENCE AT THE LEAST
VISCERAL FAT AND FILIPINA WOMEN
HAD THE MOST AND THIS REDEFINES
WHO IS OVERWEIGHT AND
METABOLICALLY HEALTHIER AT A
HIGHER BMI AND THE OBSERVATION
OF LOWER VISCERAL ADIPOSITY HAS
BEEN OBSERVED IN THE U.K. AND
CARIBBEAN AND BRAZIL AMONG
AFRICAN AMERICANS.
AND FILIPINAS HAD MORE
PERICARDIAL FAT THAN WHITE AND
BLACK PARTICIPANTS.
IN THE MESA STUDY YOU SEE IN
CHART D CHINESE AMERICANS HAD
MORE PERICARDIAL FAT COMPARED TO
AFRICAN AMERICANS AND SOUTH
ASIAIANS.
WHITES ALSO HAD EXCESS
PERICARDIAL FAT AND EXCESS SUB
CUTANEOUS FAT WAS ALSO PRESENT
AMONG BLACK PARTICIPANTS IN THE
MESA STUDY.
THIS COMPARES MASALA DATA AND
SOUTH ASIANS HAD MORE LIVER FAT,
MORE VISCERAL FAT AS WELL AS
CHINESE AMERICANS AND AFRICAN
AMERICANS HAD THE LEAST AND
SOUTH ASIANS HAD MORE -- LESS
LEAN MASS AND MORE INTRAMUSCULAR
FAT AND THE FAT DISTRIBUTION
EXACERBATES THE RISK FOR INSULIN
RESISTANCE.
IN THE NORMAL WEIGHT CATEGORY
YOU'LL IN THE IN THE RED DOTS UP
TO HALF, 40% OF SOUTH ASIANS
WERE OF NORMAL BMI BUT
METABOLICALLY ABNORMAL.
SO WHAT IS ABOUT VISCERAL
ADIPOSITY?
IT'S NOT JUST A PLACE WHERE WE
STORE EXCESS CALORIES BUT AN
ACTIVE ENDOCRINE ORAN AND WE
LOOK AT TNL6 AND WERE INTERESTED
IN WHAT IS DOWNREGULATED IN THE
EXCESS OF EXCESS VISCERAL
ADIPOSE TISSUE AROUND ADDED
ADIPONECTIN AND FILIPINAS HAD
HALF COMPARED TO WHITES AND
BLACKS HAD LESS EVEN ADJUSTING
FOR INSULIN AND INSULIN
RESISTANCE AND ANTHROPO METRIC
STANDARDS AND A STUDY IN THE
PHILIPPINES IDENTIFIED A
POLYMORPHISM THAT SEEMED TO
EXPLAIN THE LOWER ADIPONECTIN
LEVELS AND THEY WERE ABLE TO
IDENTIFY LONGITUDINAL
ASSOCIATION BETWEEN VISCERAL
ADIPOSITY AND THE RISK OF TYPE 2
DIABETES EVEN AFTER 10 YEARS AND
THE CHANGE IS ASSOCIATED WITH A
GREATER RISK OF DEVELOPING TYPE
2 DIABETES AFTER 10 YEARS.
NEXT I'D LIKE TO TALK ABOUT IN
UTERO EXPOSURES.
AND MALNUTRITION IS ASSOCIATED
WITH VISCERAL ADIPOSITY.
WE WANTED TO LOOK AT
INTERNATIONAL STUDIES.
SO OUR COHORT IN SAN DIEGO WERE
PREDOMINANTLY IMMIGRANTS.
WE COMPARED BMI AND FASTING
HYPERGLYCEMIA AND ODTT MEASURES
TO THIRD GENERATION FILIPINOS IN
HAWAI'I INCLUDING THE
PHILIPPINES FROM THE SAME
REGIONS FROM WHERE OUR
PARTICIPANTS PARTICIPATED AND IT
WAS LOWER IN THE PHILIPPINES AND
INDIMMEDIATE IN SAN DIEGO AND
HIGHEST IN HAWAI'I.
