Overnutrition and Cardiovascular Disease Flashcards
Obesity increases mortality in men and women across all age strata from 35 to 89. Increased mortality is due to what specific causes?
Ischemic heart disease, stroke, diabetes, cancer and live disease
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?
10kg
Cardiovascular disease is responsible for what percent of male and female deaths?
32% of male deaths
23% of female deaths
If your relative risk is greater than 3 then what disease outcomes are you at risk for?
Type 2 diabetes Hypertension Breathlessness Insulin resistance Dyslipidemia Sleep Apnea
If your relative risk about 2-3 then what disease outcomes are you at risk for?
Coronary heart disease/heart failure
Osteoarthritis (knees)
Hyperuricaemia and gout
Gall Bladder disease
If your relative risk is about 1-2 then what disease outcomes are you at risk for?
Pregnancy complications
Cancer (breast and endometrium)
Impaired fertility/polcystic ovary
In terms of mortality what are the benefits of 10kg of weight loss?
20-25% fall in total mortality
30-40% fall in diabetes-related death
40-50% fall in obesity-related cancer deaths
In terms of blood pressure what are the benefits of 10kg of weight loss?
Fall of 10mm Hg in systolic and diastolic
In terms of diabetes what are the benefits of 10kg of weight loss?
Risk of developing diabetes reduced by less then 50%
Fall in 30-50% in fasting blood glucose
Fall of 15% in HbA1c
In terms of lipids what are the benefits of 10kg of weight loss?
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)
How does cardiovascular disease develop?
Atherosclerosis —- unstable plaque —- rupture—- thrombosis —- ischemia —-arrhythmia —morbidity and mortality
What are the factors that help contribute to the development of atherosclerosis?
Clotting
Blood pressure
Dyslipidemia
Inflammation
What two factors are directly related to obesity?
blood pressure and inflammation
What is the role of cholesterol?
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
_________ is a better indicator of CHD risk/
Triacylglycerol
have to measure when fasting
Increased TAGs are associated with what things?
Decreased HDL and increased LDL
Intolerance to dietary fat
Pro inflammation and Pro thrombosis
A major part of the risk for CVD is modifiable by what?
Diet and lifestyle
–66% of the risk is modifiable by diet
What are the main risks in the diet associated with CVD?
- Too much salt – coming from processing of foods, not added at the dinner table and processing of foods replaces K with Na
- Too much and the wrong type of fats and carbs
- Not enough fiber, fruits, veggies and nuts
Fruits and Veggies give us what?
High potassium with low sodium
–processed foods will always have more sodium and less potassium
How does diet affect blood pressure?
- Excess salt and low potassium increase risk of HTN
2. Fruits and veggies reduce the risk
Which dietary fats are good and bad for our diets?
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
MUFA have no effect on clotting or inflammation but does help to decrease what?
Cholesterol
N-6 PUFA and N-3 PUFA have what effects on cholesterol and triglycerides?
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.
What is the current advice about dietary fat?
- If obesity is target: reduce total fat
- 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)
Fish oil is urged as a supplement for what kind of patients?
Heart attack patients
In summary explain the effects of n-3, n-6, mono–unsaturated, saturated/trans/cholesterol on CVD
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
How do carbs affect CVD?
- 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 - Low glycemic index
- Not enough fiber (non starch polysaccharides)
Low glycemic index diets improve what?
Improve blood lipids, esp triglycerides
What is the equation for glycemic load?
Glycemia index x Amount of carbs
Which fibers are shown to lower cholesterol?
Soluble fibers
Combining a low GI diet with high fiber will improve what?
Both cholesterol and triglycerides
–reducing the risk of dyslipidemia and atherosclerosis
High Gi and low fiber diet leads to what?
High cholesterol and high triglycerides
–including rice/short grain white rice and hot potatoes
Low GI and high fiber diet leads to what?
Low cholesterol and high fibers
–red lentils/beans/spaghetti/yellow split peas
Hypertension is associated with what foods that increase the CVD risk?
Excess Na (in processed foods) Low K (fruits, veggies, and unprocessed foods)
Dyslipidemia is associated with what foods that increase the CVD risk?
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
Increased clotting and inflammation is associated with what dietary factors that increase the CVD risk?
Excess n-6 PUFA
low n-3, esp oily fish
Fruits and veggies provide a good source of what?
Anti-oxidants and potassium
–remember the more antioxidants the less oxidants
Do dietary and lifestyle interventions actually work?
Yes!
—health behaviors may be additive in their effect (not smoking, exercise, decrease ETOH use, five fruits and veggies)
Patients who exhibited all 4 health behaviors in interventions, had what results?
75% reduction in total mortality and 80% reduction in CVD mortality with 14 years of extra life.
