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S and P- Nutrition > Nutrition and CVD > Flashcards

Nutrition and CVD Flashcards

1
Q

What is the incidence of CVD in the UK?

A

Accounts for almost one in two deaths in UK and is leading cause of premature death in UK

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2
Q

What is the most common form of CVD?

A

CHD

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3
Q

What non-modifiable risk factors are there for CHD?

A 
Gender- females protected
Age >65 years
Family history of CHD
Ethnicity
Co-morbidities- diabetes and renal disease
Socio-economic status
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4
Q

What modifiable risk factors are there for CHD?

A 
Body weight
Body shape
Blood pressure
Blood lipids
Lifestyle
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5
Q

What did the interheart study show?

A 
9 modifiable risk factors that account for over 90% of initial acute myocardial infarction:
Smoking
Hypertension
Lipids
Abdominal obesity
Diabetes
Fruit and veg
Alcohol
Physical activity
Psychosocial factors and others
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6
Q

What are the several mechanisms by which diet potentially influences risk of CHD?

A

Lipid levels- LDL, HDL, TG, lipoprotein(A)
Blood pressure- salt intake (high BP->damage to endothelium->inflammatory response, inflammatory cells may take up LDL forming foam cells and atherosclerosis)
Cardiac rhythm (fish oils)
Endothelial function- Types of fats
Systemic inflammation- CRP and IL-6 are predictors of CVD in women, trans fat increases these markers and so does obesity
Insulin sensitivity- body weight and dietary fat

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7
Q

What is the main problem with evidence based guidelines?

A

Little high quality evidence

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8
Q

What are the UK recommendations for diet in terms of MI?

A

Advise people to eat a Mediterranean style diet
Don’t routinely eat oily fish to avoid another MI
Don’t offer people to use omega 3 fatty acid to avoid another MI
Advise people not to take beta-carotene supplements, antioxidant supplements or folic acid to reduce CVD risk
Education- offer individual consultation on diet
Consistent advice
Keep weekly alcohol consumption within safe limits

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9
Q

Why is a mediterranean diet protective post MI?

A

More fish, fruits and veg, less sat fat and partial replacement by rapeseed or olive oil- more emphasis on fresh food

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10
Q

What does the mediterranean diet involve?

A 
Pulses, beans, legumes
Fruit and veg
Less alcohol
Fish
Low saturated fats
Nuts, seeds
Olive oil and pasta/bread
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11
Q

What is the overall effect of changing fat intake?

A

Decreasing CVD

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12
Q

What is the difference between MUFA/PUFA and trans fatty acids?

A

Cis double bond is changed to a trans double bond

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13
Q

What are the effects of trans FA?

A

Increase LDL cholesterol
Decrease HDL cholesterol
Increase CHD risk
Suppress epithelium growth factors
2% increase in total energy from TFA -> increase CHD by 23%
Greater effect than saturated fat in reducing the TC:HDL ratio

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14
Q

What are the three major groups of fats?

A

Saturated- butter, lard, cheese, fatty meat, coconut
Polyunsaturated- Sunflower, soya, safflower, corn, sesame and fish oils
Monounsaturated- Olive, peanut/walnut, rapeseed/canola, avocado and almonds

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15
Q

What is the effect of lipids?

A

All fats increase HDL except trans fatty acids
MUFA increase HDL more than PUFA but PUFA lower LDL more than a MUFA
Trans FA have detrimental effect across the spectrum

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16
Q

What effect do fruit and veg have?

A

Decrease risk of CHD
An increase of 1 portion of fruit and veg/day decreases risk of CHD by 4% and of stroke by 6%
Also helps lower blood pressure

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17
Q

What is the recommended adult fibre intake?

A

18g/day

Current UK adult intake is 12g/day

18
Q

What does plenty of fibre in diet help?

A

Insoluble fibre helps to prevent constipation and improve bowel function (e.g. wholegrain cereals and wholemeal bread)
Soluble fibre can help lower blood lipid levels/cholesterol (e.g. fruits, veg, oats, rice, bran and pulses)

19
Q

What slowly absorbed starchy foods are there?