OBESITY PREVALENCE WAS HIGHEST
AMONG THIRD GENERATION FILIPINOS
IN HAWAI'I BUT NO DIFFERENCE IN
FASTING HYPERGLYCEMIA AND NO
DIFFERENCE IN DIABETES BY ORAL
GLUCOSE TOLERANCE TEST WHICH
LEADS US TO BELIEVE THERE MAY BE
A ROLE IN THE RELATIONSHIP
BETWEEN COLONIZATION AND TYPE 2
DIABETES.
SO NATIVE HAWAIIANS AND PACIFIC
ISLANDERS AND INDIA AS A U.K.
COLONY, OUR EXPOSURE TO A
WESTERN LIFESTYLE AND DIET
OCCURRED BACK HOME AND NOT HERE
AND WHY WE'RE NOT SEEING A
DIFFERENCE UP DIABETES RISK OR
BODY SIZE, CERTAINLY.
WE ALSO LOOKED AT DURATION OF
YEARS IN THE UNITED STATES.
SO STUDIES AMONG PUERTO RICOS,
FOR EXAMPLE, SHOW SIMILAR
PATTERNS WHERE ACCULTURATION
TAKES PLACE IN THE HOME COUNTRY
THERE IS NO DIFFERENCE IN BMI.
IF YOU'VE LIVED IN THE U.S. A
LONG TIME OR RECENT IMFRANT
THERE WAS NO DIFFERENCE IN BODY
FAT PERCENTAGE BY DEXA OR IN
TRUNKLE FAT OR TYPE 2 DIABETES.
GESTATIONAL DIABETES WILL
EXACERBATE YOUR RISK FOR
DIABETES.
KAISER DATA SHOWED AMONG 200,000
BIRTHS, ASIAN INDIANS HAD THE
HIGHEST PREVALENCE OF
GESTATIONAL DIABETES 20 YEARS
AGO FOLLOWED BY FILIPINAS,
SOUTHEAST ASIANS AND SUB GROUPS
IN BLUE AND HIGHER THAN LATINO,
BLACKS AND WHITES AND
PRE-GESTATIONAL DIABETES IS A
RISK FACTOR FOR BDM.
THE RISK FOR DIABETES OCCURS
DURING FEETAL DEVELOPMENT AND
RESULTS IN POOR BETA CELL
FUNCTION AND DIFFERENTSES IN
BODY FAT AND REGIONAL ADIPOSITY
RESULTING IN IMPAIRED INSULIN
SECRETION OR ACTION AND THAT'S
EXACERBATED BY ENVIRONMENTAL AND
EPIGENETIC FACTORS AS WELL.
RECENT DATA AND THIS WAS AS
RECENT AS 2017 SHOWS CURRENTLY
IN CLINICAL RESEARCH IT'S
VIETNAMESE THAT WHO HAVE A HIGH
RISK OF GESTATIONAL DIABETES
ESPECIALLY WITH BMI LESS THAN
23.
YOU SEE THAT HIGHLIGHTED IN
GREEN.
EVEN AMONG WOMEN WITH A GREATER
BMI THAN 33, VIETNAMESE WOMEN
HAD THE HIGHEST PREVALENCE AND
SAMOAN WOMEN HAD THE LOWEST
DESPITE 60% OF THE SAMOAN
PARTICIPANTS WERE CLINICALLY
OBESE.
SOME POLYMORPHISMS HAVE BEEN
IDENTIFIED WITH HIGHER RISK OF
GESTATIONAL DIABETES IN THE
PHILIPPINES AT THE UNIVERSITY OF
SANTRO THOMAS AND POLYMORPHISMS
ASSOCIATED WITH TYPE 2 DIABETES
WERE SHOWN TO BE ASSOCIATED WITH
GESTATIONAL DIABETES AMONG
FILIPINOS AROUND HAWAI'I.
AND THE PRIOR GESTATIONAL ABOUT
THE WAS ASSOCIATED WITH
INCREASED RISK OF ELEVATEDD
GLYCOSYLATED HEMOGLOBINS.
I MENTIONED THE RISK OF DIABETES
STARTING IN INFANCY.
THIS WAS A PAPER REFERRING TO
SOUTH ASIANS AND WANTED TO SHOW
SOME OF OUR DATA WHEN IT COMES
TO IN UTERO AND LIFE COURSE
EXPOSURES.
