1 00:00:08,016 --> 00:00:10,285 AND GOOD AFTERNOON. 2 00:00:10,285 --> 00:00:14,790 WELCOME TO THE WEDNESDAY 3 00:00:14,790 --> 00:00:18,927 AFTERNOON LECTURE SERIES. 4 00:00:18,927 --> 00:00:25,667 I'M THE PROGRAM DIRECTOR AT NCI 5 00:00:25,667 --> 00:00:30,405 AND I REPRESENT ASIAN AMERICAN 6 00:00:30,405 --> 00:00:33,642 AND THE PACIFIC ISLANDER 7 00:00:33,642 --> 00:00:38,947 INTEREST GROUP WHO NOMINATE THE 8 00:00:38,947 --> 00:00:48,590 SPEAKER DR. ROSARIO ARANETA WHO 9 00:00:48,590 --> 00:00:52,160 HAS INSIGHT INTO THE ALARMING 10 00:00:52,160 --> 00:00:54,129 RISK OF THE TYPE 2 DIABETES 11 00:00:54,129 --> 00:00:58,300 AMONG THE FILIPINO AND SOUTH 12 00:00:58,300 --> 00:00:58,500 ASIAN. 13 00:00:58,500 --> 00:01:01,102 BUT I HAVE TWO FOR THE 14 00:01:01,102 --> 00:01:05,373 ANNOUNCEMENT FIRST. 15 00:01:05,373 --> 00:01:12,581 FOR THOSE WATCHING REMOTELY WE 16 00:01:12,581 --> 00:01:14,850 URGE YOU TO PARTICIPATE IN THE 17 00:01:14,850 --> 00:01:15,317 Q&A. 18 00:01:15,317 --> 00:01:18,486 CLICK ON THE BUTTON BELOW THE 19 00:01:18,486 --> 00:01:19,654 VIDEOCAST WINDOW THAT SAYS SEND 20 00:01:19,654 --> 00:01:26,928 LIVE FEEDBACK. 21 00:01:26,928 --> 00:01:29,297 CLICK ON THAT AND TYPE IN YOUR 22 00:01:29,297 --> 00:01:31,099 NAME AND QUESTION. 23 00:01:31,099 --> 00:01:32,500 WE'LL RELATE THIS TO DR. ARANETA 24 00:01:32,500 --> 00:01:36,137 AT THE END OF HER TALK. 25 00:01:36,137 --> 00:01:37,005 YOU CAN SUBMIT A QUESTION ANY 26 00:01:37,005 --> 00:01:42,277 TIME AND HOPE YOU DO SO. 27 00:01:42,277 --> 00:01:45,313 FOR THOSE HERE IN THE AUDITORIUM 28 00:01:45,313 --> 00:01:46,848 YOU CAN USE THE MIC TO YOUR LEFT 29 00:01:46,848 --> 00:01:55,023 AND RIGHT. 30 00:01:55,023 --> 00:01:56,024 ALSO WE ARE OFFERING THE 31 00:01:56,024 --> 00:01:58,560 CONTINUING EDUCATION CREDIT FOR 32 00:01:58,560 --> 00:02:01,029 THE PRESENTATION. 33 00:02:01,029 --> 00:02:06,868 THE CME CODE IS 50126. 34 00:02:06,868 --> 00:02:14,276 I WILL REPEAT THAT, 50126. 35 00:02:14,276 --> 00:02:19,247 SO, OUR SPEAKER DR. ARANETA IS A 36 00:02:19,247 --> 00:02:20,916 PROFESSOR IN THE DEPARTMENT OF 37 00:02:20,916 --> 00:02:26,354 FAMILY MEDICINE AND PUBLIC 38 00:02:26,354 --> 00:02:26,588 HEALTH. 39 00:02:26,588 --> 00:02:31,793 DIVISION OF EPIDEMIOLOGY AT THE 40 00:02:31,793 --> 00:02:35,664 UNIVERSITY OF CALIFORNIA SAN 41 00:02:35,664 --> 00:02:35,864 DIEGO. 42 00:02:35,864 --> 00:02:43,772 SHE HAS NUMEROUS ROLES AT UCSD. 43 00:02:43,772 --> 00:02:50,211 SHE'S DEAN OF DIVERSITY 44 00:02:50,211 --> 00:02:56,117 PARTNERSHIP OF THE USC SCHOOL OF 45 00:02:56,117 --> 00:02:57,052 MEDICINE AND INVESTIGATOR IN 46 00:02:57,052 --> 00:02:59,387 DIABETES PREVENTION PROGRAMS 47 00:02:59,387 --> 00:03:01,456 OUTCOME STUDY WHERE UC SAN DIEGO 48 00:03:01,456 --> 00:03:07,929 IS ONE OF THE 26 PARTICIPATING 49 00:03:07,929 --> 00:03:11,599 SITES AND THE P.I. OF UCSD 50 00:03:11,599 --> 00:03:13,668 HEALTH STUDY. 51 00:03:13,668 --> 00:03:21,376 A LONGITUDINAL STUDY OF DIABETES 52 00:03:21,376 --> 00:03:29,951 AND VASCULAR DISEASE AMONG MEN 53 00:03:29,951 --> 00:03:34,689 AND WOMEN AND THE 54 00:03:34,689 --> 00:03:39,427 CO-INVESTIGATOR OF A STUDY WHERE 55 00:03:39,427 --> 00:03:44,432 SHE LEADS THE RESEARCH IN ETHNIC 56 00:03:44,432 --> 00:03:49,104 HEALTH DISPARITIES AMONG 57 00:03:49,104 --> 00:03:54,376 FILIPINO AND NATIVE AMERICAN. 58 00:03:54,376 --> 00:03:56,011 HER INTEREST INCLUDES MATERNAL 59 00:03:56,011 --> 00:04:02,650 AND PEDIATRIC HIV AIDS AND BIRTH 60 00:04:02,650 --> 00:04:05,453 DEFECT AND LIVE COURSE EXPOSURE, 61 00:04:05,453 --> 00:04:10,892 CARDIOVASCULAR DISEASE AND 62 00:04:10,892 --> 00:04:12,027 METABOLIC STUDY. 63 00:04:12,027 --> 00:04:13,862 IN HER EPIDEMIOLOGICAL RESEARCH, 64 00:04:13,862 --> 00:04:18,433 DR. ARANETA HAS HELPED TO 65 00:04:18,433 --> 00:04:23,571 IDENTIFY THE NOVEL RISK FACTOR 66 00:04:23,571 --> 00:04:28,376 FOR DIABETES AMONG THE ASIAN 67 00:04:28,376 --> 00:04:32,113 AMERICAN INCLUDING ACCESS TO 68 00:04:32,113 --> 00:04:35,817 HEPATIC FAT ACCUMULATION SEL 69 00:04:35,817 --> 00:04:37,118 SELECSEL 70 00:04:37,118 --> 00:04:41,222 SELECTED CYTOKINES AND 71 00:04:41,222 --> 00:04:41,890 GESTATIONAL DIABETES. 72 00:04:41,890 --> 00:04:46,728 DR. ARANETA RECEIVED HER UNDER 73 00:04:46,728 --> 00:04:52,434 GRADUATE DEGREE IN BIOLOGY FROM 74 00:04:52,434 --> 00:04:55,303 UCSD AND HER Ph.D. IN 75 00:04:55,303 --> 00:04:59,741 EPIDEMIOLOGY FROM THE YALE 76 00:04:59,741 --> 00:05:00,041 UNIVERSITY. 77 00:05:00,041 --> 00:05:01,509 SHE HAS RECEIVED SEVERAL AWARDS 78 00:05:01,509 --> 00:05:09,350 FOR HER RESEARCH. 79 00:05:09,350 --> 00:05:20,161 THIS INCLUDES VIV Y AN-FONSECA 80 00:05:20,628 --> 00:05:21,629 AWEIRD AND SELECTION TO THE NIH 81 00:05:21,629 --> 00:05:23,465 COUNCIL OF COUNCILS. 82 00:05:23,465 --> 00:05:30,038 SHE ALSO IS THE RECIPIENT OF THE 83 00:05:30,038 --> 00:05:31,005 NIH INVESTIGATOR TEAM AND LOOKED 84 00:05:31,005 --> 00:05:34,976 AT CONNECTION BETWEEN DIABETES. 85 00:05:34,976 --> 00:05:41,216 THE TITLE OF DR. ARANETA TALK IS 86 00:05:41,216 --> 00:05:47,388 THE TYPE 2 DIABETES AMONG ASIAN 87 00:05:47,388 --> 00:05:49,224 AMERICANS AND KNOWN FACTORS. 88 00:05:49,224 --> 00:05:51,426 JOIN ME TO WELCOME DR. HAPPY 89 00:05:51,426 --> 00:05:57,932 ARANETA. 90 00:05:57,932 --> 00:06:01,503 >> THANK YOU, GOOD AFTERNOON 91 00:06:01,503 --> 00:06:02,737 THANK YOU FOR THE GENEROUS 92 00:06:02,737 --> 00:06:05,673 INTRODUCTION AND ESTEEMED 93 00:06:05,673 --> 00:06:15,216 INVITATION TO BE A WAL SELECTOR 94 00:06:15,216 --> 00:06:21,523 ESPECIALLY IN RECOGNITION OF 95 00:06:21,523 --> 00:06:22,257 PACIFIC ISLANDER MONTH AND WE 96 00:06:22,257 --> 00:06:24,259 WANT TO ACKNOWLEDGE THE 97 00:06:24,259 --> 00:06:24,926 PARTICIPANTS IN THE THREE 98 00:06:24,926 --> 00:06:31,099 STUDIES I'M GOING TO FEATURE 99 00:06:31,099 --> 00:06:32,400 TODAY. 100 00:06:32,400 --> 00:06:38,239 SINCE 2016, ASIAN IMMIGRANTS 101 00:06:38,239 --> 00:06:42,477 EXCEEDED THE NUMBER OF LATINO 102 00:06:42,477 --> 00:06:45,480 IMMIGRANT THE PROJECTED NUMBER 103 00:06:45,480 --> 00:06:47,248 OF THE ASIAN AMERICAN POPULATION 104 00:06:47,248 --> 00:06:49,050 IS EXPECTED TO CLIMB TO 35 105 00:06:49,050 --> 00:06:53,421 MILLION IN THE NEXT 15 YEARS AND 106 00:06:53,421 --> 00:07:00,595 46 MILLION BY 2060. 107 00:07:00,595 --> 00:07:01,629 24 MILLION ASIAN AMERICANS 108 00:07:01,629 --> 00:07:05,233 COMPRISE 7% OF THE 109 00:07:05,233 --> 00:07:07,101 U.S. POPULATION. 110 00:07:07,101 --> 00:07:10,405 THE LARGEST ARE CHINESE, INDIAN, 111 00:07:10,405 --> 00:07:14,742 FILIPINOS AND VIETNAMESE AND 112 00:07:14,742 --> 00:07:19,447 RECENT IMMIGRANTS FROM OTHER 113 00:07:19,447 --> 00:07:24,352 LOCATIONS ARE SMALLER GROUPS BUT 114 00:07:24,352 --> 00:07:26,187 IMPORTANT TO ACKNOWLEDGE THE 115 00:07:26,187 --> 00:07:28,756 GROUPS REPRESENT OVER 100 116 00:07:28,756 --> 00:07:35,096 LANGUAGES WHICH MADE IT 117 00:07:35,096 --> 00:07:35,597 CHALLENGING TO PROVIDE 118 00:07:35,597 --> 00:07:38,233 TRANSLATION SERVICES AT THE PEAK 119 00:07:38,233 --> 00:07:40,535 OF THE PANDEMIC AND THERE'S 120 00:07:40,535 --> 00:07:43,171 DISPARITIES IN SOCIAL ECONOMIC 121 00:07:43,171 --> 00:07:45,473 BACKGROUND OF THE DIVERSE ASIAN 122 00:07:45,473 --> 00:07:50,178 AMERICAN POPULATIONS VARYING IN 123 00:07:50,178 --> 00:07:50,778 COLLEGE ATTAINMENT AS WELL AS 124 00:07:50,778 --> 00:07:57,085 INCOME. 125 00:07:57,085 --> 00:07:59,654 THERE'S BEEN LIMITED COHORTS OF 126 00:07:59,654 --> 00:08:01,656 ASIAN AMERICANS AND A LOT OF THE 127 00:08:01,656 --> 00:08:03,591 PREVALENCE DATA HAVE COME FROM 128 00:08:03,591 --> 00:08:05,093 ELECTRONIC HEALTH RECORDS. 129 00:08:05,093 --> 00:08:09,063 THIS PAPER PUBLISHED BY ANDY 130 00:08:09,063 --> 00:08:11,032 CARTER IN 2013 SHOCKED THE 131 00:08:11,032 --> 00:08:12,567 MEDICAL COMMUNITY. 132 00:08:12,567 --> 00:08:14,802 IT WAS BASED ON 2 MILLION 133 00:08:14,802 --> 00:08:19,774 MEMBERS OF KAISER, NORTHERN 134 00:08:19,774 --> 00:08:22,043 CALIFORNIA PERMANENTE MEMBERS 135 00:08:22,043 --> 00:08:22,977 GENERALLY REPRESENTATIVE OF 136 00:08:22,977 --> 00:08:24,178 CALIFORNIA'S POPULATION AND 137 00:08:24,178 --> 00:08:26,781 WHENEVER I ASK OUR MEDICAL 138 00:08:26,781 --> 00:08:27,649 STUDENTS NAME THE THREE RACIAL 139 00:08:27,649 --> 00:08:30,818 ETHNIC GROUPS WITH THE HIGHEST 140 00:08:30,818 --> 00:08:32,420 PREVALENCE OF TYPE 2 DIABETES 141 00:08:32,420 --> 00:08:37,659 THEY USUALLY RESPOND WITH 142 00:08:37,659 --> 00:08:38,660 LATINOS, AFRICAN AMERICANS AND 143 00:08:38,660 --> 00:08:43,431 NATIVE AMERICANS WHEN IN 144 00:08:43,431 --> 00:08:46,167 CALIFORNIA IT'S PACIFIC 145 00:08:46,167 --> 00:08:48,069 ISLANDERS AND THIRD ARE SOUTH 146 00:08:48,069 --> 00:08:50,271 ASIANS COMING FROM INDIA, 147 00:08:50,271 --> 00:08:56,311 PAKISTAN, BANGLADESH AND NEPPAL 148 00:08:56,311 --> 00:08:58,646 IF YOU LOOK AT SOUTH EACH 149 00:08:58,646 --> 00:09:04,118 ASIAIANS FROM CAM BONE -- 150 00:09:04,118 --> 00:09:08,623 CAMBODIA AND CHINESE AND 151 00:09:08,623 --> 00:09:11,125 JAPANESE THEY HAVE ELEVATED 152 00:09:11,125 --> 00:09:12,860 DIABETES COMPARED TO WHITES. 