The Role of Diet in CVD

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  • As front line health care providers, whether physicians, nurses or allied health, you find yourself faced with questions about nutrition. Patient’s come to you to sort out media messages and count on you for reliable medical information. It is difficult enough for us Cardiac Dietitians at SMGH to sift through the media information continuously coming forward, and we work at it on a full time basis, what reliable messages can you send your patients. I hope that you can offer a bit more clarity on a few topics at the end of today’s workshop .
  • My goal is to create a true workshop setting that will allow for your questions to be answered throughout the information sharing.
  • The relationship between diet and CVD has been studied intensively for nearly a century. In the past 2 decades understanding of the nutrients and foods likely to promote cardiac health has grown substantially owing to studies of the molecular mechanisms of atherosclerosis and metabolic effects of various nutrients and foods, large and carefully conducted prospective cohort investigations and dietary intervention trials. Although the search for the optimal diet for prevention of CHD is far from over, more specific and firmer evidence on diet and CHD is now available.
  • Dr. David Jenkins, the head of a research team out of the University of Toronto, has been conducting very promising research with functional foods. Initially studies were completed in a controlled setting where participants were provided all meals and snacks each day for 2 weeks. Results were significant within a 2 week time period. A new study released in March of this year by the same research group has been able to show, 30 % of those motivated study participants who ate the dietary portfolio of cholesterol lowering foods under real world conditions were able to lower their LDL cholesterol >20%, which was not significantly different from their response to a first-generation statin taken under metabolically controlled conditions.
  • These results have been similarly duplicated by the National Cholesterol Education Program : Adult Treatment Panel III, Therapeutic Lifestyle Changes recommendations. We cannot deny as clinicians these types of changes take a very motivated patient population to see impacts on LDL cholesterol that are suggested here. The point of true interest is that even some of these recommended changes will have an impact on CVD risk.
  • Good sources of soluble fibre include psyllium, oatbran, oatmeal, beans, legumes and some fruits and vegetables
  • To date studies have included participants with established coronary disease. Whether or not this would be beneficial in primary prevention still needs to be determined. To date the research has not shown an effect on outcomes and therefore is not recommended at this time.
  • The Role of Diet in CVD

    1. 1. The Role of Diet in CVD Presented By: Lisa Spott R.D Clinical Nutrition – Cardiology St. Mary’s General Hospital
    2. 2. A Professional Opinion <ul><li>Reliable source for health information </li></ul><ul><li>Clarify media reports on various nutrition topics </li></ul><ul><li>Help distinguish nutrition myth from nutrition fact </li></ul>CLARITY
    3. 3. Workshop Goals <ul><li>Answer your questions about nutrition and CVD management. </li></ul><ul><li>Provide useful tools and resources that can be used in the treatment of the CVD patient </li></ul>
    4. 4. Workshop Topics <ul><li>Case #1 – Elevated Lipid Profile </li></ul><ul><li>Case #2 – Weight Loss </li></ul><ul><li>Case #3 – CHF </li></ul><ul><li>Points of interest: </li></ul><ul><li>Homocysteine </li></ul><ul><li>Omega-3 Fatty Acids </li></ul><ul><li>DASH Diet </li></ul>
    5. 5. Where Do You Start?
