Topic 6 - Food and Nutrition for Cardiovascular Health Flashcards
What is Cardiovascular Disease?
Cardio = heart + blood vessels Heart Disease; - coronary/ischaemic heart/artery disease - heart failure - rheumatic fever & rheumatic heart disease - congenital heart disease Stroke; - cerebrovascular disease - ischaemic strokes (blood clots) - haemorrhagic strokes (bleeding) Vascular Disease; - peripheral vascular disease
What are the risk factors for CVD?
Individual:
Non- modifiable Age Gender Genetics Modifiable Poor Nutrition Insufficient intake of fruit and vegetables Inactivity High blood cholesterol High blood pressure Excess body weight External: * Government policies and practices; - food supply - physical activity - CVD Management * Food Supply - Location & Access - Availability - Variety & Quality - Pricing - Utilisation - skills, knowledge, facilities etc.
Why is our work important?
- > 45,500 CVD deaths in Australia during 20101
- This was more than any other disease group at 32% deaths1
- On average, one Australian dies as a result of CVD every 12 minutes2
Indigenous Australians
1 in 8 reported CVD condition
1.3x as likely to have CVD
1.5x more likely to be hypertensive
3.1x (males) as likely to die from CVD (2001-05) 2.6x (females) as likely to die from CVD (2001-05)
19x as likely to die from acute rheumatic fever & chronic rheumatic heart disease1
26-27x prevalence of acute rheumatic fever & chronic rheumatic heart disease (M–F) (in NT & SA, Dec 06)
Significantly higher rates of some CVD risk factors3
Heart Foundation Nutrition Recommendations:
Heart Foundation Nutrition Recommendations:
• Dietary fats • Carbohydrate, GI/GL & dietary fibre • Dietary electrolytes – sodium, potassium • Antioxidant containing foods and drinks
Changing the Food Supply
• The Heart Foundation Tick
• NSW Healthier Fats Initiative
• Menu Labelling in Fast Food Chains
What is dietary fat? total fat
- No direct relationship between total fat intake and incidence of CHD
- Amount of fat is indirectly related via its contribution to energy intake and thus potential weight gain.
- The TYPE of fat you consume is more important
Saturated Fatty Acids
What are they? • No spare places on molecule • Most are solid at room temperature Why limit? • Associated with CHD(III-2) • Increases total and LDL-C • Myristic, palmitic and lauric acids specifically raise LDL-C (I)
trans fatty acids
What are they?
• Polyunsaturated fats
• Behave like SFAs in our body because of chemical structure
Why limit?
• increases total cholesterol, LDL-C & triglycerides (II) • decreases HDL cholesterol (II) • increases risk of heart attack (III-2) • at least as harmful as saturated fat per gram
BUT
• In food supply SFA»_space;> tFA • NB: focus on reducing both SFA + tFA
n-6 polyunsaturated fatty acids
What are they?
• Unsaturated – free spaces on molecule • First double bond bet 6th & 7th carbons • Usually softer at room temperature • Essential - our body cannot make all we need
Why choose?
• Lowers LDL cholesterol (II) • When replacing saturated & trans fats:
– Improves heart disease risk
– Improves blood lipid profiles • Need to increase P:S ratio > 1 • Essential for growth and health
n-3 polyunsaturated fatty acids
Marine : What are they?
• Unsaturated oils • DHA – docosahexaenoic acid • EPA – eicosapentaenoic acid Found in:
• Oily fish – Aust. & Atlantic salmon, blue eye trevalla, blue mackerel, gemfish, sardines, anchovy etc
• Seafood – prawns, scallops, arrow squid, green mussels
• Canned fish – sardines, salmon, some varieties of tuna (not ‘light/lite’)
• Frozen fish – read NIPs to see higher levels of EPA & DHA
n-3 polyunsaturated fatty acids
Marine n-3: Why include?
• 1 serve per week
n-3 polyunsaturated fatty acids: Plant n-3s:
What are they?
• Plant - Alpha-linolenic acid (ALA)
• The first double bond is between 3rd & 4th carbons
Why choose?
Plant n-3s:
• Lowers risk of heart disease
• May work in a different way to marine n-3s • Essential for health
Animal (non-marine)
• – DPA (docosapentaenoic acid)
• Some conversion to the marine type n-3s
• Small amounts in lean meat
Mono-unsaturated Fats
What are they? • Unsaturatedfat • Have only 1 double bond • Usuallysofteratroom temperature Why choose? • LowersLDLcholesterol • Whenreplacingsaturated& trans fats: – Improves CHD risk (I) – Improves blood lipid profiles • Essentialforhealth
Sterols – Dietary cholesterol
Where found:
• In animal products e.g. meats, particularly offal, prawns, egg yolk and full fat dairy products
Recommendations:
• Inconclusive evidence of a relationship with CVD outcomes (Heart Foundation, 2009)
• Little evidence between serum cholesterol and stroke (III-2)
• ≤ 6 eggs/week in low SFA diet not associated with adverse CVD outcomes (III-2)
NB: Greatest influence on blood lipids is SFA & tFAs • Lowering SFA & tFA intake – also lowers dietary
cholesterol
Sterols - phytosterols
What are they?
• Plant sterols and stanols
• Molecule shaped like cholesterol
• Naturally occurring part of all plants
Why choose?
• Lowers blood cholesterol lower risk of CVD (II)
• 2 g/day of plant sterol enriched margarine reduces cholesterol by ≈ 10% (I)
• 2.5 g/day of plant sterol enriched breakfast cereal, low fat yoghurt, low fat milk or bread reduces cholesterol by ≈ 5-15% (II)
• Consuming more than 2-3 serves of enriched products per day no added benefits (I)
Carbohydrate, dietary fibre,
GI/GL & CVD
Prevention:
• No direct association between total CHO & CVD (no evidence).
