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ASLMBCE > ASLMBCE Sect 5: nutrition (24%) > Flashcards

ASLMBCE Sect 5: nutrition (24%) Flashcards

1
Q

With regards to Dietary guidelines for Americans, who issues them?

A

Dept of Agriculture and the Dept of Health and Human Services

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2
Q

With regards to Dietary guidelines for Americans, how frequently are they updated?

A

every 5 years

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3
Q

With regards to Dietary guidelines for Americans, What knowledge are they based on?

A

reommendations of Dietary Guidelines Advisory Committee (DGAC)

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4
Q

With regards to Dietary guidelines for Americans, who comprises its advisory committee?

A

numerous experts from academia, government and industry

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5
Q

Outline the position of Dietary Guidelines for Americans on thee role of dairy

A
  • listed as an essential component of the “My Plate”
  • comprises 10% of calories consumed
  • about half is consumed as fluid milk, half as cheese
    (these are listed as limitations by the core text)
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6
Q

With regards to dairy, what is known about its association with CVD?

A

NO or a WEAK inverse (lower risk) relationship w/ CVD

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7
Q

With regards to dairy, what is known about its association with stroke?

A

mild inverse association (lower risk of stroke)

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8
Q

With regards to dairy, what is known about its association with diabetes?

A

yoghurt = mild inverse association (lower risk of dm)

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9
Q

Does replacement of full fat diary product w/ plant based or polyunsaturated fat products lead to a significantly lower risk of heart disease?

A

yes: significantly lowers risk (substitution analysis)

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10
Q

with regards to cardiovascular risk, what nutrients is dairy high in?

A

saturated fats and Na

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11
Q

What did prior studies show with regards to the effect of dairy on BP and diabetes?

A

moderate evidence that diary cosumption improves BP and lowers the risk of DM in adults

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12
Q

With regards to dairy, what does the evidence suggest in terms of health outcomes in women and children and what level of evidence is this?

A
  • moderate evidence: improves bone health in children
  • 1 glass (240ml) / day decr risk of fractures by 5% in Caucasian and Chinese women
  • fortified diary can incr Bone Min Dens by about 0.7-1.8% over two years
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13
Q

What does evidence suggest with regards to assoc of dairy products and inflammation?

A
  • yoghurt may have protective effect (OR 0.34)

- cheese increases plasma pro-infl. markers

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14
Q

With regards to eggs: what association does evidence suggest betw high egg consumption, CVD and DM

A
  • high egg consumption (=3 or more a week); incr risk of diabetes, no assoc w. incr risk of CVD
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15
Q

What is the relationship between eggs and cholesterol

A

141-234 mg of cholesterol / egg;

  • can increase LDL and HDL
    - 2/3 of ppn = mild rise
    - 1/3 of ppn = signif rise in LDL and HDL
  • HDL improves w/ egg consumption
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16
Q

What is the limit of daily cholesterol consumption in different editions of American Dietary Guidelines

A

2015-2020 NO limit (inadequate evidence)

2010 < 300mg/day

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17
Q

What are the most common over-consumed foods in US?

A
  1. added sugars / high fructose corn syrup (HFCS)
  2. cholesterol
  3. saturated fats
  4. sodium
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18
Q

What are the foods high in sugars and HFCS

A

HFCS = High fructose corn syrup

candies, desserts, sugar-sweetened beverages, snack foods

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19
Q

What is the WHO RDD of sugar?

A
  • max 10% of total consumed calories
  • goal = 5% of tot cal (6 teaspoons or 24grm)/ day
  • ideal = none
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20
Q

What is the current RDD for sugar of AHA?

What is the current US average of daily sugar consumption?

A

max 100cal (6 teasp.= 24grm)/ day for wom , children, teens
max 150 cal (9 teasp. = 36grm)/ day for men
US av. / day: 13%; 13 teaspoons (52grm)

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21
Q

Name top 5 sources of sugar in US diet

A
  • sugar sweetened beverages: 47% of tot US sugar cal.
  • snacks and sweets: 31%
  • grain-based desserts: 8%
  • other dessserts: 6%
  • dairy desserts: 4%
    NOTE: liquid calories contribute more sugar cal to American diet than any other category of food
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22
Q

What are the richest sources of cholesterol?

A

eggs, dairy, cheese, organ meats, shellfish and other meat, incl poultry and fish

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23
Q

Top 5 sources of cholesterol in US diet:

A 
eggs 24.6 % of total US cholesterol
chicken 12.5% 
beef 11%
cheese 4.2%
pork 3.9%
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24
Q

what are the richest sources of saturated fat?

A

all foods that have fat have a percentage of sat fat; highest conc are in: meats, diary, eggs, processed foods, oils (incl. palm and coconut)

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25
Q

name the foods with high saturated fat content (and define high sat fat content)

A

high in sat fat = 8 grm / serving of saturated fat
higher fat cuts if beef, pork and lamb, salami, saussages and other processed meats (3 oz), many fast foods (eg cheesburgers), coconut (1 oz dried), coconut oil (1 tablesp)

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26
Q

name foods moderately high in sat fats, and define mod-high sat. fat content

A 
moderately high in sat fats = 4-7grm/serving
whole milk (1 cup, 240ml), leaner meats, cheese (1oz or 28grm), other full fat diary, palm oil (1 tbsp or 15ml)
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27
Q

name examples of foods with 1 to 3 grm of sat fats per serving

A 
nuts and seeds (1-2grm)
avocado (apx 2grm)
oils (1-2grm/tbsp) except coconut oil (15grm/tbsp) and palm oil (7grm/tbsp)
egg (2grm)
fish (1-3grm)
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28
Q

name the top 5 sources of sat fats in US

A
  1. burgers and sandwiches 19% (esp w/ meat, cheese or both)
  2. snacks and sweets 18%
  3. protein foods 15%
  4. diary 13%
  5. condiments, gravies, spreads and salad dressings 7%
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29
Q

name food groups richest in sodium

A

commercially prepared food: alm 50% of dietary salt intake from mixed dishes (burgers, sandwiches, tacos, rice, pasta and grain disches, pizza, meat, poultry and seafood soups)

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30
Q

top 5 sources of Na in US

A 
mixed dishes 44% (definition by USDA Dietary Guidelines as burgers, sandwiches, tacos, rice, pasta, grain dishes: pizza; meat, poultry, seafood, soups)
protein foods 14%
grains 11%
vegetables 11%
sweets and snacks 8%
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31
Q

what is the RDD of sodium

A

2g or less

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32
Q

what is an easy way to keep the consumption of sodium within the RDD?

A

check the nutrition information if Na/ serving is less or equal to calories/ serving, then if someone is on a 2000 cal/ day diet this should be fine

easily achieved on whole plants foods diet (beware soy sauce and other high na content condiments/ pre-packaged foods)

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33
Q

What kind of foods are Trans fats found and what is their safe recommended daily dose?

