Spotlight B; Lipids in Health and Disease

Question 1

sadly, poverty is linked to a number of health problems, most notably heart disease, known more formally as cardiovascular disease (CVD)

Answer 1

yes

Question 2

cardiovascular disease (CVD) refers to the conditions that impair the heart, arteries, veins, and capillaries, which move [..] through the human body

Answer 2

blood

Question 3

CVD is the leading cause of death around the world, accounting for approximately [..]% of all deaths in the 2014.

Answer 3

31

Question 4

although we may often think of CVD as a disease that affects primarily affluent countries, this is not the case as [..]% of deaths due to CVD worldwide occur in low to middle income countries

Question 5

a major reason for this is that people in these countries are often diagnosed [..] in the course of the disease and often have [more for less] access to effective healthcare, so their death rates from CVD are higher than for individuals in developed countries

Answer 5

late
less

Question 6

in the United States, CVD has been the number one cause of death for more than 100 years; today an estimated one in three Americans have some form of disease. according to 2018 statistics from the American Heart Association, about 2300 Americans die of CVD every day, equating to an average of one death due to CVD every 36 seconds

Question 7

CVD; its not just a disease of old age either - about 2 in 20 deaths from CVD in the United States in 2016 occurred in adults younger than [..] years

Answer 7

65

Question 8

• 46% of adults in the United States have high blood pressure
• 31% of all deaths in the United States are caused by CVD
• 9% of adults in the United States have coronary heart disease, heart failure, or stroke
• 12% of adults in the United States have high blood cholesterol

Question 9

before people experience major events such as heart attack and stroke, the long term [..] and loss of [..] in blood vessels are caused by atherosclerosis

Answer 9

narrowing
elasticity

Question 10

atherosclerosis is an [..] disease characterized by the [..] of fatty plaque in the walls of arteries and blood vessels that generally develops over the course of several decades . this process is typical caused by the presence of elevated levels of cholesterol-rich [..] density lipoproteins (LDLs) in the blood. As blood levels of LDL rise, they infiltrate the artery wall, where the LDLs are likely to become [..] (by reacting with unstable oxygen containing molecules. Oxidized LDLs cause [..] to cells that line the vessel wall, and this initiates inflammatory process that attracts white blood called macrophages inside the arterial lining. other factors such as smoking and hypertension, can also cause [..] to the arterial wall and trigger inflammation. inside the vessel wall, macrophages take up the oxidized LDLs in a rapid and [..] fashion. these fat laden macrophages (now called foam cells) die and deposit their accumulated lipids within the wall the artery, promoting further inflammation

Answer 10

inflammatory
accumulation, low, oxidized
injury x2, uncontrolled

Question 11

as a result of the artery wall inflammation, the lining of the blood vessels become more prone to develop a waxy [..] of cholesterol and triglycerides, known as plaque. over time, plaque development, loss of elasticity, and thickening in the blood vessel walls may make it difficult for blood to flow through the vessel. this “traffic jam” increases the chances of forming blood clots that either block [..] at the location or break off and travel through the bloodstream, blocking blood flow elsewhere, causing tissue damage and tissue death. when blood flow is blocked in the coronary artery, which supplies blood to the [..], people experience a heart attack, or myocardial infarction. most cases of stroke result when a clot impairs the supply of blood to the brain

Answer 11

accumulation, flow
heart

Question 12

individuals with Alzheimer disease experience greater [..] of the arteries in the brain than do healthy individuals

Answer 12

narrowing

Question 13

for the most part, young people do not have heart attacks (and those who do usually suffer from rare [..] conditions).

Answer 13

genetic

Question 14

a recent study found that nearly 25% of young adults afed 18-24 had at least [..] advanced atherosclerotic plaque

Answer 14

one

Question 15

heart disease begins in [..]

