L III: DIETARY APPROACH

Transcription

1 L III: DIETARY APPROACH FOR CARDIOVASCULAR DISEASE PREVENTION General Guidelines For Dietary Interventions 1. Obtain a healthy body weight 2. Obtain a desirable blood cholesterol and lipoprotein profile 3. Obtain a desirable blood pressure 4. Achieve and maintain a healthy eating pattern.. that includes foods from each of the major food groups

2 Obtain a Healthy Body Weight Major guidelines: Match intake of energy (calories) to overall energy needs; limit consumption of foods with a high caloric density and/or low nutritional quality, including those with a high content of sugars. Maintain a level of physical activity that achieves fitness and balances energy expenditure with energy intake; for weight reduction, expenditure should exceed intake Body Weight Reduction When BMI is excessive ( >30 or > 25 with co-morbidities) Caloric intake should be less than energy expenditure. Caloric restriction sufficient to produce weight reductions between 5% and 10% can reduce the risk factors for heart disease and stroke. The generally poor long-term success of programs that encourage rapid weight reduction supports an approach that uses more modest caloric restrictions (0.5-1 Kg per week for up to 6 months).

3 Low Caloric Diet Diets for weight reduction should be limited in total calories, to predict a weight loss of Kg per week (Estimated daily requirements minus 500 to 1000 kcal/d). Because fat is 9 kcal/g, whereas carbohydrate and protein are 4 kcal/g, limitation of dietary fat as well as alcohol (7 kcal/g) are effective means to reduce both energy density and total energy intake. This diet should be low in FAT (< 30% of total caloric intake). Furthermore, it should be balanced and include all food items. Very-Low-Fat.High CHO Diets Fats <15% of total energy..carbohydrates instead Although in certain individuals very-low-fat diets may lead to weight loss and improved lipid profiles, they are not recommended for the general population. Weight loss is not sustained. May lead to nutritional inadequacies for essential fatty acids. Can amplify low HDL, high TG, and hyperinsulinemia.

4 Low CHO.. High Protein Diet few bread, rice, pasta, sugars Increased meat, fish, eggs Not recommended. d No studies to support sustained weight loss or improved health. Extra protein is not efficiently utilized & is a burden for its degradation. May lead to renal damage and a reduction in bone density. Animal protein is the most expensive source of calories. It is also higher in saturated fat and cholesterol. Food choices become restrictive. High Unsaturated Fat Diet Replacing saturated fat calories with unsaturated fat calories rather than carbohydrate calories (up to 30% of calories from monounsaturated and polyunsaturated fat, <10% of calories from saturated fat, and <300 mg/d of cholesterol). Can prevent or attenuate the decrease in HDL and the increase in TG that can occur with high-cho very low-fat diet. These latter effects may confer additional cardioprotective effects beyond LDL lowering. A healthy body weight should be achieved and maintained.

5 General Guidelines For Dietary Interventions 1. Obtain a healthy body weight 2. Obtain a desirable blood cholesterol and lipoprotein profile 3. Obtain a desirable blood pressure 4. Achieve and maintain a healthy eating pattern.. that includes foods from each of the major food groups FATS Percent t fat in diet is not enough..the type of fat is as important as the amount Replace palm oil with olive, corn or safflower oil. Do not use hydrogenated plant oils (e.g. margarine). In simple terms, food should be cooked in the least amount of oil; preferably grilled, steamed or broiled, rather than fried.

6 TRANS-Fats Trans-fats are formed by high h temperature cooking and plant oil hydrogenation Trans-fats raise LDL and lower HDL On a per-gm basis, trans fats are worse than saturated fats Dietary cholesterol Dietary cholesterol: is positively associated with both serum cholesterol l level l and CHD risk. However, it has less effect on serum cholesterol level than do saturated FAs. Cholesterol is found only in foods of animal origin (primarily egg yolks,organ meats, and dairy products). Protein intake should be approx. 1 gm/kg g ideal body weight; this usually comprises around 12-18% of the calorie intake Nuts (i.e., almonds, peanuts, etc) are rich in monounsaturated fats and should be encouraged in moderation.