THE DUTCH HUNGER FAMILY STUDY
SHOWED WOMEN PREGNANT DURING THE
WINTERS OF 1944 AND 1945 WHEN
THE ROADS WERE BLOCKED FOR THE
DELIVERY OF FOOD IN WORLD WAR II
RESULTED IN WOMEN CONSUMING AS
LITTLE AS 500 CALORIES A DAY.
IT WAS SHOWN WHEN THE BABIES
TURNED 60 YEARS OLD, INFANTS IN
THE FIRST TRIMESTER OF GESTATION
DURING THAT WINTER HAD MORE
IMPAIRED INSULIN SECRETION AND
HIGH RISK OF CARDIOVASCULAR
DISEASE.
THERE WAS SIMILAR EVIDENCE THE
CHINESE FAMINE BETWEEN 1959 TO 1
61 SHOWED THOSE ADULTS UP THEIR
EARLY '60s LAD A HIGHER RISK FOR
TYPE 2 DIABETES AS ADULTS.
SOME MECHANISMS HAVE SHOWN IN
MODELS A LOW-PROTEIN DIET ALTERS
M1A IN THE OFFSPRING INCREASING
GLUCOSE AND DIABETES AND THIS IS
FOR PEOPLE IN WAR ENVIRONMENTS
OR DISPLACED OR BY CHOICE WHO
FOLLOW A LOW PROTEIN DIET DURING
GESTATION.
SO WE DIDN'T HAVE ACCESS TO
CALORIC INTAKE BUT THE MAJORITY
WERE ALSO BORN DURING WORLD WAR
II DURING THE JAPANESE
OCCUPATION OF THE PHILIPPINES
AND MEASURED SITTING HEIGHT AND
STANDING HEIGHT AND LEG LENGTH
IS A GOOD PROXY FOR CHILDHOOD
MALNUTRITION.
AND WHAT WE FOUND WAS COMPARED
TO OUR PARTICIPANTS, WE HAVE THE
LONGEST LEG LENGTH.
THE PATIENTS WITH THE SHORTEST
LEG LENGTH HAS THREE TIMES THE
RISK OF CORONARY HEARD DISEASE
TO WOMEN WITH THE LONG EF LEG
LENGTH AND THOSE PATIENTS BORN
BEFORE THE JAPANESE OCCUPATION
WERE 2 CENTIMETERS TALLER THAN
THOSE CONCEIVED DURING THE WAR
OR AFTER.
OTHER RISK FACTORS FOR DIABETES
IN OUR COHORT IS HAVING MORE
THAN SIX LIVE BIRTHS AND THAT'S
INDEPENDENT OF VISCERAL FAT AND
ADIPONECTIN AND INSUFFICIENT
SLEEP.
DEF WE DIDN'T ASK ABOUT SHIFT
WORK FOR NURSES BUT IT MAY
EXPLAIN THE INSUFFICIENT SLEEP
PAP EARNS AND HYPERTENSION AND
FAMILY HISTORY OF DIABETES AND
LAST WEEK'S TALK FOCUSSED ON
SOCIAL AND STRUCTURAL
DETERMINATES OF HEALTH.
AMONG OUR PARTICIPANTS WITHOUT A
FAMILY HISTORY OF TYPE 2
DIABETES, LOWER EDUCATION YOU,
SUSTAINED CHILDHOOD AND
ADULTHOOD, SOCIAL DISADVANTAGE
WERE INDEPENDENTLY WERE
ASSOCIATED WITH A RISK OF
DIABETES STRESSING THE
IMPORTANCE OF INTERVENTION OF
PREVENTION MATERIAL.
THE SITE OF LOW PLASMA
ADIPONECTIN AND ACCUMULATION
SEEMS TO PERSIST AND UP
DEPENDENTLY PREDICT ACCUMULATION
OF VISCERAL ADIPOSITY.
WHAT KIND OF FUTILITY MIGHT
ADIPONECTIN HAVE IN TERMS OF
COMPLIMENTING CURRENT SCREENING
INITIATIVES.
THERE'S SYNTHETIC ADIPONECTIN
WAS EXCITED YEARS AGO ESPECIALLY
LOWERING TRIGLYCERIDES AND WHAT
VALUE MIGHT ADIPONECTIN HAVE IN
AUGMENTING SCREENING.
HERE'S DATA FROM THE PARITY
DATA.
