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Metabolism 2 > Nutrition and CVD > Flashcards

Nutrition and CVD Flashcards

1
Q

What spectrum of conditions and risk factors are part of cardiometabolic health?

A
  • Metabolic syndrome and insulin resistance
  • Type 2 diabetes
  • Dyslipidaemia
  • Hypertension
  • Overweight/ obesity
  • Central obesity and high levels of visceral fat
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2
Q

What is a lacto-ovo vegetarian?

A

Avoid meat and fish, but eat dairy foods and eggs

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3
Q

What are the components of the Nordic diet?

A
  • Fruits, berries, vegetables and potatoes >500g/day
  • Bread 4-6 slices per day
  • Nuts, mostly almonds, 15g/day
  • Meat <500g/week
  • Poultry <300g/week
  • Fish/ seafood 3-5 servings/week
  • Pasta 3 servings/ week
  • Cereal 1.5 servings/day
  • Low-fat milk < 5dL/day
  • 5g spread /bread slice
  • Eggs, stay within recommended cholesterol intake
  • Alcohol, habitual amount
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4
Q

How much can lowering BP have an affect of CVD risk?

A

A blood pressure drop of 55mmHg could overall reduce mortality by 14% with a 9% reduction in the risk of death from heart disease

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5
Q

What is the portfolio diet?
What does it include?

A

A plant-based diet that focuses on cholesterol-lowering foods

  • 42g Nuts
  • 50g Protein from soy or other legumes, e.g. beans, peas, chickpeas and lentils
  • 20g viscous soluble fibre e.g. oats, barley, psyllium, eggplant, okra, apples, oranges, or berries
  • 2g plant sterols e.g. enriched margarines

Kahleove at al 2019 –> Portfolio diet reduces LDL cholesterol by 17%

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6
Q

How does atherosclerosis affect blood vessel motility?

A

Restricts vascoconstriction and vasodilation due to rigidity
Blood clots may get stuck and lead to a stroke

Increase inflammation and immune response
- contribute to chronic low levels inflammation which is known to be able to lead to future cardiovascular events

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7
Q

What is the role of the endothelium?

A

Secretes substances that allow the blood vessels to constrict, dilate and form clots

e.g. Nitric oxide –> Vasodilation
Endothelial 1 –> Vasodilation

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8
Q

How can inflammation be measured?

A

C-reactive protein

Also cytokines such as IL-6, TNFa and IL-12

Women’s study in 2003 researched 28,000 women and found that those with the highest CRP at baseline had 4.4 time higher risk for cardiac events than women with the lowest CRP levels at baseline

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9
Q

How can diet influence inflammation

A

Positive energy balance can lead to obesity which is a large contributor to chronic low grade inflammation due to high proportion of adipose tissue

High red meat intake has been shown to increase CRP levels

Plant based diets has shown to be associated with lower levels of CRP when adhered to for at least two years

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10
Q

How can diet influence endothelial function?

A

Plant based diet can maintain and improve endothelial health

High consumption of saturated fat can lead to lower flow-mediated dilation (method of testing endothelial health)

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11
Q

How can endothelial health/ function be measured?

A

Flow-mediated dilation

Endo-Pat
- Non-invasive
- Reflects the vascular health of small vessels
- Takes 15 minutes
- Biosensors are placed on index fingers

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12
Q

How are certain dietary patterns related to BMI?

A

The less ‘vegetarian’ the diet is the higher the BMI

Excess fat stores –> Low grade inflammation –> Lack of vasculature in adipose tissue stores

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13
Q

How does WHP ratio help predict CVD risk?
Link to studies

A

Measures central visceral adiposity
Ratio greater than 0.5 represents increased proportions of visceral fat

Framingham heart study
- Visceral adipose tissue volume was 10% lower in individuals eating at least 3 servings of whole grains per day, compared to individuals who consumed almost no whole grains

Meat consumption
- High –> Higher BMI and waist circumference
- Low –> Lower BMI and waist circumferences

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14
Q

How does T2D prevalence compare in different diets?