A
  • declared unsafe for human consumption by FDA ( should have been removed from foods by 2018)
  • found in solidified plant oils,processed meats, some meats and diary products
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34
Q

what food gp is the highest in trans fats

A

snack foods, moderate: confections, dairy, oils, processed meat, red meat, reduced fat dairy, refined grains (flour, white rice, pasta)

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35
Q

top 5 sources of trans fats in the US

A 
grain-based processed foods 40%
animal products 21%
margarine 17%
french fries 8%
potato/ corn chips and microwave popcorn 5%
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36
Q

Name the food groups highest in calories

A

fats and oils, confections, snack foods, processed meats

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37
Q

Name the food groups lowest in calories

A

whole vegetables, whole grains, whole fruits, legumes, herbs and spices, mushrooms, low-fat dairy

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38
Q

Top 5 sources of calories in the US

A 
refined grain-based deserts (5.4%) of total cal. in diet
non-whole grain breads 6%
chicken 5.6%
sweetened beverages 5.3%
pizza 4.5%
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39
Q

list the most important under-consumed nutrients in the US and define what under-consumed means.

A
  • under-consumed = at least 25% ppn not consuming in adequate amount
  • Ca, Mg, K
  • fiber
  • vitamin A, C, D, E, K
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40
Q

List food groups 1. high in Ca (>20% of DV/ serving), 2. Moderately high in Ca (5-20% of DV / serving)

A
  1. High: dairy, some seeds (e.g. chia, poppy, sesamy), ca-fortified non-diary beverages, tofu (esp if made w/ Calcium sulphate)
  2. MOd.: almonds, beans, low oxalate dark greens, okra
    DV = daily value
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41
Q

With regards to Ca, name, high content plant based sources, what affects their absorption and how does their absorption compare to Ca in dairy

A
  • spinach, beet greens and swiss chard = very high in Ca but also high in oxalate, which limits the absorption of Ca
  • 40-60% of Ca from low oxalate dark greens (e.g. kale, okra, bok choy) absorbed
  • 32-34% of Ca from dairy absorbed
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42
Q

With regards to nutrients, what is considered to be 1. Hi 2. MOderate content per serving?

A
  1. high >20% of DV/ serving
  2. Moderately high 5-20% of DV / serving
    DV = daily value
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43
Q

Name foods high (> 20% DV) in fiber

How many grams does this 20% of DV represent?

A

fiber only found in plants
high > 20% DV or >5grm): beans, split peas, lentils, avocado, bran cerals, rasberries, blackberries, peas, papaya, dried fruits, flaxseeds, some whole grains and whole wheat pasta

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44
Q

NAme foods that are moderately high (5-20% of DV / serving) in fiber

A

moderately high = 5-20% DV or 1.25-5 grm) : blueberries, strawberreis, most other fruit, most vegetable, grains, whole grain breasd, popcorn, muschrooms, nuts and seeds

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45
Q

Name foods high (> 20% DV) in magnesium

A

> 20% DV or 80mg: brazil nuts, almonds, cashews, pine nuts, amaranth, edamame, dark chocolate

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46
Q

Name foods that are moderately high (5-20% of DV / serving) in magnesium

A

5-20% dv: whole grains, dairy, red meat, processed meat, fish, peanuts, hazelnuts, pecans, pistachios, walnuts, spinach, tofu, potatoes, some beans (black beans, black-eyed peas, lima beans)

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47
Q

Name foods that are high (> 20% DV) in potassium

A

> 20%DV or 700mg: potatoes, adzuki beans, avocado, soybeans, black turtle beans, lim abeans, squash, yams, pantains, bamboo shoots, passion fruit
other concentrated sources that do not meet 20%: white beans, beet greens, dates

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48
Q

Name foods that are moderately high (5-20% DV) in potassium

A

5-20% DV: dairy, fish, legumes, musrooms, nuts, poultry, processed meats, vegetables, refined grains

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49
Q

Name foods that are high (> 20% DV) in vit A

A

sweet potato (561%), beef liver, spinach, raw carrots, cantalupe, red peppers, black eyed eas

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50
Q

Name foods that are moderately high (5-20% DV) in vitamin A

A

dairy, tomato juice, herring, fortified cereals, hard boiled eggs

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51
Q

Name foods that are 1. high (>20% DV) and 2. moderately high (5-20% DV) in vitamin C

A
  1. high: bock choy, broccoli, brussel sprouts, cabbage, cantalupe, cauliflower, currants, citrus, fruits, daikom radishes, guava, kale, kiwi, mango, mustard greens, papaya, parsley, peas, pineapple, red pepper, strawberries, tomatoes, turnip greens
  2. mod high: most other vegetables and fruit
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52
Q

Name foods that are 1. high (>20% DV) and 2. moderately high (5-20% DV) in vitamin D

A
  1. high: high fat fish (e.g. salmon), fortified dairy and non-dairy milks, fortified fruit juices
  2. mod high: dairy (vit D added to milk in US), fortified margarines, large egg, beef liver, fortified cereals
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53
Q

what is the best source of vitamin D and what is the recommended dose?

A

sunlight: 5-30 min at least 2x/week, without sunscren, between 10am and 3pm

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54
Q

Name foods that are 1. high (>20% DV) and 2. moderately high (5-20% DV) in vitamin E

A
  1. high: sunflower seeds, oils (sunflower, safflower), almonds, hazelnuts
  2. mod high: peanut butter, corn oil, spinach, broccoli, avocados
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55
Q

Name foods that are 1. high (>20% DV) and 2. moderately high (5-20% DV) in vitamin K

A
  1. high: oils, snack foods, dark leafy vegetable, kiwi, dried prunes, avocado, broccoli, brussel sprouts, asparagus
  2. mod high: herbs and spices
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56
Q

Define nutrient - dense foods

A

have most “short-fall nutrients” w/ the least “over-consumed” nutrients (sugars, cholesterol, saturated fats, sodium)

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57
Q

What are the top nutrient-dense foods, based on nutrients per calorie?

A

listed in decreasing order:

  1. vegetables, incl. mushrooms
  2. herbs and spices (but eaten in very small quantities)
  3. fruits
  4. legumes
  5. whole grains
  6. nuts
  7. seeds
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58
Q

What are the top food groups to limit or avoid based on lack of nutrients and potential disease rpomoting components per calorie

A

listed in descending order:

  1. sugar-sweetened beverages
  2. processed meats
  3. fried foods
  4. processed snack foods w/ added fat, sugar, salt
  5. confections
  6. high fat dairy 9esp w/ added salt and sugar)
  7. red emats
  8. poultry
  9. eggs
  10. fish
  11. added fats and oils
  12. reduced fat dairy
  13. refined grains (white four, white rice and white pasta)
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59
Q

What are the general principles on food to consume?

A
  1. think holistically abotu the total profile; “FOOD PACKAGE” (e.g. diary excellent source of CA but also v. high in sat fats)
  2. “Is there a better source or package to get the same nutrients?”
  3. “Eat food, Not too much, mostly plants” (M. Pollan)
    - food= unprocessed, natural, not too much = approp portion sizes, doesn’t need to be vegan/vegetarian but mostly plants
  4. “Eat a rainbow every day”
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60
Q

What are helpful ways to identify wholefood?