AS WOMEN HAD MORE LIVE BIRTHS
THE BMI INCREASED SLIGHTLY BUT
MORE IMPORTANTLY VISCERAL FAT
INCREASED ONCE YOU HAD AT LEAST
THREE LIVE BIRTHS OR MORE.
AND TYPE 2 DIABETES OCCURRED IN
HALF OF WOMEN WITH SIX OR MORE
CHILDREN.
HAVING MORE BIRTHS WENT TO A
HIGHER RISK OF DIABETES
INDEPENDENT OF VISCERAL FAT OR
ADIPONECTIN AND U.C. SAN DIEGO
WANTED TO LOOK AT FAT
DISTRIBUTION AND AMONG
POST-MENOPAUSAL WOMEN WITH
DIABETES THEY HAD LESS ABDOMINAL
MUSCLE AND SIGNIFICANTLY MORE
ADIPOSE TISSUE.
WHAT ARE THE IMPLICATIONS FOR
INTERVENTIONS?
PERHAPS INCREASE BEING MUSCLE
MASS MIGHT BE AN EFFECTIVE
INTERVENTION INSTEAD OF LOSING
WEIGHT.
HOW DO YOU CONVINCE A WOMAN WITH
BMI OF 20 AND SMALL WAIST SHE
NEEDS MUSCLE AND BUT IT MAY
DELAY INSULIN RESISTANCE AND
THERE WAS A STUDY ONGOING AT
STANFORD AND ONE GROUP WAS
RANDOMIZED TO STRENGTH STRAINING
AND ONE EXERCISE AND A THIRD WAS
A COMBINATION AND MAY BE AN
INVENTION THAT LOW BMI
PARTICIPANTS MAY BE RECEPTIVE
TO.
HERE'S SOME OF YOU ARE SLEEP
DATA BY A Ph.D. STUDENT AT THE
TIME NOW FACULTY.
YOU'LL SEE THE SLEEP DEFICIENCY
AMONG FILIPINAS WITH ALMOST 60%
SLEEPING LESS THAN SEVEN HOURS.
A FOURTH SLEEPING LESS THAN SIX
HOURS.
THEN WITH REWARDS TO
HYPERTENSION, SINCE 1984
FILIPINOS AND AFRICAN AMERICANS
HAVE SUSTAINED THE HIGHEST RISK
FOR HIGH BLOOD PRESSURE IN
CALIFORNIA.
AND THESE ARE KAISER DATA.
YOU'LL SEE BLACKS IN BLUE AND
FILIPINOS IN THE OLIVE COLOR AND
THEY'RE CLOSE TO EACH OTHER
AMONG WOMEN ACROSS ALL AGE
CATEGORIES AND AMONG MEN THE
HYPERTENSION PREVALENCE FOR
BLACK AND FILIPINO MEN ARE
IDENTICAL.
SO HOW CAN WE IMPROVE
HYPERTENSION CONTROL AS A
MENTION TO PREVENT DIABETES.
IN 2021 WE HAD THE OPPORTUNITY
TO GATHER ALL THE DIABETES AND
METABOLIC ABNORMALITY RESEARCH
LED BY DR. KANIA FROM THE MASALA
STUDY AND IDENTIFY GAPS,
CHALLENGES AND OPPORTUNITIES IN
HEALTH AND PREVENTION FOR
AMERICANS.
WE WERE SO DLATED TO SHARE OUR
WORK WITH NIH AND NHLBI AND WERE
THRILLED WHEN THE ANNOUNCEMENT
CAME OUT FOR A NEW EPIDEMIOLOGIC
COHORT AMONG NATIVE HAWAIIANS
AND PACIFIC ISLANDERS AND OTHERS
AND ENROLLMENT IS ALREADY WITH
SITES SELECTED AND COORDINATING
CENTERS AND CLINIC CENTERS AND
WE LOOK FORWARD TO A NATIONAL
STUDY THAT COULD HELP US FURTHER
ELUCIDATE THE ETIOLOGY AND
PATHOPHYSIOLOGY AND
OPPORTUNITIES FOR TREATMENT AND
MANAGEMENT AMONG ASIAN AMERICANS
WITH DIABETES.
SO THIS IS THE NEW NHLBI STUDY
THAT FOCUSES ON P.I.