153 00:09:12,860 --> 00:09:15,630 IN THE ORANGE LINE YOU SEE THE 154 00:09:15,630 --> 00:09:20,902 BMI OF 30 OR THE DEFINITION OF 155 00:09:20,902 --> 00:09:24,439 CLINICAL OBESITY AMONG BLACKS, 156 00:09:24,439 --> 00:09:27,642 WHITES AND NATIVE AMERICANS AND 157 00:09:27,642 --> 00:09:30,445 PACIFIC ISLANDER AND INCIDENTS 158 00:09:30,445 --> 00:09:31,546 OF DIABETES OR PREVALENT 159 00:09:31,546 --> 00:09:33,648 DIABETES IN THE WHITE BAR, 160 00:09:33,648 --> 00:09:36,918 THEY'RE ALL EXCEEDING A BMI OF 161 00:09:36,918 --> 00:09:39,220 30 KILOGRAMS PER METER SQUARED 162 00:09:39,220 --> 00:09:43,458 BUT NOT SO AMONG CHINESE, 163 00:09:43,458 --> 00:09:45,760 JAPANESE AND FILIPINOS AND SOUTH 164 00:09:45,760 --> 00:09:48,963 ASIANS WHO ARE BMIs LESS THAN 165 00:09:48,963 --> 00:09:49,130 30. 166 00:09:49,130 --> 00:09:51,199 AROUND THEN SIX YEARS AFTER THE 167 00:09:51,199 --> 00:09:53,468 PAPER WAS PUBLISHED KAISER DID 168 00:09:53,468 --> 00:09:55,770 THE ANALYSIS AGAIN AMONG ADULTS 169 00:09:55,770 --> 00:09:59,207 OVER THE AGE OF 45 AND FOUND 170 00:09:59,207 --> 00:10:01,142 SIMILAR TREND WITH NATIVE 171 00:10:01,142 --> 00:10:03,311 HAWAIIANS AND PACIFIC ISLANDERS 172 00:10:03,311 --> 00:10:12,687 AND FILIPINOS AND SOUTH ASIANS 173 00:10:12,687 --> 00:10:19,394 HAVING HIGHER PREVALENCE AND 174 00:10:19,394 --> 00:10:25,333 AMONG NATIVE HAWAIIANS AND 175 00:10:25,333 --> 00:10:26,501 PACIFIC ISLANDERS WE'RE ALREADY 176 00:10:26,501 --> 00:10:28,469 THERE AND JAPANESE AND CHINESE 177 00:10:28,469 --> 00:10:30,004 THEY'RE DIABETES PREVALENCE 178 00:10:30,004 --> 00:10:32,573 EXCEEDS THAT OF WHITES DESPITE 179 00:10:32,573 --> 00:10:36,544 LOW BMIs AND THE ABSENCE OF 180 00:10:36,544 --> 00:10:37,512 GENERAL OBESITY. 181 00:10:37,512 --> 00:10:40,047 SO THAT'S CALIFORNIA. 182 00:10:40,047 --> 00:10:41,849 ONE-THIRD OF ALL ASIAN AMERICANS 183 00:10:41,849 --> 00:10:43,284 RESIDE IN CALIFORNIA. 184 00:10:43,284 --> 00:10:44,352 WHAT DOES DIABETES PREVALENCE 185 00:10:44,352 --> 00:10:50,425 LOOK LIKE IN OTHER PARTS OF THE 186 00:10:50,425 --> 00:10:50,658 COUNTRY? 187 00:10:50,658 --> 00:10:57,365 WE USED NHANES DATA FROM 2011 TO 188 00:10:57,365 --> 00:10:59,834 2016 AND THE DARKER BARS 189 00:10:59,834 --> 00:11:02,870 REPRESENT KNOWN OR PREVIOUSLY 190 00:11:02,870 --> 00:11:04,605 DIAGNOSED DIABETES AND THE 191 00:11:04,605 --> 00:11:06,240 LIGHTER SHADES REPRESENT 192 00:11:06,240 --> 00:11:07,508 UNDIAGNOSED ABOUT THE OR 193 00:11:07,508 --> 00:11:09,143 UNDIAGNOSED AT THE TIME OF THE 194 00:11:09,143 --> 00:11:10,645 NHANES VISIT. 195 00:11:10,645 --> 00:11:13,681 YOU'LL SEE HISPANICS, 196 00:11:13,681 --> 00:11:15,450 NON-HISPANIC BLACKS AND THE 197 00:11:15,450 --> 00:11:17,351 NUMBER THREE, ASIANS HAVE THIS 198 00:11:17,351 --> 00:11:20,955 FIRST, SECOND AND THIRD HIGHEST 199 00:11:20,955 --> 00:11:24,125 PREVALENCE BUT WHEN YOU 200 00:11:24,125 --> 00:11:24,759 DISAGGREGATED THE GROUPS INTO 201 00:11:24,759 --> 00:11:27,195 EAST ASIAN, KOREAN AND JAPANESE 202 00:11:27,195 --> 00:11:31,165 AND THEN HAVE THE SOUTH ASIANS 203 00:11:31,165 --> 00:11:33,434 AND SOUTHEAST ASIANS 204 00:11:33,434 --> 00:11:35,403 PREDOMINANTLY FILIPINO IN THIS 205 00:11:35,403 --> 00:11:38,973 GROUP THEIR DIABETES PREVALENCE 206 00:11:38,973 --> 00:11:41,342 EXCEEDS THAT OF LATINOS AND 207 00:11:41,342 --> 00:11:45,913 BLACKS AND IF YOU ADJUST FOR NET 208 00:11:45,913 --> 00:11:53,354 JUST AGE AND SEX BUT BMI ALSO, 209 00:11:53,354 --> 00:11:55,022 SOUTHEAST ASIANS HAVE HIGHER 210 00:11:55,022 --> 00:11:56,390 DIABETES PREVALENCE THAN GROUPS 211 00:11:56,390 --> 00:11:57,992 THAT ARE TRADITIONALLY PERCEIVED 212 00:11:57,992 --> 00:12:00,094 TO BE AT HIGHEST RISK. 213 00:12:00,094 --> 00:12:04,165 SO THIS IS AN OPPORTUNITY TO 214 00:12:04,165 --> 00:12:05,800 EMPHASIZE THE IMPORTANCE OF 215 00:12:05,800 --> 00:12:10,705 DISAGGREGATING ASIAN SUB GROUPS. 216 00:12:10,705 --> 00:12:12,773 GLOBALLY THE INTERNATIONAL 217 00:12:12,773 --> 00:12:14,542 DIABETES FOUNDATION PUBLISHED 218 00:12:14,542 --> 00:12:18,679 THE DATA FOR 2021 AND THE BURDEN 219 00:12:18,679 --> 00:12:21,382 OF DIABETES IS IN THE WESTERN 220 00:12:21,382 --> 00:12:23,618 PACIFIC REGION THAT INCLUDES 221 00:12:23,618 --> 00:12:26,487 ASIA AS WELL AS OCEANA WITH OVER 222 00:12:26,487 --> 00:12:29,056 206 MILLION CASES. 223 00:12:29,056 --> 00:12:31,192 THESE ARE ALSO SOME OF THE MOST 224 00:12:31,192 --> 00:12:34,028 POPULOUS COUNTRIES FOLLOWED BY 225 00:12:34,028 --> 00:12:37,231 INDIA AND SOUTHEAST ASIAN WITH 226 00:12:37,231 --> 00:12:40,034 90 MILLION CASES. 227 00:12:40,034 --> 00:12:41,536 IS THIS A NEW OBSERVATION? 228 00:12:41,536 --> 00:12:43,504 THIS IS ACTUALLY RECOGNIZED 60 229 00:12:43,504 --> 00:12:44,105 YEARS AGO. 230 00:12:44,105 --> 00:12:46,507 WE LOOKED BACK AT THE LITERATURE 231 00:12:46,507 --> 00:12:50,011 AND THIS PAPER IN HAWAI'I BASED 232 00:12:50,011 --> 00:12:55,616 ON 38,000 MIGRANTS TO HAWAI'I 233 00:12:55,616 --> 00:12:59,053 BEFORE THE CURRENT OBESITY 234 00:12:59,053 --> 00:13:01,355 EPIDEMIC, 7 PER 1,000 CAUCASIANS 235 00:13:01,355 --> 00:13:03,324 HAD TYPE 2 DIABETES AND THE RATE 236 00:13:03,324 --> 00:13:05,359 WAS TWICE THAT AMONG CHINESE IN 237 00:13:05,359 --> 00:13:07,895 BLUE AND THREE TIMES THAT AMONG 238 00:13:07,895 --> 00:13:10,898 KOREANS, FILIPINOS AND JAPANESE 239 00:13:10,898 --> 00:13:12,900 AND OVER SEVEN FOLD AMONG NATIVE 240 00:13:12,900 --> 00:13:15,169 HAWAIIANS. 241 00:13:15,169 --> 00:13:19,173 AND 50 YEARS LATER THE STUDY IN 242 00:13:19,173 --> 00:13:20,775 THE BIG ISLAND OF HAWAI'I LOOKED 243 00:13:20,775 --> 00:13:23,844 AT A DOOR TO DOOR SAMPLE. 244 00:13:23,844 --> 00:13:26,080 IT WAS GENERALIZABLE TO THE 245 00:13:26,080 --> 00:13:26,614 POPULATION. 246 00:13:26,614 --> 00:13:29,517 YOU'LL NOTICE THE BMI OF WHITES 247 00:13:29,517 --> 00:13:31,752 IN BEIGE AND JAPANESE IN GREEN 248 00:13:31,752 --> 00:13:37,558 AND FILIPINOS IN ORANGE AND THE 249 00:13:37,558 --> 00:13:39,894 MIXED ASIANS WAS AT THE 250 00:13:39,894 --> 00:13:43,564 DEFINITION OF OVERWEIGHT AND THE 251 00:13:43,564 --> 00:13:48,436 BMI OF NATIVE HAWAIIANS WAS AT 252 00:13:48,436 --> 00:13:50,972 CLINICAL OBESITY BEYOND 30 AND 253 00:13:50,972 --> 00:13:52,607 YOU'D EXPECT DIABETES PREVALENCE 254 00:13:52,607 --> 00:13:54,141 TO BE SIMILAR AMONG WHITES, 255 00:13:54,141 --> 00:13:56,477 JAPANESE AND FILIPINOS BUT 256 00:13:56,477 --> 00:13:58,312 FOLLOWING THE TRENDS FROM 50 257 00:13:58,312 --> 00:14:01,983 YEARS EARLIER, IT WAS AT LEAST 258 00:14:01,983 --> 00:14:06,621 FOUR TIMES HIGHER IN JAPANESE 259 00:14:06,621 --> 00:14:08,956 AND FILIPINOS AND OTHER MIXED 260 00:14:08,956 --> 00:14:10,424 ASIANS AS WELL AS NATIVE 261 00:14:10,424 --> 00:14:13,361 HAWAIIANS COMPARED TO WHITES. 262 00:14:13,361 --> 00:14:15,062 AND SO THAT'S PREVALENCE DATA. 263 00:14:15,062 --> 00:14:17,264 WHAT ARE THE IMPLICATIONS WHEN 264 00:14:17,264 --> 00:14:19,400 IT COMES TO CARDIOVASCULAR AND 265 00:14:19,400 --> 00:14:21,369 ALL-CAUSE MORTALITY? 266 00:14:21,369 --> 00:14:23,638 IN CHART A YOU'LL SEE DIABETES 267 00:14:23,638 --> 00:14:26,874 RELATED ALL-CAUSE MORTALITY WAS 268 00:14:26,874 --> 00:14:28,442 HIGHEST AMONG FILIPINOS. 269 00:14:28,442 --> 00:14:31,112 SECOND HIGHEST AMONG HISPANICS 270 00:14:31,112 --> 00:14:33,347 AND THEN WAS ALSO HIGH AMONG THE 271 00:14:33,347 --> 00:14:37,284 ASIAN SUBGROUPS THAT ARE 272 00:14:37,284 --> 00:14:39,654 VIETNAMESE OR ASIAN INDIAN. 273 00:14:39,654 --> 00:14:41,789 AMONG MALES ALL CAUSE MORTALITY 274 00:14:41,789 --> 00:14:43,991 RELATED TO DIABETES AGAIN WAS 275 00:14:43,991 --> 00:14:47,428 HIGHEST AMONG FILIPINOS FOLLOWED 276 00:14:47,428 --> 00:14:49,997 BY ASIAN INDIANS. 277 00:14:49,997 --> 00:14:50,931 CARDIOVASCULAR DISEASE MORTALITY 278 00:14:50,931 --> 00:14:54,235 IN CHART B YOU'LL SEE AGAIN 279 00:14:54,235 --> 00:14:57,071 FILIPINOS AND ASIAN INDIANS HAVE 280 00:14:57,071 --> 00:15:01,342 THE HIGHEST CVD MORTALITY AND 281 00:15:01,342 --> 00:15:04,578 AMONG HISPANIC AND NON-HISPANIC 282 00:15:04,578 --> 00:15:08,849 BLACKS IT'S SIMILAR DESPITE 283 00:15:08,849 --> 00:15:10,851 RECENT RECOGNITION OF VIETNAMESE 284 00:15:10,851 --> 00:15:12,687 BEING AT HIGH RISK FOR TYPE 2 285 00:15:12,687 --> 00:15:13,521 DIABETES. 286 00:15:13,521 --> 00:15:16,724 AND THEN AMONG MEN, DIABETES 287 00:15:16,724 --> 00:15:18,893 RELATED CARDIOVASCULAR DISEASE 288 00:15:18,893 --> 00:15:21,162 MORTALITY WAS HIGHEST AGAIN 289 00:15:21,162 --> 00:15:24,198 AMONG FILIPINOS AND ASIAN 290 00:15:24,198 --> 00:15:24,465 INDIANS. 291 00:15:24,465 --> 00:15:26,867 THE KAISER PAPER THAT WAS 292 00:15:26,867 --> 00:15:29,704 PUBLISHED IN 2013 PROMPTED THE 293 00:15:29,704 --> 00:15:32,239 AMERICAN DIABETES ASSOCIATION TO 294 00:15:32,239 --> 00:15:34,809 REACH OUT TO FOUR GROUPS THAT 295 00:15:34,809 --> 00:15:37,611 HAD LONGITUDINAL COHORTS TO 296 00:15:37,611 --> 00:15:39,814 EVALUATE THE BMI SCREENING CUT 297 00:15:39,814 --> 00:15:41,248 POINTS FOR DIABETES WHICH WAS 298 00:15:41,248 --> 00:15:44,151 PREVIOUSLY AT A BMI OF 25 299 00:15:44,151 --> 00:15:51,225 KILOGRAMS PER METER SQUARED. 300 00:15:51,225 --> 00:15:54,562 THE ONLY LONGITUDINAL STUDY, THE 301 00:15:54,562 --> 00:15:57,364 FIRST STARTED IN 1979 THE PILOT 302 00:15:57,364 --> 00:16:00,234 STUDY LED BY THE UNIVERSITY OF 303 00:16:00,234 --> 00:16:02,603 WASHINGTON IN SEATTLE AND 304 00:16:02,603 --> 00:16:05,673 BETWEEN 1983 AND 1991 HE 305 00:16:05,673 --> 00:16:08,809 ENROLLED 420 U.S.