A

Oats, potato, fruit, barley, basmati rice, beans and lentils, pasta and noodles, wholegrain bread

20
Q

What fatty acids do oily fish have?

A

N-3 fatty acids- DHA and EPA fatty acids (long chain fatty acids with multiple double bonds)

21
Q

What are the protective effects of N-3 fatty acids?

A 
TG reduction
Reduced blood clotting
Improved endothelial function
Platelet inhibition
Stabilisation of plaque structure
Anti-arrhythmic effects
22
Q

How is hypertension linked to CHD?

A

It is an independent risk factor for CHD- A decrease of 3-5mmHg of systolic blood pressure reduces CHD risk by 10% and stroke by 15%

23
Q

What does the DASH diet contain?

A

Rich in veg, low in fat and low in salt

24
Q

What is the recommended daily salt intake?

A

No more than 6g/day

Current average is 9g/day

25
Q

What are the main sources of salt in our diet?

A

Cereals, breads, biscuits, cakes and pastries

26
Q

How does dietary salt have an effect on BP?

A

High dietary salt raises CSF Na+ -> Increased SNS activity -> Vasoconstriction -> increase in central ouabain (Na-K ATPase inhibitor) -> increase ACTH -> increase RAAS -> high dietary salt -> endogenous oubain, Na+ pump ligand -> vasoconstriction

27
Q

What are the recommended weekly alcohol guidelines?

A

<21 for men and <14 for women

28
Q

What are the recommended daily alcohol guidelines?

A

<3-4 units for men

2-3 units for women

29
Q

What is binge drinking?

A

> 3 drinks in 1-2 hours or 2x daily limit (8u for men and 6u for women)

30
Q

How do sterols work?

A

Stanol/sterol compete for sites where cholesterol sits in the micelle formation as it travels through the GI tract. If cholesterol can’t enter the micelle, it is lost from the GI tract as it can’t be reabsorbed
Plant sterols/stanol esters are clinically proven to reduce LDL cholesterol by 10-15%

31
Q

What does soy protein do?

A

It has modest effects on reducing cholesterol
25g of soya protein/day lowers LDL, cholesterol and triglycerides
It protects epithelial surface

32
Q

In terms of cholesterol, what do the guidelines recommend?

A

Keep dietary cholesterol <300mg/day

33
Q

What are high dietary sources of cholesterol?

A

Eggs, offal and shellfish

34
Q

How does BMI affect risk of diabetes?

A

BMI >30kg/m2 have 40 fold increase in risk of diabetes

2-3 fold risk of CHD

35
Q

How is central obesity measured?

A

By waist circumference (better predictor of CVD risk than BMI)

36
Q

What are the benefits of 10% weight loss?

A

Realistic, a lot of benefits:
Mortality- >20% fall in total mortality, >30% fall in DM related deaths, >40% fall in obesity related deaths
Blood pressure- Fall of 10mmHg systolic and 20mmHg diastolic
Diabetes- fall of 50% in fasting glucose and 50% less likely to develop
Lipids- Fall of 10% of total cholesterol, fall of 15% in LDL, fall of 30% in triglycerides and increase of 8% in HDL

37
Q

What is the main dietary recommendation for people with CVD?

A 
Advise people to eat a Mediterranean style diet:
Bread/pasta
Fruit and veg
Beans, pulses, legumes
Olive oil, nuts, seeds
Fish, less meat
38
Q

What would you suggest to reduce LDL?

A

Decrease saturated fatty acids and trans fats
Choose PUFA and MUFA
Soluble fibre
Weight loss in the overweight and obese

39
Q

What would you suggest to increase HDL?

A

Increase physical activity
Weight loss
Improved glycaemic control in diabetes
Moderate alcohol consumption

40
Q

What would you suggest to reduce triglycerides?

A 
Increase physical activity
Weight loss
Improved glycaemic control 
Reduced alcohol consumption
Reduced sugar consumption
Increased oily fish consumption

S and P- Nutrition (15 decks)

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