Nutritional care in coronary artery disease and hypertension Flashcards
- lipids are soluble in ____ but not soluble in ___
- they include? (types of lipids)
- organic solvents (benzene, ether) but not in water.
- triglycerides (fats and oils), sterols (cholesterol), phospholipids (lecithin).
what is triglyceride composed of?
1 glycerol + 3 fatty acids
fatty acids may be?
they vary in?
- saturated fatty acids or unsaturated fatty acids (presence of double bond; can be mono or polyunsaturated)
- length of their hydrocarbon chain and degree of unsaturation
saturated fatty acids:
- at room temperature
- shelf life
- oxygen
- where is it found
- solid
- longer
- doesnt react with atmospheric oxygen
- fat in animal products (red meat, full fat milk, butter, pork, bacon, etc); cooconut oil and palm oil.
monounsaturated fatty acids:
- bond?
- where is it found
- how does it affect HDL and LDL
- second bond is vulnerable - easily oxidized at room temperature
- plant oils - peanut oil, olive, canola, etc
- dec ldl inc hdl
polyunsaturated FAs
multiple double bonds
liquid at room temp
found mainly in vegetable oils
how do the length and saturation of fatty acids affect?
- affect triglycerides’ physical characteristics (solid vs liquid) and storage properties (stability & shelf life).
vegetable and fish oils:
- what type of fat
- how at room temp
- stability
- polyunsaturated fatty acids
- liquid at room temp
- not very stable => becomes rancid via oxidation process: double bonds are unstable and react with atmospheric oxygen
animal fats:
- what type of fat
- room temp how is it
- stability
- saturated
- solid
- stable
where is visible fat found?
where is invisible fat found?
- butter, oil, mayonaise, fat trimmed from meat
- milk, cheese, pastries, fried food, fat in the marbling of meat
how do saturated FAs affect LDL? receptors?
sources?
increase LDL => dec receptor synthesis and activity
animal products: beef, chicken, pork, dairy
why do fried oils increase LDL cholesterol in the blood?
due to oxidization of the fat => inc aldehydes => inc LDL
MUFAS:
how do they affect the cholesterol
sources
increase HDL levels (if MUFAS >15%)
decrease LDL & triglycerides
sources: oleic acids = olive, canola oil, avocados, almonds, peanuts
how does PUFA affect cholesterol?
sources?
decrease LDL and HDL levels
in vegetable seeds and fish
PUFAS: classified into? which is further classified into?
omega 3: alph linolenic acid –> docosahexaenoic acid and eicosapentaenoic acid
omega 6: arachidonic acid
we aim to reach a ratio of omega 6 : omega 3 of how much?
4:1 (still not official in the guidelines)
how are trans fatty acids made?
hydrogenation (adding hydrogens to fatty acids double bonds) = fat becomes > saturated, more solid, and more stable (can last longer before becoming rancid).
advantages of trans fats
- alters texture of food
- makes the oil more stable and more resistant to oxidation = longer shelf life
disadvantages of trans fats
- makes PUFAs more saturated = less healthy
- dec HDL, inc LDL
what are phospholipids?
example
naturally occurring where?
composed of?
- important constituents of cell membranes and emulsifiers
- lecithin
- peanuts, egg yolk, liver, soybeans
- 1 glycerol + 2 Fatty acids (hydrophobic end) + phosphate group (hydrophilic end)
what are sterols?
examples
- compounds with multiple ring structure
1. cholesterol
2. sex hormones (testosterone & estrogen)
3. bile
4. vitamin D
cholesterol:
- why is it important
- where is it synthesized
- do we need extra from diet?
- how much cholesterol does the liver make every day
- dietary cholesterol and hdl/ldl
- starting material for all the above cpds (bile, vitamin D, sex hormones)
its also an imp structural component of the brain & nerve cells. - liver of humans (endogenous) but can be obtained from exterior source (exogenous)
- no; Our body makes enough cholesterol: no need to get extra cholesterol through the diet.
- 800 mg - 1500 mg /day
- raises total cholesterol and LDL but to a lesser extent than saturated fatty acids
foods rich in cholesterol?
- eggs
- red meat
- shellfish
- liver
- dairy products
- egg yolk
how is cholesterol in the blood transported?
- in 2 forms: LDL which transports cholesterol from liver to tissues = linked to heart diseases
- HDL: transports cholesterol from tissues to liver = protective effect
factors that inc HDL?
factors that inc LDL?