    6. 6. Case Study <ul><li>55 year old male </li></ul><ul><li>PMHx: hypercholesterolemia </li></ul><ul><li>Family Hx: premature CVD </li></ul><ul><li>Ex-smoker </li></ul><ul><li>Exercises 30min 3x/wk </li></ul><ul><li>BP 115/79 mm hg </li></ul><ul><li>BMI - 29 </li></ul><ul><li>WC - 39in </li></ul>
    7. 7. Lab Values <1.7 1.58 Triglycerides >1.0 0.93 HDL Cholesterol <2.5 4.32 LDL Cholesterol < 5.2 7.44 Total Cholesterol ATP III Reference Values (primary prevention) Values Lab test
    8. 8. Problem List <ul><li>Elevated TC </li></ul><ul><li>Elevated LDL </li></ul><ul><li>Low HDL </li></ul><ul><li>Overweight </li></ul><ul><li>Family History concerns </li></ul>
    9. 9. Diet Vs. Drugs <ul><li>Despite the wide spread use of statins and their effectiveness in reducing cardiovascular disease, diet is still the preferred treatment option in primary prevention </li></ul>
    10. 10. The Portfolio Diet 5 30g/day Almonds 5 2g/d Plant Sterols 5 80g/d Vegetable protein 5 20g/d Soluble Fibre Portfolio Diet: 10 <7% saturated fat <200mg cholesterol/d NCEP II Approx. % LDL Dietary Change Diet Components 20-30 Cumulative Potential Effect
    11. 11. ATP III 6-15 2g/d Plant Sterols 3-5 5-10g/d Soluble Fibre 5-8 Lose 10 pounds Weight Reduction 3-5 <200mg/d Cholesterol 8-10 <7% kcal Saturated Fatty Acids Approx. % LDL Dietary Change Dietary Component 20-30 Cumulative Potential Effect
    12. 12. The Mediterranean Diet Daily Activity www.oldwayspt.org/
    13. 13. A Diet Prescription for Heart Disease In 5 minutes or less…
    14. 15. Physician Nutrition Check List for Heart Health “ The 5 F’s” F ruits & Vegetables Unsaturated F ats F ish F ibre F ood Portions
    15. 16. F ruits and Vegetables <ul><li>Current recommendations are to aim for 7-10 fruits and vegetable servings everyday </li></ul>
    16. 17. <ul><li>Limit red meat to < 1 x per week </li></ul><ul><li>Choose a soft non-hydrogenated margarine </li></ul><ul><li>Choose low fat dairy products 1% M.F.or less for milk, yogurt and cottage cheese, <20% M.F. for cheese </li></ul><ul><li>Choose olive and canola oil for cooking </li></ul><ul><li>Snack on a ¼ cup of nuts daily </li></ul>Unsaturated F ats
    17. 18. <ul><li>Aim for 2-3 meals of fish per week </li></ul><ul><li>Salmon and trout are high in omega-3 fats </li></ul>F ish
    18. 19. F ibre <ul><li>Recommendations for daily Fibre intake: </li></ul><ul><li>Men: 30-38 grams per day </li></ul><ul><li>Women: 21-27 grams per day </li></ul><ul><li>Soluble Fibre recommendation: 10-15grams per day </li></ul><ul><li>Sources include: psyllium, oatbran, oatmeal, beans, lentils, some fruits and vegetables </li></ul>
    19. 20. <ul><li>Eat frequently throughout the day so it is easier to control food portions </li></ul><ul><li>Measure foods at home and become familiar with recommended portion sizes </li></ul>F ood Portions
    20. 21. In 5 minutes or less…
    21. 22. Get a HAND le on Heart Healthy Nutrition F ruits & Vegetables F ish F ibre F ats F ood Portions
    22. 23. Get a HAND le on Food Portions 3 oz ¼ cup 1 cup & ½ cup 1 tsp 1 oz
    23. 24. Case Study # 2 -Weight Loss <ul><li>Patient returns to your office to review results of blood lipid profile </li></ul><ul><li>In addition to elevated LDL-C patient has a BMI of 29. </li></ul>Patient asks which “fad” diet you would recommend.
