Reducing Metabolic Syndrome Risks for the Hispanic Worker:

A Culturally Sensitive Approach

Steven Marks, DNP, RN, APN, COHN-S, FAAOHN

Who, What, When, Where, Howbut most importantly WHY?

Who - Hispanic workers at Viking Yachts

What Metabolic syndrome When 2015 Where Rural South Jersey How Full management

support

WHY? Speak in a language they understand

Not just Spanish A life language

Acknowledge their culture Hispanic is not necessarily Mexican Favorite foods Cooking methods Who cooks and shops Ideas about body shape and disease Income

Metabolic Syndrome

Insulin Resistance

Dyslipidemia

Hypertension

Obesity

Population at Risk

Hispanic men - According to the American Heart Association (2015)

0

10

20

30

40

50

60

CVDisease

Stroke Pre-diabetes

20132015

% of Population

Challenges with Target Population

Wage Language Female dominant household Transportation Varying cultural backgrounds

Literature Review

53 million Hispanic/Latino in US in 2011 Hispanic population at increased risk due to:

Barriers to healthcare Transportation Availability of affordable healthy food choices Differing cultural norms

Body image Health care beliefs

Literature Review

Latinos en Control study Disease management Interactive cooking sessions Health literacy and education Decreased barriers to care Improved outcomes

Project

Pre-Intervention Handouts and posters in work area Participant consent Baseline vitals and measurements

BP, Height, Weight, Abdominal Circumference and BMI Baseline labs

Fasting blood sugar, Lipid panel and Hgb A1C Latino Dietary Behavior Questionnaire (LDBQ)

Project

Intervention Education session

Spanish interpreter Metabolic Syndrome Nutrition

Live cooking session Techniques and tips

Family style meal Female household members invited

Time for questions Healthy Hispanic recipes and food baskets

Program

Focus Whole grains Grilled foods Lean/inexpensive proteins Minimize processed foods Portion control Spice, not salt

Metabolic Syndrome

Steven Marks, APN-C

1

Metabolic Syndrome

Steven Marks, APN-C

1

Sndrome Metablico

Steven Marks, APN-C

2

Metabolic Syndrome

High Cholesterol

Overweight

High Blood Sugar

High Blood Pressure

3

Sndrome Metablico

Colesterol Alto

Sobrepeso

Azcar en la sangre

Presion Alta

4

Hypertension

High blood pressure

The pressure of blood on the artery walls

120/80 Normal

Elevated pressure damages

Eyes

Brain

Heart

Kidneys

5

https://espanol.kaiserpermanente.org/health/care/!ut/p/a0/FchBCsIwEEbhE5Wfooi48wxFNNmU6XRoBpNJsIPS29vu3vcQ8UI0-upCrtUo7w5czcX8loSyp06MN861yayEJyJi-9BSCMFqx8RJjudbE4SmR6efzgg0vftLf8Yg6_gY0Eq5nsp4_wOA0_Lq/

5

Hipertensin

Presin arterial alta

La presin de la sangre en las paredes de las arterias

120/80 Normal

La presin elevada daa

Ojos

Cerebro

Corazn

Riones

6

https://espanol.kaiserpermanente.org/health/care/!ut/p/a0/FchBCsIwEEbhE5Wfooi48wxFNNmU6XRoBpNJsIPS29vu3vcQ8UI0-upCrtUo7w5czcX8loSyp06MN861yayEJyJi-9BSCMFqx8RJjudbE4SmR6efzgg0vftLf8Yg6_gY0Eq5nsp4_wOA0_Lq/

6

Hypertension

Causes

Heredity

Being overweight

Belly fat is worse

Salt in foods

Fast foods

Pre-packaged/boxed foods

Deli meats

Snacks

7

http://authoritynutrition.com/wp-content/uploads/2014/01/greedy-overweight-man-eating-junk-food.jpg

7

Hipertensin

Causas

Hereditario

Tener sobrepeso

La grasa del estomago es peor

Sal en los alimentos

Comida rpida

Pre-envasados/alimentos en caja

Carnes fras

Comestibles

8

http://authoritynutrition.com/wp-content/uploads/2014/01/greedy-overweight-man-eating-junk-food.jpg

8

Hypertension

Causes

La hipertensin puede ser el resultado de un exceso de lquido en los vasos sanguneos normales o de la cantidad normal de lquido en vasos sanguneos estrechos, duros u obstruidos.