• Dietary fibre (cereals, fruit) associated with lower CHD risk + wholegrains are protective. (moderate evidence)
• High sucrose & fructose (in drinks) may increase energy intake increase overweight & obesity increase type 2 diabetes CVD. (moderate evidence)
• High refined CHO and high GL associated with increase CVD risk (through BMI) (some evidence)
Carbohydrate, dietary fibre, GI/GL & CVD
Management:
• Soluble fibre lowers plasma LDL-C (good evidence)
• High glycaemic load increases serum TG levels, particularly in those with elevated TGs and high BMI (good evidence)
We are consuming 50% more sodium than we should be
Dietary electrolytes
• Reducing dietary sodium by 1700 mg/day is associated with a fall in systolic BP in hypertensive (of 4-5 mmHg) and normotensive (of 2 mmHg) individuals. (good evidence)
• High dietary sodium intake is associated with increased stroke incidence, and mortality from CHD and CVD. (moderate evidence)
• Increasing dietary potassium by 2100
mg/day is associated with a fall in BP
in hypertensive (of 4-8mmHg) and
normotensive (of 2mmHg) individuals.
Healthy eating and drinking messages
- Antioxidants are beneficial for health, including CVH in adults.
- Consumed as part of a balanced diet containing a wide variety of plant-based foods
Adult Australians
Source of antioxidants
Good choice for CVH
Heart Foundation Recommendation
Fruit and vegetables; At least 2 serves of fruit per day. At least 5 serves of vegetables per day
Tea; Either black or green tea made with leaves or tea bags. May add reduced, low or no fat milk.
High Polyphenol Cocoa; Use raw cocoa powder in drinks and cooking.
NO to CHOCOLATE; Most commercial cocoa and chocolate will be poor sources of antioxidants.
Menu Labelling & Consumer Messaging for Fast Food Chains (NSW)
From our rapid review: Food eaten away from home was: • Higher in energy • Larger portion sizes • Provided more energy Consumers: • Not aware of the number of kJ they need to eat in a day • Underestimate kJ in fast food • Overestimate kJ in healthy foods
Menu Labelling & Consumer Messaging for Fast Food Chains (NSW)
From our rapid review: Food eaten away from home was: • Higher in energy • Larger portion sizes • Provided more energy Consumers: • Not aware of the number of kJ they need to eat in a day • Underestimate kJ in fast food • Overestimate kJ in healthy foods
Menu Labelling:
Where:
– Cafes and coffee chains, QSRs/fast food chains including independents, snack food chains, bakery chains, juice bars,
– Foodservice businesses with • >20 outlets in NSW or • >50 outlets in nationally
– Supermarkets
What:
– kJ per serve – ‘The average adult daily intake is 8700 kJ’ – Adjacent to menu item at point-of-purchase – At least size of price – Full NIPs in store (provide if asked)
Menu Labelling:
Where:
– Cafes and coffee chains, QSRs/fast food chains including independents, snack food chains, bakery chains, juice bars,
– Foodservice businesses with • >20 outlets in NSW or • >50 outlets in nationally
– Supermarkets
What:
– kJ per serve – ‘The average adult daily intake is 8700 kJ’ – Adjacent to menu item at point-of-purchase – At least size of price – Full NIPs in store (provide if asked)
What did our advocacy achieve? Evaluation strategy
Data collection:
1. Industry consultation and feedback 2. On-site compliance checks 3. Verification of energy values displayed 4. Nutrients purchased 5. Consumer knowledge and use of energy information
(Report to be tabled in NSW Government by 1 Feb 2013)
What did our advocacy achieve? Evaluation strategy
Data collection:
1. Industry consultation and feedback 2. On-site compliance checks 3. Verification of energy values displayed 4. Nutrients purchased 5. Consumer knowledge and use of energy information
(Report to be tabled in NSW Government by 1 Feb 2013)
Healthier Oils
Initiative
Small to Medium sized food outlets
• Local takeaway, café, restaurant, club or pub
• Reduce saturated fats in food supply
• Swap to healthier oils
• Work with Health or Environmental health Officers in LGA councils across NSW
Healthier Oils
Initiative
Small to Medium sized food outlets
• Local takeaway, café, restaurant, club or pub
• Reduce saturated fats in food supply
• Swap to healthier oils
• Work with Health or Environmental health Officers in LGA councils across NSW
Healthier Oils Initiative – NSW
Working with Local Govt:
• Now 11% of Councils
Local Government Kit
• Supportive material – Process chart
– Examples of: • Council motion • Media articles
– Surveys and tips to record oils used by food outlets
• HF Tools – 3 Step Guide
– A Healthier Serve – The Right Ingredient
Healthier Oils Initiative – NSW
Working with Local Govt:
• Now 11% of Councils
Local Government Kit
• Supportive material – Process chart
– Examples of: • Council motion • Media articles
– Surveys and tips to record oils used by food outlets
• HF Tools – 3 Step Guide
– A Healthier Serve – The Right Ingredient
The Tick Program
- Over 20 years – launched in 1989 • National program - based in Sydney • Over 60 Tick product categories • Over 70 licensees
- We’re not just about heart disease
The Tick Program
- Over 20 years – launched in 1989 • National program - based in Sydney • Over 60 Tick product categories • Over 70 licensees
- We’re not just about heart disease
Why improve the food supply?
- Improve the nutritional profile of the foods we eat most often
- Increase availability of healthier food • Impact all population groups • Requires no individual behaviour change
Why improve the food supply?
- Improve the nutritional profile of the foods we eat most often
- Increase availability of healthier food • Impact all population groups • Requires no individual behaviour change