A
  1. no list of ingredients
  2. can you visualize everything that was used to produce this food?
  3. generally the less processing, the more whole and the more nutricious
  4. check ingredients if: “nothing bad added, nothing good taken away” (M. Greger: How not to die)
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61
Q

Which institutions agree on mostly plant based recommendations as healthy eating, in the US

A

USDA (Dept of Agriculture), Dietary Guidelines Advisory Committee (DGAC), American Institute for Cancer Research (AICR), Kaiser PErmanente, Harvard School of Public HEalth

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62
Q

Why is a nutritional assessment useful and who can perform it?

A
  • Can be done a provider, w/ a f/u from registered dietitian or a RD in a collaborative team
  • helps determine what the nutritional prescription should be
  • helps create a pers database of pat. nutrit adequacies & needs to monitor
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63
Q

What are the elements of nutritional assessment?

A 
ABCD
A= anthropometric data
B= biochemical data
C= clinical assessment
D dietary assessment
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64
Q

What does A represent in nutritional assessment and how do you assess it?

A

Anthropometric data:

  1. weight, height, BMI, waist circumference
  2. BMI
  3. bioelectrical impedance analysis (common, accuracy varies)
  4. hydrostatic underwater weighing ; uncommon, accurate
  5. caliper measuring: not accurate and NOT RECOM.
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65
Q

What are the 1. advantages and 2. limitations of BMI ?

A
  1. low cost and easy to calculate
  2. does not account for
    - muscle and bone mass
    - differences in body composition due to gender, race, ethnicity
    - less valid for ppl under 20 and over 65
    less precise for very short people
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66
Q

With reg to bioelectrical impedance analysis, what does it measure, what is it used for and what are its shortfalls

A

uses a small electrical signal to measure the amount of water w/in a pers body to assess its composition; calculates body fat percentage based on water measurements (dif water content in fat vs muscle)
common
accuracy variable
more accurate than BMI at measuring body fat `

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67
Q

What does B represent in nutritional assessment and how do you assess it?

A

B= biochemical data

  • almost every lab test linked to nutritional status
  • when evaluating lab work keep in mind pt’s hstory and current status, as well as effects of hydration and dehydration on lab values
  • primary tests: Na, K, Hb, Hct, glucose, HbA1c, albumin, tot chol., LDL-C, HDL-C, TAGs
  • secondary tests: vit D, B12, iron, ferritin
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68
Q

What does C represent in nutritional assessment and how do you assess it? (7 items)

A

C = clinical assessment

  1. age
  2. gender
  3. medical and surgical history
  4. activity level
  5. nutritional history
    - (weight history; highs and lows, changes, at what wt did pat feel best)
    - any hx of nutritional deficiencies, problems w/ mlabsorption or spec considerations (e.g. bariatric surg, Coeliac dis)
  6. vital signs
  7. physical exam:
    - condition of skin, nails, hair (dry, brittle?)
    - muscle (fitness/ wasting)
    - hydration status
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69
Q

What are some examples of conducting a dietary assessment as part of nutritional assessment of a patinet?

A

variety of q’s can be used, examples are:
1. daily intake of solids and liq.
2. 24 hr recall
3. three-day food recall
4. mini nutritional assessment of elderly
5. online and interactive individ dietary assessment tools
6. tracking apps
7. books
8. in-depth asses by dietitian
etc.

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70
Q

How is the 24-hr food recall conducted?

A
  1. ask pt whe he ate during the last 24 hrs
  2. usually a verbal interview
  3. to incr accuracy clarify:
    - how was the food prepared (brold, baked, grileld etc.)
    - how big was the portion?
    - how often is that food/ drink consumed?
    - did he eat any food, snacks, or beverages etw meals?
    - drinks between or after meals?
    - any desserts? sweets?
    - was this a typical day? ; if not how did it differ?
    - does his intake over weekends? if so how?
    - any nutritional supplements used? (e.g. bars, shakes, pills, etc.) if so what and how much/ often?
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71
Q

How is the 3 day food recall conducted?

A

best if pat can catch a range of eating behaviours (e.g. workday vs weekend), good, bad, average day

  • be specific about portion sizes, brand names, preparation methods, anuthing added to the food (sauces, condiments, sugar, salt), was it home made?
  • often given as an assignent to bring to the next session
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72
Q

What is the mini nutritional assessment for the elderly conducted?

A
  • validated nutrit screening
  • 65 yo and older
  • identifies malnurishment or risk thereof
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73
Q

What does D represent in nutritional assessment and how do you assess it?

A

D= dietary assessment

  • components of pat current diet and beh drivers for food choices;
    1. variety of questinnairs/ tools (recalls, apps, etc)
    2. meal schedule, incl. TIMING, PLACE, ACTIVITIES during eating
    3. social history, incl. fa structure, psychosicial factors, cultural/ relig. aspects; asses also:
  • financial ability/ food budget
  • functional ability (ab to chew, intolerances, allergies)
  • special dietary needs (renal failure, constipation, etc.)
    4. emotions at times of eating
    5. any food groups/ nutrients underconsmed?
    6. any food groups/ nutrients overconsumed?
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74
Q

Highlights of a collaborative team approach to nutrit. assessment

A
  1. physical exam + basic nutrition assessment by a medical provider
  2. if indicated: f/u for comprehensive assess by RD (NB all complex patients should be referred)
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75
Q

Who constitutes a “complex” patient, requiring a comprehensive nutritional assessment by a registered dietitian, after basic nutrit assesm. by a provider?

A

COMPLEX PT = diabetes (T1/T2, gest), renal dis., CVD, COPD, weight do, bariatric surgery, cancer, compromised imm syst., food allergies, Gi do’s (e.g. coeliac, IBD, cirrhosis)

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76
Q

What is the role of medical provider / physician in nutritional assessment?

A
  1. obtain baseline history and physical examintion
  2. determine pat. RF’s and comorbidities
  3. create a framework for treatment:
    - for most chronic conditions nutrition must be emohasised as the primary and often most effective treatment
    - explain importance of nutrition specially in therms of pat current medical treatment and goals
  4. lead an integrated care team
  5. help patients set short and long-term lifestyle and dietary goals
  6. oversee recommendations by dietician
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77
Q

What is the role of dietician in nutritional assessment?