9

http://kidney.niddk.nih.gov/Spanish/pubs/highblood/index.aspx

9

Hipertensin

Causas

La hipertensin puede ser el resultado de un exceso de lquido en los vasos sanguneos normales o de la cantidad normal de lquido en vasos sanguneos estrechos, duros u obstruidos.

10

http://kidney.niddk.nih.gov/Spanish/pubs/highblood/index.aspx

10

Hypertension

Causes

Smoking

Alcohol

Being male

11

http://www.standard.co.uk/incoming/article7847401.ece/binary/original/Smoking%20drinking.jpg

11

Hipertensin

Causas

Fumar

Alcohol

Ser hombre

12

http://www.standard.co.uk/incoming/article7847401.ece/binary/original/Smoking%20drinking.jpg

12

Obesity

Overweight

Fat around the belly is the most dangerous

More than 60% of Hispanics are overweight

Leads to high rates of

Heart disease

Diabetes

Other health problems

13

http://img.medscape.com/fullsize/migrated/542/635/mc542635.fig1.gif

https://www.asu.edu/courses/css335/whyconcern.htm

13

Obesidad

Obesidad

Grasa al rededor del estomago es mas peligroso

Mas del 60% de hispanos tienen sobrepeso

Conduce a las altas tasas de

Enfermedades del corazn

Diabetes

Otros problemas de salud

14

http://img.medscape.com/fullsize/migrated/542/635/mc542635.fig1.gif

https://www.asu.edu/courses/css335/whyconcern.htm

14

High Cholesterol

Good/Bad Cholesterol

Bad fats

Saturated fats

Meats, manteca, fried foods, deli meats

Trans fats

Chemically altered

Some commercial fry oils

15

http://www.health.harvard.edu/media/content/images/bigstock-Fast-Food-45761026.jpg

15

Cholesterol Alto

Colesterol Bueno/Malo

Grasas malas

Grasas saturadas

Carnes, manteca, comida frita, carnes fras

Grasas trans

Alteradas qumicamente

Algunos aceites de frer comerciales

16

http://www.health.harvard.edu/media/content/images/bigstock-Fast-Food-45761026.jpg

16

High Cholesterol

Good/Bad Cholesterol

Healthy fats

Olive, canola oil, soy and corn oil

Salmon, tuna, trout, mackerel, sardines and herring.

Flaxseed (ground), walnuts, butternuts and sunflower, almonds

17

http://www.clevelandclinicwellness.com/food/GoodFats/PublishingImages/TheGoodFats_Introduction_Md.jpg

17

Colesterol Alto

Colesterol Bueno/malo

Grasas saludables

Oliva, aceite de canola, aceite de soja y maz

Salmn, el atn, la trucha, mackerel, sardinas y herring.

Linaza (molida), nueces, calabaza y girasol, almendras

18

http://www.clevelandclinicwellness.com/food/GoodFats/PublishingImages/TheGoodFats_Introduction_Md.jpg

18

High Cholesterol

Good Cholesterol

HDL

Bad Cholesterol

LDL

Triglycerides

Excess calories are stored in fat cells as triglycerides

19

Colesterol Alto

Colesterol Bueno

HDL

Colesterol Malo

LDL

Triglicridos

El exceso de caloras se almacenan en las clulas grasas como los triglicridos

20

Latino stats

High Blood Pressure

29.6% Men

29.9% Women

High Cholesterol

46.2% Men

43.4% Women

Cardiovascular Disease

48.3% Men

32.4% Women

Stroke

2.8% Men

2.0% Women

21

Estadsticas de Latinos

Presin alta

29.6% Hombres

29.9% Mujeres

Colesterol Alto

46.2% Hombres

43.4% Mujeres

Enfermedad cardiovascular

48.3% Hombres

32.4% Mujeres

Accidente cerebrovascular

2.8% Hombres

2.0% Mujeres

22

Prevention

Eat less fats

Eat more vegetables and fruits

Eat more whole grains

Exercise 30 minutes a day

10 minutes 3 times a day

Take all medication as directed

23

Prevencin

Coma menos grasas

Coma mas frutas y vegetales

Coma mas granos integrales

Haga ejercicios 30 minutos por da

10 minutos 3 veces al da

Tome todos los medicamentos segn las indicaciones

24

Diabetes

Steven Marks

25

Diabetes

La diabetes es la condicin donde el cuerpo no convierte la azcar en energia

Ingerir pruductos naturales contiene menos azcar que los productos fabricdos

Ejemplos de azcar en la dieta serian:

26

El contenido de azcar de los alimentosdiabeticos

Banana

4.5

Durazno

3 Vrs 3.5

Fresa

1.5

Red Bull

7 Cucharitas

Te' Casero

Vrs

Te Frio

6 Vrs 14.5

Limonada

Vrs

Tropical

6.5 Vrs 16.5

27

El contenido de azcar de los alimentosdiabeticos

Zanahoria - 1

Confites

12

28

El contenido de azcar de los alimentosdiabeticos- Frutas

Pia

2.5

Naranja

6

La naranja contiene mas azcar que la pia

29

El contenido de azcar de los alimentosdiabeticosFrutas Vrs Jugos

8

Onza

En 8 onzas vaso de naranja contiene cuatro veces mas azcar que una naranja

30

El contenido de azcar de los alimentosdiabeticos- Batido

28!!

31

El contenido de azcar de los alimentosdiabeticos- Arrollado de Canela

14

32

El contenido de azcar de los alimentosdiabeticos- Cereal

Fruit Loops contiene tres veces mas azcar que el cereal integral!

33

Las formas del cuerpo

Las formas de salud

se muestran

en la parte verde

34

El Pancreas

El pancreas es el organo que produce insulina

35

Sintomas de diabetes

Mucha Sed

Mucha Hambre

Mucha Ganas de Orina

36

Gentica

Si mam o pap es diabetico, el riesgo de padacer aumenta

37

Prevencin

Aumentar la actividad fisica

Una media hora cada dia

38

http://cdn2-b.examiner.com/sites/default/files/styles/image_content_width/hash/8c/7f/8c7f2e159320cf8dca3862ee6694c6fa.jpg?itok=pCvqENP9

38

Prevencin

Controlar el Peso

39

Prevencin

Ingerir menos azcar Ejemplo:

Jugo

Coca Cola (Gaseosa)

Confites

Pan

Arroz

Pasta

Cereal

Postres

40

Prevencin

El arroz blanco y la harina no son saludables

41

Granos Integrales

El grano integral incluye:

La cascara

Bran

Los germenes

Germ

La endosperma

Endosperm

Trigo

42

Granos Integrales

El cuerpo trabaja mas duro transformando el arroz integral y harina integral en azcar en comparacion con los productos fabricados

43

En Conclusin

Contolar el peso teniendo una dieta saludable

Limitar el uso de azcar

Incrementar comidas de granos integrales

Aumentar la actividad fisica

44

Nutricin

Steven Marks

45

Aspectos Bsicos

La nutricin es la ciencia que estudia cmo el cuerpo hace uso de los alimentos

La dieta es todo lo que come y bebe

Los nutrientes son las sustancias presentes en los alimentos

46

Por qu tengo hambre?

Usted necesita energa

T sientes hambre

Se come y el hambre desaparece

Usted ya no tiene hambre

Su cuerpo utiliza la energa y necesita ms

El ciclo se repite de nuevo

47

Qu beneficios tiene la comida?

Se convierte en energa para sus actividades diarias

Provee nutrientes

Como para estar contento

48

Beneficios del Agua

60% (sesenta) de su peso corporal es agua

El agua es esencial, ya que transporta los nutrientes

Beber agua te hace sentir menos hambre

Beba por lo menos ocho vasos de agua al da

49

Vitaminas y Minerales

Vitaminas: ayudan a que el organismo aproveche los elementos suministrados por los alimentos

Minerales: actan en el metabolismo y son esenciales para su buen funcionamiento

50

Aspectos Bsicos

Grupos de Comida

Frutas

Vegetales

Granos

Protenas

Productos lcteos

Grasas

51

http://www.choosemyplate.gov/print-materials-ordering/MultipleLanguages.html

51

Grupos de Comidas

Protena

Su funcin es reparar y construir aminocidos que constituyen todos los tejidos de los msculos, la piel y las uas.