COMMUNITIES.
I LEARNED A FEW DAYS AGO A
DIRECTOR FOR NATIVE HAWAIIAN
PACIFIC ISLANDER HEALTH IS BEING
RECRUITED BY NIMHD.
THESE STUDIES WERE COLLECTIVELY
FUNDED BY DIFFERENT INSTITUTES
OF NIH, THE AMERICAN HEART
ASSOCIATION AND THE DEPARTMENT
OF VETERAN AFFAIRS.
THANK YOU.
>> SO ANYONE HAS ANY QUESTIONS,
PLEASE.
>> HI, DR. ARANETA I ENJOYED THE
TALK.
IT'S QUITE ENLIGHTENING.
I HAVE A FAMILY HISTORY OF
DIABETES AND MONITOR MY
HEMOGLOBIN A1C SO MAYBE THAT'S
NOT ENOUGH.
THE QUESTION I HAVE FOR YOU IS
IN LIGHT OF A LOT OF DIFFERENCES
YOU HAVE SHOWN WITH THE ASIAN
POPULATION, HOW DIFFERENT FROM
THE WHITE AND BLACK POPULATION
IN TERMS OF DIAGNOSIS.
HAVE YOU LOOKED AT THE AREA OF
EARLY TREATMENT OF PRE-DIABETES
AND DIABETES BECAUSE THERE'S
BEEN A LOT OF DISCUSSION WHETHER
WE SHOULD BE MORE PROACTIVE IN
TREATING PEOPLE WITH EARLY OR
PREDIABETES.
I WONDER WHETHER THERE'S SOME
AREA THAT WOULD BE RELEVANT
ESPECIALLY FOR ASIAN AMERICAN
WITH HIGH LIKELIHOOD OF DIABETES
WHETHER THAT SHOULD BE MORE
PROGRESSIVE OR ACTIVE IN
TREATING AND MONITORING THEM.
>> THE DIABETES PREVENTION
PROGRAM THE DPP STUDY WHICH WAS
STARTED OVER 20 YEARS AGO
RANDOMIZED PREDIABETIC ADULTS TO
A LIFESTYLE INTERVENTION
INCLUDING EXERCISING 150 MINUTES
A WEEK PLUS LOSING 7% OF YOUR
WEIGHT OR METFORMIN OR PLACEBO.
WHAT THEY FOUND WAS THERE WAS A
HUGE BETWEEN FIT TO LIFESTYLE
INTERVENTIONS INCLUDING AMONG
LOW BMI PARTICIPANTS AND ASIAN
PARTICIPANTS.
METFORMIN SEEMED TO BE LESS
EFFECTIVE IN A SIMILAR CPP STUDY
IN INDIA AND ANOTHER LOCATION.
THE FIRST INTERVENTION
PARTICIPANTS MAY BE RECEPTIVE TO
BECAUSE IT WAS MORE EFFICACIOUS
IS A LIFESTYLE INTERVENTION.
AND AGAIN, I THINK THE PUBLIC
HEALTH MESSAGE HAS ALWAYS BEEN
LOSE WEIGHT, EXERCISE BUT MAYBE
IT'S THE TYPE OF EXERCISE AND
ONCE THE NUMBERS FOR THE
STRENGTH TRAINING DATA ARE
INCREASED, IT MAY BE WORTHWHILE
TO CONSIDER THAT BUT ALSO TO
PROMOTE THAT IN COMMUNITIES.
MANY OF OUR PARTICIPANTS WITH 26
INCH WAISTLINES WILL TELL YOU, I
DON'T NEED TO LOSE WEIGHT AND ON
TV WHAT I HEAR IS AS IT ONLY THE
OVERWEIGHT PEOPLE OR THEY'LL
WALK BUT HAVEN'T HEARD THE
BENEFITS OF STRENGTH TRAINING TO
IMPROVE INSULIN SIGNAL.
AND ALSO DIET.
>> AND DIET.
SO DIET WAS INTERESTING BECAUSE
THE QUESTIONS WE OFTEN GET IS
MUST BE THE RICE.
AMONG 453 PARTICIPANTS WE TRIED
TO LOOK AT DIFFERENCES BETWEEN
PARTICIPANTS WHO ATE ONE TO TWO
CUPS OF RICE PER DAY VERSUS LESS
THAN HALF A COUP.