- weight loss (if obese), exercise, estrogen, mod alcohol intake
- smoking, sedentary lifestyle, obesity, saturated and trans fat intake.
wht do cardiovascular diseases include
- CHD
- atherosclerosis
- htn
- ischemic heart disease
- pvd
- hf
what are the 3 major risk factors for CVD?
blood cholesterol concentration
smoking
htn
- major risk factors for cardiovascular disease
- hypertension
- age
- diabetes
- family history of premature cardiovascular disease
modifiable risk factors of cardiovascular disease
inc LDL
inc TG
dec HDL
CRP
inflammatory markers
lifestyle RF for cardiovascular disease
- poor diet
- physical inactivity
- tobacco
- stress
- insufficient sleep
- excessive alcohol
related conditions
HTN
obesity
metabolic syndrome (hdl dec, tg inc, abdominal obesity)
desirable range of:
- total cholesterol
- LDL
- HDL
- TG
- < 200 mg/dl
- < 130 mg/dl
- > 40 mg/dl
- < 150 mg/dl
13 recommendations from the AHA for CVD risk reduction
- healthy body weight
- diet rich in fruits & vegetables
- inc fiber food
- 2 x /week of fish
- saturated fat <7% of total calories
- trans fat <1% of total calories
- total cholesterol intake < 300 mg/dl
- lean meats
- low fat dairy
- little - no salt in food
- moderate alcohol intake
- dec hydrogenated oil
- dec food with added sugar
TLC diet:
- % of total fat
- % proteins
- CHO %
- saturated fat %
- trans fat %
- PUFA %
- MUFA %
- daily cholesterol intake
- physical acivity
- fiber
- sterols
- 25 - 35%
- 15%
- 50 - 60% (whole grain, fruits, veggies)
- < 7%
- zero or as low as possible
- up to 10%
- up to 20%
- < 200 mg/day
- 200 kcal/day
- 25 - 35 g (mostly soluble)
- 2g/day
how does increased intake of total fat increase the risk of CVD?
increased postprandial lipemia = increased debris or fragments of chylomicrons = increased risk of CVD
if the diet is < 25% of fat how does that affect?
inc TG, dec HDL
effect of fatty acids on TG and HDL
- Fatty acids, regardless of their type, decrease TG when they replace carbohydrates.
what fibers do we go for in CVD?
inc Intake levels of dietary fiber are
associated with dec prevalence of
CHD and stroke. In particular,
SOLUBLE FIBERS pectins , gums
and mucilages etc.) that dec LDL
cholesterol.
how do soluble fibers decrease cholesterol?
- the fiber binds bile acid = lowers serum cholesterol
- bacteria in the colon ferment the fiber to produce acetate, propionate, butyrate = inhibit cholesterol synthesis
where are stanols and sterols derived from
soybean or pine tree
how do stanols and sterols help in cholesterol
decrease blood cholesterol by decreasing its absorption
when stanols and sterols are made into margarines?
decrease cholesterol up to 20%
when does oxidative stress occur?
when the free radical activity»_space;» antioxidant defenses
this leads to inflammation => heart disease and cancer
what are antioxidants?
compounds that protect other cpds from damaging reactions involving oxygen by themselves reacting with oxygen
what has an antioxidant effect?
vitamins A, C, E
what are phytochemicals?
Phytochemicals are compound in
plants that confer color, taste and
other characteristics.
*
Known to have an antioxidant
activity.
*
Some can mimic the body’s own
hormones ( i.e :
*
Catechins found in red grapes, red
wine, tea (especially green),
chocolate, and olive oil , have been
found to improve vascular
reactivity.
4. Antioxidants and their role
in disease prevention
what is hypertension?
Hypertension is persistently high arterial blood pressure, the force exerted per unit area on the walls of arteries
risk factors of hypertension
- smoking
- diabetes
- hypercholesterolemia
- obesity
- excessive alcohol
- MI
- impaired renal function
- cerebrovascular accident
- retinal hemorrhage
- black race
- male gender
prevention of hypertension?
- limiting alcohol
- decreased dietary intake of Na
- as per DRI of Ca, Mg, K
- inc fruits and vegetables
- physical activity
- weight reduction if overweight
- dec fat dairy products
food sources of na
- salty snacks (chips, popcorn, etc)
- cheese and bread rolls
- soy sauce
- pasta dishes
- cured meats
- processed soups, poultry, sandwich
- pizz
- meat mixtures
- cold cuts
lifestyle modifications to reduce BP
- weight reduction: maintaining a BMI of < 25
- DASH diet: low fat dairy, fruits, vegetables, reduced saturated fat intake
- aerobic physical activity for at least 30 mins per day most days of the week
- alcohol intake decreased: 2 drinks for men per day, 1 drink for women per day.
- Na restriction: < 6g of salt /day ; < 2300 mg of Na /day.
DASH diet
- 2 x the servings of fruits & vegetables
- 1/2 the typical amounts of fats, oils, and salad dressing
- limiting by 1/3 the amount of beef, pork, and ham
- eating 1/4 the number of snacks and sweets
how does a diet rich in K help?
examples of K+ rich food sources
Ca & Mg
lowers BP and blunts the effect of salt on BP in some individuals
leafy green vegetables, root vegetables, fruiits: oranges, beet greens, white beans, spinach, bananas, sweet potatoes
- may have BP benefits: low fat dairy, beans nuts
what is moderate physical activity defined as
30 - 45 minutes of brisk walking on most days of the week
