MEDICAL NUTRITION THERAPY IN CARDIOVASCULAR DISEASE

dr. Dina Keumala Sari, MG, SpGKNutrition Department Medical Faculty USU

NCEP ATP III, 2001

ComponentRecommendationPolyunsaturated fatMonounsaturated fatTotal fatCarbohydrateDietary fiberProteinUp to 10% of total caloriesUp to 20% of total calories20-25% of total calories50-60% of total calories20-30 grams per dayApproximately 15% of total calories

ComponentRecommendationLDL raising nutrients: Saturated fat (TFA ) Dietary cholesterolTherapeutic options for LDL lowering: Plant stanols/sterols Increased viscous (soluble fibers)Total calories (energy)

Physical activityLess than 7% of total caloriesLess than 200 mg/day

2 grams per day

10-25 grams per dayAdjust total calories intake to maintain desireable weight/prevent weight gainInclude enough moderate exercise to expand at least 200 kcal per day

Nutrients related to lipid profileType of fatty acidsFat intakeCholesterol intakeNutrients intake:Dietary fiber AlcoholCoffee Antioxidant PhytochemicalHomocystein and Folic acid CalsiumSoy proteinOmega-3 fatty acidsPhytosterol/stanol

SFAPUFAMUFATFAType of fatty acids

SATURATED FATTY ACIDS (SFA)

SFAs tend to elevate blood cholesterol in all lipoprotein fractions Atherogenic SFAs areLauric acids (C12:0)Myristic acids (C14:0)Palmitic acids (C16:0)Animal food, butter fat, coconut, coconut oils, palm kernel oils, chocholate, cheese

POLYUNSATURATED FATTY ACIDS (PUFA)

Omega-6 and omega-3Predomimant dietary omega-6: linoleic acids (C18:2) lower LDL chol. And raise HDL chol.A 1% increase in omega-6 PUFA would lower total cholesterol by 1.4 mg/dL; however, PUFAs have been shown to decrease VLDL, apo B, and HDL synthesisSources: sesami oil, soybean oil, corn oil, sunflower oil

Monounsaturated Fatty AcidsMost prevalent: Oleic acids (C18:1)Mediterranean DietLower serum cholesterol, LDL, and triglycerides levelsSFA: PUFA: MUFA= 1:1:1 EFFECTIVE 1:1:1.8Sources: olive oil, non hidrogenated oil, canola oil, fruits-vegetables

Trans Fatty AcidHidrogenation process and food industry to harden unsaturated oils and soft margarinesRaising CHD riskRaise LDL cholesterol, lower HDL chol.America: intake 7-8% total caloriesStick margarine, shortening, commercial frying fats, and high baked goods

AMOUNT OF FATRelated to Obesity ATHEROSCLEROSISLow fat diets (

DIETARY CHOLESTEROL Raises total cholesterol and LDL cholesterolLesser extent than SFAs25 mg cholesterol 1 mgNCEP ATP III, 2001: < 200 mg per day Brain, liver, egg yolk, butter, shrimp, tuna

OTHER DIETARY FACTORS

FIBERSOLUBLE FIBERPectins, gum, mucilages, algal, polysaccharides Hypocholesterolemic effect (10-14%):Bind bile acids lowers serum cholesterol to replete the bile acids poolBacteria in the colon ferment the fiber to produce acetate, propionate, and butyrate inhibits cholesterol synthesislegumes., oats, fruits, and psyllium

FIBERINSOLUBLE FIBERCellulose and ligninNo effect on serum cholesterol levelbulky effectsVegetables

Total fiber recommended: 25-30 g/day (adults) and 6-10 g soluble fiberAnother: 14 g/ 1000 cal per dayWHO: 5 portions fruits and vegetables/day

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