A

The incidence of T2D, marked by impaired glucose metabolism, is lowest in vegans and highest in omnivores

Plant based diets improve glucose metabolism
- Reduction of insulin resistance in body tissues
- Improvement in the function of pancreatic beta cells

HbA1c level had a large reduction in DASH, Med and vegetarian diet

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15
Q

What is the glucose metabolism mechanism in T2D?

A
  • Glucose enters the bloodstream
  • Insulin enters the blood stream
  • Cell doesn’t respond to insulin
  • The cell can’t open for glucose to enter and be used for a fuel (protein cascade reaction does not occur, or is less functional meaning glucose transporters are not/ less translocated to cell membrane for glucose uptake)

With insulin resistance, glucose can’t enter cells efficiently, so it remains in high levels in the circulation

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16
Q

How do fat stores in muscle cells contribute to insulin resistance?

A

Greater insulin resistance as fat interferes with glucose uptake by muscles
The conversion of glucose into glycogen stores

Since glucose cannot enter cells, it’s left in circulation, promoting more insulin secretion in pancreatic B-cells. Persistent overworking of pancreatic B-cells can lead to dysfunction and beta cell death, further contributing to hyperglycaemia

17
Q

What has been observed between glucose metabolism and diet?

A

Saturated fats
- Impact the beta cells that secrete insulin
- Reduce beta-cell proliferation
- Induce beta-cell death

Unsaturated fatty acids
- Protective effects

Low fat, plant based
- Improve insulin sensitivity and beta cell function in participants without diabetes

DASH, Med and vegetarian
- Improved glucose control

18
Q

How does the Mediterranean Diet have cardiovascular benefits?
Studies?

A

7 Countries study –> Ancel Keys (1958)
- An ecological, interventional, investigation of diet and cardiovascular in 16 groups totalling nearly 13000 men in 7 countries (Greece, Italy, Japan, Finland, Yugoslavia, Netherlands and US)

1st research on the MedDiet by studying in situ the dietary patterns in italy, spain and crete and their association with cardiovascular health, with special emphasis on the effects of dietary fat and fatty acids on serum cholesterol and CVD risk

The importance of fat subtypes, and not of total fat intake, the relevance of MUFA:SFA ratio. Rich in fat (40% total calories) but with an optimal MUFA:SFA ratio appeared as an ideal model for cardiovascular health

All these fats were in accordance with the long lasting experience of use of this dietary pattern in relatively poor sectors of the world with high rates of smoking and nevertheless with a very low CHD mortality

High saturated fat intake increases CVD risk, as shown in USA and Finland who had much higher results than other countries such as Japan and Corfu.
Found the links between diets high in saturated fat also are high in cholesterol which is a risk factor for CVD.
The first study that found saturated fat in diet is linked to CVD in different populations

19
Q

What is the Lyon Diet Heart study?

A

Aim
- Secondary prevention trial aimed at reducing the risk of cardiovascular deaths and recurrent MI by diet modification in 605, survivors of a previous MI and recruited between 1988 and 1992

Methods - patients were randomised to
MedDiet
- High consumption of fruit, vegetables, bread and fish
- Low consumption of red meat
- Replace butter and cream by a special margarine

Control
- Diet similar to the low fat step 1 diet of the American Heart association

Results
- A dramatic reduction in major coronary events and death, that was maintained over a 4 year follow up period. Interim analysis at 27 months of follow up, 73% reduction in coronary events and 70% reduction in total mortality

20
Q

What is the PREDIMED study?