A
  1. asssess and monitor nutritional status
  2. determine macronutrient and/ or micronutrient needs
  3. develp individualised meal plan
  4. coach pat tow pers goals w/ consideration of emdical hx
  5. track progress (e.g. impact on biomarkers)
  6. provide ongoing support and education
  7. provide medical nutrition therapy
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78
Q

Name major nutrition studies for nutrition recommendation for treatment of disease

A
  1. PORTFOLIO : HYPERCHOLESTEROLEMIA
  2. DASH : HTN
  3. ORNISH for early dx’d prostate ca
  4. ORNISH for CAD
  5. LYON HEART STUDY (Mediteranian vs AHA diet)
  6. Esselstyn plant-based diet for CAD
  7. CHIP program amd diet for DIABETES
  8. VEGETARIAN AND VEGAN diets fro DIABETES
  9. many more
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79
Q

Briefly describe the PORTFOLIO diet and its results

A
  • PORTFOLIO diet for hypercholesterolaemia; very low sat fat diet, high in plant sterols, soy protein, viscous fibers and almonds
  • decrease in LDL by 28.6%
  • lovastatin 20mg LDL decr. by 30.9%
    no statistical difference betw the two
80
Q

Briefly describe the DASH diet and its results

A

DASH diet for HYPERTENSION

- vegetables, low salt and low-fat dairy = adequate as first line for treatment of essential hypertension

81
Q

Briefly describe the ORNISH diet for prostate cancer and itsresults

A
  • early dx’d prostate ca, localised, low to mod grade
  • 1 year on low fat, plant based - treatment gp lower PSA (6.3-6.0), inhibition of ca growth by 70%
  • control gp incresaed PSA (to 6.7), inhibition of ca growth 9%
82
Q

Briefly describe Ornish diet for coronary artery disease and its results

A
  • low fat, plant based

- improved stenosis, maintained after 5 years

83
Q

Briefly describe the LYON diet heart study and its results

A
  • secondary prevention of cad
  • Mediteranian diet vs American Heart Association Step 1 diet
  • protective effects of mediteranian diet maintained for 4 years, after first heart attack
84
Q

Briefly describe the Esselstyn plant based diet and its results

A
  • coronary artery dis.
  • very low fat, plant based
  • reverse and prevent major cardiac events in 177 adherent patients over 3.7 years
  • events among adherent patients rare (0.6%)
  • events among non adherent patients 62% (13 out of 21 experienced an event)
85
Q

Briefly describe the CHIP program and its results

A
  • for diabetes
  • multifactorial lifestyle intervention
  • effective in treating T2 Dm
  • return investment w/in a few months
86
Q

Briefly describe the vegan diet for diabetes and its results

A
  • superior to ADA (American Diabetes Association)
  • improved serum gluc control
  • 22 weeks RCT
  • 99 subjects w T2DM
87
Q

With regards to nutrition and physical activity counselling, what is the US Preventive Services Task Force recommendation for their use in people with no chronic disease or risk factors?

A

Nutrition prescription should be based on readiness for change (grade C recommendation; service should be offered in a selective manner based on professional assessment and patient preference)

88
Q

With regards to nutrition and physical activity counselling, what is the US Preventive Services Task Force recommendation for their use in people with overweight or chronic disease?

A

Physical activity and nutrition counselling recommended, level B : provide service, as there is a high certainty the benefit will be moderate to substantial

89
Q

The evidence behind Nutrition prescriptions

A

Not much literature for nutrition prescriptions but strong evidence for exercise Rx
- similar, therefore reason to blelieve that are effective for food behaviour change

90
Q

What is the evidence behind exercise prescriptions?

A

Effectiveness of physical activity advice and prescrioption by physicians in routine primary care: a cluster randomised trial. 2009

  • 4317 physically inactive patients divided into 2 gps
  • intervention: physical activity advice during an office visit; subgroup (30%) = extra intervention : tailored physical activity Rx at additional appoitment
  • 6 months: intervention gp incr in xerc av.18min / week
  • subgroup ; incr activity >50min 130min / week, <50 yo 31.5min/week
91
Q

How to write a nutrition prescription?

A
  1. SMART
    - specific: what are you prescribing (apples. etc.), don’t prescribe nutritional categories (eg cruciferous veg)- more difficult to undestand
    - Measurable: How much/ many (one medium size/ one cup, etc.)
    - ACHIEVABLE: Who will be doing the shopping? Who prepares the food? Who is overseeing the eating of the food? patients will determine if they have the ability to to follow through
    - REALISTIC: IMPROVEMENT IS NOT GOAL, NOT PERFECTION
    - TIME connected: How frequent? (e.g. daily, each meal, weekly…), how long? (three moths…) , time limits may encourage compliance
92
Q

Format of a nutrition prescription

A
  1. identifiers: patients namen the date, signature
  2. CORE COMPONENTS: (pneumonic TAF, fat backwards):
    - TYPE of foor (specifict)
    - AMOUNT of food (be exact)
    - FREQUENCY food should be eaten
  3. positive (consume (more of) xy) vs negative (don’t cosume/ less of xy)
93
Q

Describe strategies that can help pat. achieve dietary changes

A
  • PRACTICAL discussion about the role of nutrition in treating pt’s current conditions and preventing additional issues
  • TIMELY AND SPECIFIC: when pt ready for action; he leaves with a specific nutrition prescription / planand/or is referred to registered dietitian
  • POSITIVE initially focus on the positive: ie what to add to the diet
  • REALISTIC (small change better than no change)
  • PERSONALISED: base goals on pt’s medical and wt hx , schedule and food preferences
  • set MEASURABLE GOALS:
94
Q

describe some strategies that can help pt adopt healthy habits

A
  • encouragement
  • choose variety of foods
  • balance and moderation
  • increase awareness (e.g food and exerc. journals)
  • consistent meal schedules
  • incr self- awarenes of eating cues (hunger, satiety, stress, environmental cues)
  • develop healthy eating beh:
    • slow down, chew well, pay attention to cues
    • avoid eating in the car or on the run
  • encourage cbt techniques: self monitoring, structured eating pattenrs, rewards and reinforcements, soc support, cog. support, cog. restruct., stress management
95
Q

name strategies that can help improve outcomes of nutritional counselling

A
  • collaborative team approach
  • long term followup!!!
  • collaborative approach w/ patient (partnership): provide accurate, comprehensive information re evidence, engage pat., let pt. choose change
  • provide online and other resources to support ongoing healthy dietary practices
96
Q

List the most protein-dense foods

A
  • animal based protein most concentrated but packaged w/ sat. fat
    1. chicken breast 25g/ serving
    2. beef 22g
    3. salmon 17g
97
Q

What are the differences betw animal- and plant- sources of proteine

A

animal:
- most concentrated but packaged w/ fat
- more readily digested
- greater content of sulfur-containing amino-acids; these are broken down into acidic substances, that need buffering in human body; can lead to extraction of Ca from bones
plant based proteins:
-

98
Q

What are the differences betw animal- and plant- sources of proteine

A

animal:
- most concentrated but packaged w/ fat
- more readily digested
- greater content of sulfur-containing amino-acids; these are broken down into acidic substances, that need buffering in human body; can lead to extraction of Ca from bones
plant based proteins:
- generally less digestible; however soy protein, wheat gluten and wheat flour >90% digestable (sim to meat and eggs), much less digestability for plants w/ intact cell walls (50-80%)
- in general, a;; plants cntain all essential amino-acids, although oft not in the right proportion, however, most vegan and vegetarian diets can provide complete amino acid profile by combining an unprocessed starch (rice, beans, potato, corn) w/ a combination of fruit and veg.