Protenas de origen animal

Carnes

Pescado

Aves

Huevos

Protenas de origen vegetal

Soya y Frutos secos

5 1/2 onzas cada dia

52

Grupos de Comidas

Granos

Carbohidratos: Su funcin principal es la de proporcionar energa al organismo

Tipos de carbohidratos: simples y complejos

Los granos enteros son carbohidratos complejos

6 onzas cada dia

53

Grupos de Comidas

Vegetales

Contiene fibra, vitaminas y minerales

Fibra es buena para la digestion y estimula la peristalsis

2 tazas cada dia

54

Grupos de Comidas

Frutas

Las frutas frescas son ms saludables

Contiene fibra, vitaminas y minerales

Frutas en conserva pueden contener azcar adicional

2 tazas cada dia

55

Grupos de Comida

Productos Lcteos

Leche

Yogur

Queso

Mantequilla

2 tazas cada dia

56

Grupos de Comidas

Grasas

Limite la cantidad de grasa en su dieta

Las grasas trans son muy malas

57

Colesterol

El colesterol es una sustancia en el cuerpo que viene de las grasas

El colesterol bloquea las arterias y causa problemas al corazon

Las grasas saludables son mostradas con la marca verde

58

MiPlato

Frutas

Protena

Vegetales

Granos

Leche

Medio plato de frutas y vegetales para la salud

59

Porciones

3 onzas de carne igual al tamao de la palma de su mano

1/2 taza de cereal, arroz, pasta o helado, que es igual a 1/2 naranja

una cucharadita de mantequilla, margarina, mayonesa o aceite igual a la punta de su dedo pulgar

una onza igual a un puado (no llena!!)

una cucharada de aderezo para ensalada o mantequilla de man es igual a la mitad de una bola de ping-pong

60

61

https://www.pinterest.com/pin/207095282837751673/

61

En Conclusin

Tome mas vegetales, frutas y granos integrales

Medio plato de frutas y vegetales es bueno para la salud

Cambia a leche descremada o baja en grasa (1%)

Beba mucha agua

62

Menu Grilled pork on bamboo

skewers Skewers soaked in agave

to mimic sugar cane Fish stew

Fish portions $1.00 each Marinated grilled chicken

thighs $0.99/lb Demonstrated skin

removal and boning to save money

Menu

Green beans with bacon Frozen beans 4 slices of bacon cooked well

and dried Crumbled to infuse flavor not

fat to dish

Coconut pudding Lower calorie and fat recipe

Tres Leches cake Portion control with mini

muffin tins

Post Intervention

Repeat Vital signs and measurements

BP, Weight, BMI, Abdominal circumference Lab work

Lipid panel, FBS, HgBA1C LDBQ

Data Comparison

Pre PostIntervention Group 19.8 24.2Non-intervention Group 23.3 21.7

0

5

10

15

20

25

30

LD

BQ

Sco

re

Mean Total LDBQ Score

Mean total LDBQ score. This chart compares the mean total scores of both the intervention and non-

intervention groups.

Data ComparisonPre and Post Intervention Body Measurements and Blood Pressure

Group Measurement Pre M Post M % Change

Intervention Weight 192.25 190.08 -1.13

Abd Circ 41.50 40.46 -2.50

BMI 31.17 30.82 -1.11

Systolic BP 114.77 113.85 -0.80

Diastolic BP 75.85 76.00 0.20

LDBQ Score 19.77 24.23 22.57

Non Intervention Weight 232.53 231.47 -0.46

Abd Circ 46.17 45.33 -1.81

BMI 36.37 36.20 -0.46

Systolic BP 114.00 101.33 -11.11

Diastolic BP 64.67 66.00 2.06

LDBQ Score 23.33 21.67 -7.14

Data ComparisonPre and Post Intervention Laboratory ValuesGroup Measurement Pre M Post M %

Change

Intervention FBS 102.67 96.83 -5.68HGB A1C 5.91 5.87 -0.71Cholesterol 184.33 183.33 -0.54LDL 114.25 111.36 -2.53Triglyceride 127.08 170.67 34.30