WE HAD ZERO PEOPLE TO SAY I'LL
EAT RICE.
WHAT WE DID FIND AMONG DIABETICS
VERSUS NON-DIABETICS IN
FILIPINOS IS LOWER CAFFEINE AND
LOWER DAIRY INTAKE WAS
ASSOCIATED WITH HIGHER DIABETES
SO LATTES ARE GOOD FOR YOU AND
WE HAD A STUDENT, SHEENA LADINA
LOOKING AT ADIPONECTIN
CONCENTRATION.
MONOUNSATURATED, POLY
UNSATURATED, OMEGA 3 AND 6
LEVELS WERE INVERSELY ASSOCIATED
WITH ADIPONECTIN.
THAT WAS CROSS SECTIONAL.
WE DIDN'T HAVE A CHANCE TO LOOK
AT IT PROSPECTIVELY BUT THAT
MIGHT EXPLAIN SOME OF THE
OPPORTUNITIES FOR DIETARY
INTERVENTIONS.
>> RAPHAEL FROM NHLBI.
FIRST, THANK YOU FOR A WONDERFUL
TALK.
I THINK IT WAS ENLIGHTENING I
DIDN'T REALIZE PACIFIC ISLANDER
AND NATIVE HAWAIIANS AND ASIAN
AMERICANS WERE AT HIGHER RISK OF
DIABETES.
THE FIRST PART, WE KNOW APOE
CONTAINING PROTEINS AND INCREASE
THE RISK OF DEVELOPING TYPE 2
DIABETES IN OVER ALL POPULATION
BUT HAS THIS BEEN STUDIED IN
ASIAN AMERICANS?
>> NOT IN OUR COHORT.
I THINK IT MIGHT HAVE BEEN
EVALUATED IN THE MASALA STUDY.
>> HAVE YOU FOUND LIPID
ABNORMALITIES BETWEEN OTHER
ETHNICITIES AND OTHER COHORTS.
>> AFRICAN AMERICANS HAD THE
BEST AND FILIPINOS HAD HIGH
TRIGLYCERIDES AND LOW HDL LEVELS
DESPITE REPORTS OF EXERCISE
FREQUENCY.
>> WE KNOW THE LDL SECRETION IS
ALTERED IN TYPE 2 DIABETES BUT
HAS THIS BEEN STUDIED
SPECIFICALLY BY ETHNICITY?
>> WE DIDN'T MEASURE OTHER THAN
LDL.
IT MAY BE AN OPPORTUNITY FOR THE
NEW COHORT.
>> IN THE SENSE OF PERHAPS
EITHER CALCULATING LDL WITH THE
NEW FORMULA OR SMALL DENSE LDL
TO SEE A DIFFERENCE IN THE LIPID
BURDEN AND CARDIOVASCULAR
DISEASE ESPECIALLY IN THIS
POPULATION.
>> WE CAN CERTAINLY LOOK AT
THAT.
WITH CARDIOVASCULAR DISEASE WE
ADMINISTERED THE ROSE
QUESTIONNAIRE AND LOOKED AT
ARTERY CALCIUM AT FIVE YEARS
AROUND AT 10 YEARS AND FOUND
JUST MORE SUBCLINICAL
ATHEROSCLEROTIC DISEASE AMONG
FILIPINAS.
>> THANK YOU SO MUCH.
>> AND HIGHER RISK FOR
PROGRESSION 10 YEARS LATER.
>> THANK YOU.
>> THANK YOU FOR THE WONDERFUL
TALK.
FROM LOOKING AT THE DATA AND
REVIEWING THE LITERATURE SO
SOUTH ASIANS HAVE LESS SUB
CUTANEOUS FAT ADIPO AND POORER
CELL DYSFUNCTION.
IN THE SETTING OF CALORIE CASES
OBVIOUSLY.
ARE THESE FACTORS SIMILAR ACROSS
DIFFERENT ETHNICITIES AND
GENETIC STUDIES REALLY DON'T
SHOW ANY SPECIFIC -- IF YOU LOOK
AT THIS TO EXPLAIN THE HIGHER
RISK.
GIVEN WHAT WE KNOW WHAT CAN WE
DO NOW?
