Nutrition and Cardiovascular Disease

Question 1

1. List elements of the diet that can be reduced and their relative magnitude on lowering LDL. (5)

Answer 1

saturated fat <200mg (-3-5%)
adding 5-10g viscous fiber/day (-3-5%)
adding 2-3 g plant stannous or sterols (-6-15%)
adding 25g soy protein (-3-5%)

also 10lbs weight loss (-5-8%)

Question 2

1. What dietary component has the greatest effect on reducing LDL when reduced?

Answer 2

saturated fat, it is consumed by the gram, while cholesterol is consumed by the mg

Question 3

Considering the variability in responses to a low fat diet, what regarding the diet has been shown to result in reduced inflammation?

Answer 3

increasing nutritional variety as well as decreasing fats and simple carbs has been shown to decrease LDL, increase HDL and decrease inflammation; it important to remember that feeding people the same foods, low fat diets show tremendous variability in response

Question 4

2. A 1% increase in calories consumed as saturated fat increases serum cholesterol by 1.8mg/dL, what types of fats can be substituted for saturated fats in reducing cholesterol?

Answer 4

monosaturated fats (lowers LDL-C and raises HDL-C)

substituting polyunsaturated fats (neutral for HDL-C)

** recommended only 7% of calories /day from sat. fat

Question 5

2. Discuss recommended dietary changes to address lowering cholesterol from food.

Answer 5

found only in animal products
low-fat dairy
small amounts of lean meat
no more than 4 egg yolks/week
shrimp once/week
liver and organ meats once/month

Question 6

2. How much trans fat is recommended as part of a health diet?

Answer 6

as little as possible, usually found in processed foods

Question 7

Name some sources of monounsaturated fats.

Answer 7

olive oil
canola oil-rapeseed oil
mustard oil
peanut oil
nuts
olives
avocado

Question 8

Name some sources of omega 3 oil

Answer 8

fish and fish oils
soybean and canola oils
walnuts and butternuts

Question 9

How much and what kind of omega -3 oil is recommended for benefits of reduced TG, decreased platelet aggregation, anti-inflammatory and anti-arrhythmic properties?

Answer 9

WHO recommends 0.3-0.5g/ day of EPA and DHA for general public, 3-4g /day used to reduce

top fish sources: salmon, herring and sardines
top plant sources: flax seed (oil), canola oil and soybean oil

Question 10

Alpha linolenic acid in foods is converted to EPA and DHA by which enzyme?

Answer 10

desaturase enzymes (not omega-6 are converted from linoleum acid to arachidonic acid by the same enzyme)

Question 11

Which type of fiber is most beneficial for the reduction of blood cholesterol?

Answer 11

soluble (viscous) fiber delays gastric emptying, slows glucose absorption (decreases blood cholesterol) and increases fecal excretion of bile acids

this is in contrast with insoluble fiber mostly beneficial for increasing fecal bulk and intestinal health

Question 12

Which foods are most rich in soluble fiber?

Answer 12

soy nuts
legumes
oat bran
oatmeal and barley

psyllium supplements also provide a source of soluble fiber that can decrease LDL-C by increased bile acid excretion (possible reduces absorption of cholesterol)

Question 13

By what mechanism do soy foods reduce cholesterol?

Answer 13

soy can reduce cholesterol, probably by stimulating production of LDL receptors (does not negatively affect thyroid function or breast cancer)

Question 14

Name recommended sources of soy.

Answer 14

recommended whole soy foods include roasted soybeans, textured soy protein, soy milk, tempeh, tofu or edemame

Question 15

What is the role of phytosterols in food?

Answer 15

the amount of photo sterols (stannous and sterols) in food is very small compared to the amount you would need to reduce LDL-C, can buy supplemented foods which can be a helpful tool given patient preference or need

Question 16

What are the dietary goals regarding carbohydrates and dyslipidemia?

Answer 16

especially refined carbs can increase glucose that is transformed into TG, fructose having a greater effect, the goal is to have 60% or less as carbs to control TG

Question 17

What is the role of alcohol in dyslipidemia?

Answer 17

alcohol increases hepatic TG production leading to greater VLDL production (esp if you drink a lot, are obese, have diabetes, or have a TG disorder)

Question 18

Name 4 categories of lipid disorders.

Answer 18

elevated LDL-C
metabolic syndrome/combined dyslipidemia
low HDL-C
hypertriglyceridemia (TG>500)

Question 19

3. Describe the components of the Therapeutic Lifestyle Changes.

Answer 19

lower in sat fat and cholesterol than Step One (general public)
can be enhanced with additional fiber or plant stannous/sterols
encourages regular exercise

Question 20

3. Discuss dietary recommendations for the Mediterranean diet.

Answer 20

olive oil, tree nuts, fresh fruits, vegetables, fish, legumes, sofrito sauce and white meats

addition of evoo or nuts resulted in a reduction in 3 major CV events/1,000 person years

Question 21

3. Describe the elements of very low fat plans.

Answer 21

include diets like Pritikin, Ornish, Esselstyn

many means very low fat <10% of calories, have to intentional about increasing complex carbs instead of simple sugars

likely to increase TG and reduce HDL

Question 22

Give recommendations regarding increasing HDL through diet.

Answer 22

effect of lifestyle on HDL is very small, although weight loss and exercise may help

include moderate amounts of unsaturated fats, and moderate amours of carbs (reducing TG usually results in HDL increase)

Question 23

Give recommendations on reducing TG.

Answer 23

reduce the percent calories that come from fat
avoid alcohol
control weight and moderate exercise
consider medium chain triglycerides

Question 24

5. List categories of people for whom the lowest sodium intake (1500mg/day) is recommended.

Answer 24

people with HTN
people older than 40 yo
all african americans

people at greater risk for sodium sensitivity

females
>40 yo
abdominal obesity
impaired glucose tolerance/DM
african-americans
HTN
family Hx of hypertension

Question 25

6. Outline recommended dietary changes for a low sodium nutrition.

Answer 25

use ½ or less salt recipes call for
no salt at the table
limit use of high sodium processed foods
eat out less often
salt substitutes OK unless serum K+ is increased

Question 26

7. Describe the components of the DASH eating plan.

Answer 26

8-10 servings of fruits or vegetables
2-3 servings of low fat dairy products
1500-2400mg sodium

Question 27

8. Outline recommendations for diet in the management of heart failure.

Answer 27

manage fluid and sodium
limit or avoid alcohol
small frequent meals, esp during weight loss
calorie and protein supplements as needed
tailored aerobic exercise program