Answer 15

childhood

Question 16

factors you can’t do anything about, CVD; individuals with a family history of heart disease at an early age are more likely to develop CVD, as are African Americans, and both men and women are at increased risk as they age

Answer 16

yes

Question 16

although the exact cause of CVD is often unknown, the Bogalusa study has shown that certain risk factors [increase or decrease] young peoples chances of developing heart disease- and the more risk factors they have, the higher their chances

Answer 16

increase

Question 17

there are many risk factors people of all ages can modify, most significantly through diet, exercise, and other lifestyle practices

Answer 17

yes

Question 18

CVD; modifiable risk factors include smoking; a diet high in saturated and trans fats, cholesterol, sodium and added sugar, a sedentary lifestyle (physical); obesity; excessive alcohol consumption and high blood pressure

Answer 18

yes

Question 19

having high blood pressure (hypertension) - a condition in which blood pushes with excessive [..] against artery walls - is correlated closely with the extent of atherosclerosis found in the arteries

Answer 19

force

Question 20

although many risk factors for CVD are modifiable, more than 90% of Americans eat a “poor
diet for heart health, according to the American heart association . e.g. the concentrations of cholesterol and triglycerides in blood are a major risk factor for CVD.

Question 21

blood cholesterol levels measuring less than [..] milligrams of cholesterol - are considered desirable. yet the average cholesterol level for a US adult is just under 200 mg/dl - meaning the average American has a borderline high level

Answer 21

200

Question 22

people with high levels of total blood cholesterol have approximately [..] the risk of heart disease as those who do not.

Answer 22

twice

Question 23

normal trigylercide levels vary by age and sex, but anything above [..] mg/dl is considered elevated. high triglyceride levels are common in people with heart disease or diabetes and correlate with lower levels of HDL cholesterol, or “good” cholesterol

Answer 23

200

Question 24

one of the most important tools Berenson and his Bogalusa study team sued to evaluate healthy diets was children's intake of [..] and [..]. besides asking children about their diets, the Bogalusa researchers also directly measured levels of lipids in their blood by looking at the lipoproteins that [..] lipids around the body

Answer 24

fat and cholesterol transport

Question 25

physicians use a diagnostic test called a lipid panel to provide information about levels of triglycerides, total cholesterol, and cholesterol in high density lipoproteins (HDL-C) and low density lipoproteins (LDL-C) in blood

Answer 25

yes

Question 26

lipoproteins contain diffrent proportions of proteins, cholesterol, triglycerides, and other components that affect their density and function - as well as their impact in the risk of CVD

Answer 26

yes

Question 27

the LDLs ferry cholesterol to all of the cells of the body. this cholesterol forms the root of the plaques that slowly constrict blood low through the vessels that feed the heart and brain the lower your LDL cholesterol level, the lower your risk of heart attack and stroke

Question 28

if you have other risk factors for CVD, its best to keep your LDL-C concentration below 100 mg/dl (some experts recommend levels closer to 70 mg/dl especially if other risk factors are present)

Question 29

CVD; in some cases, diet and exercise may not suffice, in which case people also take medications that lower their total cholesterol and LDL-C concentrations

Question 30

HDLs, in contrast, bring cholesterol from tissues [..] to the liver, where it is processed and eliminated. not surprisingly, low levels of HDL-C less than 40 mg/dl in men and 50 mg/dl in women - are associated with an [increased or decreased] risk of CVD

Answer 30

back increased

Question 31

higher levels of HDL-C can be associated with a lower risk of heart disease, but only up to a value of about [..] mg/dl. so higher levels of HDL cholesterol have a [..] ability to offset the risk of heart disease seen with increasing levels of LDL cholesterol. for this reason, calculating the ratio of LDL-C to HDL-C is not clinically useful, particularly in individuals with LDL-C concentrations.