A

A study in 2013 that looked at the primary prevention of cardiovascular disease with a Mediterranean Diet.
Randomised trial of the diet pattern for the primary prevention of cardiovascular events
Dietitian led
Participants all at risk of CVD e.g. pre-diabetes or metabolic syndrome

7447 randomised participants
- MedDiet supplemented with extra virgin olive oil (1L/ week / family) –> 2543 participants
- MedDiet supplemented with mixed nuts (30g/ day), 7 almonds, 4 walnuts and 7 hazelnuts (raw) –> 2454 participants
- American Heart Association low fat diet, no energy restriction (control) –> 2450 participants

Both MedDiet interventions showed a decrease in mortality and incidence of CVD.

A dietary intervention with the MedDiet carried out by a dietitian in primary care setting can reduce by 30% the risk of suffering from cardiovascular disease and associated mortality

21
Q

What are the potential mechanisms of how the MedDiet could protect against CVD?

A
  • High fibre content
  • Low caloric density
  • High nutrient density
  • Lower saturated fay
  • Beneficial fatty acids composition (higher in unsaturated fats)
  • Anti-inflammatory compounds

A better control of risk factors to improve
- Lipid profile
- Inflammation
- Oxidation
- BP
- Glucose metabolism
- Without affecting body weight

22
Q

What are the beneficial components of the MedDiet?

A
  • Minerals
  • Polyphenols
  • Fibre
  • Vitamins
  • Minerals
  • MUFAs
  • PUFAs

Individual food components
- Olive oil
- Nuts
- Legumes
- Fruit
- Vegetables
- Whole grains

23
Q

How does nut consumption influence CVD?

A

67g nuts associated with
- 5% decrease in total cholesterol
- 7% decrease in LDL
- 3% decrease in triglycerides
- 0.09% increase in HDL
Nut consumption benefits can be shown in blood lipid profile

High in magnesium, fibre low GI, ALA a3, antioxidants, MUFA, arginine

Shown improvement in
- Endothelial function
- Inflammation
- Insulin resistance

Which overall contributes to reduced cardiovascular mortality

Nuts

Satiety –> Decreased energy intake from other foods –> decreased adiposity
- Rich in fibre which contributes to satiety

Energy metabolism –> BEE –> Postprandial thermogenesis –> Fat oxidation –> Increased energy expenditure –> decreased adiposity
- More energy required to digest nuts, increase energy expenditure

Incomplete intestinal absorption –> Foecal energy loss (fat) –> Decreased adiposity

10-20% of energy from nut is lost in faeces, which is a reason why weight gain isn’t seen (often).

Food intake study in Spain showed that those with the lowest BMI had the highest intake of nuts. Also shown that those with the lowest BMI had the highest adherence to the MedDiet

24
Q

Discuss nut consumption and insulin resistance

A

A 90 day study with the intervention group that consumed a healthy diet + 30g nuts/day and a control with just a healthy diet.
A stool sample was taken.
Results showed that the intervention group there was a decrease in the hormone insulin resistance markers in comparison to the control group
- higher fat content in stool

MUFAs shown to improve beta cell efficiency which could improve insulin sensitivity

25
Q

Discuss nuts and vascular function
Study

A

Effect of pistachio nut consumption on endothelial function and arterial stiffness

Treatment
- Lifestyle modification –> diet and exercise
- ‘’ ‘’ & 80g (in shell) pistachios daily for 3 months

Measurements
- Biochemical parameters
- Brachial artery flow-mediated vasodilator
- Carotid-femoral and branchial ankle pulse wave velocity

Results
- Improved glycaemic and lipid parameters
- Improvements in vascular stiffness and endothelial function

26
Q

Discuss possible mechanisms of different nutrients from nuts that influence cardiovascular health

A

Lipid profile

PUFA and MUFA
- Decrease in circulation time of VLDL particles
- Double the direct clearance of circulating triglycerides

Fibre and phytosterols
- Inhibit the absorption of cholesterol

Abdominal obesity

Fat, fibre and protein
- Increase the feeling of satiety
- Decrease intake of other foods
- Increase faecal fat content

PUFA and MUFA
- Increase diet-induced thermogenesis
- Increase the oxidation of fats