-BORN SECOND 306 00:16:08,809 --> 00:16:11,512 GENERATION JAPANESE AMERICANS AS 307 00:16:11,512 --> 00:16:14,648 WELL AS THIRD-GENERATION 308 00:16:14,648 --> 00:16:16,250 JAPANESE AMERICANS YET THESE 309 00:16:16,250 --> 00:16:17,685 ELEGANT STUDIES COMPARING 310 00:16:17,685 --> 00:16:19,987 DIABETES PREVALENCE AMONG 311 00:16:19,987 --> 00:16:20,654 JAPANESE AMERICANS COMPARED TO 312 00:16:20,654 --> 00:16:24,959 THOSE IN JAPAN AND THOSE IN 313 00:16:24,959 --> 00:16:27,094 BRAZIL AND FOUND HIGHER DIABETES 314 00:16:27,094 --> 00:16:29,363 PREVALENCE AMONG THE IMMIGRANT 315 00:16:29,363 --> 00:16:32,666 OR U.S.-BORN POPULATIONS. 316 00:16:32,666 --> 00:16:36,137 SO 1979 THIS WAS 45 YEARS AGO 317 00:16:36,137 --> 00:16:37,238 THE RECOGNITION OF EXCESS RISK 318 00:16:37,238 --> 00:16:41,776 IN THIS GROUP OF ASIAN AMERICANS 319 00:16:41,776 --> 00:16:42,676 WAS FIRST RECOGNIZED. 320 00:16:42,676 --> 00:16:44,245 THEY HAD THEIR CLINICAL BASELINE 321 00:16:44,245 --> 00:16:49,216 VISIT WITH FOLLOW UP AFTER FIVE 322 00:16:49,216 --> 00:16:51,519 AND 10 YEARS. 323 00:16:51,519 --> 00:16:55,589 I WAS A NEW CLINICAL INSTRUCTOR 324 00:16:55,589 --> 00:16:56,857 NOT YET ASSISTANT PROFESSOR WHEN 325 00:16:56,857 --> 00:17:00,294 I HAD THE PRIVILEGE OF RUNNING 326 00:17:00,294 --> 00:17:03,597 INTO ELIZABETH BARRETT-CONNOR AT 327 00:17:03,597 --> 00:17:05,833 A CONFERENCE AND NOT KNOWING MY 328 00:17:05,833 --> 00:17:07,735 ETHNICITY SHE MENTIONED WE 329 00:17:07,735 --> 00:17:09,370 NOTICED AT THE VETERANS 330 00:17:09,370 --> 00:17:10,938 ADMINISTRATION HOSPITAL THE 331 00:17:10,938 --> 00:17:14,575 MAJORITY OF PATIENTS IN THE 332 00:17:14,575 --> 00:17:15,976 DIALYSIS UNITS ARE THIN FILIPINO 333 00:17:15,976 --> 00:17:16,377 MEN. 334 00:17:16,377 --> 00:17:18,445 THEY HAVE ACCESS TO CARE AND IN 335 00:17:18,445 --> 00:17:20,181 THE NAVY AND EXERCISE FREQUENTLY 336 00:17:20,181 --> 00:17:24,485 AND MAINTAIN LOW BMIs. 337 00:17:24,485 --> 00:17:26,720 WERE THEY JUST DIAGNOSED LATE OR 338 00:17:26,720 --> 00:17:27,888 IS THERE SOMETHING DIFFERENT IN 339 00:17:27,888 --> 00:17:31,959 THE PATHOPHYSIOLOGY OF TYPE 2 340 00:17:31,959 --> 00:17:32,993 DIABETES IN ASIANS. 341 00:17:32,993 --> 00:17:34,228 WE'D LIKE TO START A COHORT. 342 00:17:34,228 --> 00:17:37,464 THAT'S HOW I WAS ABLE TO JOIN UC 343 00:17:37,464 --> 00:17:38,232 SAN DIEGO. 344 00:17:38,232 --> 00:17:42,036 WE ENROLLED 453 WOMEN FIRST WITH 345 00:17:42,036 --> 00:17:43,337 A BASELINE VISIT FOLLOWED FIVE 346 00:17:43,337 --> 00:17:47,842 YEARS AND 10 YEARS LATER AND 347 00:17:47,842 --> 00:17:50,945 BASELINE VISIT OF 107 FILIPINO 348 00:17:50,945 --> 00:17:51,545 MEN. 349 00:17:51,545 --> 00:17:55,282 AND THE THIRD LONGITUDINAL 350 00:17:55,282 --> 00:18:01,555 COHORT IS THE MA SA LA IT STAND 351 00:18:01,555 --> 00:18:08,362 FOR MEDIATORS OF ATHEROSCLEROSIS 352 00:18:08,362 --> 00:18:14,134 AND HAVE SOUTH ASIANS IN THE SAN 353 00:18:14,134 --> 00:18:15,102 FRANCISCO AND CHICAGO AND 354 00:18:15,102 --> 00:18:20,808 EXPANDED TO ENROLL A LARGE 355 00:18:20,808 --> 00:18:25,246 POPULATION OF BANGLADESHI TAXI 356 00:18:25,246 --> 00:18:25,679 DRIVERS. 357 00:18:25,679 --> 00:18:27,715 SO TO INFORM THE AMERICAN 358 00:18:27,715 --> 00:18:28,816 DIABETES ASSOCIATION GUIDELINES 359 00:18:28,816 --> 00:18:32,186 WE ALSO COLLECTED DATA FROM THE 360 00:18:32,186 --> 00:18:34,154 STUDY LED BY DR. CHANG FROM THE 361 00:18:34,154 --> 00:18:37,558 UNIVERSITY OF HAWAI'I AT MEN 362 00:18:37,558 --> 00:18:37,791 OWA. 363 00:18:37,791 --> 00:18:39,660 THE CRITERIA WAS THEY HAD TO BE 364 00:18:39,660 --> 00:18:44,331 OVER THE AGE OF 45, NO PRIOR 365 00:18:44,331 --> 00:18:46,634 DIAGNOSIS OF TYPE 2 DIABETES 366 00:18:46,634 --> 00:18:51,105 WITH INCOMBINANT MEASURES OF BMI 367 00:18:51,105 --> 00:18:58,312 GLYCOSYLATED LEVELS AND A 368 00:18:58,312 --> 00:19:01,015 GLUCOSE TOLERANCE TEST. 369 00:19:01,015 --> 00:19:02,082 IF SCREENING WAS LIMITED TO 370 00:19:02,082 --> 00:19:04,151 PARTICIPANTS WITH A BMI LESS 371 00:19:04,151 --> 00:19:11,592 THAN 25, 37% OF ASIAN AMERICANS 372 00:19:11,592 --> 00:19:12,960 WOULD BE MISSED INCLUDING A 373 00:19:12,960 --> 00:19:15,963 WOMAN WITH A BMI OF 16 NEWLY 374 00:19:15,963 --> 00:19:17,798 DIAGNOSED DURING OUR CLINIC 375 00:19:17,798 --> 00:19:18,065 VISIT. 376 00:19:18,065 --> 00:19:26,674 SHE WAS 5'4" AND 96 POUNDS. 377 00:19:26,674 --> 00:19:28,142 WE WERE GLAD TO BE ABLE TO 378 00:19:28,142 --> 00:19:30,010 INFLUENCE THE SCREENING 379 00:19:30,010 --> 00:19:30,644 GUIDELINES TO ASIAN AMERICANS 380 00:19:30,644 --> 00:19:34,281 WITH THE BMI OF 23 OR GREATER 381 00:19:34,281 --> 00:19:35,683 AND HAVE THESE RISK FACTORS 382 00:19:35,683 --> 00:19:37,885 SHOULD BE TESTED. 383 00:19:37,885 --> 00:19:47,361 WE DON'T KNOW ABOUT THE 384 00:19:47,361 --> 00:19:49,396 IMPLEMENTATION OF THIS IN 385 00:19:49,396 --> 00:19:52,032 CLINICAL CENTERS AND WE PREDICT 386 00:19:52,032 --> 00:19:55,069 THERE'S OVER HALF A MILLION 387 00:19:55,069 --> 00:19:57,838 ASIAN AMERICANS UNDIAGNOSED 388 00:19:57,838 --> 00:20:01,275 MOVING THE SCREENING GUIDELINES 389 00:20:01,275 --> 00:20:04,912 JUST TWO BMI UNITS WOULD HELP 390 00:20:04,912 --> 00:20:08,282 IDENTIFIED AT LEAST 300,000 391 00:20:08,282 --> 00:20:09,950 ASIAN AMERICANS WITH DIABETES. 392 00:20:09,950 --> 00:20:11,251 ANOTHER IMPORTANT OBSERVATION IS 393 00:20:11,251 --> 00:20:16,156 THE IMPORTANCE OF THE TWO HOUR 394 00:20:16,156 --> 00:20:16,824 GLUCOSE TOLERANCE TEST. 395 00:20:16,824 --> 00:20:19,293 USING THE THREE TESTS WE FOUND 396 00:20:19,293 --> 00:20:22,062 DIABETES PREVALENCE WAS 18%. 397 00:20:22,062 --> 00:20:25,466 IF YOU LIMIT SCREENING JUST TO 398 00:20:25,466 --> 00:20:30,204 GLYCOSYLATED HEMO GLOBIN 399 00:20:30,204 --> 00:20:31,605 MEASURES YOU'LL ONLY CAPTURE 9%. 400 00:20:31,605 --> 00:20:38,178 IF YOU RELY ON A FASTING GLUCOSE 401 00:20:38,178 --> 00:20:39,913 MEASURE HYPERGLYCEMIA WILL ONLY 402 00:20:39,913 --> 00:20:42,583 BE 5%. 403 00:20:42,583 --> 00:20:45,486 IF SCREENING IS LIMITED TO A 404 00:20:45,486 --> 00:20:48,222 FASTING GLUCOSE MEASURE ALMOST 405 00:20:48,222 --> 00:20:49,156 HALF OF ASIAN AMERICANS WITH 406 00:20:49,156 --> 00:20:51,458 DIABETES MIGHT REMAIN 407 00:20:51,458 --> 00:20:51,759 UNDIAGNOSED. 408 00:20:51,759 --> 00:20:54,862 THIS IS PARTICULARLY RELEVANT TO 409 00:20:54,862 --> 00:20:55,329 JAPANESE AND FILIPINO 410 00:20:55,329 --> 00:20:59,633 COMMUNITIES. 411 00:20:59,633 --> 00:21:04,605 THIS IS FROM THE MASALA STUDIES 412 00:21:04,605 --> 00:21:06,373 WITH COMPARISONS TO THE MESA 413 00:21:06,373 --> 00:21:08,308 STUDY WITH 800 CHINESE AMERICANS 414 00:21:08,308 --> 00:21:09,643 MOSTLY FROM LOS ANGELES. 415 00:21:09,643 --> 00:21:15,549 AND THE MECHANISMS INCLUDE FOR 416 00:21:15,549 --> 00:21:19,253 SOUTH ASIANS MORE INSULIN RE 417 00:21:19,253 --> 00:21:22,790 RESISTANCE AND LOWER BETA CELL 418 00:21:22,790 --> 00:21:29,730 FUNCTION THOUGH THE GLYCOSYLATED 419 00:21:29,730 --> 00:21:30,664 HEMOGLOBIN TEST DON'T REQUIRE 420 00:21:30,664 --> 00:21:34,268 FAST WE WANTED TO LOOK AT 421 00:21:34,268 --> 00:21:35,335 SPECIFICITY AND HOW MANY ASIAN 422 00:21:35,335 --> 00:21:37,071 AMERICANS WOULD BE MISSED BY 423 00:21:37,071 --> 00:21:41,708 RELYING ON THE CUT POINT OF 6.5% 424 00:21:41,708 --> 00:21:46,847 COMPARED TO AN ORAL GLUCOSE 425 00:21:46,847 --> 00:21:49,516 TOLERANCE REST TO 2.6% IN 426 00:21:49,516 --> 00:21:53,353 JAPANESE HOWEVER, WHEN YOU 427 00:21:53,353 --> 00:21:55,722 ADMINISTER AN OGTT THE 428 00:21:55,722 --> 00:21:57,891 PERCENTAGE OF JAPANESE TRIPLES. 429 00:21:57,891 --> 00:22:01,261 THE IMPLICATIONS ARE LIMITING 430 00:22:01,261 --> 00:22:03,597 DIABETES DIAGNOSIS TO JUST A1C 431 00:22:03,597 --> 00:22:07,000 MEASURES ALONE COULD MISS 432 00:22:07,000 --> 00:22:08,802 DIABETES DIAGNOSIS AMONG 433 00:22:08,802 --> 00:22:10,904 ONE-THIRD OF FILIPINO AMERICANS, 434 00:22:10,904 --> 00:22:12,606 HALF OF NATIVE HAWAIIANS AND 435 00:22:12,606 --> 00:22:13,107 TWO-THIRDS OF JAPANESE 436 00:22:13,107 --> 00:22:18,579 AMERICANS. 437 00:22:18,579 --> 00:22:22,216 WE CONDUCTED PHOTOGRAPHS AND 438 00:22:22,216 --> 00:22:27,121 FOUND THAT AN A1C CUT POINT OF 439 00:22:27,121 --> 00:22:29,890 5.8% MIGHT IMPROVE THE 440 00:22:29,890 --> 00:22:31,158 SENSITIVITY DIAGNOSED DIABETES 441 00:22:31,158 --> 00:22:32,292 VERSUS THE CURRENT GUIDELINES OF 442 00:22:32,292 --> 00:22:42,469 AN A 1C CUT POINT AND IT WAS 443 00:22:42,469 --> 00:22:43,637 USEFUL IN IDENTIFYING 444 00:22:43,637 --> 00:22:49,143 PARTICIPANTS WITH A RETINOPATHY 445 00:22:49,143 --> 00:22:53,580 AND ALSO IN THE KAISER 446 00:22:53,580 --> 00:22:55,249 POPULATION MEMBERS WHO DID NOT 447 00:22:55,249 --> 00:23:00,254 HAVE CARDIOVASCULAR DISEASE, 448 00:23:00,254 --> 00:23:05,225 WHITES AND SOUTH ASIAN 449 00:23:05,225 --> 00:23:09,263 INDIVIDUALS HAD THRESHOLDS FOR 450 00:23:09,263 --> 00:23:11,265 CARDIOVASCULAR CONVENIENT LESS 451 00:23:11,265 --> 00:23:13,867 THAN THE TREATMENT GOALS OF 7%. 452 00:23:13,867 --> 00:23:14,835 WHAT'S CAUSING THIS DIFFERENCE? 