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Nutritional Factors affecting Cardiac Risk
Weight LDL-C TGs HDL-C BP GlucoseCalories ✔ ✔ ✔ ✔ ✔ ✔
Exercise ✔ ✔ ✔ ✔ ✔
Saturated Fat
✔
Cholesterol ✔
Fiber ✔ ✔ ✔
Carbohydrates
✔ ✔
Plant Stanols
✔
Alcohol ✔ ✔ ✔ ✔
Sodium ✔
Fish oil supplements
✔
Reduces BP, improves glucose control, improves serum
lipids (cholesterol, HDL-C and triglycerides levels)
Diabetes Prevention Program
3234 overweight & obese with hyperinsulinemia - 1/3 given intensive lifestyle intervention, 1/3 metformin, 1/3 usual care
Lifestyle intervention reduced incidence of type 2 DM by 58%, metformin by 31% compared to usual care group
Lifestyle group achieved 5.6 kg weight loss and exercised 5 times a week for 30 minutes
Calories
Modest weight loss of 10-15%
More than 4,500 people who have lost at least 30 lbs. with 3,000
losing an average of 60 pounds (32.4 kg); keeping this weight off
for over 6 years with 30-40% of people are able to maintain a
loss of 10% of their body weight.
• 60 to 90 minutes of exercise daily
• Lower intakes of dietary fat
• Lack of exceptions to diet plan
• Social support – meetings, family/friends of like mind
• Weighing weekly
• Alternating strategies – “watching weight” and losing weight
Calories
National Weight Control Registry
Calories
Current popular weight loss approaches
Paleo Diet Includes fruit, vegetables, generous amounts of meat, seafood. Avoids grains and dairy. Moderate to high fat
Zone, South Beach Low, carb, moderate fat, high protein
Atkins Very low carb, high fat, high protein
Glycemic Index Eat only foods with a low glycemic index
Eat Clean Detox 2 liquid meals per day, one “clean” meal-nuts, legumes, fruits, vegetables
Health clubs with weight loss programs
Commercial weight loss chains
Weight loss websites
Diet food home delivery services
Retail Meal replacements
Spent annually
Estimated $70 billion in 2010-Market includes registered dietitians and
nutritionists, surgical/bariatric programs, prescription medications, and
the VLCD/LCD fasting supplement programs
More than one way (researched programs)
Ornish, Zone, Atkins, Weight Watchers – all work
No single answer for everyone
Diverse needs and preferences
Pick a safe approach and stick with it
Calories
Weight loss approaches
Losing weight:
Weigh weekly
Limit sugar
Planning and preparation
Healthy snacks available
Weight loss programs
Exercise variety
Calories
Approaches to encourage
Maintaining weight:
Consistent lean protein
Consistent exercise
Renew as priority
Reward yourself
Weigh regularly
Successful weight loss can contain plateaus and
fluctuations
Prevent further weight gain
Maintenance of weight loss that is sustained–successful
weight loss is maintained weight loss
Calories
Degrees of weight loss
Prevention, attention to weight change
Multidisciplinary programs that are 3 to 12 months long
Evidence of commercial weight loss programs leading to success is
small but there is weight loss for some
Follow-up important
One-to-one
Social media
Online, App
Long-term success-realistic expectation is 5 to 10 % loss and
maintenance (what most can achieve)
Calories
What works
Approach Potential change
Saturated fat >7% 8-10 %
Dietary cholesterol <200 mg 3-5 %
10 # weight loss 5-8 %
Addition of 5 to 10 grams soluble fiber daily 3-5 %
Addition of 2-3 grams plant stanols or sterols6-15 %
Addition of 25 grams soy protein daily 3-5 %
Total LDL-C lowering 25-35 %
LDL-C lowering estimates with diet
Main influence on serum cholesterol
For every 1% increase in consumption of saturated fat calories there is an increase in serum cholesterol of 1.8 mg/dL
Some variation expected given genetic predisposition
Recommendations
7% of calories
15-20 grams per day based on 2000 to 2500 kcal respectively
