Authors: Anna Biggins, MPH, RDN, LD and Jaime Burkle, MD

Affiliation: Georgia Heart Institute

Background: Severe hypertriglyceridemia with triglycerides (TGs) exceeding 500 mg/dL increases the risk for acute pancreatitis. TG levels over 500 mg/dL are also associated with increased risk of all-cause mortality, premature coronary artery disease (CAD) and atherosclerotic cardiovascular disease (ASCVD) events. Ineffective triglyceride catabolism results in the accumulation of triglyceride-rich lipoproteins, namely chylomicrons. While chylomicrons are not routinely tested directly, chylomicronemia is suspected with TGs greater than 750 mg/dL, and significant chylomicronemia is present with TGs greater than 1000 mg/dL. The most common form of chylomicronemia is multifactorial chylomicronemia syndrome (MCS) related to a genetic susceptibility for ineffective TG catabolism triggered by lifestyle factors. Familial chylomicronemia syndrome (FCS), an autosomal recessive disorder, is less common. Medical nutrition therapy delivered by registered dietitian nutritionists (RDNs) specialized in lipid management plays a critical role in treating severe hypertriglyceridemia and chylomicronemia.

Methods: Three cases were selected from a pool of patients with type 2 diabetes and TGs exceeding 500 mg/dL. In an outpatient preventive cardiology clinic, all three patients separately participated in MNT delivered by an RDN. Estimated nutrient intake was assessed at baseline (T1) and follow up (T2) using verbal 24-hour recall and typical intake review. Patients were educated on a short term (2-3 week) chylomicron-clearing diet based on guidelines from the National Lipid Association. Key features of the diet included: 1) Limit the total daily fat intake to 20-30 grams, 2) Avoid alcohol, 3) Avoid fruit juice and sugar-sweetened beverages, 4) Avoid sweets and desserts, and 5) Avoid added sugars (syrup, honey, agave, etc). Lipid panels were drawn 2-3 weeks following initiation of the diet. Individual support was offered via telephone during the 2-3 week diet. Follow up occurred in-person 3-6 weeks following diet initiation. Nutrient analysis was conducted on a web-based platform.

Results: Average TGs at baseline were 2169 (± 1607) mg/dL, and the average hemoglobin A1c (HbA1c) was 8.0 (± 1.2). Average TGs at follow up were 476.3 (± 247.4) mg/dL. After delivery of MNT, average total energy, total fat and saturated fat intake decreased by 596.4 (± 18.2) kilocalories, 50.8 (± 13.1) grams, and 20.6 (± 10.2) grams, respectively. While total fat intake decreased from baseline, none of the patients achieved the target of 20-30 grams of total fat per day.

Authors: Anna Biggins, MPH, RDN, LD and Jaime Burkle, MD

Affiliation: Georgia Heart Institute

Background: Cardiovascular disease (CVD) remains the number one cause of death among Americans despite continual advances in treatment options. A healthy lifestyle throughout life is recognized as the most important prevention strategy against atherosclerotic cardiovascular disease (ASCVD). A team-based approach is acknowledged as an effective strategy for ASCVD prevention and improved patient outcomes. The Georgia Heart Institute launched the Prevention Center in 2022. The multidisciplinary care team comprises cardiologists, a nurse facilitator, dietitian, wellness coach, and medical assistants, resulting in a comprehensive clinical and lifestyle assessment of cardiovascular risk.

Purpose: This exploratory study examined population characteristics of prevention patients over 12 months for three main purposes: 1) Identify trends in clinical and demographic characteristics; 2) Identify gaps in equity of care; 3) Reveal opportunities to improve ASCVD risk reduction.

Methods: The electronic health record was audited to identify patients between August 2022 and August 2023 who underwent an assessment at the Prevention Center. A descriptive analysis of clinical and demographic variables was conducted.

Results: The Prevention Center encountered 870 new patients over 12 months. Fifty-two percent were female, 88% were white, 6.5% were Black, and 93% were non-Hispanic. The average age was 62 years, with 85% of patients being age 50 years or older. Key clinical characteristics included dyslipidemia (LDL >100mg/dL: 58%; TG >150mg/dL: 44%), poor glycemic control (A1c 5.7-6.4: 28%; A1c >6.5: 31%), and elevated ASCVD risk scores (35% with score 7.5%–20%; 18% with score >20%). Obesity and overweight were present in 53% and 32% of patients, respectively. Forty one percent of patients had hypertension. Family histories were significant for heart disease (57%), hypertension (54%), heart attack or stroke (49%), and diabetes (34%). The majority of patients had never smoked (59%). Out of the 116 patients with lipoprotein(a) results, 41% had Lp(a) levels >75 nmol/L.

Conclusion: This population analysis confirms the appropriateness of a multidisciplinary team to treat ASCVD and cardiometabolic risk factors. Patients displayed multiple comorbidities and a strong family history of heart disease, with lipoprotein(a) providing a targeted risk assessment. Gaps exist in racial and ethnic diversity considering the disproportionate burden of ASCVD present in Black individuals and those with South Asian ancestry. Only 15% of the patient population is below age 50 years, conflicting with the knowledge of ASCVD as a progressive disease with risk factors emerging as early as childhood. There exists a potential opportunity to strengthen partnerships with primary care providers to enhance ASCVD prevention across the lifespan.