453 00:23:14,835 --> 00:23:16,370 THIS PAPER WAS PUBLISHED 20 454 00:23:16,370 --> 00:23:19,339 YEARS AGO AND AN EXAMPLE OF A 455 00:23:19,339 --> 00:23:25,245 EUROPEAN MAN WITH GLASSES AND 456 00:23:25,245 --> 00:23:27,080 SOUTH ASIAN MAN WITH A BEARD 457 00:23:27,080 --> 00:23:30,117 WITH LOW BMIs AND SCANS WERE 458 00:23:30,117 --> 00:23:33,086 USED TO ESTIMATE THEIR PERCENT 459 00:23:33,086 --> 00:23:33,787 BODY FAT. 460 00:23:33,787 --> 00:23:35,889 THE SOUTH ASIAN MAN HAS TWICE AS 461 00:23:35,889 --> 00:23:38,659 MUCH BODY FAT AS THE EUROPEAN 462 00:23:38,659 --> 00:23:40,627 MAN THOUGH THEY BOTH HAVE VERY 463 00:23:40,627 --> 00:23:45,199 LOW BMIs. 464 00:23:45,199 --> 00:23:48,101 SO THERE ARE SO BODY COMPOSITION 465 00:23:48,101 --> 00:23:49,736 INCLUDING EXCESS FAT IN THE 466 00:23:49,736 --> 00:23:53,340 VISCERAL ADIPOSE TISSUE, FATTY 467 00:23:53,340 --> 00:23:56,476 LIVER, INTRAMUSCULAR FAT AND 468 00:23:56,476 --> 00:23:57,744 PERICARDIAL FAT ALSO SEEM TO THE 469 00:23:57,744 --> 00:23:59,546 RISK FOR DIABETES. 470 00:23:59,546 --> 00:24:01,848 SO WE WERE INTERESTED IN 471 00:24:01,848 --> 00:24:10,958 QUANTIFYING VISCERAL ADIPOSITY 472 00:24:10,958 --> 00:24:13,560 AND WE CONDUCTED CT SCANS IN 473 00:24:13,560 --> 00:24:15,262 ABOUT 200 IN EACH GROUP. 474 00:24:15,262 --> 00:24:18,832 WOMEN WHO DID NOT HAVE 475 00:24:18,832 --> 00:24:20,100 CARDIOVASCULAR DISEASE. 476 00:24:20,100 --> 00:24:22,402 YOU'LL SEE THE FILIPINO WOMEN 477 00:24:22,402 --> 00:24:24,338 WERE SLIGHTLY YOUNGER, THEY HAD 478 00:24:24,338 --> 00:24:28,175 HIGHER COLLEGE ATTAINMENT 479 00:24:28,175 --> 00:24:30,410 CONSISTENT WITH NATIONAL DATA, 480 00:24:30,410 --> 00:24:33,013 WERE LESS LIKELY TO HAVE EVER 481 00:24:33,013 --> 00:24:35,048 SMOKED. 482 00:24:35,048 --> 00:24:35,782 DON'T DRINK ALCOHOL AND THEIR 483 00:24:35,782 --> 00:24:37,184 EXERCISE FREQUENCY WAS SIMILAR 484 00:24:37,184 --> 00:24:38,552 TO WHITES SO YOU'D EXPECT THEM 485 00:24:38,552 --> 00:24:43,957 TO HAVE OPTIMAL OUTCOMES. 486 00:24:43,957 --> 00:24:46,059 WE LOOKED AT ANTHROPOMETRIC 487 00:24:46,059 --> 00:24:49,229 MEASURES AND BLACK WOMEN HAD THE 488 00:24:49,229 --> 00:24:53,834 LARGEST BMI AND WAIST GIRTH AND 489 00:24:53,834 --> 00:24:56,136 TRUNKAL FAT AND LOOK AT DIABETES 490 00:24:56,136 --> 00:24:59,906 PREVALENCE WAS HIGHEST AMONG 491 00:24:59,906 --> 00:25:03,610 FILIPINAS ONE OUT OF THREE 492 00:25:03,610 --> 00:25:06,613 INTERMEDIATE AND LOWEST IN BLACK 493 00:25:06,613 --> 00:25:09,516 WOMEN AND MEASURED ADIPOSE 494 00:25:09,516 --> 00:25:13,253 TISSUE AND HIGHER AMONG 495 00:25:13,253 --> 00:25:15,856 FILIPINAS WHERE IN BLACK WOMEN 496 00:25:15,856 --> 00:25:20,560 THE EXCESS WAS IN SUB CUTANEOUS 497 00:25:20,560 --> 00:25:20,761 FATS. 498 00:25:20,761 --> 00:25:21,461 HERE'S MEASURES. 499 00:25:21,461 --> 00:25:24,898 ON THE LEFT WAS A MILLIMETER 500 00:25:24,898 --> 00:25:29,303 SLICE BETWEEN THE L4 AND L5 501 00:25:29,303 --> 00:25:37,244 VERTEBRAE BELONGING TO A 502 00:25:37,244 --> 00:25:38,545 65-YEAR-OLD BLACK WOMEN AND A' 503 00:25:38,545 --> 00:25:43,350 5'7", 160 POUND AND COMPARED TO 504 00:25:43,350 --> 00:25:51,725 A FILIPINA 5'4", 115 POUNDS AND 505 00:25:51,725 --> 00:25:53,493 HAD MORE THAN THREE TIMES THE 506 00:25:53,493 --> 00:25:56,763 VOLUME OF VISCERAL ADIPOSE 507 00:25:56,763 --> 00:25:57,364 TISSUE COMPARED TO THE BLACK 508 00:25:57,364 --> 00:26:03,303 WOMAN. 509 00:26:03,303 --> 00:26:08,275 THIS PERSISTED AT EVERY LEVEL OF 510 00:26:08,275 --> 00:26:09,276 WAIST GIRTH. 511 00:26:09,276 --> 00:26:12,612 THIS IS ADIPOSE TISSUE AMONG 512 00:26:12,612 --> 00:26:16,550 WOMEN DEFINED WITH A BMI LESS 513 00:26:16,550 --> 00:26:21,655 THAN 23 IN PHILIPFIPHILIPPINE'S 514 00:26:21,655 --> 00:26:24,791 BLACK WOMEN AT EVERY WAIST 515 00:26:24,791 --> 00:26:31,231 CIRCUMFERENCE AT THE LEAST 516 00:26:31,231 --> 00:26:33,800 VISCERAL FAT AND FILIPINA WOMEN 517 00:26:33,800 --> 00:26:36,069 HAD THE MOST AND THIS REDEFINES 518 00:26:36,069 --> 00:26:38,071 WHO IS OVERWEIGHT AND 519 00:26:38,071 --> 00:26:39,773 METABOLICALLY HEALTHIER AT A 520 00:26:39,773 --> 00:26:42,943 HIGHER BMI AND THE OBSERVATION 521 00:26:42,943 --> 00:26:48,382 OF LOWER VISCERAL ADIPOSITY HAS 522 00:26:48,382 --> 00:26:52,652 BEEN OBSERVED IN THE U.K. AND 523 00:26:52,652 --> 00:26:55,088 CARIBBEAN AND BRAZIL AMONG 524 00:26:55,088 --> 00:26:56,289 AFRICAN AMERICANS. 525 00:26:56,289 --> 00:27:00,293 AND FILIPINAS HAD MORE 526 00:27:00,293 --> 00:27:02,996 PERICARDIAL FAT THAN WHITE AND 527 00:27:02,996 --> 00:27:03,430 BLACK PARTICIPANTS. 528 00:27:03,430 --> 00:27:06,867 IN THE MESA STUDY YOU SEE IN 529 00:27:06,867 --> 00:27:08,435 CHART D CHINESE AMERICANS HAD 530 00:27:08,435 --> 00:27:12,172 MORE PERICARDIAL FAT COMPARED TO 531 00:27:12,172 --> 00:27:14,941 AFRICAN AMERICANS AND SOUTH 532 00:27:14,941 --> 00:27:15,208 ASIAIANS. 533 00:27:15,208 --> 00:27:18,912 WHITES ALSO HAD EXCESS 534 00:27:18,912 --> 00:27:20,847 PERICARDIAL FAT AND EXCESS SUB 535 00:27:20,847 --> 00:27:22,949 CUTANEOUS FAT WAS ALSO PRESENT 536 00:27:22,949 --> 00:27:23,784 AMONG BLACK PARTICIPANTS IN THE 537 00:27:23,784 --> 00:27:31,024 MESA STUDY. 538 00:27:31,024 --> 00:27:33,126 THIS COMPARES MASALA DATA AND 539 00:27:33,126 --> 00:27:38,064 SOUTH ASIANS HAD MORE LIVER FAT, 540 00:27:38,064 --> 00:27:42,335 MORE VISCERAL FAT AS WELL AS 541 00:27:42,335 --> 00:27:43,637 CHINESE AMERICANS AND AFRICAN 542 00:27:43,637 --> 00:27:45,238 AMERICANS HAD THE LEAST AND 543 00:27:45,238 --> 00:27:49,509 SOUTH ASIANS HAD MORE -- LESS 544 00:27:49,509 --> 00:27:53,180 LEAN MASS AND MORE INTRAMUSCULAR 545 00:27:53,180 --> 00:27:55,015 FAT AND THE FAT DISTRIBUTION 546 00:27:55,015 --> 00:27:55,949 EXACERBATES THE RISK FOR INSULIN 547 00:27:55,949 --> 00:28:01,788 RESISTANCE. 548 00:28:01,788 --> 00:28:03,356 IN THE NORMAL WEIGHT CATEGORY 549 00:28:03,356 --> 00:28:04,891 YOU'LL IN THE IN THE RED DOTS UP 550 00:28:04,891 --> 00:28:09,529 TO HALF, 40% OF SOUTH ASIANS 551 00:28:09,529 --> 00:28:11,965 WERE OF NORMAL BMI BUT 552 00:28:11,965 --> 00:28:18,472 METABOLICALLY ABNORMAL. 553 00:28:18,472 --> 00:28:22,676 SO WHAT IS ABOUT VISCERAL 554 00:28:22,676 --> 00:28:22,943 ADIPOSITY? 555 00:28:22,943 --> 00:28:25,078 IT'S NOT JUST A PLACE WHERE WE 556 00:28:25,078 --> 00:28:27,180 STORE EXCESS CALORIES BUT AN 557 00:28:27,180 --> 00:28:30,350 ACTIVE ENDOCRINE ORAN AND WE 558 00:28:30,350 --> 00:28:34,120 LOOK AT TNL6 AND WERE INTERESTED 559 00:28:34,120 --> 00:28:37,257 IN WHAT IS DOWNREGULATED IN THE 560 00:28:37,257 --> 00:28:43,263 EXCESS OF EXCESS VISCERAL 561 00:28:43,263 --> 00:28:49,035 ADIPOSE TISSUE AROUND ADDED 562 00:28:49,035 --> 00:28:52,038 ADIPONECTIN AND FILIPINAS HAD 563 00:28:52,038 --> 00:28:55,809 HALF COMPARED TO WHITES AND 564 00:28:55,809 --> 00:29:00,146 BLACKS HAD LESS EVEN ADJUSTING 565 00:29:00,146 --> 00:29:03,116 FOR INSULIN AND INSULIN 566 00:29:03,116 --> 00:29:11,024 RESISTANCE AND ANTHROPO METRIC 567 00:29:11,024 --> 00:29:14,060 STANDARDS AND A STUDY IN THE 568 00:29:14,060 --> 00:29:17,664 PHILIPPINES IDENTIFIED A 569 00:29:17,664 --> 00:29:22,269 POLYMORPHISM THAT SEEMED TO 570 00:29:22,269 --> 00:29:25,238 EXPLAIN THE LOWER ADIPONECTIN 571 00:29:25,238 --> 00:29:29,075 LEVELS AND THEY WERE ABLE TO 572 00:29:29,075 --> 00:29:30,977 IDENTIFY LONGITUDINAL 573 00:29:30,977 --> 00:29:32,913 ASSOCIATION BETWEEN VISCERAL 574 00:29:32,913 --> 00:29:36,650 ADIPOSITY AND THE RISK OF TYPE 2 575 00:29:36,650 --> 00:29:42,756 DIABETES EVEN AFTER 10 YEARS AND 576 00:29:42,756 --> 00:29:47,093 THE CHANGE IS ASSOCIATED WITH A 577 00:29:47,093 --> 00:29:48,428 GREATER RISK OF DEVELOPING TYPE 578 00:29:48,428 --> 00:29:49,229 2 DIABETES AFTER 10 YEARS. 579 00:29:49,229 --> 00:29:52,666 NEXT I'D LIKE TO TALK ABOUT IN 580 00:29:52,666 --> 00:30:00,907 UTERO EXPOSURES. 581 00:30:00,907 --> 00:30:02,943 AND MALNUTRITION IS ASSOCIATED 582 00:30:02,943 --> 00:30:06,880 WITH VISCERAL ADIPOSITY. 583 00:30:06,880 --> 00:30:09,616 WE WANTED TO LOOK AT 584 00:30:09,616 --> 00:30:12,619 INTERNATIONAL STUDIES. 585 00:30:12,619 --> 00:30:15,121 SO OUR COHORT IN SAN DIEGO WERE 586 00:30:15,121 --> 00:30:16,890 PREDOMINANTLY IMMIGRANTS. 587 00:30:16,890 --> 00:30:21,194 WE COMPARED BMI AND FASTING 588 00:30:21,194 --> 00:30:23,229 HYPERGLYCEMIA AND ODTT MEASURES 589 00:30:23,229 --> 00:30:26,766 TO THIRD GENERATION FILIPINOS IN 590 00:30:26,766 --> 00:30:29,769 HAWAI'I INCLUDING THE 591 00:30:29,769 --> 00:30:31,972 PHILIPPINES FROM THE SAME 592 00:30:31,972 --> 00:30:33,673 REGIONS FROM WHERE OUR 593 00:30:33,673 --> 00:30:34,941 PARTICIPANTS PARTICIPATED AND IT 594 00:30:34,941 --> 00:30:37,711 WAS LOWER IN THE PHILIPPINES AND 595 00:30:37,711 --> 00:30:39,613 INDIMMEDIATE IN SAN DIEGO AND 596 00:30:39,613 --> 00:30:40,880 HIGHEST IN HAWAI'I. 597 00:30:40,880 --> 00:30:43,183 OBESITY PREVALENCE WAS HIGHEST 598 00:30:43,183 --> 00:30:44,884 AMONG THIRD GENERATION FILIPINOS 599 00:30:44,884 --> 00:30:50,657 IN HAWAI'I BUT NO DIFFERENCE IN 600 00:30:50,657 --> 00:30:52,559 FASTING HYPERGLYCEMIA AND NO 601 00:30:52,559 --> 00:30:55,295 DIFFERENCE IN DIABETES BY ORAL 602 00:30:55,295 --> 00:30:56,763 GLUCOSE TOLERANCE TEST WHICH 603 00:30:56,763 --> 00:30:59,432 LEADS US TO BELIEVE THERE MAY BE 604 00:30:59,432 --> 00:31:01,568 A ROLE IN THE RELATIONSHIP 605 00:31:01,568 --> 00:31:02,502 BETWEEN COLONIZATION AND TYPE 2 606 00:31:02,502 --> 00:31:08,408 DIABETES. 