HDL 44.67 40.58 -9.14

Non Intervention FBS 107.00 94.33 -11.84

HGB A1C 6.27 6.13 -2.13Cholesterol 176.00 171.67 -2.46LDL 102.00 111.33 9.15Triglyceride 161.67 112.67 -30.31

HDL 41.67 38.00 -8.80

Limitations

Short time frame 6 weeks between pre and post intervention

screening

Location and transportation 3 participants got lost and did not attend live

session

Non-intervention group did get education materials

Clinical Implications

Culturally sensitive education is effective Well received Many education projects can benefit from

cultural awareness Ability to address the specific needs of the

population Not cookie cutter education

Decreased barriers to care Improved health outcomes and decreased cost of

care

References

American Diabetes Association. (2013). Economic costs of diabetes in the U.S. in 2012. Diabetes Care, 1-14. http://dx.doi.org/10.2337/dc12-2625

American Heart Association. (2013). Statistical fact sheet : 2013. Retrieved from http://www.heart.org/idc/groups/heart-

public/@wcm/@sop/@smd/documents/downloadable/ucm_319572.pdf

American Heart Association. (2015). Statistical fact sheet 2015 update: Hispanics/Latinos & Cardiovascular Diseases. Retrieved from

http://www.heart.org/HEARTORG/General/Heart-and-Stroke-Association-Statistics_UCM_319064_SubHomePage.jsp

Boudreau, D. M., Malone, D. C., Raebel, R. A., Fishman, P. A., Nichols, G. A., Feldstein, A. C., ... Okamoto, L. J. (2009). Health care utilization and costs by metabolic

syndrome risk factors. Metabolic Syndrome and Related Disorders, 7(4), 305-314. Abstract retrieved from PubMed. (Accession No. PMID: 19558267)

Fernandez, S., Olendzki, B., & Rosal, M. C. (2011, April). A dietary behaviors measure for use with low-income, Spanish-speaking Caribbean Latinos with type 2 diabetes: The

Latino Dietary behaviors Questionnaire. Journal of the American Dietetic Association, 111, 589-599. http://dx.doi.org/10.1016/j.jada.2011.01.015

Ford, E. S. (2005, July). Risks for all cause mortality, cardiovascular disease, and diabetes associated with metabolic syndrome. Diabetes Care, 28, 1769-1778.

http://dx.doi.org/10.2337/diacare.28.7.1769

Grundy, S. M., Hansen, B., Smith, Jr, S. C., Cleeman, J. I., & Kahn, R. A. (2004). Clinical management of metabolic syndrome: Report of the American Heart Association/

National Heart, Lung and Blood Institute/ American Diabetes Association: Conference on scientific issues related to management. Arteriosclerosis, Thrombosis

and Vascular Biology, 24, 1-6. http://dx.doi.org/10.1161/01.ATV.0000112379.88385.67

Haynes, D., Pruitt, R., Watt, P., Parker, V., & Price, K. M. (2010). Controlling metabolic syndrome in the Latino population: Support for the current guidelines. Hispanic Health

Care International, 8, 85-92. http://dx.doi.org/10.1891/1540-4153.8.2.85

Huang, P. L. (2009, May-June). A comprehensive definition for metabolic syndrome. Disease Models & Mechanisms, 2, 231-237. http://dx.doi.org/10.1242/dmm.001180

Lennie, T. A. (2006). The metabolic syndrome. Circulation, 114, e528-e529. http://dx.doi.org/10.1161/CIRCULATIONAHA.106.633156

Lindberg, N. M., Stevens, V. J., & Halperin, R. O. (2013, January 28). Weight-loss interventions for Hispanic populations: The role of culture. Journal of Obesity, 2013, 1-6.

http://dx.doi.org/10.1155/2013/542736

Mishra, S., Xu, J., Agarwal, U., Gonzalez, J., Levin, S., & Barnard, N. (2013). A multicenter randomized controlled trial of a plant-based nutrition program to reduce body weight

and cardiovascular risk in a corporate setting: The GEICO study. European Journal of Clinical Nutrition, 1-7.

