Obesity , Metabolic
Syndrome and Diabetes in
Hispanics: implications on
Cardiovascular Disease 2011
Eduardo de Marchena M.D., F.A.C.C., F.A.C.P.
Professor of Medicine & Surgery
Associate Dean for International Medicine &
Director International Medicine Institute
Director of Cardiovascular Center
University of Miami Miller School of Medicine
Obesity Trends* Among U.S. Adults
BRFSS, 1985
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1986
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1987
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4”
person)
No Data
<10%
10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1988
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1989
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1990
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1991
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1992
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1993
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1994
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1995
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1996
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1997
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
≥20%
Obesity Trends* Among U.S. Adults
BRFSS, 1998
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
≥20%
Obesity Trends* Among U.S. Adults
BRFSS, 1999
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
≥20%
Obesity Trends* Among U.S. Adults
BRFSS, 2000
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
≥20%
Obesity Trends* Among U.S. Adults
BRFSS, 2001
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2002
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2003
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2004
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2005
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults
BRFSS, 2006
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults
BRFSS, 2007
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults
BRFSS, 2008
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults
BRFSS, 2009
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
“Globesity”
Colombia and Brazil
40% women in 2001
Prevalence of Obesity
in Males
Prevalence of Obesity
in Females
“Globesity”
Alarming trend for
Obesity in Children
Evolution of Man
Diet
2.5 million years
Exercise
50 years
2050
New Concept of Ideal Body Type
Number and Percentage of U.S. Population with
Diagnosed Diabetes, 1958-2008
7
20
6
Percent with Diabetes
16
Percent with Diabetes
Number with Diabetes
5
14
12
4
10
3
8
6
2
4
1
2
0
0
1958
61
64
67
70
73
76
79
82
85
88
91
94
97
00
03
06
Year
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System
available at http://www.cdc.gov/diabetes/statistics
Number with Diabetes (Millions)
18
However, the prevalence of chronic diseases such as diabetes
is rising, due to population aging but also to changes in lifestyle
Prevalence estimates of diabetes, adults aged 20-79
years, 2010
Note: The data are age-standardised to the World Standard Population.
Source: International Diabetes Federation (IDF) (2009), “Diabetes Atlas, 4th edition”.
Age-adjusted Percentage of U.S. Adults Who
Were Obese or Who Had Diagnosed Diabetes
Obesity (BMI ≥30 kg/m2)
1994
No Data
<14.0%
2008
2000
14.0-17.9%
18.0-21.9%
22.0-25.9%
>26.0%
Diabetes
1994
No Data
2008
2000
<4.5%
4.5-5.9%
6.0-7.4%
7.5-8.9%
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System
available at http://www.cdc.gov/diabetes/statistics
>9.0%
State-specific Prevalence of Obesity*
Among U.S. Adults, by Race/Ethnicity,
2006-2008
Black nonWhite non-Hispanic
Hispanic
(*BMI
30)
Hispanic
Percent of Population
Prevalence of Physician Diagnosed Type 2 diabetes in Adults
age 20+ by Race/Ethnicity, and Years of Education
(NHANES: 2003-2006). Source: NCHS and NHLBI. NH – nonHispanic.
18
16
14
12
10
8
6
4
2
0
13.4
15.3
13.0
12.8
11.0
9.2
9.6
6.2 5.8
NH Whites
NH Blacks
Less than high school
High school
Mexican Americans
More than high school
Prevalence of Diabetes
Today
However, the prevalence of chronic diseases such as diabetes
is rising, due to population aging but also to changes in lifestyle
Prevalence estimates of diabetes, adults aged 20-79
years, 2010
Note: The data are age-standardised to the World Standard Population.
Source: International Diabetes Federation (IDF) (2009), “Diabetes Atlas, 4th edition”.