607 00:31:08,408 --> 00:31:13,413 SO NATIVE HAWAIIANS AND PACIFIC 608 00:31:13,413 --> 00:31:16,182 ISLANDERS AND INDIA AS A U.K. 609 00:31:16,182 --> 00:31:19,252 COLONY, OUR EXPOSURE TO A 610 00:31:19,252 --> 00:31:23,356 WESTERN LIFESTYLE AND DIET 611 00:31:23,356 --> 00:31:25,558 OCCURRED BACK HOME AND NOT HERE 612 00:31:25,558 --> 00:31:27,560 AND WHY WE'RE NOT SEEING A 613 00:31:27,560 --> 00:31:29,629 DIFFERENCE UP DIABETES RISK OR 614 00:31:29,629 --> 00:31:32,365 BODY SIZE, CERTAINLY. 615 00:31:32,365 --> 00:31:34,901 WE ALSO LOOKED AT DURATION OF 616 00:31:34,901 --> 00:31:37,270 YEARS IN THE UNITED STATES. 617 00:31:37,270 --> 00:31:40,807 SO STUDIES AMONG PUERTO RICOS, 618 00:31:40,807 --> 00:31:42,676 FOR EXAMPLE, SHOW SIMILAR 619 00:31:42,676 --> 00:31:44,177 PATTERNS WHERE ACCULTURATION 620 00:31:44,177 --> 00:31:46,980 TAKES PLACE IN THE HOME COUNTRY 621 00:31:46,980 --> 00:31:49,282 THERE IS NO DIFFERENCE IN BMI. 622 00:31:49,282 --> 00:31:52,919 IF YOU'VE LIVED IN THE U.S. A 623 00:31:52,919 --> 00:31:54,754 LONG TIME OR RECENT IMFRANT 624 00:31:54,754 --> 00:31:56,856 THERE WAS NO DIFFERENCE IN BODY 625 00:31:56,856 --> 00:32:02,195 FAT PERCENTAGE BY DEXA OR IN 626 00:32:02,195 --> 00:32:09,903 TRUNKLE FAT OR TYPE 2 DIABETES. 627 00:32:09,903 --> 00:32:11,738 GESTATIONAL DIABETES WILL 628 00:32:11,738 --> 00:32:13,707 EXACERBATE YOUR RISK FOR 629 00:32:13,707 --> 00:32:14,407 DIABETES. 630 00:32:14,407 --> 00:32:16,843 KAISER DATA SHOWED AMONG 200,000 631 00:32:16,843 --> 00:32:19,145 BIRTHS, ASIAN INDIANS HAD THE 632 00:32:19,145 --> 00:32:21,247 HIGHEST PREVALENCE OF 633 00:32:21,247 --> 00:32:22,482 GESTATIONAL DIABETES 20 YEARS 634 00:32:22,482 --> 00:32:26,920 AGO FOLLOWED BY FILIPINAS, 635 00:32:26,920 --> 00:32:28,755 SOUTHEAST ASIANS AND SUB GROUPS 636 00:32:28,755 --> 00:32:32,459 IN BLUE AND HIGHER THAN LATINO, 637 00:32:32,459 --> 00:32:36,663 BLACKS AND WHITES AND 638 00:32:36,663 --> 00:32:39,099 PRE-GESTATIONAL DIABETES IS A 639 00:32:39,099 --> 00:32:40,900 RISK FACTOR FOR BDM. 640 00:32:40,900 --> 00:32:43,369 THE RISK FOR DIABETES OCCURS 641 00:32:43,369 --> 00:32:46,406 DURING FEETAL DEVELOPMENT AND 642 00:32:46,406 --> 00:32:48,007 RESULTS IN POOR BETA CELL 643 00:32:48,007 --> 00:32:50,610 FUNCTION AND DIFFERENTSES IN 644 00:32:50,610 --> 00:32:55,048 BODY FAT AND REGIONAL ADIPOSITY 645 00:32:55,048 --> 00:32:58,752 RESULTING IN IMPAIRED INSULIN 646 00:32:58,752 --> 00:33:02,188 SECRETION OR ACTION AND THAT'S 647 00:33:02,188 --> 00:33:04,457 EXACERBATED BY ENVIRONMENTAL AND 648 00:33:04,457 --> 00:33:09,696 EPIGENETIC FACTORS AS WELL. 649 00:33:09,696 --> 00:33:12,832 RECENT DATA AND THIS WAS AS 650 00:33:12,832 --> 00:33:18,938 RECENT AS 2017 SHOWS CURRENTLY 651 00:33:18,938 --> 00:33:20,073 IN CLINICAL RESEARCH IT'S 652 00:33:20,073 --> 00:33:21,374 VIETNAMESE THAT WHO HAVE A HIGH 653 00:33:21,374 --> 00:33:24,344 RISK OF GESTATIONAL DIABETES 654 00:33:24,344 --> 00:33:25,979 ESPECIALLY WITH BMI LESS THAN 655 00:33:25,979 --> 00:33:26,179 23. 656 00:33:26,179 --> 00:33:26,780 YOU SEE THAT HIGHLIGHTED IN 657 00:33:26,780 --> 00:33:34,020 GREEN. 658 00:33:34,020 --> 00:33:36,256 EVEN AMONG WOMEN WITH A GREATER 659 00:33:36,256 --> 00:33:39,459 BMI THAN 33, VIETNAMESE WOMEN 660 00:33:39,459 --> 00:33:41,628 HAD THE HIGHEST PREVALENCE AND 661 00:33:41,628 --> 00:33:45,632 SAMOAN WOMEN HAD THE LOWEST 662 00:33:45,632 --> 00:33:49,702 DESPITE 60% OF THE SAMOAN 663 00:33:49,702 --> 00:33:50,303 PARTICIPANTS WERE CLINICALLY 664 00:33:50,303 --> 00:33:54,741 OBESE. 665 00:33:54,741 --> 00:33:57,677 SOME POLYMORPHISMS HAVE BEEN 666 00:33:57,677 --> 00:33:59,879 IDENTIFIED WITH HIGHER RISK OF 667 00:33:59,879 --> 00:34:00,480 GESTATIONAL DIABETES IN THE 668 00:34:00,480 --> 00:34:05,351 PHILIPPINES AT THE UNIVERSITY OF 669 00:34:05,351 --> 00:34:08,988 SANTRO THOMAS AND POLYMORPHISMS 670 00:34:08,988 --> 00:34:10,423 ASSOCIATED WITH TYPE 2 DIABETES 671 00:34:10,423 --> 00:34:13,293 WERE SHOWN TO BE ASSOCIATED WITH 672 00:34:13,293 --> 00:34:14,594 GESTATIONAL DIABETES AMONG 673 00:34:14,594 --> 00:34:18,998 FILIPINOS AROUND HAWAI'I. 674 00:34:18,998 --> 00:34:20,934 AND THE PRIOR GESTATIONAL ABOUT 675 00:34:20,934 --> 00:34:22,135 THE WAS ASSOCIATED WITH 676 00:34:22,135 --> 00:34:30,810 INCREASED RISK OF ELEVATEDD 677 00:34:30,810 --> 00:34:32,579 GLYCOSYLATED HEMOGLOBINS. 678 00:34:32,579 --> 00:34:34,147 I MENTIONED THE RISK OF DIABETES 679 00:34:34,147 --> 00:34:36,549 STARTING IN INFANCY. 680 00:34:36,549 --> 00:34:42,722 THIS WAS A PAPER REFERRING TO 681 00:34:42,722 --> 00:34:44,057 SOUTH ASIANS AND WANTED TO SHOW 682 00:34:44,057 --> 00:34:46,826 SOME OF OUR DATA WHEN IT COMES 683 00:34:46,826 --> 00:34:49,596 TO IN UTERO AND LIFE COURSE 684 00:34:49,596 --> 00:34:50,496 EXPOSURES. 685 00:34:50,496 --> 00:34:53,499 THE DUTCH HUNGER FAMILY STUDY 686 00:34:53,499 --> 00:34:55,068 SHOWED WOMEN PREGNANT DURING THE 687 00:34:55,068 --> 00:35:01,007 WINTERS OF 1944 AND 1945 WHEN 688 00:35:01,007 --> 00:35:03,543 THE ROADS WERE BLOCKED FOR THE 689 00:35:03,543 --> 00:35:07,080 DELIVERY OF FOOD IN WORLD WAR II 690 00:35:07,080 --> 00:35:09,015 RESULTED IN WOMEN CONSUMING AS 691 00:35:09,015 --> 00:35:11,117 LITTLE AS 500 CALORIES A DAY. 692 00:35:11,117 --> 00:35:14,387 IT WAS SHOWN WHEN THE BABIES 693 00:35:14,387 --> 00:35:17,490 TURNED 60 YEARS OLD, INFANTS IN 694 00:35:17,490 --> 00:35:20,960 THE FIRST TRIMESTER OF GESTATION 695 00:35:20,960 --> 00:35:27,267 DURING THAT WINTER HAD MORE 696 00:35:27,267 --> 00:35:29,302 IMPAIRED INSULIN SECRETION AND 697 00:35:29,302 --> 00:35:32,505 HIGH RISK OF CARDIOVASCULAR 698 00:35:32,505 --> 00:35:33,339 DISEASE. 699 00:35:33,339 --> 00:35:36,309 THERE WAS SIMILAR EVIDENCE THE 700 00:35:36,309 --> 00:35:41,114 CHINESE FAMINE BETWEEN 1959 TO 1 701 00:35:41,114 --> 00:35:44,250 61 SHOWED THOSE ADULTS UP THEIR 702 00:35:44,250 --> 00:35:48,254 EARLY '60s LAD A HIGHER RISK FOR 703 00:35:48,254 --> 00:35:50,256 TYPE 2 DIABETES AS ADULTS. 704 00:35:50,256 --> 00:35:55,261 SOME MECHANISMS HAVE SHOWN IN 705 00:35:55,261 --> 00:36:03,836 MODELS A LOW-PROTEIN DIET ALTERS 706 00:36:03,836 --> 00:36:13,012 M1A IN THE OFFSPRING INCREASING 707 00:36:13,012 --> 00:36:15,782 GLUCOSE AND DIABETES AND THIS IS 708 00:36:15,782 --> 00:36:17,450 FOR PEOPLE IN WAR ENVIRONMENTS 709 00:36:17,450 --> 00:36:20,053 OR DISPLACED OR BY CHOICE WHO 710 00:36:20,053 --> 00:36:21,321 FOLLOW A LOW PROTEIN DIET DURING 711 00:36:21,321 --> 00:36:25,758 GESTATION. 712 00:36:25,758 --> 00:36:29,662 SO WE DIDN'T HAVE ACCESS TO 713 00:36:29,662 --> 00:36:33,833 CALORIC INTAKE BUT THE MAJORITY 714 00:36:33,833 --> 00:36:36,202 WERE ALSO BORN DURING WORLD WAR 715 00:36:36,202 --> 00:36:38,471 II DURING THE JAPANESE 716 00:36:38,471 --> 00:36:40,306 OCCUPATION OF THE PHILIPPINES 717 00:36:40,306 --> 00:36:42,508 AND MEASURED SITTING HEIGHT AND 718 00:36:42,508 --> 00:36:44,510 STANDING HEIGHT AND LEG LENGTH 719 00:36:44,510 --> 00:36:49,716 IS A GOOD PROXY FOR CHILDHOOD 720 00:36:49,716 --> 00:36:50,283 MALNUTRITION. 721 00:36:50,283 --> 00:36:55,154 AND WHAT WE FOUND WAS COMPARED 722 00:36:55,154 --> 00:36:57,357 TO OUR PARTICIPANTS, WE HAVE THE 723 00:36:57,357 --> 00:36:58,758 LONGEST LEG LENGTH. 724 00:36:58,758 --> 00:37:01,561 THE PATIENTS WITH THE SHORTEST 725 00:37:01,561 --> 00:37:04,263 LEG LENGTH HAS THREE TIMES THE 726 00:37:04,263 --> 00:37:06,632 RISK OF CORONARY HEARD DISEASE 727 00:37:06,632 --> 00:37:09,202 TO WOMEN WITH THE LONG EF LEG 728 00:37:09,202 --> 00:37:10,903 LENGTH AND THOSE PATIENTS BORN 729 00:37:10,903 --> 00:37:15,041 BEFORE THE JAPANESE OCCUPATION 730 00:37:15,041 --> 00:37:20,413 WERE 2 CENTIMETERS TALLER THAN 731 00:37:20,413 --> 00:37:21,547 THOSE CONCEIVED DURING THE WAR 732 00:37:21,547 --> 00:37:22,181 OR AFTER. 733 00:37:22,181 --> 00:37:24,751 OTHER RISK FACTORS FOR DIABETES 734 00:37:24,751 --> 00:37:27,553 IN OUR COHORT IS HAVING MORE 735 00:37:27,553 --> 00:37:29,088 THAN SIX LIVE BIRTHS AND THAT'S 736 00:37:29,088 --> 00:37:37,296 INDEPENDENT OF VISCERAL FAT AND 737 00:37:37,296 --> 00:37:46,372 ADIPONECTIN AND INSUFFICIENT 738 00:37:46,372 --> 00:37:46,572 SLEEP. 739 00:37:46,572 --> 00:37:50,176 DEF WE DIDN'T ASK ABOUT SHIFT 740 00:37:50,176 --> 00:37:53,913 WORK FOR NURSES BUT IT MAY 741 00:37:53,913 --> 00:37:58,451 EXPLAIN THE INSUFFICIENT SLEEP 742 00:37:58,451 --> 00:37:59,886 PAP EARNS AND HYPERTENSION AND 743 00:37:59,886 --> 00:38:01,587 FAMILY HISTORY OF DIABETES AND 744 00:38:01,587 --> 00:38:03,589 LAST WEEK'S TALK FOCUSSED ON 745 00:38:03,589 --> 00:38:04,390 SOCIAL AND STRUCTURAL 746 00:38:04,390 --> 00:38:06,626 DETERMINATES OF HEALTH. 747 00:38:06,626 --> 00:38:08,728 AMONG OUR PARTICIPANTS WITHOUT A 748 00:38:08,728 --> 00:38:10,763 FAMILY HISTORY OF TYPE 2 749 00:38:10,763 --> 00:38:12,265 DIABETES, LOWER EDUCATION YOU, 750 00:38:12,265 --> 00:38:15,701 SUSTAINED CHILDHOOD AND 751 00:38:15,701 --> 00:38:16,636 ADULTHOOD, SOCIAL DISADVANTAGE 752 00:38:16,636 --> 00:38:21,874 WERE INDEPENDENTLY WERE 753 00:38:21,874 --> 00:38:23,709 ASSOCIATED WITH A RISK OF 754 00:38:23,709 --> 00:38:24,210 DIABETES STRESSING THE 755 00:38:24,210 --> 00:38:31,050 IMPORTANCE OF INTERVENTION OF 756 00:38:31,050 --> 00:38:33,186 PREVENTION MATERIAL. 757 00:38:33,186 --> 00:38:35,588 THE SITE OF LOW PLASMA 758 00:38:35,588 --> 00:38:42,261 ADIPONECTIN AND ACCUMULATION 759 00:38:42,261 --> 00:38:44,397 SEEMS TO PERSIST AND UP 760 00:38:44,397 --> 00:38:46,532 DEPENDENTLY PREDICT ACCUMULATION 761 00:38:46,532 --> 00:38:49,335 OF VISCERAL ADIPOSITY. 