    24. 26. Discrediting Fad Diets None Reported - - - + + + + DASH None Reported + + + + + + + + AHA Gout, renal disorders, hair loss, constipation, bad breath + + + + +/- +/- Low Carb Atkins DM, Met Syndrome + + + + + + + + + VLFD Ornish Potential Worsening/ Side effects Compliance Weight Loss Short term Long term Evidence of in Coronary Disease Diets
    25. 28. Questions to ask when choosing a weight loss program… <ul><li>Has a registered dietitian helped to design the program or is one available to talk with you? </li></ul><ul><li>Is the recommended weight loss more than 2 pounds per week? </li></ul><ul><li>Does the program provide at least 1200 Calories (5000 kilojoules) per day for women and 1500 Calories (6500 kilojoules) per day for men? </li></ul><ul><li>Does the program depend on special products, special foods, supplements or treatments? </li></ul>
    26. 29. Case Study #3– CHF <ul><li>Patient with know history of CHF comes to see you with complaints of increased ankle edema. The patient is on maximum diuretic therapy , what else can you do for this patient to help her out of this potential crisis? </li></ul>
    27. 30. Nutrition Management of CHF <ul><li>Low Salt Diet: </li></ul><ul><li>2400mg sodium per day </li></ul><ul><li>Fluid restriction: </li></ul><ul><li>1.5L fluid per day </li></ul>
    28. 31. Ask your CHF patient… <ul><li>Are you adding salt at the table or in cooking? </li></ul><ul><li>Do you consume canned soups, vegetables or stews? </li></ul><ul><li>Do you eat packaged frozen entrees? </li></ul><ul><li>Do you eat processed cheese </li></ul><ul><li>and prepared meats ? </li></ul><ul><li>Do you eat out frequently? </li></ul>
    29. 32. Sodium and Food Labels
    30. 33. Using % Daily Value A high sodium food that should not be consumed daily when following a low sodium diet >500mg sodium per serving >20% A food that can be carefully fit into a low sodium diet 250-500mg sodium per serving 11-20% A food that can easily fit into a low sodium diet 125-250mg sodium per serving 5-10% A low sodium food that can be enjoyed daily <125mg sodium per serving < 5% What does it mean? How Much Sodium? % Daily Value
    31. 34. Fluid restriction <ul><li>Encourage the patient to track their fluid intake daily </li></ul><ul><li>Remind patients that fluids include: </li></ul><ul><li>Water, coffee, tea, milk, juice, pop, soup, jello, nutrition supplements, alcohol, ice cream, thin fluids at room temperature </li></ul>
    32. 35. Additional Thoughts on CHF Management… <ul><li>Multivitamin supplementation </li></ul><ul><li>Thiamine supplementation </li></ul><ul><li>Interpreting BMI in the CHF patient </li></ul>
    33. 36. Heart Failure Society of America <ul><li>Education modules available online at </li></ul><ul><li>www.hfsa.org/pdf/module2.pdf </li></ul>
    34. 37. Should I be taking a vitamin B supplement? Although two recent studies did show that the vitamins cut homocysteine levels, that did not translate into a reduction in the risk for heart attacks or strokes . Lonn, E. et al. McMaster University. N Eng J of Med. 2006 Bonaa, K.H. et al. University or Tromso. N Eng J of Med.2006
    35. 38. I have heard a lot recently about Omega-3 fats… <ul><li>AHA recommends 2-3 meals of fish per week to meet omega-3 fatty acid requirements, 1000mg per day , for CVD prevention </li></ul>
    36. 39. Is an Omega-3 supplement a good idea? <ul><li>Omega-3 supplements are recommended for those who do not eat fish regularly </li></ul><ul><li>Choosing a supplement: </li></ul><ul><li>1000mg capsule 400mg EPA </li></ul><ul><li>200mg DHA </li></ul><ul><li>600mg total </li></ul><ul><li>Take 1-2 times per day. </li></ul>
    37. 40. The DASH Diet <ul><li>D ietary A pproaches to S top H ypertension </li></ul>7-8 daily Grains and grain products 2-3 daily Fats and oils 5 per week Sweets 4-5 x per week Nuts,seeds and dry beans 2 or less daily Meats 2-3 daily Low fat or fat free dairy 4-5 daily Vegetables 4-5 daily Fruits
    38. 41. The DASH Eating Plan Website Resource: Download a copy of the DASH Eating Plan www.nhlbi.nih.gov/health/public/heart/hbp/dash/
    39. 43. Community Services <ul><li>Referral to a private practice dietitian </li></ul><ul><li>Meals on Wheels </li></ul><ul><li>Cardiac Rehab </li></ul><ul><li>Heart Function Clinic </li></ul><ul><li>SMGH is considering a fee-for-service weightloss program…details to come </li></ul>

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