Answer 31

60 limited

Question 32

in general, the risk for CVD increases with the number of risk factors you have

Answer 32

yes

Question 33

people who carry around a cluster of some of the most dangerous risk factors for CVD are said to have metabolic syndrome. e.g. having an elevated blood glucose level is a serious condition, but when coupled with excessive amounts of abdominal fat and high blood pressure, a person has a greater chance of cardiovascular problems because of the combination of risk factors

Answer 33

(not surprisingly, this makes them much more likely to have a heart attack or stroke and five times more likely to develop type 2 diabetes)

Question 34

to be given a diagnosis of metabolic syndrome, individuals must have at least [..] of the following problems; - excessive [..] fat, - high blood [..], - [..] levels of triglycerides in the blood, - [..] levels of HDL, - and [..] blood glucose levels (either predates or type 2 diabetes). is on the rise. affects more than 50 million adults in the United States and approximately [..]% of adults worldwide

Answer 34

abdominal , pressure, elevated, low three

Question 35

concept; although saturated fatty acids do, indeed, have the potential to raise total and LDL cholesterol levels, an important factor to consider is what people who cut back on saturated fatty acids eat instead.

Answer 35

e.g. if people replace high-fat foods with lower-fat options that are high in carbohydrates, particularly refined starches, added sugar, and potatoes (which happens frequently), then they won’t likely see any health benefits.

Question 36

low fat diets high in [..], particularly when low in fiber and high in sugar, actually increase [..] levels in the blood. and some recent analyses even suggest that certain sources of saturated fatty acids long thought to be contributors to CVD, such as those in dairy products, actually may not affect blood [..] level or increase the risk of CVD as negatively as other sources

Answer 36

carbohydrates triglyceride lipid

Question 37

coconut oil [..] LDL cholesterol to the same degree as saturated fats from other sources such as butter beef fat and palm oil

Answer 37

raises

Question 38

Based on current evidence, the best overall strategy to protect your heart health is to [..] saturated fatty acids with unsaturated ones and to emphasize vegetables, fruits, and whole grains in the diet.

Answer 38

replace

Question 39

The Dietary Guidelines for Americans recommend limiting overall saturated fat intake to [..]% or less of total daily calories

Answer 39

10%

Question 40

neither the 2015 nor the 2020 Guidelines establish specific limits for dietary cholesterol, but they do qualify that eating as little as possible is advisable within a healthy eating pattern.

Answer 40

yes

Question 41

For those with increased risk for heart disease and high blood cholesterol levels, recommendations from the National Cholesterol Education Program (NCEP) of the National Institutes of Health are to keep calories from saturated fat under [..]%

Answer 41

7%

Question 41

When the researchers examined women’s fat intake, they found that women who ate the most polyunsaturated fatty acids were [..] likely to develop heart disease.

Answer 41

least

Question 42

Research also indicates that replacing saturated fats with monounsaturated fatty acids can [..] blood lipid profiles and [..] the risk of heart disease, but not as effectively as what is seen when saturated fats are replaced with polyunsaturated fatty acids.

Answer 42

improve reduce

Question 43

you can get too much of a good thing - there is no consistent rationale or recommendation for the specific amount of monounsaturated fatty acids we should obtain from our diets, but the American Heart Association suggests that people get no more than [..]-[..]% of their total calories from fat, most of which should come from unsaturated fatty acids, and that saturated fat not exceed [..]% of total calories

Answer 43

25-35% 7%

Question 44

different unsaturated fats have different effects on the body as well. omega-6 polyunsaturated fatty acids, for instance, appear to improve blood lipid profiles, especially the they take the place of saturated fatty acids, reducing the risk of heart disease

Answer 44

the American heart association suggest that this type of fat should make up no less than 5-10% of our total calories, given that they appear to reduce inflammation, a culprit in the initiation of plaque development

Question 45

low levels of the omega-3 docosahexaeconic acid (DHA) in the diet are associated with an increase in the risk of alzeihmer disease and other forms of dementia, and higher intakes of oily fish are consistently associated with reduced risk of dementia. its unclear, however, whether fish oil supplements containing DHA and eicosapentaenoic acid (EPA), another omega-3 fatty acid, hold any benefits relative to the risk of dementia

Question 46

Most Americans, and others who follow a Western diet, eat much more omega-6 fatty acids than omega-3 fatty acids, with a typical ratio of 10:1. It has long been argued that lowering this ratio, (such as to 5:1 or 4:1) would improve our health, but recent evidence raises significant questions regarding the general recommendation as high intakes of linoleic acid are associated with a significant reduction in the risk of heart disease.