99
Q

List the most protein-rich plant based foods/ serving

A 
soy beans 18g
tofu 20g
lentils 17.9 g
pinto beans 15.4g
hempseed 15g
100
Q

Name special populations that may need a protein prescription

A

seniors (>70 yo = decr absorption of protein, hence many need 25% more protein than younger adults)
children
athletes

101
Q

What are the daily calcium requirements?

A

19-50 yo = 1000 mg/day

> 50 you = 1200 mg/day

102
Q

List the general principles of fat consumption to reduce CVD risk

A
  • dietary patterns and food packages are far more important in the reduction of heart and vasc dis than total fat consumed
  • MOno and poly- unsaturated fats from healthy plant and seafood sources should replace saturated fat and trans-fats from processed foods a tropical oils
103
Q

With regards to polyunsaturated fats, what are their main sources and are they thought to be harmful or beneficial?

A
  1. Omega 3s (considered anti-inflammatory)
    - oily fish, plant based: flaxseed, chia, wallnuts, soy beans
  2. Omega 6s (usually considered pro-inflammatory but some are anti-inflammatory; inflammatory effect = arachidonic acid, other omega6s are anti-inflammatory); it’s the food package that counts here again
    Foods high in omega 6 fats include unhealthy foods like processed snacks, fast foods, cakes, fatty meats, and cured meats.
    Healthier options: tofu, walnuts, and peanut butter.
104
Q

With regards to monosaturated fats, what are their main sources and are they thought to be harmful or beneficial?

A
  • usually liquid at room temp. (oils): olive, canola, peanut, safflower, sesame
  • if used inplace of sat fats may help: lower cholesterol=> lower CVD risk and overall mortality
105
Q

With regards to saturated fats, what are their main sources and are they thought to be harmful or beneficial?

A
  • Lauric acid (coconuts); incr total cholesterol, HDL and LDL (HDL may not lower CVD risk, and incr LDL known to incr CVD risk
  • stearic acid (cheese, emat, poultry, dairy, dark chocolate)- known harmful effect; may lower LDL, assoc w/ incr endothel cell damage and cell death, assoc w/ incr risk of colorectal ca
  • palmitic acid (palm oil, butter, cheese, milk, meat= most common sat fat); harmful, incr risk CVD
  • myristic acid (dairy products, coconut oil, palm kernel oil): harmful
106
Q

With regards to trans- fats, what are their main sources and are they thought to be harmful or beneficial?

A
  • partially hydrogenated vegetable oils, processed foods, some meats and diary products, fried foods, commertially baked goods and snacks, coffee cremers, etc.
  • incr risk of CVD
  • unsafe for human consumption, FDA mandated removal from food by 2018
107
Q

Outline the general principles of giving a Fat prescription

A
  • mostly negative

- less helpful to count fat grams, more helpful to limit specific foods

108
Q

What are the general principles around carbohydrates as essential nutrients?

A
  • must be addressed in the context of whole foods versus processed foods
  • whole foods = ideal (vegetables, fruits, legumes, etc)
  • processed carbs generally harmful and should not be eaten freely (sugars, flours)
109
Q

What are the components of carbohydrates?

A

Fiber;
Refined or industrial sugars, and flours ( ie fiber and other “packaging” removed
Starch

110
Q

What is the recommended daily intake, the average American intake, the physiology and health benefits of fiber and what are the best sources of it?

A

Fiber; in whole foods, oft removed from processed

  • incr stool bulk, viscosity, holds extra water, modulates fermenting and promotes healthier gut bacteria
  • improves constipation, lowers cholesterol, stabilises bl sugars, improves satiety and decreases cravings, decr risk of diabetes, decr risk of colon ca
  • rec. daily intake =
    • women 25g/day, greater benefits of >40g / day
    • men 38g/day, greater benefit if >45g/day
  • average American daily intake 18g/day, - <3% meet the recommended intake
  • best sources: legumes, whole grains, vegetables, fruits, nuts and seeds
  • no fiber in meet and dairy
111
Q

What are the sources of starch and where is what foods is it found in? Is it beneficial or harmful?

A
  • neutral to protective if coming from whole foods (e.g. corn, potatoes)
  • harmful if coming from processed or refiend foods (eg potato chips or corn syrup)
112
Q

Define micronutrients

A

= chemical elements or substances that are essential in small or minute amounts for growth and health: vitamins and minerals

113
Q

Define beneficial non-nutrients ad how they can be prescribed on nutrition prescription?

A

valuable to health but not proven to be essential for life: antioxidants, anti-inflammatory molecules, phytochemicals, polyphenols, phytosterols, glucosinoates, carotenoids
- prescribed as food families

114
Q

What does the evidence suggest w/ reg to supplements of micronutrients and beneficial non-nutrients?

A
  • multiple studies indicate a variety of whole foods helps achieve micronutrient balance better than taking supplements
  • harm can occur from overdosing on micronutrients
  • some supplements are warranted: partic B12 for people on plant-only diets
115
Q

name anti-oxidant and other micronutirent-rich foods

A
  1. cruciferous vegetables: contain sulforaphane and indole 3-carbinols; broccoli, cauliflower, brussel sprouts, bok choy, kale, chinese cabbage
  2. dark berreis and fruits: cont polyphenols (e.g. ellagic acid, anthocyanidins, anthocyanids); blueberries, rasberreis, strawberreis, cranberries, pomegranades
  3. allium vegetables; cont organosulfurs; garlic, onions, leeks
  4. orange, yellow and dark green vegetables and fruits
    ; carotenoids- stimulate natural kilelr cells; carrots, yams, mango
  5. dark green vegetables; high in potassium, calcium, magnesium; spinacj, colalrds, swiss chards, dark letuces, msutard and turnip greens
116
Q

What do cruciferous vegetables contain, what is their effect on health and what are their exampels

A

contain sulforaphane and indole 3-carbinols; broccoli, cauliflower, brussel sprouts, bok choy, kale, chinese cabbage

117
Q

What foods are known to increase inflammation?

A
  1. processed grains and sugar
  2. Processed (salted, smoked, fermented, cured, or processed in any other way) meat and red meat
  3. harmful fats: trans, oxidised (heat or rancid), solid
118
Q

What food or ingestible substances are known carcinogens to humans?

A

alcohol, processed meat (colon, stomach, pancreatic, prostate, red meat (?probable- assoc w/ colorectal ca), tobacco (smiking and other smokeless)

119
Q

What are AGEs and what effects do they have on human body?