WE CAN LOOK AT SLEEPING AND THE
PREVALENCE OF DIABETES IS
EXPLODING SO WHAT SHOULD NIH
FOCUS ON AND IF YOU LOOK AT FAT
AND DO A DEX ON ALL OF THEM
WHICH WE CAN'T DO AND INSTEAD OF
BMI FOR SOUTH ASIANS WHO LOOK
LIKE ME ARE MORE FAT IF YOU LOOK
AT THE AMOUNT OF FAT I HAVE WHAT
DO WE DO NOW AND WHAT ARE THE
INTERACTIONS WITH THE DRUGS WE
HAVE NOW?
>> THE FIRST STEP IS OPTIMAL
SCREENING.
THE H HANES DATA SHOWED 40% OF
FILIPINOS AND SOUTH EAST ASIANS
WERE UNDIAGNOSED AND WITH
EARLIER DETECTION YOU HAVE MORE
OPPORTUNITIES TO PREVENT MICRO
AND MACRO DISEASES.
THERE'S STILL A LOT TO BE
LEARNED A LOT WHY SOUTH ASIANS
ACCUMULATE HEPATIC FAT AND
OTHERS ACCUMULATE ADIPOSE
TISSUE.
I THINK THERE'S STILL A LOT OF
KNOWLEDGE TO BE GAINED BY
UNDERSTANDING THE MECHANISMS FOR
THE FAT COMPARTMENTALIZATION AND
DIET AND EXERCISE THAT COULD
PREVENT THAT ACCUMULATION.
MAYBE YOU CAN USE ADIPONECTIN
FOR CURRENT SCREENING.
I MET WITH STAFF FROM NIDDK WHO
WERE ALSO INTERESTED IN LOOKING
AT OZEMPIC EVEN AMONG LEAN
INDIVIDUALS TO SEE IF THERE'S A
BENEFIT TOWARDS REDUCING INSULIN
RESISTANCE.
SO I DON'T KNOW WHAT COULD BE
RECOMMENDED FROM MEDICAL
MANAGEMENT BUT I THINK RAISING
AWARENESS OF WHO IS AT RISK TO
EXPAND THE PUBLIC HEALTH MI
MESSAGES THAT IT'S NOT JUST
PEOPLE OVERWEIGHT AT HIGHER
RISK.
WHAT CAN THE NIH DO?
I THINK CREATING THIS NEW
INAUGURAL COHORT THE NATIONAL
STUDY OF ASIAN AMERICANS IS A
BIG STEP WHEREAS PREVIOUSLY WITH
DR. FUFUGIMOTO THEY USED DIFFERT
PROTOCOLS AND LABORATORIES.
A WAY TO SYSTEMATICALLY ADDRESS
THESE COHORTS USING THE SAME
PROTOCOL IS A HUGE STEP FOR NIH.
>> THANK YOU.
>> WE HAVE A FEW ONLINE.
>> OKAY.
>> DON'T KNOW IF YOU ANSWERED
THIS DURING THE DUTCH HUNKER
CONVERSATION, DOES GESTATIONAL
DIABETES IN ASIAN AMERICANS
RAISE THE RISK OF DIABETES FOR
THEIR CHILDREN?
I DON'T KNOW.
GESTATIONAL DIABETES WAS
ORIGINALLY RECOGNIZED IN 1973,
THE EARLY 1970s, SO THAT IF
THERE WAS A GDM MOM BORN THERE
AND WOULD JUST BE AROUND 50 NOW
AND IF SHE HAS A CHILD WHOA IS
-- WHO IS 25, WOULD THAT CHILD
BE AT RISK OF GDM?
I THINK IT'S STILL EARLY TO TELL
BUT MY GUESS IS PROBABLY YES.
>> OKAY.
THANK YOU FOR THE COMPREHENSIVE
TALK IT WAS EYE OPENING FOR ME
PARTICULARLY THE LOW BMIVE
ASPECT AND DOES THE DATA
INCLUDING PEOPLE STILL LIVING IN
GUAM OR NORTHERN MARIANA
ISLANDS?
MY UNDERSTANDING THEIR OBESITY
AND DIABETES RATES ARE HIGH AND
THIS IS BLAMED ON THE ADOPTION
OF U.S. OR NON-TRADITIONAL
FOODS.
