Nutrition Counselling Frieda Dähler Augustiny, Nutritional Counsellor Preventive Cardiology & Sports Medicine University Clinic of Cardiology
Optimal Diet for Prevention of Coronary Heart Disease Diet Intermediary Biological Mechanisms: Lipid levels Blood pressure Thrombotic tendency Cardiac Rhythm Endotelial Function Systemic Inflammation Insulin Sensitivity Oxidative Stress Visceral fat Risk of Coronary Heart Disease Hu et al., JAMA 2002 Copyright 2015 American Medical Association. All rights reserved. EACPR Nutrition Nov. 2015 2
Evidence from Human Studies for Effects of selected foods on Cardiovascular Disease Selected Foods Randomized Trials of Risk Factors Prosp. Cohort Studies of Clinical End Points Fruits and Vegetables ++ ++++ --- Whole grains + ++++ --- Fish ++ ++++ + Nuts ++ ++++ --- Processed meats --- ++++ --- Unprocessed red meats --- ++ --- Dairy + +++ --- Sugar-sweetened beverages + ++ --- Alcohol +++ ++++ --- Randomized Trials of Clinical End Points American Heart Association: Mozaffarian, Circulation 2011 EACPR Nutrition Nov. 2015 3
Evidence from Human Studies for Effects Dietary Patterns on Cardiovascular Disease Dietary patterns Randomized Trials of Risk Factors Prosp. Cohort Studies of Clinical End Points Randomized Trials of Clinical End Points DASH ++++ ++++ + Mediterranean ++++ ++++ --- Vegetarian + ++ --- Japanese --- ++ --- American Heart Association: Mozaffarian, Circulation 2011 EACPR Nutrition Nov. 2015 4
Mediterranean Diet Vegetables / salad and fruit: 5 a day Starch: with every main dish, prefere wholegrain and pulses Fish: 2 3 times a week Meat: avoid processed meats, preferably white meat Dairy products: 2 3 portions daily Fat: olive oil, nuts. Avoid Transfat Sugar: small amounts of homemade sweets / avoid sugar-sweetened beverages Limited alcohol intake EACPR Nutrition Nov. 2015 5
Organisation 12 different groups (e.g. CHD, CVI, CHF...) Each group visits 4 or 5 lessons nutrition counselling Cooking course (4 hours) individual, single counselling if - BMI > 30 - Diabetes EACPR Nutrition Nov. 2015 6
Subjects of the nutrition course for patients with a coronary heart disease 1. Quality of fat 2. Quantity of fat 3. Carb and sugar 4. Vegetables and fruit and vitamin D 5. Salt by heart failure EACPR Nutrition Nov. 2015 7
1. Quality of fat Topics: Omega-3-FA / oily fish Which oil for cold dishes Which oil for frying Spread: butter or margarine EACPR Nutrition Nov. 2015 8
Trans fatty acid (TFA): Multivariable Adjusted Relative Risk of CHD Associated with Trans Fatty Acid Intake Mozaffarian, N Engl J Med 2006; 354;15:1608 EACPR Nutrition Nov. 2015 9
Recommendation for TFA Recommendation of the WHO: < 1 % of daily energy requirement (~ 2 g per person / day) Most TFA are found in processed foods. Avoid processed foods or Ban trans fatty acid by law Eating dairy products and meat from ruminant animals, gives ~1,5 g TFA/day EACPR Nutrition Nov. 2015 10
2. Quantity of fat Topics: Problem of fatty food: Main distribution of SFA / kj Processed meats Handling fatty food Alternatives to fatty food EACPR Nutrition Nov. 2015 11
Summary most adjusted relative risks for saturated fat intake and all cause mortality, CHD mortality, CVD mortality, total CHD, ischemic stroke, and type 2 diabetes. Russell J de Souza et al. BMJ 2015;351:bmj.h3978 2015 by British Medical Journal Publishing Group EACPR Nutrition Nov. 2015 12
Saturated fatty acids (SFA) There is no evidence that SFA increase the incidence of CVD Skeaff CM, Miller J. Dietary fat and coronary heart disease: Summary of evidence from prospective cohort and randomized controlled trials. Ann Nutr Metab 2009 Siri-Tarino et al. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. AmJClinNutr 2010 But replacing SFA with a unsaturated FA lowers the risk for CVD Ferro-Luzzi et al: The high-fat Greek diet: a recipe for all? Eur J Clin Nutr 2002 de Lorgeril et al. Effect of a Mediterranean Type of Diet on the Rate of Cardiovascular Complications in Patients with CHD. JACC 1996 Puska et al. Fat and Heart Disease: Make a chanke The Case of North Karelia (Finland). Ann Nutr Metab 2009;54 (suppl) Siri-Tarino et al. Saturated fat, carbohydrate, and CVD. AmJClinNutr 2010 EACPR Nutrition Nov. 2015 13
3. Carb and Sugar Topics: - hidden sugar (especially soft drinks) - food with high GI (low fat, low fiber) EACPR Nutrition Nov. 2015 14
Sugar sweetened beverages Fung TT, Willet WC, Hu FB: Sweetened beverage consumption and risk of coronary heart disease in women. Am J Clin Nutr 2009 Chen L et al: Reducing consumption of sugar-sweetened beverages is associated with reduced blood pressure: a prospective study among United States adults. Circulation 2010 Malik VS et al: Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care 2010 EACPR Nutrition Nov. 2015 15
4. Vegetables and Fruits Agents protect the heart Vitamins Minerals Phytochemicals (Flavonoids, polyphenols,...) EACPR Nutrition Nov. 2015 16
Supplements EACPR Nutrition Nov. 2015 17
Single counselling Obese patients Patients with diabetes Discuss the results of the PREDIMED Food Questionnaire EACPR Nutrition Nov. 2015 18
Martinez-Gonzalez et al. PLoS One. 2012; 7(8): e43134. EACPR Nutrition Nov. 2015 19
Evaluation PREDIMED Food questionnaire 0 5 points: increases the risk of CHD 6 9 points: slightly increases the risk of CHD 10 14 points: No risk for CHD caused by dietary patterns Martinez-Gonzalez et al. PLoS One. 2012; 7(8): e43134. EACPR Nutrition Nov. 2015 20
Results from our own analysis from 114 outpatients in Berne using the PREDIMED food questionnaire 0-5 points: increased risk 66 6-9 points: slightly increased risk 48 > 9 points: no risk 0 0 10 20 30 40 50 60 70 EACPR Nutrition Nov. 2015 21
Consequences from this results All patients are invitated by letter to make an appointement with the nutrition counsellor and in the same letter we reinforme the importance following to the nutrition course Conclusion: The Food questionnaire is a good tool to get in contact with the patients and its a good basis for a discussion It s a good motivation tool EACPR Nutrition Nov. 2015 22
End