A

Advanced Glycation End Products= oxidative stress inducers; known to cause inflammation
- spontaneous chemical reaction betw amino acid (protein) and a monosacharide (simple sugar)
- ocure more in:
protein&raquo_space; fat»carb, high temp (> 120C/ 248F), prolonged cooking, dry heat preparation, acidic pH
- can build up in the body
- directly related to: diabetes (T1&2), atherosclerosis, kidney dis,m slow wound healing

120
Q

What beneficial substances are found in DARK GREEN vegetables and what are their benefits to health

A

dark green vegetables; high in potassium, calcium, magnesium; spinacH, colalrds, swiss chards, dark letuces, msutard and turnip greens

121
Q

What is the assoc. betw hyperlipidaemia and diet? And what dietary interventions can be of benefit?

A
  • vegans <5%, non-vegans 15%
  • reduce: harmful fats (trans, sat, omega 6) - i.e meat, processed foods
  • increase: fiber (at least 40-45g/day), nuts (handful a day- almonds, walnuts, pecans), omega 3, plant sterols and stanols (soybeans, gr peas, legumes, nuts and seeds, sprouts, avocados, what germ, br sprouts)
122
Q

what is the largest source of saturated fat in a typical American diet

A

cheese, then pizza

found in dairy, meat (esp fatty cuts)

123
Q

PORTFOLIO study

A

intervention 1: fed portfolio diet (foods high in plant STEROLS and VISCOUS FIBERS: oatmeal, soybeans, almonds, eggplant, okra & LOW SAT.FAT)
intervention 2: lovastatin 20mg od + fed LOW SAT.FAT DIET
CONTROL: ADVISED to eat low sat fa diet but no specificic foods discussed
- measured effect on serum LIPIDS and CRP
- 2 weeks
- LDL reduction 28.6% portfolio, 30.9% lovastatin , 8% control (stat sig.)

124
Q

How does food preparation affect nutrient value?

A

through oxidation

125
Q

How can diet affect HYPERTENSION?

Which food groups are known to negatively affect hypertention?

A

vegans 7%, 23% non-vegans (RR>3)

  • high sodium
  • high sat fats
  • high alcohol (men no more than 2SD/day, wom. no more than 1SD/day)
  • high caffeine
126
Q

How do cooking tmethods affect AGEs in food?

A
  • higher temperature
  • longer application of heat
  • dry food preparation (moisture reduces AGEs formation)
  • acidic ph» basic
    increase w/ grilling, broiling, roasting, searing and frying
127
Q

what are the highest sources of dietary sodium in the US?

A
  • processed foods (account for 75% of dietary sodium intake in the US)`; pizza, breads, rolls, crackers, processed meats, canned food (soups and veg.)
128
Q

What is the recommended intake of alcohol to improve/ prevent hypertension?

A

men no more than 2SD/day, wom. no more than 1SD/day

129
Q

What are the known modifiable lifestyle factors to improve hypertension?

A
  • diet (LOWER: sodium, sat. fats, INCREASE: potassium, calcium, garlic)
  • limit alcohol men no more than 2SD/day, wom. no more than 1SD/day
  • limit caffeine
  • smoking cessation
  • stress reduction
  • increased physical activity
130
Q

Name good food sources of potassium

A

potatoes, sweet potatoes
fruits (bananas, peaches, catalupe)
vegetables (squash, broccoli,, spinach)
legumes (whote beans, lentils, soy, lima)

131
Q

What are the best sources of plant sterols and stanols?

A

soybeans, green peas, legumes, nuts, seeds, sprouts, avocados, wheat germ, brussel sprouts)

132
Q

DASH diet **

A

reduction of BP appx 11 mmHg in 8 weeks
right portion sizes, variety of foods and nutrients
lower Na, sat fats
increase fruit and veg., nuts

133
Q

What is the association between hypertension and diet

A

7% vegans, 23% non vegetarian (RR>3)

positive assoc betw intake of animal products, high Na etoh, caffeine and hypertension

134
Q

What consumables and life style factors are positively linked w/ hypertension

A

animal products, high sat fats, high Na foods, alcohol, caffeine, tobacco, stress, low level physical activity

135
Q

What are the known modifiable lifestyle factors to improve hypertension?

A

vegans 2.9%, non vegetarians 7%

REDUCE: simple/processed sugars (r=0.83, p<0.001), dietary fat (r=0.84, p<0.001), total caloric intake, high GI foods
INCREASE: fiber (fiber assoc w/ lower risk diabetes r 0.16, p<0.03), hig GI foods

136
Q

What are the most common names of processed sugars on food labels?

A
  • ose (e.g. glucose, fructose, sucrose, lactose, etc.), sugar, syrup, malt, fruit concentrate
  • processed grains (white fours, “puffed” cereals (rice puffs, rice cakes), flaked cereals (e.g. cornflakes), white rice, ground, flaked and puffed whole grains
137
Q

What does the current evidence suggest re artificial sweeteners?

A
  • cause dysbiosis, can adversely affect wt control

- should be avoided

138
Q

Increase in what foods can be beneficial for hypertension?

A
  1. potassium (potatoes and sweet potatoes, fruits- cantalupe, bananas, peaches, vegetables- squash, broccoli, spinach, legumes - white beans, lentils, soy, lima)
  2. calcium (low oxalate greens- collards, kale, turnip and mustard greens, bok choy, beans- white, black eyed peas; fortified non-diary milks, low fat diary - recom in DASH diet but more recent evidence suggests replacing diary w/ plant-based or polyunsaturated fats may signif reduce CVD risk)
  3. magnesium ( almonds, cashews, peanuts, beans - black, soy, kidney, amaranth, quinoa, avocadoes, potatoes)
  4. garlic (SBP 5 mmHg, DBP 2.5mmHg) - metanalysis 2016
  5. water-only fasting under medical supervision 18-21 d. incl. fast and re-feeding
139
Q

What was the effect of DASH diet on BP in the study?

A
  • reduced syst BP by appx 11mmHg over 8 weeks
140
Q

what do cruciferous vegetables contain, what is their effect on health and what are their exampels

A

contain sulforaphane and indole 3-carbinols; broccoli, cauliflower, brussel sprouts, bok choy, kale, chinese cabbage

141
Q

What food or ingestible substances are known carcinogens to humans?

A

alcohol, processed meat, red meat (?probable- assoc w/ colorectal ca), tobacco (smiking and other smokeless)

142
Q

What are AGEs and what effects do they have on human body?

A

Advanced Glycation End Products= oxidative stress inducers; known to cause inflammation
- spontaneous chemical reaction betw amino acid (protein) and a monosacharide (simple sugar)
- ocure more in:
protein&raquo_space; fat»carb
high temp (> 120C), prolonged cooking

143
Q

What are the recommendations w/ reg. to food preparation in order to decrease AGEs?

A
  • incr whole foods, decrease processed foods

- prepare foods using wet cooking techniques at temp below 120C/248F

144
Q

what is the largest source of saturated fat in a typical American diet

A

cheese, tehn pizza

found in dairy, meat (esp fatty cuts)

145
Q

Which food groups are known to increase the risk of hyperlipidaemia?

