Overnutrition and Cardiovascular Disease

Question 1

Obesity increases mortality in men and women across all age strata from 35 to 89. Increased mortality is due to what specific causes?

Answer 1

Ischemic heart disease, stroke, diabetes, cancer and live disease

Question 2

Obesity shortens lifespan. Therefore how much weight loss can increase lifespan via lower mortality and blood pressure, decreasing risk of DM and improving lipid profile?

Answer 2

10kg

Question 3

Cardiovascular disease is responsible for what percent of male and female deaths?

Answer 3

32% of male deaths

23% of female deaths

Question 4

If your relative risk is greater than 3 then what disease outcomes are you at risk for?

Answer 4

Type 2 diabetes
Hypertension 
Breathlessness
Insulin resistance 
Dyslipidemia 
Sleep Apnea

Question 5

If your relative risk about 2-3 then what disease outcomes are you at risk for?

Answer 5

Coronary heart disease/heart failure
Osteoarthritis (knees)
Hyperuricaemia and gout
Gall Bladder disease

Question 6

If your relative risk is about 1-2 then what disease outcomes are you at risk for?

Answer 6

Pregnancy complications
Cancer (breast and endometrium)
Impaired fertility/polcystic ovary

Question 7

In terms of mortality what are the benefits of 10kg of weight loss?

Answer 7

20-25% fall in total mortality
30-40% fall in diabetes-related death
40-50% fall in obesity-related cancer deaths

Question 8

In terms of blood pressure what are the benefits of 10kg of weight loss?

Answer 8

Fall of 10mm Hg in systolic and diastolic

Question 9

In terms of diabetes what are the benefits of 10kg of weight loss?

Answer 9

Risk of developing diabetes reduced by less then 50%
Fall in 30-50% in fasting blood glucose
Fall of 15% in HbA1c

Question 10

In terms of lipids what are the benefits of 10kg of weight loss?

Answer 10

Fall of 10% in total cholesterol
Fall of 15% in low density lipoprotein
Fall in 30% in triglycerides
Increase of 8% in high density lipoprotein (HDL)

Question 11

How does cardiovascular disease develop?

Answer 11

Atherosclerosis —- unstable plaque —- rupture—- thrombosis —- ischemia —-arrhythmia —morbidity and mortality

Question 12

What are the factors that help contribute to the development of atherosclerosis?

Answer 12

Clotting
Blood pressure
Dyslipidemia
Inflammation

Question 13

What two factors are directly related to obesity?

Answer 13

blood pressure and inflammation

Question 14

What is the role of cholesterol?

Answer 14

Higher cholesterol is associated with increased mortality from CHD when comparing countries
—there are big differences between populations, but it is a poor discriminator when comparing CHD risk within a country

Question 15

_________ is a better indicator of CHD risk/

Answer 15

Triacylglycerol

have to measure when fasting

Question 16

Increased TAGs are associated with what things?

Answer 16

Decreased HDL and increased LDL
Intolerance to dietary fat
Pro inflammation and Pro thrombosis

Question 17

A major part of the risk for CVD is modifiable by what?

Answer 17

Diet and lifestyle

–66% of the risk is modifiable by diet

Question 18

What are the main risks in the diet associated with CVD?

Answer 18

1. Too much salt – coming from processing of foods, not added at the dinner table and processing of foods replaces K with Na
2. Too much and the wrong type of fats and carbs
3. Not enough fiber, fruits, veggies and nuts

Question 19

Fruits and Veggies give us what?

Answer 19

High potassium with low sodium

–processed foods will always have more sodium and less potassium

Question 20

How does diet affect blood pressure?

Answer 20

1. Excess salt and low potassium increase risk of HTN

2. Fruits and veggies reduce the risk

Question 21

Which dietary fats are good and bad for our diets?

Answer 21

Saturated and trans fat are bad

• —dyslipidemia caused by marked elevation of triglycerides and cholesterol.
• -cholesterol only has an effect on serum cholesterol and not triglycerides

Question 22

MUFA have no effect on clotting or inflammation but does help to decrease what?

Answer 22

Cholesterol

Question 23

N-6 PUFA and N-3 PUFA have what effects on cholesterol and triglycerides?

Answer 23

N-6: decreases cholesterol, but are pro-inflammatory and thrombotic
N-3: decreases triglycerides and are anti-inflammatory and anti-thrombotic
–there needs to be a good balance.

Question 24

What is the current advice about dietary fat?

Answer 24

1. If obesity is target: reduce total fat
2. Heart disease: fat quality
   - –atherogenesis: reduce SFA/trans fat and increased PUFA and MUFA n-3 with oily fish
   - clotting/inflammation: increase n-3 with oily fish (to improve eicosanoid balance)

Question 25

Fish oil is urged as a supplement for what kind of patients?

Answer 25

Heart attack patients

Question 26

In summary explain the effects of n-3, n-6, mono–unsaturated, saturated/trans/cholesterol on CVD

Answer 26

n-3: decreased clotting, inflammation and triglycerides
n-6: increases clotting, decreases cholesterol and increased inflammation
mono-unsaturated: decreases cholesterol
Saturated/Trans: increases triglycerides and increased cholesterol
Cholesterol: increases cholesterol

Question 27

How do carbs affect CVD?

Answer 27

1. Eating too much of the wrong type — high glycemic index (GI)
   - -which is related to how quickly the blood glucose falls and rises after consumption
2. Low glycemic index
3. Not enough fiber (non starch polysaccharides)

Question 28

Low glycemic index diets improve what?

Answer 28

Improve blood lipids, esp triglycerides

Question 29

What is the equation for glycemic load?

Answer 29

Glycemia index x Amount of carbs

Question 30

Which fibers are shown to lower cholesterol?

Answer 30

Soluble fibers

Question 31

Combining a low GI diet with high fiber will improve what?

Answer 31

Both cholesterol and triglycerides

–reducing the risk of dyslipidemia and atherosclerosis

Question 32

High Gi and low fiber diet leads to what?

Answer 32

High cholesterol and high triglycerides

–including rice/short grain white rice and hot potatoes

Question 33

Low GI and high fiber diet leads to what?

Answer 33

Low cholesterol and high fibers

–red lentils/beans/spaghetti/yellow split peas

Question 34

Hypertension is associated with what foods that increase the CVD risk?

Answer 34

Excess Na (in processed foods) 
Low K (fruits, veggies, and unprocessed foods)

Question 35

Dyslipidemia is associated with what foods that increase the CVD risk?

Answer 35

Excess SFA/trans fat/dietary cholesterol
Low PUFA, MUFA, and VLC n-3 PUFA (oily fish)
High GI/GL carbs, excess fructose
Low NSP
Low antioxidants in fruits and vegetables, nuts

Question 36

Increased clotting and inflammation is associated with what dietary factors that increase the CVD risk?

Answer 36

Excess n-6 PUFA

low n-3, esp oily fish

Question 37

Fruits and veggies provide a good source of what?

Answer 37

Anti-oxidants and potassium

–remember the more antioxidants the less oxidants

Question 38

Do dietary and lifestyle interventions actually work?

Answer 38

Yes!

—health behaviors may be additive in their effect (not smoking, exercise, decrease ETOH use, five fruits and veggies)

Question 39

Patients who exhibited all 4 health behaviors in interventions, had what results?

Answer 39

75% reduction in total mortality and 80% reduction in CVD mortality with 14 years of extra life.