Global projection for the
Diabetes Epidemic:
2003 – 2025 (millions)
Diabetes Caused by Excessive
Weight per Global Region
The Increased Atherosclerosis Risk in Type 2
Diabetes Begins in the Prediabetic State
Clinical
Diagnosis
Glucose
(mg/dL)
%
Relative
to Normal
350
300
250
200
150
100
Postprandial glucose
Fasting glucose
200 mg/dl
126 mg/dl
Insulin resistance
250
200
150
100 At risk for
50 diabetes b-cell dysfunction
Insulin level
0
30
5 10 15 20 25
-10 -5 0
Years
Interrelationship Between Insulin
Resistance, Abdominal Obesity and
Atherosclerosis
Insulin Resistance
Obesity
Hyperglycemia
H/T
Hypertriglyceridemia
Small
LDL
Low
HDL
Hypercoagulability
Pro-inflammatory
Atherosclerosis
Endothel.
dysfunctn
Hyperinsulinemic
mitogenesis
Age-adjusted prevalence trends for high blood pressure in
Adults age 20 and older by race/ethnicity and sex survey
(NHANES: 1988-94, 1999-02 and 2003-06). Source: NCHS and
NHLBI. NH- non-Hispanic.
Percent of Population
50
40
37.5
38.5
41.4
40.3
41.9
38.2
30.3
30
27.0
25.6
27.8
27.6
26.9 24.8
23.7 25.0
22.9
25.4 26.4
20
10
0
NH White
Men
NH White
Women
NH Black
Men
1988-94
NH Black
Women
1999-02
Mexican
American
Men
2003-06
Mexican
American
Women
Extent of Awareness, Treatment and Control of High
Blood Pressure by Race/Ethnicity and Sex
(NHANES: 1999-2006). Source: NCHS and NHLBI.
90
85.3
80
76.9
Percent of Population
With Hypertension
71.8
76.6
69.9
70.1
68.1
70
57.7
61.8
59.6
57.9
60
50
41.8
40
43.8
41.9 40.0
34.1
30
31.9
25.6
20
10
0
Awareness
Treatment
Controlled
NH White Men
NH White Women
NH Black Men
NH Black Women
Mexican-American Men
Mexican-AmericanWomen
Trends in mean total serum cholesterol among adolescents ages
12-17 by race, sex, and survey
(NHANES: 1976-80, 1988-94, 1999-02, 2003-04, and 2005-06).
Mean Total Blood Cholesterol
Source: NCHS and NHLBI.
180
175
170
165
160
155
150
145
140
135
172
171
174
170
168
165
166
166
163 163
163
164
163
161161
161
161
160
157
155 156
158
158
151
W hite
Males
Black
Males
1976-80
W hite
Black
Females Females
1988-94
1999-02
Mex.
Am.
Males
2003-04
Mex.
Am.
Females
2005-06
CHD Mortality and Hyperinsulinemia:
Paris Prospective Study (n=943)
3
P<0.01
2
CHD
mortality
(per 1,000)
1
0
29
30-50
51-72
73-114
115
Quintiles (pmol) of fasting plasma insulin
Fontbonne AM et al. Diabetes Care. 1991;14:461-
Atherosclerosis in Diabetes
~80% of all diabetic mortality
75% from coronary atherosclerosis
25% from cerebral or peripheral
vascular disease
>75% of all hospitalizations for diabetic
complications
>50% of patients with newly diagnosed
type 2 diabetes have CHD
National Diabetes Data Group. Diabetes in America. 2nd ed. NIH;1995.
Framingham Heart Study 30-Year Follow-Up:
CVD Events in Patients With Diabetes
(Ages 35-64)
10
8
Men
Women
Risk
6
ratio
4
Rate in non-diabetic
population
*P<0.05
2
0
Total
CVD
CHD
Cardiac
failure
Intermittent Stroke
claudication
Age-adjusted annual rate/1,000
P<0.001 for all values
Wilson PWF, Kannel WB. In: Hyperglycemia, Diabetes and Vascular Disease.
Ruderman N et al, eds. Oxford; 1992.