A
  • meat, processed foods;
    hyperlipidaemia increases in direct proportion to meat consumed)
  • Countries with high intake of processed foods & animal products have higher amounts of hyperlipidemia
146
Q

HYPERTENS

ION

A

vegans 7%, 23% non-vegans (RR>3)

147
Q

What is the effect of reduced dietary sodium intake on SBP in mmHg? What is the RDI and the highest tolerable daily intake of sodium for hypertension?

A
  • reduction typically reduces SBP 2.5-7mmHg
  • greatest effects in Af Am and elderly
  • RDI g<1.5; highest tolerable intake 2.3g
148
Q

what are the highest sources of dietary sodium in the US?

A
  • processed foods (account for 75% of dietary sodium intake in the US)`
149
Q

What is the reccommended intake of alcohol to improve/ prevent hypertension?

A

men no more than 2SD/day, wom. no more than 1SD/day

150
Q

What are the known modifiable lifestyle factors to improve hypertension?

A
  • diet (lower sodium, sat. fats)
  • limit alcohol men no more than 2SD/day, wom. no more than 1SD/day
  • limit caffeine
  • smoking cessation
  • stress reduction
  • increased physical activity
151
Q

Name good food sources of Calcium

A

greens low in oxalate: collards, kale, turnip and mustard greens, bok choy
beans - white, black eye peas,, etc.
fortified non diary milks
low fat diary

152
Q

DASH diet ***

A

reduction of BP appx 11 mmHg in 8 weeks

153
Q

Name good food sources of magnesium

A

nuts (cashwes, almonds, peanuts)
beans (black, soy, kidney)
beans (black, soy, kidney)
amaranth, quinoa, avocado, potato

154
Q

What are the known modifiable lifestyle factors to improve type 2 diabetes?

A
  • diet: (DECREASE simple carbohydrates & high GI foods, sat fats & trans fats, total caloric intake, INCREASE fiber, low GI foods)
155
Q

What are the known modifiable lifestyle factors to improve hypertension?

A

vegans 2.9%, non vegetarians 7%

REDUCE: simple/processed sugars (r=0.83, p<0.001), dietary fat (r=0.84, p<0.001)
INCREASE: fiber fiber assoc w/ lower risk diabetes (r 0.16, p<0.03)

156
Q

What are the most common names of processed sugars on food lables?

A
  • ose (e.g. glucose, fructose, sucrose, lactose, etc.), sugar, syrup, malt, fruit concentrate
157
Q

What does the current evidence suggest re artificial sweeteners?

A
  • cause dysbiosis, can adversely affect wt control

- should be avoided

158
Q

Which two processes, with the potential to be changed by lifestyle, are though to results in cancer?

A
  1. immune system (Natural killer cells)

2. chronic inflammation (

159
Q

Name foods that are known to be pro-inflammatory.

A

saturated fat, processed sugar, processed meat, red meat, processed foods

160
Q

What group of phytochemicals have been shown to have anti-oxidant properties?

A

beta carotene: carrots, sweet potatoes, spinach, kale, et.c
lycopne : tomatoes, watermelon, gava, pink grapefruit, etc.
resveratrol: red grapes, blueberries, peanuts, soy, etc.
selenium: brazil nuts, sunflower seeds, fish, mushrooms, etc.
vitamin C: cantalupe, citrus fruits, kiwi, mango, berries, etc.
vitamin E: almond, peanuts, green leafy vegetables, etc
increase Fiber
NB: antioxidant supplements do not seem to reduce risk of cancer but wholefoods do

161
Q

What are life-style modifiable risk and protective factors for breast cancer?

A

RF: BMI >30, incr meat intake
PF: soy, fruits and veg.

162
Q

What are life-style modifiable risk and protective factors for prostate cancer?

A

RF: smoking, obesity, high dairy intake (?), Ca supplements (?),
PF: high lycopene, selenium, whole food soy (but not processed soy)

163
Q

What are life-style modifiable risk and protective factors for colon cancer?

A

RF: red meat, processed meats
PF: high fiber, calcium, folate

164
Q

What are life-style modifiable risk and protective factors for gastric cancer?

A

RF: processed meats
PF: high fruit and vegetable intake

165
Q

Which published article first linked western disease with lifestyle, when and where was it published and who is the author?
What was the proposed common mechanism?

A

“The etiological significance of related diseases” by Dennis Burkitt, CAnadian JOurnal of Family MEdicine, 1972;
- lack of dietary fiber proposed as common mechainsm

166
Q

Which “western diseases” were discussed in Burkitt’s first (1972) article that linked these with lifestyle?

A
  1. IHD (most common cause of death)
  2. gallbladder surgery (most comon gall bladdder surgery)
  3. appendicitis (most common cause of emerg abdo surg)
  4. diverticualr disease: most common dis of the intestine
  5. cancer of the colon and rectum: sec most com, cause of cancer death, after lung ca
  6. haemorrhoids” est. prev. 50% over 50yo
  7. varicose veins; prev appx 20%
  8. hiatus hernia; prev in 20% rad. examinations
  9. obesity; most com nutrit prob
167
Q

What did conclude Burkitt’s second landmark article from 1982?

A

“Western diseases and their emergence related to diet”

  • most signif pub health finding of our time is that chron diseases are lifestyle related, in part diet related and therefore preventable; proposed dietary changes to treat these dis.
168
Q

What did Burkitt’s and Trowell’s article “The development of the concept of dietary fiber” from 1987 discuss?

A
  1. descr. how during indust revol. fiber taken out of flour die to belief that dietary fiber was a gastrointestinal irritant
  2. inplace of starchy and high-fiber foods people began increasing intake of animal products, salt and sugar
169
Q

Briefly outline the design and findings of 2008 LS intervention for early prostate cancer

A

“Clinical events in prostate cancer lifestyle trial”

  • 2 y f/u; early stage prostate ca under active surveilance
    1. intervention= whole food, plant-based diet, exercise, stress management, participation in group support sessions
    2. results:
  • intervention gp: 70% of participants PSA suppressed; 4% needed treatment
  • control gp: 9% PSA suppression, 26% needed treatment
    5. conclusion: patients w/ prostate ca who choose active surveilance may be able to delay treatment by makink LS changes
170
Q

Name and briefly describe studies that looked at the effects of LS on breast ca

A
  1. BArnard (2006): 12 wom, exercise and low- fat, high fiber, 2 weeks on then 2 weeks off intervention;
    results:
    - significant reduction in br sa cell growth and incr in ca. cell appoptosis;
    - IGF-1 (cancer promoting) dropepd, IGF-1 dinding prot (reduces free IGF-1) increased
    - both diet and exercise stat sig dif.
  2. Pierce (2007) “Greater Survival after breast cancer in physically active women w/ high vegetable-fruit intake regardless of obesity”; 1490 - prospective- from diagnosis
    - results: 5 servings of F&V/day & 180min mod int exerc./week almost 50% REDUCTION IN MORTALITY
    - risk reduction not affected by BMI
171
Q

briefly describe the findings of “Diabetes prevention trial” 2002

A
  • first major study to compare LS interv. to med interv. to PREVENT dm; concl: LS interv. almost 2x MORE EFFECTIVE vs metformin
172
Q