762 00:38:49,335 --> 00:38:52,472 WHAT KIND OF FUTILITY MIGHT 763 00:38:52,472 --> 00:38:55,975 ADIPONECTIN HAVE IN TERMS OF 764 00:38:55,975 --> 00:39:01,080 COMPLIMENTING CURRENT SCREENING 765 00:39:01,080 --> 00:39:01,380 INITIATIVES. 766 00:39:01,380 --> 00:39:04,016 THERE'S SYNTHETIC ADIPONECTIN 767 00:39:04,016 --> 00:39:08,287 WAS EXCITED YEARS AGO ESPECIALLY 768 00:39:08,287 --> 00:39:13,159 LOWERING TRIGLYCERIDES AND WHAT 769 00:39:13,159 --> 00:39:17,296 VALUE MIGHT ADIPONECTIN HAVE IN 770 00:39:17,296 --> 00:39:21,367 AUGMENTING SCREENING. 771 00:39:21,367 --> 00:39:24,170 HERE'S DATA FROM THE PARITY 772 00:39:24,170 --> 00:39:24,370 DATA. 773 00:39:24,370 --> 00:39:27,707 AS WOMEN HAD MORE LIVE BIRTHS 774 00:39:27,707 --> 00:39:32,478 THE BMI INCREASED SLIGHTLY BUT 775 00:39:32,478 --> 00:39:33,980 MORE IMPORTANTLY VISCERAL FAT 776 00:39:33,980 --> 00:39:37,250 INCREASED ONCE YOU HAD AT LEAST 777 00:39:37,250 --> 00:39:39,752 THREE LIVE BIRTHS OR MORE. 778 00:39:39,752 --> 00:39:42,822 AND TYPE 2 DIABETES OCCURRED IN 779 00:39:42,822 --> 00:39:45,324 HALF OF WOMEN WITH SIX OR MORE 780 00:39:45,324 --> 00:39:51,964 CHILDREN. 781 00:39:51,964 --> 00:39:54,734 HAVING MORE BIRTHS WENT TO A 782 00:39:54,734 --> 00:39:58,104 HIGHER RISK OF DIABETES 783 00:39:58,104 --> 00:40:02,708 INDEPENDENT OF VISCERAL FAT OR 784 00:40:02,708 --> 00:40:05,111 ADIPONECTIN AND U.C. SAN DIEGO 785 00:40:05,111 --> 00:40:06,913 WANTED TO LOOK AT FAT 786 00:40:06,913 --> 00:40:08,781 DISTRIBUTION AND AMONG 787 00:40:08,781 --> 00:40:10,249 POST-MENOPAUSAL WOMEN WITH 788 00:40:10,249 --> 00:40:12,919 DIABETES THEY HAD LESS ABDOMINAL 789 00:40:12,919 --> 00:40:15,755 MUSCLE AND SIGNIFICANTLY MORE 790 00:40:15,755 --> 00:40:16,122 ADIPOSE TISSUE. 791 00:40:16,122 --> 00:40:18,524 WHAT ARE THE IMPLICATIONS FOR 792 00:40:18,524 --> 00:40:19,358 INTERVENTIONS? 793 00:40:19,358 --> 00:40:21,427 PERHAPS INCREASE BEING MUSCLE 794 00:40:21,427 --> 00:40:24,363 MASS MIGHT BE AN EFFECTIVE 795 00:40:24,363 --> 00:40:25,598 INTERVENTION INSTEAD OF LOSING 796 00:40:25,598 --> 00:40:26,632 WEIGHT. 797 00:40:26,632 --> 00:40:32,205 HOW DO YOU CONVINCE A WOMAN WITH 798 00:40:32,205 --> 00:40:35,374 BMI OF 20 AND SMALL WAIST SHE 799 00:40:35,374 --> 00:40:41,314 NEEDS MUSCLE AND BUT IT MAY 800 00:40:41,314 --> 00:40:42,315 DELAY INSULIN RESISTANCE AND 801 00:40:42,315 --> 00:40:51,457 THERE WAS A STUDY ONGOING AT 802 00:40:51,457 --> 00:40:52,825 STANFORD AND ONE GROUP WAS 803 00:40:52,825 --> 00:40:55,528 RANDOMIZED TO STRENGTH STRAINING 804 00:40:55,528 --> 00:40:59,232 AND ONE EXERCISE AND A THIRD WAS 805 00:40:59,232 --> 00:41:00,933 A COMBINATION AND MAY BE AN 806 00:41:00,933 --> 00:41:04,337 INVENTION THAT LOW BMI 807 00:41:04,337 --> 00:41:06,872 PARTICIPANTS MAY BE RECEPTIVE 808 00:41:06,872 --> 00:41:07,039 TO. 809 00:41:07,039 --> 00:41:10,676 HERE'S SOME OF YOU ARE SLEEP 810 00:41:10,676 --> 00:41:12,545 DATA BY A Ph.D. STUDENT AT THE 811 00:41:12,545 --> 00:41:14,880 TIME NOW FACULTY. 812 00:41:14,880 --> 00:41:17,350 YOU'LL SEE THE SLEEP DEFICIENCY 813 00:41:17,350 --> 00:41:20,353 AMONG FILIPINAS WITH ALMOST 60% 814 00:41:20,353 --> 00:41:24,290 SLEEPING LESS THAN SEVEN HOURS. 815 00:41:24,290 --> 00:41:25,291 A FOURTH SLEEPING LESS THAN SIX 816 00:41:25,291 --> 00:41:29,996 HOURS. 817 00:41:29,996 --> 00:41:32,531 THEN WITH REWARDS TO 818 00:41:32,531 --> 00:41:35,334 HYPERTENSION, SINCE 1984 819 00:41:35,334 --> 00:41:37,303 FILIPINOS AND AFRICAN AMERICANS 820 00:41:37,303 --> 00:41:39,805 HAVE SUSTAINED THE HIGHEST RISK 821 00:41:39,805 --> 00:41:41,807 FOR HIGH BLOOD PRESSURE IN 822 00:41:41,807 --> 00:41:42,108 CALIFORNIA. 823 00:41:42,108 --> 00:41:46,245 AND THESE ARE KAISER DATA. 824 00:41:46,245 --> 00:41:49,882 YOU'LL SEE BLACKS IN BLUE AND 825 00:41:49,882 --> 00:41:52,852 FILIPINOS IN THE OLIVE COLOR AND 826 00:41:52,852 --> 00:41:55,955 THEY'RE CLOSE TO EACH OTHER 827 00:41:55,955 --> 00:41:57,590 AMONG WOMEN ACROSS ALL AGE 828 00:41:57,590 --> 00:42:01,694 CATEGORIES AND AMONG MEN THE 829 00:42:01,694 --> 00:42:04,330 HYPERTENSION PREVALENCE FOR 830 00:42:04,330 --> 00:42:06,332 BLACK AND FILIPINO MEN ARE 831 00:42:06,332 --> 00:42:06,632 IDENTICAL. 832 00:42:06,632 --> 00:42:10,303 SO HOW CAN WE IMPROVE 833 00:42:10,303 --> 00:42:11,537 HYPERTENSION CONTROL AS A 834 00:42:11,537 --> 00:42:16,309 MENTION TO PREVENT DIABETES. 835 00:42:16,309 --> 00:42:18,911 IN 2021 WE HAD THE OPPORTUNITY 836 00:42:18,911 --> 00:42:22,515 TO GATHER ALL THE DIABETES AND 837 00:42:22,515 --> 00:42:23,182 METABOLIC ABNORMALITY RESEARCH 838 00:42:23,182 --> 00:42:28,321 LED BY DR. KANIA FROM THE MASALA 839 00:42:28,321 --> 00:42:29,588 STUDY AND IDENTIFY GAPS, 840 00:42:29,588 --> 00:42:32,425 CHALLENGES AND OPPORTUNITIES IN 841 00:42:32,425 --> 00:42:35,161 HEALTH AND PREVENTION FOR 842 00:42:35,161 --> 00:42:35,428 AMERICANS. 843 00:42:35,428 --> 00:42:40,666 WE WERE SO DLATED TO SHARE OUR 844 00:42:40,666 --> 00:42:44,203 WORK WITH NIH AND NHLBI AND WERE 845 00:42:44,203 --> 00:42:48,007 THRILLED WHEN THE ANNOUNCEMENT 846 00:42:48,007 --> 00:42:52,545 CAME OUT FOR A NEW EPIDEMIOLOGIC 847 00:42:52,545 --> 00:42:55,548 COHORT AMONG NATIVE HAWAIIANS 848 00:42:55,548 --> 00:42:59,018 AND PACIFIC ISLANDERS AND OTHERS 849 00:42:59,018 --> 00:43:00,519 AND ENROLLMENT IS ALREADY WITH 850 00:43:00,519 --> 00:43:02,054 SITES SELECTED AND COORDINATING 851 00:43:02,054 --> 00:43:04,457 CENTERS AND CLINIC CENTERS AND 852 00:43:04,457 --> 00:43:06,992 WE LOOK FORWARD TO A NATIONAL 853 00:43:06,992 --> 00:43:09,428 STUDY THAT COULD HELP US FURTHER 854 00:43:09,428 --> 00:43:11,897 ELUCIDATE THE ETIOLOGY AND 855 00:43:11,897 --> 00:43:15,000 PATHOPHYSIOLOGY AND 856 00:43:15,000 --> 00:43:18,270 OPPORTUNITIES FOR TREATMENT AND 857 00:43:18,270 --> 00:43:19,672 MANAGEMENT AMONG ASIAN AMERICANS 858 00:43:19,672 --> 00:43:21,807 WITH DIABETES. 859 00:43:21,807 --> 00:43:27,513 SO THIS IS THE NEW NHLBI STUDY 860 00:43:27,513 --> 00:43:29,482 THAT FOCUSES ON P.I. 861 00:43:29,482 --> 00:43:32,885 COMMUNITIES. 862 00:43:32,885 --> 00:43:38,324 I LEARNED A FEW DAYS AGO A 863 00:43:38,324 --> 00:43:40,426 DIRECTOR FOR NATIVE HAWAIIAN 864 00:43:40,426 --> 00:43:43,329 PACIFIC ISLANDER HEALTH IS BEING 865 00:43:43,329 --> 00:43:46,499 RECRUITED BY NIMHD. 866 00:43:46,499 --> 00:43:49,168 THESE STUDIES WERE COLLECTIVELY 867 00:43:49,168 --> 00:43:51,637 FUNDED BY DIFFERENT INSTITUTES 868 00:43:51,637 --> 00:43:54,039 OF NIH, THE AMERICAN HEART 869 00:43:54,039 --> 00:43:54,673 ASSOCIATION AND THE DEPARTMENT 870 00:43:54,673 --> 00:43:55,307 OF VETERAN AFFAIRS. 871 00:43:55,307 --> 00:44:04,884 THANK YOU. 872 00:44:04,884 --> 00:44:09,422 >> SO ANYONE HAS ANY QUESTIONS, 873 00:44:09,422 --> 00:44:10,189 PLEASE. 874 00:44:10,189 --> 00:44:15,027 >> HI, DR. ARANETA I ENJOYED THE 875 00:44:15,027 --> 00:44:15,227 TALK. 876 00:44:15,227 --> 00:44:17,363 IT'S QUITE ENLIGHTENING. 877 00:44:17,363 --> 00:44:19,999 I HAVE A FAMILY HISTORY OF 878 00:44:19,999 --> 00:44:23,169 DIABETES AND MONITOR MY 879 00:44:23,169 --> 00:44:24,603 HEMOGLOBIN A1C SO MAYBE THAT'S 880 00:44:24,603 --> 00:44:25,738 NOT ENOUGH. 881 00:44:25,738 --> 00:44:28,707 THE QUESTION I HAVE FOR YOU IS 882 00:44:28,707 --> 00:44:30,276 IN LIGHT OF A LOT OF DIFFERENCES 883 00:44:30,276 --> 00:44:32,445 YOU HAVE SHOWN WITH THE ASIAN 884 00:44:32,445 --> 00:44:34,213 POPULATION, HOW DIFFERENT FROM 885 00:44:34,213 --> 00:44:37,316 THE WHITE AND BLACK POPULATION 886 00:44:37,316 --> 00:44:39,485 IN TERMS OF DIAGNOSIS. 887 00:44:39,485 --> 00:44:42,288 HAVE YOU LOOKED AT THE AREA OF 888 00:44:42,288 --> 00:44:43,989 EARLY TREATMENT OF PRE-DIABETES 889 00:44:43,989 --> 00:44:45,524 AND DIABETES BECAUSE THERE'S 890 00:44:45,524 --> 00:44:46,659 BEEN A LOT OF DISCUSSION WHETHER 891 00:44:46,659 --> 00:44:48,828 WE SHOULD BE MORE PROACTIVE IN 892 00:44:48,828 --> 00:44:52,998 TREATING PEOPLE WITH EARLY OR 893 00:44:52,998 --> 00:44:53,299 PREDIABETES. 894 00:44:53,299 --> 00:44:54,633 I WONDER WHETHER THERE'S SOME 895 00:44:54,633 --> 00:44:58,170 AREA THAT WOULD BE RELEVANT 896 00:44:58,170 --> 00:44:59,572 ESPECIALLY FOR ASIAN AMERICAN 897 00:44:59,572 --> 00:45:03,609 WITH HIGH LIKELIHOOD OF DIABETES 898 00:45:03,609 --> 00:45:05,611 WHETHER THAT SHOULD BE MORE 899 00:45:05,611 --> 00:45:06,846 PROGRESSIVE OR ACTIVE IN 900 00:45:06,846 --> 00:45:08,247 TREATING AND MONITORING THEM. 901 00:45:08,247 --> 00:45:10,549 >> THE DIABETES PREVENTION 902 00:45:10,549 --> 00:45:15,054 PROGRAM THE DPP STUDY WHICH WAS 903 00:45:15,054 --> 00:45:19,458 STARTED OVER 20 YEARS AGO 904 00:45:19,458 --> 00:45:21,393 RANDOMIZED PREDIABETIC ADULTS TO 905 00:45:21,393 --> 00:45:23,596 A LIFESTYLE INTERVENTION 906 00:45:23,596 --> 00:45:25,564 INCLUDING EXERCISING 150 MINUTES 907 00:45:25,564 --> 00:45:27,967 A WEEK PLUS LOSING 7% OF YOUR 908 00:45:27,967 --> 00:45:31,303 WEIGHT OR METFORMIN OR PLACEBO. 909 00:45:31,303 --> 00:45:33,539 WHAT THEY FOUND WAS THERE WAS A 910 00:45:33,539 --> 00:45:36,575 HUGE BETWEEN FIT TO LIFESTYLE 911 00:45:36,575 --> 00:45:38,277 INTERVENTIONS INCLUDING AMONG 912 00:45:38,277 --> 00:45:43,148 LOW BMI PARTICIPANTS AND ASIAN 913 00:45:43,148 --> 00:45:43,816 PARTICIPANTS. 