Chronic inflammation

Magnesium, fibre, a-linolenic acid, L-arginine and antioxidants
- Inhibit the activation of nuclear factor kapa B
- Inhibit lipoxygenase enzymes

Glucose interolerance/ hyperinsulinaemia

MUFA
- Improve efficiency of B cells

Fibre
- Decrease glycaemic and insulinemic response to diet

Antioxidants
- Restore the ratio of oxidised glutathione/ reduce glutathione
- Improve B cell response

Hypertension

Magnesium
- Stimulates the production of prostacyclins and the synthesis of nitric oxide, and blocks the calcium channel causing vasodilation

Potassium
- Reduces the volume of extracellular fluid
- Decreases the influence of angiotensin
- Relaxes vascular smooth muscle
- Reduces peripheral vascular resistance

PUFA and MUFA
- Decrease thromboxane-2-concentrations

Calcium
- Inhibits parathyroid hormones, which induces hypertension by increasing intracellular calcium levels

Nutritional composition
- High in unsaturated fatty acids, low in carbohydrates, rich in fibre, minerals, vitamins and other bioactive compounds such as polyphenols

Cardiovascular protection
- Modulate lipid metabolism, oxidative stress, and inflammation without affecting body weight

Mechanisms
- Lipid lowering effect, improving the function of vessels, reducing postprandial glycaemia and insulin resistance without affecting body weight

27
Q

Discuss extra virgin olive oil and cardiometabolic health influence

A

Nutrients
- MUFA
- A oelic acid
- Polyphenols
- Phytosterols
- Vitamin E

Cardiometabolic risk factors
- Lipid profile
- Blood pressure
- Cardiovascular event

Mechanism of action
- Anti-inflammatory and anti-atherogenic
- Reducing oxidative stress
- Improving lipid profile, insulin sensitivity, glycaemic control
- Decrease blood pressure

28
Q

Discuss legumes and influence on cardiovascular health

A

Nutrients
- Fibre
- Low GI CHO
- Magnesium
- Potassium
- Polyphenols

Cardiometabolic risk factors
- Cardiovascular disease
- CHD
- BP

Mechanisms of action
- Improving lipid profile, fasting glucose and HbA1c
- Decrease BP
- Decrease adiposity
- Decrease inflammation

29
Q

Discuss wholegrains and influence to cardiovascular health

A

Nutrients
- Fibre –> viscous soluble fibre beta-glucan

Cardiometabolic risk factors
- Diabetes
- BP
- Lipid profile
- CVD

Mechanisms of action
- Lipid lowering effect
- Decrease BP
- Improve glycaemic control
- Contribution to stool bulking and laxation

30
Q

Discuss fruits and veg influence to cardiovascular health

A

Nutrients
- Vitamins
- Minerals
- Phytonutrients (carotenoids, a-tocopherol, flavonoids)
- Bioactive compounds (lycopene)

Cardiometabolic risk factors
- BP
- Diabetes
- CHD
- Stoke
- CVD

Mechanism
- Decrease BP
- Improve inflammation –> lower CRP and TNFa
- Reduce incidence of diabetes –> improvements in risk factors such as HbA1c
- Improve lipid profile

31
Q

Discuss ultra-processed foods and influence on cardiovascular health

A

Nutrients
- High –> energy, fat, salt, sugar
- Low –> micronutrients, fibre, food additives, food packaging

Cardiometabolic risk factors
- CVD
- CHD
- BP
- Obesity
- Metabolic syndrome
- Diabetes
- Lipid profile

Mechanism
- Positive energy balance
- Increase CRP
- Increase VLDL-c synthesis, LDL-c and TG
- LPL inactivation –> prevent hydrolysis of chylomicron TAG to liberate FA, prevent uptake into adipose of muscle
- High accumulation in visceral adipose tissue
- High sodium intake –> increase blood pressue

Metabolism 2 (6 decks)

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