What is the relationship between Diabetes prevalence vs animal products

A 
non-vegetarian 1
semi-vegetarian 0.72
pesco-vegetarian 0.49
lacto-ovo vegetarian 0.39
vegan 0.22
=> inverse relationship
173
Q

What is the relationship between BMI and diabetes prevalence

A

higher BMI, higher prevalence

NB: plant based protective even when controlled for BMI

174
Q

Briefly describe the relationship between plant-based diet and diabetes and a study (Anderson) that looked at this

A
  • 20 men w/ T2DM, plant-based, high fiber diet, no caloric restriction to prevent wt loss
    results:
    1. insulin discontinued in 11/20 pat. and reduced in the remaining pat. within 16 days
    2. Plant based effective even in absence of wt loss => types of foods consumed impact blood sugar regulation
175
Q

What effects did high nutrient dense diet have on diabetes in a sample of patients w/ T2DM

A
  • 13 pat, av. HbA1c 8.2% , 7 mo of eating “high nutrient dense diet” (i.e. high in phytochemicals & whole meal antiox. from greens, fruits, nuts, seeds, beans, legumes)
  • most meds stopped , HbA1c dropped to 5.8%
176
Q

What was the effect of low-fat vegan diet in an RCT by BArnard et. all 2017?

A
  • RCT (74 w): low fat vegan diet superior to ADA diet
177
Q

What is the relationship between plant-based diet and hypertension?

A
  • more exclusively plant based, less hypertension prevalence
178
Q

How long does it take for SBP to change after changing to plant-based diet?

A

significant improvemnt in 2 weeks

179
Q

What diseases have been shown to improve from plant based diets in studies?

A
  • cataracts
  • copd (incr fruit and veg impr lung funct)
  • renal disease (animal protein, animal fat, cholesterol known to affect)
  • mental health (arachidonic acid- found in poultry and eggs- pro-inflammatory)
  • immune function improved w/ incr plant based d.
  • Crohn’s dis - remission 80%
  • MS
180
Q

What do patient surveys suggest when it comes to the intensity of lifestyle change?

A

DRAMATIC CHANGES MORE ACCEPTABLE

181
Q

What is the average tot chol at age 40 in Uganda and why is this improtant?

A

145mg/dl ; similar to vegans (141mg/dl pr 3.6mmol/L)

  • their diet = mostly plant based
  • CVD almost non existent
182
Q

What did Caldwell Esselstyn Jr describe in his article “Present therapy for CAD the radical mastectomy of 21-st century’?

A

CVD = acquired from food

  • western diets high in fat; CVD = common
  • plant based cultures very little CVD
183
Q

Name some cultures known to have markedly decreased prevalence of CVD and what do they have in common?

A
  1. Tarahumara Indians Northern Mexico (beans, corn)
  2. Papua highlinders on New Guinea (sweet potatoes)
  3. rural China (rice and vegetables)
  4. rural Africa (green platains, sweet potatoes, pumpkins, tomatoes, green leafy veg); e.g. MI incidence in Uganda 0.22% (US 22%)
184
Q

Briefly outline the findings of Campbell’s study “Diet, lifestyle and etiology of coronary artery disease”

A
  • epid. stud, described diff. betw rural China and US in incidence of CVD
  • 246000 men 64or younger: no recorder CVD event sin 3 years of observation
  • mean tot chol 127mg/dl rural China, 203 mg/dl US
  • sig. greater morbidity and mortality sec to CVD in US ppn
  • diet difference: 1 tenth of meat, 3x the fiber
185
Q

What is the relationship of cholesterol and heart disease?

A
  • main RF for heart disease is chosterol
  • cholesterol is the only DIRECT risk factor for heart disease: “If the serum total cholesterol is 90 to 140mg/dl (2.3-3.6mmol/L), there is no evidence that cigarette smoking, systemic hypertension, diabetes mellitus, inactivity or obesity produces aterosclerotic plaques. Hypercholesterolemia is the only direct risk factor, the others are indirect” - W.C. Roberts, Baylor Cardiovascular Institute
186
Q

With respect to LDL, what is the optimal level to prevent/ reverse progression of eterosclerotic disease and what evidence is this based on?

A

75% of heart attacks in the US in people within normal LDL range
lower = better ;
OPTIMAL 50-70mg/dl (treshold for developing atherosclerotic dis)
- healthy neonates and wild primates have LDL 40-80 mg/dl
- regression suggests that aterosclerosis does not progress when LDL less or eq. to 70mg/dl (1.8mmol/L)

187
Q

What is the effect of plant-based diet on HDL cholesterol and chol ratio?

A

HDL may decrease but ratio improves, hence benefit

188
Q

How can the optimal cholesterol levels be achieved?

A 
(optimal = 50-70mg/dl)
2013 AHA (Am Heart Assoc) and Am College of Cardiology guidelines recommend no more than 6% calories from sat fat: this is difficult to achieve on a non-vegan diet
any increase of trans-fats, sat-fats and cholesterol above 0% energy may increase LDL
189
Q

Describe the relationship between Trans fats and CVD

A
  • assoc w/ increased CVD risk, whether occur naturally or are processed
190
Q

What are normal and optimal lipid levels in US

A 
normal       optimal    (gm/dl)
total chol   <200            <150
HDL          >40(men), >50(wom)
LDL           <100               50-70
TAGs          <149             <100
191
Q

What is the best way to manage coronary artery disease?

A

lower LDL and TAGs : LS +/- meds

192
Q

What type of diet has been shown to reduce cholestrol in studies?

A
  • very high fiber vegan diet reduction in cholest equiv to therapeutic dose of statin in 2 weeks
  • the greater the dietary change the greater the reduction in cholesterol
    high fiber diet outprformed both low-fat and starch based diets
193
Q

What are the main findings of “Lifestyle Heart Trial”, Ornish

A
  • 10% fat, whool foods vegetarian diet + aerobic exerc. + stress management + smoking cessation + group psychosocial support: regression of plaque stenosis and reduction in cholesterol
  • 5 y follow up showed continued regression of stenosis in the intervention gp (@ 1 year stenosis diameter decreased 1.75%, @ 5y 3.1%); control gp worsened (incr @1y 2.3, @5y 11.8%)
  • ADHERENCE???
194
Q

Are American Dietary Guidelines widely accepted by experts?

A

no: some experts question the methodology and conclusions due to involvement of food industries in their creation

195
Q

what are the most commonly consumed vegetables in the US and what are their most common sources?

A

potatoes and tomatoes

mostly consumed as part of “mixed dishes”

196
Q

Define what proportion is considered “high” in a micro-nutrient?

A

high >20% of DV/ serving

DV = daily value)

197
Q

Define what proportion is considered “ moderately high” in a micro-nutrient?

A

moderately high = 5-20% of DV (daily value)

ASLMBCE (13 decks)

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