914 00:45:43,816 --> 00:45:45,351 METFORMIN SEEMED TO BE LESS 915 00:45:45,351 --> 00:45:50,489 EFFECTIVE IN A SIMILAR CPP STUDY 916 00:45:50,489 --> 00:45:52,291 IN INDIA AND ANOTHER LOCATION. 917 00:45:52,291 --> 00:45:53,259 THE FIRST INTERVENTION 918 00:45:53,259 --> 00:45:56,262 PARTICIPANTS MAY BE RECEPTIVE TO 919 00:45:56,262 --> 00:45:57,429 BECAUSE IT WAS MORE EFFICACIOUS 920 00:45:57,429 --> 00:45:59,798 IS A LIFESTYLE INTERVENTION. 921 00:45:59,798 --> 00:46:02,468 AND AGAIN, I THINK THE PUBLIC 922 00:46:02,468 --> 00:46:05,671 HEALTH MESSAGE HAS ALWAYS BEEN 923 00:46:05,671 --> 00:46:06,705 LOSE WEIGHT, EXERCISE BUT MAYBE 924 00:46:06,705 --> 00:46:09,375 IT'S THE TYPE OF EXERCISE AND 925 00:46:09,375 --> 00:46:12,478 ONCE THE NUMBERS FOR THE 926 00:46:12,478 --> 00:46:14,280 STRENGTH TRAINING DATA ARE 927 00:46:14,280 --> 00:46:16,081 INCREASED, IT MAY BE WORTHWHILE 928 00:46:16,081 --> 00:46:18,117 TO CONSIDER THAT BUT ALSO TO 929 00:46:18,117 --> 00:46:19,418 PROMOTE THAT IN COMMUNITIES. 930 00:46:19,418 --> 00:46:23,155 MANY OF OUR PARTICIPANTS WITH 26 931 00:46:23,155 --> 00:46:24,757 INCH WAISTLINES WILL TELL YOU, I 932 00:46:24,757 --> 00:46:27,793 DON'T NEED TO LOSE WEIGHT AND ON 933 00:46:27,793 --> 00:46:31,864 TV WHAT I HEAR IS AS IT ONLY THE 934 00:46:31,864 --> 00:46:32,698 OVERWEIGHT PEOPLE OR THEY'LL 935 00:46:32,698 --> 00:46:34,166 WALK BUT HAVEN'T HEARD THE 936 00:46:34,166 --> 00:46:35,734 BENEFITS OF STRENGTH TRAINING TO 937 00:46:35,734 --> 00:46:36,969 IMPROVE INSULIN SIGNAL. 938 00:46:36,969 --> 00:46:38,070 AND ALSO DIET. 939 00:46:38,070 --> 00:46:42,174 >> AND DIET. 940 00:46:42,174 --> 00:46:42,875 SO DIET WAS INTERESTING BECAUSE 941 00:46:42,875 --> 00:46:46,779 THE QUESTIONS WE OFTEN GET IS 942 00:46:46,779 --> 00:46:48,213 MUST BE THE RICE. 943 00:46:48,213 --> 00:46:50,716 AMONG 453 PARTICIPANTS WE TRIED 944 00:46:50,716 --> 00:46:54,086 TO LOOK AT DIFFERENCES BETWEEN 945 00:46:54,086 --> 00:46:56,155 PARTICIPANTS WHO ATE ONE TO TWO 946 00:46:56,155 --> 00:46:58,057 CUPS OF RICE PER DAY VERSUS LESS 947 00:46:58,057 --> 00:46:59,792 THAN HALF A COUP. 948 00:46:59,792 --> 00:47:04,029 WE HAD ZERO PEOPLE TO SAY I'LL 949 00:47:04,029 --> 00:47:05,664 EAT RICE. 950 00:47:05,664 --> 00:47:08,400 WHAT WE DID FIND AMONG DIABETICS 951 00:47:08,400 --> 00:47:12,638 VERSUS NON-DIABETICS IN 952 00:47:12,638 --> 00:47:16,542 FILIPINOS IS LOWER CAFFEINE AND 953 00:47:16,542 --> 00:47:20,646 LOWER DAIRY INTAKE WAS 954 00:47:20,646 --> 00:47:21,847 ASSOCIATED WITH HIGHER DIABETES 955 00:47:21,847 --> 00:47:24,717 SO LATTES ARE GOOD FOR YOU AND 956 00:47:24,717 --> 00:47:28,387 WE HAD A STUDENT, SHEENA LADINA 957 00:47:28,387 --> 00:47:31,690 LOOKING AT ADIPONECTIN 958 00:47:31,690 --> 00:47:33,092 CONCENTRATION. 959 00:47:33,092 --> 00:47:35,961 MONOUNSATURATED, POLY 960 00:47:35,961 --> 00:47:37,329 UNSATURATED, OMEGA 3 AND 6 961 00:47:37,329 --> 00:47:41,333 LEVELS WERE INVERSELY ASSOCIATED 962 00:47:41,333 --> 00:47:42,167 WITH ADIPONECTIN. 963 00:47:42,167 --> 00:47:42,901 THAT WAS CROSS SECTIONAL. 964 00:47:42,901 --> 00:47:44,770 WE DIDN'T HAVE A CHANCE TO LOOK 965 00:47:44,770 --> 00:47:47,239 AT IT PROSPECTIVELY BUT THAT 966 00:47:47,239 --> 00:47:50,009 MIGHT EXPLAIN SOME OF THE 967 00:47:50,009 --> 00:47:50,576 OPPORTUNITIES FOR DIETARY 968 00:47:50,576 --> 00:47:55,214 INTERVENTIONS. 969 00:47:55,214 --> 00:47:56,415 >> RAPHAEL FROM NHLBI. 970 00:47:56,415 --> 00:47:58,617 FIRST, THANK YOU FOR A WONDERFUL 971 00:47:58,617 --> 00:48:01,320 TALK. 972 00:48:01,320 --> 00:48:06,692 I THINK IT WAS ENLIGHTENING I 973 00:48:06,692 --> 00:48:08,961 DIDN'T REALIZE PACIFIC ISLANDER 974 00:48:08,961 --> 00:48:12,197 AND NATIVE HAWAIIANS AND ASIAN 975 00:48:12,197 --> 00:48:14,533 AMERICANS WERE AT HIGHER RISK OF 976 00:48:14,533 --> 00:48:15,467 DIABETES. 977 00:48:15,467 --> 00:48:20,506 THE FIRST PART, WE KNOW APOE 978 00:48:20,506 --> 00:48:22,675 CONTAINING PROTEINS AND INCREASE 979 00:48:22,675 --> 00:48:27,179 THE RISK OF DEVELOPING TYPE 2 980 00:48:27,179 --> 00:48:28,881 DIABETES IN OVER ALL POPULATION 981 00:48:28,881 --> 00:48:31,583 BUT HAS THIS BEEN STUDIED IN 982 00:48:31,583 --> 00:48:32,117 ASIAN AMERICANS? 983 00:48:32,117 --> 00:48:33,786 >> NOT IN OUR COHORT. 984 00:48:33,786 --> 00:48:35,854 I THINK IT MIGHT HAVE BEEN 985 00:48:35,854 --> 00:48:43,328 EVALUATED IN THE MASALA STUDY. 986 00:48:43,328 --> 00:48:46,699 >> HAVE YOU FOUND LIPID 987 00:48:46,699 --> 00:48:47,733 ABNORMALITIES BETWEEN OTHER 988 00:48:47,733 --> 00:48:52,271 ETHNICITIES AND OTHER COHORTS. 989 00:48:52,271 --> 00:48:54,006 >> AFRICAN AMERICANS HAD THE 990 00:48:54,006 --> 00:48:59,311 BEST AND FILIPINOS HAD HIGH 991 00:48:59,311 --> 00:49:03,615 TRIGLYCERIDES AND LOW HDL LEVELS 992 00:49:03,615 --> 00:49:04,817 DESPITE REPORTS OF EXERCISE 993 00:49:04,817 --> 00:49:05,184 FREQUENCY. 994 00:49:05,184 --> 00:49:08,887 >> WE KNOW THE LDL SECRETION IS 995 00:49:08,887 --> 00:49:10,322 ALTERED IN TYPE 2 DIABETES BUT 996 00:49:10,322 --> 00:49:11,924 HAS THIS BEEN STUDIED 997 00:49:11,924 --> 00:49:18,497 SPECIFICALLY BY ETHNICITY? 998 00:49:18,497 --> 00:49:21,233 >> WE DIDN'T MEASURE OTHER THAN 999 00:49:21,233 --> 00:49:21,400 LDL. 1000 00:49:21,400 --> 00:49:22,501 IT MAY BE AN OPPORTUNITY FOR THE 1001 00:49:22,501 --> 00:49:26,438 NEW COHORT. 1002 00:49:26,438 --> 00:49:27,539 >> IN THE SENSE OF PERHAPS 1003 00:49:27,539 --> 00:49:30,776 EITHER CALCULATING LDL WITH THE 1004 00:49:30,776 --> 00:49:38,283 NEW FORMULA OR SMALL DENSE LDL 1005 00:49:38,283 --> 00:49:40,919 TO SEE A DIFFERENCE IN THE LIPID 1006 00:49:40,919 --> 00:49:41,520 BURDEN AND CARDIOVASCULAR 1007 00:49:41,520 --> 00:49:44,590 DISEASE ESPECIALLY IN THIS 1008 00:49:44,590 --> 00:49:44,890 POPULATION. 1009 00:49:44,890 --> 00:49:50,796 >> WE CAN CERTAINLY LOOK AT 1010 00:49:50,796 --> 00:49:51,396 THAT. 1011 00:49:51,396 --> 00:49:52,498 WITH CARDIOVASCULAR DISEASE WE 1012 00:49:52,498 --> 00:49:54,600 ADMINISTERED THE ROSE 1013 00:49:54,600 --> 00:49:57,136 QUESTIONNAIRE AND LOOKED AT 1014 00:49:57,136 --> 00:50:00,973 ARTERY CALCIUM AT FIVE YEARS 1015 00:50:00,973 --> 00:50:05,277 AROUND AT 10 YEARS AND FOUND 1016 00:50:05,277 --> 00:50:08,447 JUST MORE SUBCLINICAL 1017 00:50:08,447 --> 00:50:10,382 ATHEROSCLEROTIC DISEASE AMONG 1018 00:50:10,382 --> 00:50:10,649 FILIPINAS. 1019 00:50:10,649 --> 00:50:12,151 >> THANK YOU SO MUCH. 1020 00:50:12,151 --> 00:50:16,789 >> AND HIGHER RISK FOR 1021 00:50:16,789 --> 00:50:17,356 PROGRESSION 10 YEARS LATER. 1022 00:50:17,356 --> 00:50:23,162 >> THANK YOU. 1023 00:50:23,162 --> 00:50:24,329 >> THANK YOU FOR THE WONDERFUL 1024 00:50:24,329 --> 00:50:24,663 TALK. 1025 00:50:24,663 --> 00:50:31,336 FROM LOOKING AT THE DATA AND 1026 00:50:31,336 --> 00:50:33,806 REVIEWING THE LITERATURE SO 1027 00:50:33,806 --> 00:50:36,275 SOUTH ASIANS HAVE LESS SUB 1028 00:50:36,275 --> 00:50:41,346 CUTANEOUS FAT ADIPO AND POORER 1029 00:50:41,346 --> 00:50:43,315 CELL DYSFUNCTION. 1030 00:50:43,315 --> 00:50:46,084 IN THE SETTING OF CALORIE CASES 1031 00:50:46,084 --> 00:50:46,351 OBVIOUSLY. 1032 00:50:46,351 --> 00:50:48,821 ARE THESE FACTORS SIMILAR ACROSS 1033 00:50:48,821 --> 00:50:50,823 DIFFERENT ETHNICITIES AND 1034 00:50:50,823 --> 00:50:55,127 GENETIC STUDIES REALLY DON'T 1035 00:50:55,127 --> 00:51:00,499 SHOW ANY SPECIFIC -- IF YOU LOOK 1036 00:51:00,499 --> 00:51:03,368 AT THIS TO EXPLAIN THE HIGHER 1037 00:51:03,368 --> 00:51:07,673 RISK. 1038 00:51:07,673 --> 00:51:18,217 GIVEN WHAT WE KNOW WHAT CAN WE 1039 00:51:20,853 --> 00:51:24,223 DO NOW? 1040 00:51:24,223 --> 00:51:26,358 WE CAN LOOK AT SLEEPING AND THE 1041 00:51:26,358 --> 00:51:29,394 PREVALENCE OF DIABETES IS 1042 00:51:29,394 --> 00:51:30,729 EXPLODING SO WHAT SHOULD NIH 1043 00:51:30,729 --> 00:51:35,801 FOCUS ON AND IF YOU LOOK AT FAT 1044 00:51:35,801 --> 00:51:38,303 AND DO A DEX ON ALL OF THEM 1045 00:51:38,303 --> 00:51:41,173 WHICH WE CAN'T DO AND INSTEAD OF 1046 00:51:41,173 --> 00:51:43,408 BMI FOR SOUTH ASIANS WHO LOOK 1047 00:51:43,408 --> 00:51:45,644 LIKE ME ARE MORE FAT IF YOU LOOK 1048 00:51:45,644 --> 00:51:52,451 AT THE AMOUNT OF FAT I HAVE WHAT 1049 00:51:52,451 --> 00:51:55,821 DO WE DO NOW AND WHAT ARE THE 1050 00:51:55,821 --> 00:51:56,655 INTERACTIONS WITH THE DRUGS WE 1051 00:51:56,655 --> 00:52:00,225 HAVE NOW? 1052 00:52:00,225 --> 00:52:03,795 >> THE FIRST STEP IS OPTIMAL 1053 00:52:03,795 --> 00:52:04,062 SCREENING. 1054 00:52:04,062 --> 00:52:09,368 THE H HANES DATA SHOWED 40% OF 1055 00:52:09,368 --> 00:52:12,871 FILIPINOS AND SOUTH EAST ASIANS 1056 00:52:12,871 --> 00:52:14,273 WERE UNDIAGNOSED AND WITH 1057 00:52:14,273 --> 00:52:17,309 EARLIER DETECTION YOU HAVE MORE 1058 00:52:17,309 --> 00:52:19,444 OPPORTUNITIES TO PREVENT MICRO 1059 00:52:19,444 --> 00:52:21,780 AND MACRO DISEASES. 1060 00:52:21,780 --> 00:52:23,515 THERE'S STILL A LOT TO BE 1061 00:52:23,515 --> 00:52:26,084 LEARNED A LOT WHY SOUTH ASIANS 1062 00:52:26,084 --> 00:52:29,288 ACCUMULATE HEPATIC FAT AND 1063 00:52:29,288 --> 00:52:31,690 OTHERS ACCUMULATE ADIPOSE 1064 00:52:31,690 --> 00:52:31,924 TISSUE. 