DO THEY HAVE IMPROVED HEALTH
OUTCOMES WHEN MOVING TO THE
MAINLAND?
>> SO OUR DATA DID NOT INCLUDE
POLYNESIANS, NATIVE HAWAIIANS OR
PACIFIC ISLANDERS WHO REMAIN IN
THE OCEANA AND THERE'S A BIG
DIFFERENTS IN OBESITY PREVALENCE
IN AMERICAN SAMOA VERSUS
WESTERN.
I MENTIONED THE ROLE OF
COLONIZATION AND THE
INTRODUCTION OF WESTERN DIETS
AND LIFESTYLE AND IF THAT
EXPLAINS THE DIFFERENCE IN
OBESITY RISK AMONG THE TWO.
DID THEIR CONDITIONS IMPROVE
ONCE THEY COME HERE?
I'M NOT FAMILIAR WITH THAT DATA
BUT I THINK THE ESTABLISHMENT AT
NIMHD -- THEY HAD A WORKSHOP ON
NATIVE HAWAIIAN PACIFIC ISLANDER
HEALTH IN FEBRUARY AND NOW
RECRUITING FOR A DIRECTOR GIVES
OPPORTUNITIES TO STUDY THESE
POPULATIONS WHICH ARE SOMETIMES
DISMISSED AS TOO SMALL AND
EMPHASIZE THE IMPORTANCE TO
SERVING A POPULATION THAT'S A
SIGNIFICANT PART OF AMERICAN
HISTORY.
>> MAYBE ONE MORE.
IS LANGUAGE A UNIQUE CHALLENGE
TO ASIAN AMERICANS IN ACCESSING
HEALTH CARE AND DIABETES
MANAGEMENT RESOURCES?
>> ABSOLUTELY.
I WAS BORN IN THE PHILIPPINES.
WE HAVE 187 DIALECTS.
SO WHEN WE WERE RECRUITING, FOR
EXAMPLE, WE JUST SO HAPPENED
BETWEEN OUR NURSE CLINICAL
COORDINATOR AND PHLEBOTOMIST AND
DRIVER AND MYSELF WERE ABLE TO
COVER SIX OF THE 187 LANGUAGES.
THE LANGUAGE DEFICIENCY BECAME
PRONOUNCED DURING THE COVID-19
PANDEMIC WHERE WE SAN DIEGO, 35%
LATINO THERE WERE ONLY
SPANISH-SPEAKING INTERPRETERS AT
THE MOBILE SHOPS.
WE LAD TO RELY ON THE STUDENTS
TO PROVIDE TRANSLATION SERVICES.
SO UNLIKE SPANISH-SPEAKING
COMMUNITIES, GENERALLY THAT'S
ONE LANGUAGE MOST PEOPLE FROM
LATIN AMERICA WILL UNDERSTAND
BUT AMONG THE ASIAN AMERICAN
MIGRANTS IT'S IN EXCESS OF OVER
40 LANGUAGES.
INDIA ALONE HAS 125 LANGUAGES.
THERE'S ALSO THIS MISCONCEPTION
THAT COLONIZED COUNTRIES THE
PHILIPPINES, INDIA, MALAYSIA ARE
ENGLISH SPEAKING.
WE SPEAK FUNCTIONAL ENGLISH BUT
IT DOESN'T TRANSLATE TO WILL A
PATIENT UNDERSTAND
INSTRUCTIONSFIDANCE FROM THEIR
NUTRITIONIST VERSUS IF GUIDANCE
IS PROVIDED IN LANGUAGE THEY
COMPREHEND.
SO VERY IMPORTANT CONSIDERATION.
WE TALK ABOUT CULTURAL
CONCORDANCE, HAVING PHYSICIANS
AND PATIENTS WHO COME FROM THE
SAME RACIAL AND ETHNIC
BACKGROUND AND IT'S IMPORTANT TO
HAVE LANGUAGE CONCORDANCE.
THANK YOU.
>> LET ME REPEAT THE CME CODE,
50126 AND FOR EVERYONE HERE
THERE'S A RECEPTION OUTSIDE WITH
HEALTHY FOOD.
>> NO RICE.
THANK YOU TO OUR SPEAKER.