7 Meat & Poultry Choose lean red meat, chicken & turkey. Remove all visible fat from meat & skin from poultry. Avoid completely organ meat (e.g. liver, kidney, brain) and processed meat (i.e., salami sausages, and hamburger). egg yolks: max 1-3 / week. Meat Alternatives Legumes: Using beans, peas and lentils instead of meat Consumption of 1 serving of beans/d is associated with a 38% lower risk of MI. FISH (omega-3 fatty acids) Relative hazard of sudden death across increasing levels of fish intake expressed as servings of fish per week Albert, C. M. et al. JAMA 1998;279:23-28.

8 MILK & DAIRY FOODS Choose reduced fat dairy products (i.e., semi-skimmed skimmed milk, low fat or diet varieties of yoghurts, reduced fat hard cheeses, reduced fat cheese spreads and cottage cheese). Aim for 2-3 servings per day. A serving is 1 cup of milk, small pot of either yoghurt, cottage cheese or small matchbox size of processed cheese. General Guidelines For Dietary Interventions 1. Obtain a healthy body weight 2. Obtain a desirable blood cholesterol and lipoprotein profile 3. Obtain a desirable blood pressure 4. Achieve and maintain a healthy eating pattern.. that includes foods from each of the major food groups

9 Dietary approach to obtain a desirable BP Low Salt Diet Intersalt study: a correlation between both SBP and DBP and average sodium intake. Meta-analysis: analysis: hypertensive patients decreased their BP by a mean 5/3 mm Hg through sodium reduction. DASH-SODIUM: SODIUM: Reducing dietary Na, lowered BP for both the control and DASH diets. Reduce salt intake to < 3.8 g/day NaCl. AVOID أنواع الجبن ما عدا الجبن األبيض كل القريش قليل الملح أو األسود و المخلالت. الزيتون و األسماك المحفوظة اللحوم و المملحة. والمجففة الخضر و اللحوم و األسماك المعلبة. الجاھزة األطعمة

10 The DASH Study Dietary Approaches to Stop Hypertension Proved to lower BP in studies sponsored by the NIH Can lower cholesterol l level, l and with weight loss and exercise can reduce insulin resistance Based on eating diet rich in fruits and vegetables, and low-fat or non-fat dairy products Best response in moderately high BP and prehypertensives People who follow a DASH eating pattern have reduced risk of stroke and heart disease The DASH Study Dietary Approaches to Stop Hypertension L.J. Appel et al, N Engl J Med; L.J. Appel et al, N Engl J Med; 366: , wk randomization to one of 3 diets: Control Fruits and vegetables fruits and vegetables and low fat dairy products

11 At least 8-10 servings ( gms) of a variety of fruits or vegetables recommended per day (especially those which are dark green, deep orange, or yellow). Count a serving as a banana, apple, orange, glass of fruit juice, bowl of vegetable soup, small salad or 2-3 tablespoons of vegetables. Fruits and Vegetables

12 General Guidelines For Dietary Interventions 1. Obtain a healthy body weight 2. Obtain a desirable blood cholesterol and lipoprotein profile 3. Obtain a desirable blood pressure 4. Achieve and maintain a healthy eating pattern... that includes foods from each of the major food groups Achieve and Maintain a Healthy Eating Pattern Limit fatty meals, dairy fat and cooking oil (less than two tablespoons) per day. Replace palm or coconut oil with olive / soy / corn/ safflower oil. Replace red meat with chicken (without skin) or fish. Limit the intake of foods high in cholesterol [egg yolks, fatty meats, internal organs, and dairy products]. When cooking, avoid frying; use boiling, steaming, baking or grilling.

13 The Mediterranean Diet Plenty of plant-based foods (fruit, vegetables, breads, cereals, potatoes, beans, nuts, and seeds) Olive oil (high in monounsaturated fat) as the principal source of fat Daily dairy products (mainly cheese and yogurt) in low to moderate amounts Fish and poultry in low to moderate amounts Four eggs weekly Red meat rarely Wine in low to moderate amounts with meals Dietary Interventions Highly effective in primary and secondary prevention of CV events. Cost effective relative to other common interventions. Support of the family is particularly important. The collaboration of the food industry is essential to ensure that healthy food choices are feasible.

14 Summary Egyptian Guidelines for Prevention of Atherosclerotic CV Disease Substitute unsaturated (especially polyunsaturated) fats for saturated and trans-fats Increase omega-3 fatty acids from fish oil or plant sources Increased fruits, vegetables, nuts and whole grains Avoid excessive salt or sugar Healthy weight (BMI < 25 kg/m 2 ) 30 minutes of physical activity daily