Question 47

trans fatty were added to foods to help lengthen shelf life and were often found in many commercial cakes, cookies, pies, and pasties. were found to [..] LDL-C and [..] HDL-C, along with raising total cholesterol levels (women who ate diets high in trans fats and significantly [..] risk of heart disease.)

Answer 47

raise, lower higher

Question 48

Unsalted peanuts and some tree nuts, specifically walnuts, almonds, pecans, and pistachios, are particularly beneficial, and eating at least 5 ounces per week (roughly 900 calories) is consistently associated with a lower risk of heart disease

Answer 48

As long as you don’t add nuts to the foods you’re already eating—thereby increasing your fat and calorie intake—they are a good component of a healthy diet, contributing unsaturated fatty acids, fiber, protein, folate, minerals, antioxidants, and phytochemicals.

Question 49

reduce the risk of heart disease; plant based diets that provide abundant deeply colored fruit and vegetables supply thousands of [..] (flavonoids) that [..] LDL oxidation and blood clotting

Answer 49

phytochemical , reduce

Question 50

reduce the risk of heart disease; oily, cold water fish such as salmon, trout, and albacore tuna contain omega-3 fatty acids, which can lower blood [..] and delay [..]

Answer 50

triglycerides clotting (the American heart association recommends at least two weekly servings of these fish, which provide omega-3 fatty acids, protein, vitamin D, and other key nutrients)

Question 51

reduce the risk of heart disease; moderate alcohol consumption raises HDL cholesterol and reduces the risk of CVD. moderate drinking is [..] drink for a woman and no more than [..] for a man

Answer 51

one two

Question 52

reduce the risk of heart disease; consumption of plant sterols or stanols reduces cholesterol [..] and thereby reduces blood cholesterol. they are added to some food products, which are allowed to display an FDA approved health claim stating that they may reduce the risk of heart disease

Answer 52

absorption

Question 53

reduce the risk of heart disease; nut consumption has consistently been found to reduce the risk of [..] disease. a recent study observed that those who ate nuts nearly every day a [..]% lower risk of dying of heart disease and cancer than those who did not eat nuts

Answer 53

heart 20%

Question 54

reduce the risk of heart disease; whole grain oats and rye, as well as legumes (beans), are good sources of soluble [..], which can lower blood cholesterol [..] and reduce the risk of heart disease

Answer 54

fiber cholesterol

Question 55

reduce the risk of heart disease; substituting unsaturated oils for saturated fats improves blood [..] and reduces the risk of CVD

Answer 55

lipids

Question 56

the American heart associate does support the use of fish oil supplements for reducing the risk of future cardiovascular events in individuals with prior heart disease

Answer 56

yes

Question 57

Whereas whole fish consumption is encouraged, some types of fish can have high levels of mercury and other environmental pollutants. Thus, it is prudent to limit consumption of certain species, such as shark, swordfish, king mackerel, and tilefish.

Answer 57

yes

Question 58

eating unhealthy foods is not associated with just heart problems

Answer 58

yes

Question 59

many studies have shown that people who eat high fat diets, particular diets high in animal fats, are more likely to develop [..]

Answer 59

cancer

Question 60

more than 30% of cancers in adults could be delayed or even prevented by eating a healthy diet, exercising regularly, and maintaining a healthy weight.

Answer 60

yes

Question 61

a heart healthy diet also protects against cancer. specifically, a diet rich in plant based foods (such as fruits and vegetables), whole grains, and fish appears to be protective, whereas a diet with few servings of fruits and vegetables and extra portions of processed meat, sodium, alcohol, refined carbohydrates, and high amounts of total fat have the opposite effect

Answer 61

yes

Question 62

diet is one of the biggest risk factors for many disease - including cancer - over which we have some control . naturally watching your calorie intake and having a healthy body weight also help

Answer 62

yes

Question 63

Fat is [..]-dense, and any extra is more likely to be stored as body fat than excess protein or carbohydrate.

Answer 63

calorie