Culvers 1 scoop Turtle Sundae
980 calories
27 grams saturated fat
Saturated Fats
Saturated Fats
Food-amt sat fat Food- amt sat fat
Food- amt sat fat
Butter- 1T 7.6 Ground beef
6 Salmon 0.5
Margarine, tub- 1T
1.5 Brat 16 Chcheese-1oz
6
Olive oil- 1T 1.8 Turkey 0.5 Ice cream-1c
9
Mayo- 1T 1.5 Pork chop 2.5 Skim milk-1c
0.3
Cream cheese-1oz
6.2 Salmon 0.5 Peanut butter-1T
1.7
Prime rib 12 Dark chicken
2.3 Almonds-1oz
1.8
Ground round 4 Tuna in water
0.7 Avocado- 1/4
0.9Meat, poultry, fish are 3 ounce portions
Claims:
Reduce heart disease
Anti-viral
Anti-bacterial
Weight loss
Reduce cancer
Better for cooking
Normalize thyroid
Good for skin and hair
Improve immune function
New trend is coconut oil
Types of Saturated Fats
Butterfat
Lauric 3
Myristic 18
Palmitic 26
Stearic 12
Coconut oil 49 18 8 3
Beef fat 0 3 26 22
Cocoa butter
0 0 26 35
Less LDL-C increaseIncreases LDL-C No LDL-C effect
Trans fat recommendations
Soft tub margarine, 1 T.0-2 grams
Stick margarine, 1 T. 2-3.5 grams
Vegetable shortening, 1 T. 0-3 grams
KFC Chicken Pot Pie 14 grams
Burger King hash browns 13 grams
McDonald’s medium fries 5 grams
Limit to <1% of total calories (2000 calories per day = 2 grams)
Trans fat in foods
Margarine/Butter
Total Saturated
Trans Sat + Trans
Butter 10.8 grams
7.2 grams 0.3 grams 7.5 grams
Margarine
Regularstick
11.4 2.3 2.4 4.7
Regulartub
11.2 1.9 0 1.9
Lite stick 9.5 1.6 1.8 3.4
Lite tub 5.6 1.1 0 1.1
Cholesterol in Foods
Only found in animal products
Influence on LDL-C more variable than saturated fat
Control intake
Low-fat dairy
Less lean meat
> 2-4 egg yolks per week
Shrimp > once a week
Liver?
Goal is > 200 mg daily
Fiber
Soluble (gummy or viscous)
Slows glucose absorption,decreases blood cholesterol
Increases fecal excretion of bile acids
Delays gastric emptying
Psyllium supplements–10.2 g (3 doses per day)– see decreased in LDL- C from 5% to 10% depending, more if from typical American diet
Stanols/Sterols
5 chews per day for 2 grams plant stanols
6 capsules for 2 grams plant stanols
4 T Benecol margarine provide 2 grams
Carbohydrates
Raise TG, lower HDL-C
Processed CHO, especially fructose, can increase TG dramatically
Very low fat diets likely too high in CHO for patients with elevated TG
50-60% CHO as goal (starches, fruit, sugars)
Fish Oil Supplements
High doses can reduce TG, raise HDL
Low doses can reduce stickiness of blood, reduce inflammation, and irregular heart beats
? prophylactic 1 gram level, 3- 4 gram for lipid lowering
DHA and EPA are protective components
Cod liver oil and flaxseed oil-not recommended
Check supplement label to assess potency, serving size–many varieties and not regulated or standard
Alcohol
Increases TG production, VLDLs
Effects more pronounced in those who drink large amounts of ETOH
Are overweight/obese
Have diabetes
Have TG disorder
What is a serving?
12 ounce beer
5 ounce wine
1.5 ounces of 80 proof liquor
Sodium RecommendationAHA and US Dietary Guidelines
2300 mg per day or less, 1500 mg eventual goal
DASH Diet benefits
Restaurant Menu Item mg of sodium
Jimmy John’s Turkey #4 1075
Panera-Bacon, Egg, Cheese on Ciabatta Roll 1170
Applebee’s Spicy Cheese Nachos 4270
Auntie Anne’s Original Pretzel 1060
Buffalo Wild Wings Boneless Wings– 50 pieces 19,590
Papa John’s Favorite Original Crust Pizza 1110
Taco Bell Supreme Beef Burrito 1110
SummaryBe active
Healthy weight
Mainly plant foods
Unsaturated fats
Smaller amounts of poultry, lean meat and cheese
Less processed foods to reduce salt, sugar and add more fiber
Alcohol moderation
HealthDecision™.org is a site that provides data analysis and decision support for health care providers and their patients as they assess and manage the risk of cardiovascular events.
https://www.healthdecision.org/index/tool#