1065 00:52:31,924 --> 00:52:33,325 I THINK THERE'S STILL A LOT OF 1066 00:52:33,325 --> 00:52:41,366 KNOWLEDGE TO BE GAINED BY 1067 00:52:41,366 --> 00:52:42,467 UNDERSTANDING THE MECHANISMS FOR 1068 00:52:42,467 --> 00:52:44,569 THE FAT COMPARTMENTALIZATION AND 1069 00:52:44,569 --> 00:52:45,304 DIET AND EXERCISE THAT COULD 1070 00:52:45,304 --> 00:52:52,010 PREVENT THAT ACCUMULATION. 1071 00:52:52,010 --> 00:52:54,546 MAYBE YOU CAN USE ADIPONECTIN 1072 00:52:54,546 --> 00:52:59,217 FOR CURRENT SCREENING. 1073 00:52:59,217 --> 00:53:02,020 I MET WITH STAFF FROM NIDDK WHO 1074 00:53:02,020 --> 00:53:06,625 WERE ALSO INTERESTED IN LOOKING 1075 00:53:06,625 --> 00:53:10,228 AT OZEMPIC EVEN AMONG LEAN 1076 00:53:10,228 --> 00:53:12,264 INDIVIDUALS TO SEE IF THERE'S A 1077 00:53:12,264 --> 00:53:16,435 BENEFIT TOWARDS REDUCING INSULIN 1078 00:53:16,435 --> 00:53:16,735 RESISTANCE. 1079 00:53:16,735 --> 00:53:19,171 SO I DON'T KNOW WHAT COULD BE 1080 00:53:19,171 --> 00:53:24,242 RECOMMENDED FROM MEDICAL 1081 00:53:24,242 --> 00:53:26,979 MANAGEMENT BUT I THINK RAISING 1082 00:53:26,979 --> 00:53:28,480 AWARENESS OF WHO IS AT RISK TO 1083 00:53:28,480 --> 00:53:32,818 EXPAND THE PUBLIC HEALTH MI 1084 00:53:32,818 --> 00:53:34,686 MESSAGES THAT IT'S NOT JUST 1085 00:53:34,686 --> 00:53:36,254 PEOPLE OVERWEIGHT AT HIGHER 1086 00:53:36,254 --> 00:53:36,455 RISK. 1087 00:53:36,455 --> 00:53:38,724 WHAT CAN THE NIH DO? 1088 00:53:38,724 --> 00:53:42,094 I THINK CREATING THIS NEW 1089 00:53:42,094 --> 00:53:43,662 INAUGURAL COHORT THE NATIONAL 1090 00:53:43,662 --> 00:53:45,697 STUDY OF ASIAN AMERICANS IS A 1091 00:53:45,697 --> 00:53:50,335 BIG STEP WHEREAS PREVIOUSLY WITH 1092 00:53:50,335 --> 00:53:59,911 DR. FUFUGIMOTO THEY USED DIFFERT 1093 00:53:59,911 --> 00:54:04,649 PROTOCOLS AND LABORATORIES. 1094 00:54:04,649 --> 00:54:07,152 A WAY TO SYSTEMATICALLY ADDRESS 1095 00:54:07,152 --> 00:54:08,820 THESE COHORTS USING THE SAME 1096 00:54:08,820 --> 00:54:11,289 PROTOCOL IS A HUGE STEP FOR NIH. 1097 00:54:11,289 --> 00:54:13,525 >> THANK YOU. 1098 00:54:13,525 --> 00:54:14,493 >> THANK YOU. 1099 00:54:14,493 --> 00:54:16,928 >> WE HAVE A FEW ONLINE. 1100 00:54:16,928 --> 00:54:17,596 >> OKAY. 1101 00:54:17,596 --> 00:54:19,531 >> DON'T KNOW IF YOU ANSWERED 1102 00:54:19,531 --> 00:54:22,601 THIS DURING THE DUTCH HUNKER 1103 00:54:22,601 --> 00:54:25,270 CONVERSATION, DOES GESTATIONAL 1104 00:54:25,270 --> 00:54:26,304 DIABETES IN ASIAN AMERICANS 1105 00:54:26,304 --> 00:54:27,139 RAISE THE RISK OF DIABETES FOR 1106 00:54:27,139 --> 00:54:32,811 THEIR CHILDREN? 1107 00:54:32,811 --> 00:54:34,613 I DON'T KNOW. 1108 00:54:34,613 --> 00:54:35,947 GESTATIONAL DIABETES WAS 1109 00:54:35,947 --> 00:54:37,649 ORIGINALLY RECOGNIZED IN 1973, 1110 00:54:37,649 --> 00:54:43,088 THE EARLY 1970s, SO THAT IF 1111 00:54:43,088 --> 00:54:46,958 THERE WAS A GDM MOM BORN THERE 1112 00:54:46,958 --> 00:54:51,263 AND WOULD JUST BE AROUND 50 NOW 1113 00:54:51,263 --> 00:54:56,101 AND IF SHE HAS A CHILD WHOA IS 1114 00:54:56,101 --> 00:54:58,170 -- WHO IS 25, WOULD THAT CHILD 1115 00:54:58,170 --> 00:54:59,671 BE AT RISK OF GDM? 1116 00:54:59,671 --> 00:55:02,074 I THINK IT'S STILL EARLY TO TELL 1117 00:55:02,074 --> 00:55:03,375 BUT MY GUESS IS PROBABLY YES. 1118 00:55:03,375 --> 00:55:07,412 >> OKAY. 1119 00:55:07,412 --> 00:55:09,247 THANK YOU FOR THE COMPREHENSIVE 1120 00:55:09,247 --> 00:55:14,019 TALK IT WAS EYE OPENING FOR ME 1121 00:55:14,019 --> 00:55:16,388 PARTICULARLY THE LOW BMIVE 1122 00:55:16,388 --> 00:55:20,525 ASPECT AND DOES THE DATA 1123 00:55:20,525 --> 00:55:22,561 INCLUDING PEOPLE STILL LIVING IN 1124 00:55:22,561 --> 00:55:25,664 GUAM OR NORTHERN MARIANA 1125 00:55:25,664 --> 00:55:27,365 ISLANDS? 1126 00:55:27,365 --> 00:55:28,100 MY UNDERSTANDING THEIR OBESITY 1127 00:55:28,100 --> 00:55:29,267 AND DIABETES RATES ARE HIGH AND 1128 00:55:29,267 --> 00:55:31,002 THIS IS BLAMED ON THE ADOPTION 1129 00:55:31,002 --> 00:55:33,839 OF U.S. OR NON-TRADITIONAL 1130 00:55:33,839 --> 00:55:34,039 FOODS. 1131 00:55:34,039 --> 00:55:36,141 DO THEY HAVE IMPROVED HEALTH 1132 00:55:36,141 --> 00:55:38,176 OUTCOMES WHEN MOVING TO THE 1133 00:55:38,176 --> 00:55:38,443 MAINLAND? 1134 00:55:38,443 --> 00:55:44,516 >> SO OUR DATA DID NOT INCLUDE 1135 00:55:44,516 --> 00:55:48,153 POLYNESIANS, NATIVE HAWAIIANS OR 1136 00:55:48,153 --> 00:55:50,222 PACIFIC ISLANDERS WHO REMAIN IN 1137 00:55:50,222 --> 00:56:00,732 THE OCEANA AND THERE'S A BIG 1138 00:56:04,703 --> 00:56:05,704 DIFFERENTS IN OBESITY PREVALENCE 1139 00:56:05,704 --> 00:56:10,809 IN AMERICAN SAMOA VERSUS 1140 00:56:10,809 --> 00:56:11,276 WESTERN. 1141 00:56:11,276 --> 00:56:12,911 I MENTIONED THE ROLE OF 1142 00:56:12,911 --> 00:56:13,979 COLONIZATION AND THE 1143 00:56:13,979 --> 00:56:15,180 INTRODUCTION OF WESTERN DIETS 1144 00:56:15,180 --> 00:56:19,351 AND LIFESTYLE AND IF THAT 1145 00:56:19,351 --> 00:56:20,485 EXPLAINS THE DIFFERENCE IN 1146 00:56:20,485 --> 00:56:22,154 OBESITY RISK AMONG THE TWO. 1147 00:56:22,154 --> 00:56:24,589 DID THEIR CONDITIONS IMPROVE 1148 00:56:24,589 --> 00:56:26,091 ONCE THEY COME HERE? 1149 00:56:26,091 --> 00:56:29,227 I'M NOT FAMILIAR WITH THAT DATA 1150 00:56:29,227 --> 00:56:34,366 BUT I THINK THE ESTABLISHMENT AT 1151 00:56:34,366 --> 00:56:37,002 NIMHD -- THEY HAD A WORKSHOP ON 1152 00:56:37,002 --> 00:56:37,869 NATIVE HAWAIIAN PACIFIC ISLANDER 1153 00:56:37,869 --> 00:56:40,906 HEALTH IN FEBRUARY AND NOW 1154 00:56:40,906 --> 00:56:45,877 RECRUITING FOR A DIRECTOR GIVES 1155 00:56:45,877 --> 00:56:49,314 OPPORTUNITIES TO STUDY THESE 1156 00:56:49,314 --> 00:56:51,449 POPULATIONS WHICH ARE SOMETIMES 1157 00:56:51,449 --> 00:56:55,020 DISMISSED AS TOO SMALL AND 1158 00:56:55,020 --> 00:56:56,121 EMPHASIZE THE IMPORTANCE TO 1159 00:56:56,121 --> 00:56:57,389 SERVING A POPULATION THAT'S A 1160 00:56:57,389 --> 00:56:57,989 SIGNIFICANT PART OF AMERICAN 1161 00:56:57,989 --> 00:57:02,827 HISTORY. 1162 00:57:02,827 --> 00:57:03,728 >> MAYBE ONE MORE. 1163 00:57:03,728 --> 00:57:05,931 IS LANGUAGE A UNIQUE CHALLENGE 1164 00:57:05,931 --> 00:57:08,500 TO ASIAN AMERICANS IN ACCESSING 1165 00:57:08,500 --> 00:57:09,434 HEALTH CARE AND DIABETES 1166 00:57:09,434 --> 00:57:10,569 MANAGEMENT RESOURCES? 1167 00:57:10,569 --> 00:57:11,670 >> ABSOLUTELY. 1168 00:57:11,670 --> 00:57:15,140 I WAS BORN IN THE PHILIPPINES. 1169 00:57:15,140 --> 00:57:18,009 WE HAVE 187 DIALECTS. 1170 00:57:18,009 --> 00:57:20,579 SO WHEN WE WERE RECRUITING, FOR 1171 00:57:20,579 --> 00:57:25,050 EXAMPLE, WE JUST SO HAPPENED 1172 00:57:25,050 --> 00:57:27,018 BETWEEN OUR NURSE CLINICAL 1173 00:57:27,018 --> 00:57:28,486 COORDINATOR AND PHLEBOTOMIST AND 1174 00:57:28,486 --> 00:57:30,589 DRIVER AND MYSELF WERE ABLE TO 1175 00:57:30,589 --> 00:57:33,191 COVER SIX OF THE 187 LANGUAGES. 1176 00:57:33,191 --> 00:57:36,528 THE LANGUAGE DEFICIENCY BECAME 1177 00:57:36,528 --> 00:57:40,432 PRONOUNCED DURING THE COVID-19 1178 00:57:40,432 --> 00:57:45,570 PANDEMIC WHERE WE SAN DIEGO, 35% 1179 00:57:45,570 --> 00:57:47,939 LATINO THERE WERE ONLY 1180 00:57:47,939 --> 00:57:49,374 SPANISH-SPEAKING INTERPRETERS AT 1181 00:57:49,374 --> 00:57:51,409 THE MOBILE SHOPS. 1182 00:57:51,409 --> 00:57:54,779 WE LAD TO RELY ON THE STUDENTS 1183 00:57:54,779 --> 00:57:57,215 TO PROVIDE TRANSLATION SERVICES. 1184 00:57:57,215 --> 00:58:00,452 SO UNLIKE SPANISH-SPEAKING 1185 00:58:00,452 --> 00:58:01,720 COMMUNITIES, GENERALLY THAT'S 1186 00:58:01,720 --> 00:58:04,689 ONE LANGUAGE MOST PEOPLE FROM 1187 00:58:04,689 --> 00:58:08,226 LATIN AMERICA WILL UNDERSTAND 1188 00:58:08,226 --> 00:58:09,861 BUT AMONG THE ASIAN AMERICAN 1189 00:58:09,861 --> 00:58:12,497 MIGRANTS IT'S IN EXCESS OF OVER 1190 00:58:12,497 --> 00:58:15,233 40 LANGUAGES. 1191 00:58:15,233 --> 00:58:17,569 INDIA ALONE HAS 125 LANGUAGES. 1192 00:58:17,569 --> 00:58:20,105 THERE'S ALSO THIS MISCONCEPTION 1193 00:58:20,105 --> 00:58:23,141 THAT COLONIZED COUNTRIES THE 1194 00:58:23,141 --> 00:58:25,877 PHILIPPINES, INDIA, MALAYSIA ARE 1195 00:58:25,877 --> 00:58:27,145 ENGLISH SPEAKING. 1196 00:58:27,145 --> 00:58:30,415 WE SPEAK FUNCTIONAL ENGLISH BUT 1197 00:58:30,415 --> 00:58:34,386 IT DOESN'T TRANSLATE TO WILL A 1198 00:58:34,386 --> 00:58:37,322 PATIENT UNDERSTAND 1199 00:58:37,322 --> 00:58:38,423 INSTRUCTIONSFIDANCE FROM THEIR 1200 00:58:38,423 --> 00:58:41,326 NUTRITIONIST VERSUS IF GUIDANCE 1201 00:58:41,326 --> 00:58:47,365 IS PROVIDED IN LANGUAGE THEY 1202 00:58:47,365 --> 00:58:47,666 COMPREHEND. 1203 00:58:47,666 --> 00:58:51,603 SO VERY IMPORTANT CONSIDERATION. 1204 00:58:51,603 --> 00:58:55,940 WE TALK ABOUT CULTURAL 1205 00:58:55,940 --> 00:58:56,775 CONCORDANCE, HAVING PHYSICIANS 1206 00:58:56,775 --> 00:58:59,778 AND PATIENTS WHO COME FROM THE 1207 00:58:59,778 --> 00:59:04,382 SAME RACIAL AND ETHNIC 1208 00:59:04,382 --> 00:59:05,550 BACKGROUND AND IT'S IMPORTANT TO 1209 00:59:05,550 --> 00:59:09,487 HAVE LANGUAGE CONCORDANCE. 1210 00:59:09,487 --> 00:59:11,289 THANK YOU. 1211 00:59:11,289 --> 00:59:19,931 >> LET ME REPEAT THE CME CODE, 1212 00:59:19,931 --> 00:59:21,666 50126 AND FOR EVERYONE HERE 1213 00:59:21,666 --> 00:59:23,468 THERE'S A RECEPTION OUTSIDE WITH 1214 00:59:23,468 --> 00:59:23,868 HEALTHY FOOD. 1215 00:59:23,868 --> 00:59:24,169 >> NO RICE. 1216 00:59:24,169 --> 00:59:24,235 1217 00:59:26,705 --> 00:59:37,082 THANK YOU TO OUR SPEAKER.