Authors: Sermin Aras, MS,^1,2; Jennifer L. Lemacks, PhD^1,2, Tammy Greer, PhD³, Shantoni Holbrook, MPH⁴, June Gipson, PhD⁴

Affiliations:

1. Telenutrition Center, Mississippi INBRE Community Engagement and Training Core, The University of Southern Mississippi, Hattiesburg, MS 
2. School of Health Professions, College of Nursing and Health Professions, The University of Southern Mississippi, Hattiesburg, MS 
3. School of Psychology, Center for American Indian Research and Studies, Mississippi INBRE Community Engagement and Training Core, The University of Southern Mississippi, Hattiesburg, MS 
4. My Brother’s Keeper, Inc., Mississippi INBRE Community Engagement and Training Core, Jackson, MS

Background: Racial and ethnic minorities and individuals living in the Southern US generally have a greater incidence and prevalence of cardiometabolic diseases compared to other groups. With an increased focus on diet and lifestyle modification for disease prevention, there are opportunities to address dietary behaviors in community-based healthcare entities that have proven success at reaching individuals from racial/ethnic minority or disadvantaged backgrounds and have the capacity to circumvent key barriers to healthcare. The healthcare environment is in need of models to provide holistic and integrated care to maximize efficiency of each patient contact opportunity. Therefore, the purpose of this research was to utilize a multiphase optimization study design to select and optimize essential components to address diet behaviors among racial/ethnic minority, young to middle aged adult populations in Mississippi.

Methods: A pilot intervention was conducted at a community-based healthcare clinic consisting of two arms: 1. Psychosocial Intervention and 2. Structural Intervention. Each intervention arm consisted of three different delivery and support modalities. The duration was 12 weeks with each modality being delivered for 4 weeks. Young to middle aged adults who were at risk for cardiovascular disease-related premature mortality and resided in Jackson metropolitan area were eligible to participate. Optimization criteria were established based on computed participant burden scores, cost-effectiveness (cost: burden), and attendance. Intervention modalities were assessed to determine whether each criterion was met.

Results: Forty-two individuals were enrolled in the program and 31 of them completed baseline surveys and were randomized to an intervention arm. Both intervention delivery and support modalities met the burden score criterion whereas only one modality from each intervention met cost-effectiveness and two structural modalities met attendance criterion.

Conclusion: Further analysis of data from this pilot intervention will inform healthcare organizations who are seeking models to provide holistic and integrated care to maximize efficiency of each patient contact opportunity.

GRANT SUPPORT: This project has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract No. HHSN268201800015I

Authors: Nathaniel Johnson, Julie Garden-Robinson, Sherri Stastny

Affiliation: North Dakota State University

Objective: Understand which lifestyle behaviors were identified as negatively impacted according to an online survey. Although many adults aged 50 and older and living in rural areas of ND may be interested in practicing healthy lifestyle behaviors, this population experiences unique barriers to practicing healthy lifestyles. For instance, while cities have choices in grocery retailers, many small towns and rural communities may be limited to only convenience stores (e.g., gas stations with retail food) where choices are limited to ultra-processed foods (UPF), which are calorically, but not nutritionally, dense. A greater proportion of rural North Dakotans have low access to healthy foods. Further, those living in rural communities often face a lack of nearby recreational facilities, especially during the winter months, which can negatively impact physical activity. In addition, many older adults live alone and, therefore, do not wish to cook only for themselves, which may increase the consumption of UPFs. Rural older adults tend to be more isolated as the result of greater distances between them and their neighbors. Due to lack social interaction they formerly had at mealtimes, maintaining a balanced diet often is not a priority. At the same time, adults aged 50 and older in rural ND have some unique opportunities for improvement in lifestyle choices because a high number of these individuals are insured for medical care, have access to internet/computer, are not living in poverty, and have at least a high school education, according to research. Nourish is an online and/or face-to-face Extension program designed to combat the increasing prevalence of diabetes and other chronic diseases. The program provides North Dakotans aged 50 and older with information to prevent chronic illness, with strategies to eat more nutritiously and be more physically active. The program, created in 2013, is being updated and expanded to better serve the needs of older adults in ND. As part of this process, a 79-item, online survey was designed to assess current lifestyle choices among adults aged 50 and older living in North Dakota. The survey was administered in Spring 2023 and used mixed methods including dichotomous and Likert-type scale questions. Of the 658 participants from North Dakota who completed the survey, 544 participants were from rural counties, and all rural counties were represented with a maximum of n=55 in Adams County and minimum of n=1 in Slope County, the least populated County in ND. A total of 119 of these 544 lived alone (28%). General linear models controlling for age, sex, race, education, and income were used to assess differences between rural North Dakotans living alone and those living with others. Rural North Dakotans who live alone reported lower overall health (p = 0.001), a greater proportion of impairment in performing physical activity (p < 0.001), lower intakes of fruits (p < 0.001) and vegetables (p = 0.016) at mealtimes and snacks, and less regular exercise (p = 0.027). The Nourish program will focus on increasing fruit and vegetable intake and on increasing exercise and physical activity, in addition to other strategies to reduce risk of chronic disease.