Lec 3: Nutr Therapy of Dyslipidemia

Question 1

DIET - Dyslipidemia Studies

• POP studies look for _____
• Controlled Feeding Studies…
• Community Studies ->

Acute vs Long-term =

title of a study that’s FYI
*Plant-BasedDiets Are Associated With a Lower Risk of
Incident CardiovascularDisease,CardiovascularDisease Mortality, and All-Cause Mortality in a General
Population of Middle-Aged Adults

Answer 1

for + or - associations
- eqns developed linking cholesterol, S FA, PUFA to CVD mortality

… -> are specified

• which nutr/foods changed LDL-C, TG, HDL-C
• could decrease LDL-C by 25%
• > follow diet & ‘see what happens’
• complex whole diet interventions
• multiple sm effects of diet changes
• decrease LDL-C by 5-10%
• some whole diet studies reported decrease in CVD mortality

= Acute - immediate influence of changes
- how food impacts post meal TG/BG etc

Long - Term - looks at how food changes have changed according to many factors

Question 2

Role of Diet: why bother with diet?
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Answer 2

• Lower cost
• Fewer side effects
• decreases med dosage needed
• some ppl are ‘diet responsive’ - not all respond to the same diet
• Diet has multiple effects beyond lipid levels & thus has an impact on CVD risk
  EFFECTS can include:
  weight loss; decreased BP, decreased inflammatory markers; increased insulin sensitivity & others

Question 3

Diet Composition: Biological Responsiveness varies
MORE responsive...
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LESS responsive...
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Answer 3

MORE
- Older
- increased LDL-C levels
- Apo - E4 genotype
- Men
- Lower body fat
LESS
- Type 2A
- Normal levels of blood lipids
- Women (sex hormones influence some diets)

Question 4

NCEP (National Cholesterol Education Program) FYI

• Step 1 = LDL lowering [after 6-12wks - no response -> Step 2*
• > Diet Recommendation SLIDE 10

NCEP Diet - main focus on ____

• > S FA
• > Omega 6 - PUFA
• > MUFA
• > Trans FA
• > Dietary Cholesterol

Omega -3 PUFA
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Answer 4

on fat

• > Saturated Fatty Acids
• <7% of total calories
• decreased TC, LDL-C, HDL-C
• palmitic acid (<16) most prevalent in US; 60-70% of all dietary FA
• Is atherogenic
• > Omega 6 - PUFA
• <10% total cal
• replace CHO or S FA’s with linoleic acid -> decrease in LDL-C
• Dietary sources- vege oils, salad dressings & margarine
• > MUFA
• <20% of cal
• Replace CHO - little effect on lipids
• Replace S FA - decrease TG, TC, LDL-C
• > Trans Fatty Acids
• <1% of cal
• increase LDL-C, decrease HDL-C
• associated with increased inflammatory responses

-> Dietary Cholesterol
- limited effect on serum total cholesterol [body has a strong regulation mechanism]
- dietary cholesterol not correlated with increased risk of CHD
[WHY - not only increases LDL but HDL also]

• 5-10% total cal as omega- 3
• decrease TG, may increase LDL-C, no effect on HDL-C or TC
• Dietary sources: oily fish (2-3x/wk)
• supplement highly promoted for those who don’t consume enough oily fish
• 2-4g of EPA [eicosapentaenoic acid] plus DHA [docosahexaenoic acid] a day

Question 5

Research - SLIDE 13 = ** look at slide **

Other diet constituents
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Answer 5

= Patients with MCI - Omega 3 shown to be important

• > Alcohol
• modest amt may increase HDL
• limit alcohol intake to 30g or less per day (1-2drinks)
• decrease alcohol to decrease TG