Rosal, M., Ockene, I. S., Restrepo, A., White, M. J., Borg, A., Olendzki, B., ... Reed, G. (2011, April). Randomized trial of a literacy-sensitive, culturally tailored diabetes self-

management intervention for low-income Latinos. Diabetes Care, 34, 838-844. http://dx.doi.org/10.2337/dc10-1981

References

American Diabetes Association. (2013). Economic costs of diabetes in the U.S. in 2012. Diabetes Care, 1-14. http://dx.doi.org/10.2337/dc12-2625

American Heart Association. (2013). Statistical fact sheet : 2013. Retrieved from http://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_319572.pdf

American Heart Association. (2015). Statistical fact sheet 2015 update: Hispanics/Latinos & Cardiovascular Diseases. Retrieved from http://www.heart.org/HEARTORG/General/Heart-and-Stroke-Association-Statistics_UCM_319064_SubHomePage.jsp

Boudreau, D. M., Malone, D. C., Raebel, R. A., Fishman, P. A., Nichols, G. A., Feldstein, A. C., ... Okamoto, L. J. (2009). Health care utilization and costs by metabolic syndrome risk factors. Metabolic Syndrome and Related Disorders, 7(4), 305-314. Abstract retrieved from PubMed. (Accession No. PMID: 19558267)

Fernandez, S., Olendzki, B., & Rosal, M. C. (2011, April). A dietary behaviors measure for use with low-income, Spanish-speaking Caribbean Latinos with type 2 diabetes: The Latino Dietary behaviors Questionnaire. Journal of the American Dietetic Association, 111, 589-599. http://dx.doi.org/10.1016/j.jada.2011.01.015

Ford, E. S. (2005, July). Risks for all cause mortality, cardiovascular disease, and diabetes associated with metabolic syndrome. Diabetes Care, 28, 1769-1778. http://dx.doi.org/10.2337/diacare.28.7.1769

Grundy, S. M., Hansen, B., Smith, Jr, S. C., Cleeman, J. I., & Kahn, R. A. (2004). Clinical management of metabolic syndrome: Report of the American Heart Association/ National Heart, Lung and Blood Institute/ American Diabetes Association: Conference on scientific issues related to management. Arteriosclerosis, Thrombosis and Vascular Biology, 24, 1-6. http://dx.doi.org/10.1161/01.ATV.0000112379.88385.67

Haynes, D., Pruitt, R., Watt, P., Parker, V., & Price, K. M. (2010). Controlling metabolic syndrome in the Latino population: Support for the current guidelines. Hispanic Health Care International, 8, 85-92. http://dx.doi.org/10.1891/1540-4153.8.2.85

Huang, P. L. (2009, May-June). A comprehensive definition for metabolic syndrome. Disease Models & Mechanisms, 2, 231-237. http://dx.doi.org/10.1242/dmm.001180

Lennie, T. A. (2006). The metabolic syndrome. Circulation, 114, e528-e529. http://dx.doi.org/10.1161/CIRCULATIONAHA.106.633156

Lindberg, N. M., Stevens, V. J., & Halperin, R. O. (2013, January 28). Weight-loss interventions for Hispanic populations: The role of culture. Journal of Obesity, 2013, 1-6. http://dx.doi.org/10.1155/2013/542736

Mishra, S., Xu, J., Agarwal, U., Gonzalez, J., Levin, S., & Barnard, N. (2013). A multicenter randomized controlled trial of a plant-based nutrition program to reduce body weight and cardiovascular risk in a corporate setting: The GEICO study. European Journal of Clinical Nutrition, 1-7.

Rosal, M., Ockene, I. S., Restrepo, A., White, M. J., Borg, A., Olendzki, B., ... Reed, G. (2011, April). Randomized trial of a literacy-sensitive, culturally tailored diabetes self-management intervention for low-income Latinos. Diabetes Care, 34, 838-844. http://dx.doi.org/10.2337/dc10-1981

Questions?

Steven Marks, DNP, RN, APN, COHN-S, FAAOHNEmail: smarks@vikingyachts.com

mailto:smarks@vikingyachts.com

Reducing Metabolic Syndrome Risks for the Hispanic Worker: A Culturally Sensitive ApproachWho, What, When, Where, Howbut most importantly WHY?WHY?Metabolic SyndromePopulation at RiskChallenges with Target PopulationLiterature ReviewLiterature ReviewProjectProjectProgramSlide Number 12MenuMenuPost InterventionData ComparisonData ComparisonData ComparisonLimitationsClinical ImplicationsSlide Number 21Questions?