-> Mediterranean diet - VERY controversial

• > Soy- beneficial to manage lipid levels
• 25g/day
• mechanisms? combination of estrogen-like compounds, fiber & substitution for meat
• > Soluble Fiber
• Total fiber: increases to DRI levels
• Soluble fiber: 10-25g/day; ie - 4 servings psyllium
• decreases LDL-C, decreases lipid absorption; no effect on HDL-C & TG
• > Nuts
• High fiber, high fat, low CHO
• > Phytosterols
• Typical constituents of plants’ cell walls [similar structure to cholesterol]
• Interfere with absorption of cholesterol *
• ie. in fortified margarines

Question 6

“Nonlinear dose-response analysis of the relationship between total phytosterol consumption and cancer risk” SLIDE 17
“The use of probiotics may improve lipid metabolism by decreasing total and LDL cholesterol concentrations”

Portfolio Diet [PD] Jenkins et al - TO understand...
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Answer 6

• Soy-based foods for meat
• Fiber - metamucil, oats, barley, okra, eggplant replace other grains
• Plant-sterol enriched margarine
• handful of almonds
  AFTER 4 wks, LDL-C reductions were dramatic
• Control +/- 1.9%
• Statins +/- 1.9%
• PD +/- 1.3%
  (Dietary combinations may not differ in potency from
  first-generation statins in achieving current lipid goals
  for primary prevention)

Question 7

Mediterranean Diet - PREDIMED Study : to understand
READ SLIDE 20**
UNDERSTAND SLIDE 21** (14 points is the max you can achieve)

DASH Diet
Dietary Approaches to stop hypertension - To understand
SLIDE 22/23 *** READ THESE SLIDES

Weight Loss [Shouldn't be the main focus]
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SLIDE 25 - study***

Answer 7

• > Modest weight loss reduces lipid levels in the majority of ppl
• compared with weight stable participants, those who lost 5 to <10% of their body weight had increased odds of achieving a 5mg/dl increase in HDL cholesterol & a 40mg/dl decrease in TG
• Even greater in those who lost 10-15% of their body weight
• > Multiple effects on CVD risk
• decrease insulin resistance
• improve glycemia
• decrease blood pressure

Question 8

‘Finding common ground: RD best practices for treating high cholesterol’
‘Dyslipidemia care cap for overweight clients’

Examples of NEW objectives NOT addressed in previous guides
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Evolving Diet Guidelines
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Answer 8

• > Initial counselling
• involves spouse/ significant other
• understands the role of the RD
• understands benefits of modest weight loss of 5-10%
• increased intake of low-fat milk products
• distributes food intake through the day into 3 or more eating occasions
• uses the plate model

-> Group classes

• Promote eat well plate model
• decrease sat fat, with balance of other fats
• increase basic foods - aka DASH, CFG, Mediterranean “diets”
• fish & legumes - difficult to change but desirable
• modest weight loss
• IF have high TG - avoid alcohol & sugar

Question 9

Food Behaviour Change for fat
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Counselling Tips
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Answer 9

• Easier to change type of fat
• Easier to substitute lower fat version for higher fat version but maintain food habits
• Easier to take visible fat off meat
• Easier to add foods than remove
• Encourage long-term follow up
• Consider diet in context of other risk factors
  
  • smoking, physical inactivity
• Check intention: readiness to change varies for each specific behaviour
• Teaching skills: show flexibility in diet planning

Question 10

Canada's Guidelines for the Young & Elderly
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** READ summary SLIDES 36-39 **

Answer 10

-> Recommended lipid levels:
- for children under age 2 (lipid screening - not recommended)
- BTW 2-17, universal screening NOT recommended UNLESS there are risk factors such as Family history of CVD, high blood pressure, diabetes, smoking, High BMI etc
- From age 17 -21, universal screening is recommended as lipid levels are more STABLE after puberty
[Age 17- cholesterol/lipid levels stabilize]

• > Children <2yrs shouldn’t be given diet <30% fat
• potential to stunt growth & brain development
• > Elderly patients should be well managed
• at high risk
• CVD events have important consequences on morbidity
• > Same management & treatment goals/target should be used
• > Should not be denied treatment; encourage lifestyle changes
• advanced age is not a reason to stop statins