siti khadijah_dietitian & your heart [autosaved]
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Dietitian & Your Heart
Siti KhadijahDietitian
Institut Jantung Negara
Kuala Lumpur
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Is nutrition therapy effective in
reducing risk of CVD?
Improving diet and lifestyle is a critical
component of the American Heart Associations
strategy for cardiovascular disease riskreduction (AHA Scientific Statement, 2006)
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The National Cholesterol Education Program
Adult Treatment Panel III (NCEP III)recommends lifestyle changes as the primary
and most cost effective means of reducing the
risk of coronary heart disease(JAMA, 2001)
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Nutrition Counseling?
Low Fat
Low Calories
Low Salt High Fiber
MORE THAN THIS !
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Whats new?
Cardio Protective Diet Food-based components of dietary patterns that improve
cardio metabolic health
(Mozaffarian D, Appel L & Van Horn L, 2011)
Functional Food Foods that include whole foods and fortified, enriched or
enhanced foods that have a potentially beneficial effect onhealth when consumed as part of a varied diet on a regularbasis at effective levels
(JADA, 2009)
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FiberHealth & Satiety
Goal : 45 servings fruits / day
45 servings vegetables / day
Breakfast
Lunch
Dinner
Snack
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Choose More of Whole grains
Whole grains contain all the essential parts of the
entire grain seed includes bran, endosperm and
germ.
http://www.hpb.gov.sg/HOPPortal/content/conn/HOPUCM/uuid/dDocName:HPB-047342 -
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Make The Switch
Per serving
(1 cup)
White
Rice
Brown
Rice
Calorie (kcal) 150 111
Protein (g) 4.0 3.0
Fiber (g) 0 1.8
Per serving(2 slices) WhiteBread BrownBread
Calorie (kcal) 147 145
Protein (g) 4.9 4.8
Fiber (g) 0.8 5.2
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Goal : 3+ servings / day
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Consume More Fish & Shellfish
Increase intake of Omega-3 Fatty Acids Fish consumption reduces sudden cardiac death and
CHD mortality
(Albert et al, 1998, Kris-Etherton et al, 2002)
2 servings of fatty fish meals per week reduced 50%
primary cardiac arrest (Albert et al, 2002)
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Go Nuts
Tree nuts eg : almonds, hazelnuts,walnuts,
pecan, cashew, pistachios
Eat 30 grams per day may reduce the risk of
coronary heart disease
Choose unsaltedor without h oney coated nuts
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Monounsaturated Fats (MUFA)
Decreases LDL and total cholesterol.
Sources : Olive, Peanut, Rice Bran
Choose Vegetable Oil
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Polyunsaturated Fats (PUFA)
Decreases LDL and total cholesterol
Sources : Sunflower, Corn
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How To Spot For Trans Fat?
Read the ingredient list and look out for
terms
Hydrogenated / Partially Hydrogenated Oil
Vegetable Shortening
Look at nutrition facts paneltrans fat
should be 0g or
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Saturated Fat
Increases LDL & total cholesterol
Sources
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Blended Oil
To maximize the potential of palm oil by mixing with PUFA in
ratio 1:2 Stable for high temperature cooking
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Functional Food
Foods that include whole foods and fortified,
enriched or enhanced foods that have a
potentially beneficial effect on health when
consumed as part of a varied diet on a regularbasis at effective levels (JADA, 2009)
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Effectiveness of functional foodsStrong evidence Level A
Functional
ingredients
Sources Potential benefits
Dietary fiber (functional & total)
Betaglucan Oats, barley May risk of CHD &
improve blood glucose
Soluble fiber Peas, beans, apples,
citrus fruits
May risk of CHD &
improve blood glucose
Whole grains Brown rice, whole
meal bread /
biscuits, capati,
breakfast cereal
May risk of CHD &
improve blood glucose
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Functional
ingredients
Source Potential benefits
Plant sterols / stanols
Free stanols
/sterols
Corn, soy, fortified foods
& beverages e.g. milk
May risk of CHD
Stanol/
sterol esters
Fortified margarines,
dietary supplements
May risk of CHD
Phytoestrogens
Soy proteins Soybeans & soybeanproducts
May risk of CHD
Effectiveness of functional foodsStrong evidence level A
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Functional FoodCholesterol Reducing Effect
Food Items Evidence
Soy 25 gram of soy protein per day may reduce the risk of
heart disease, LDL cholesterol and triglycerides
Nuts 30 grams (a handful) of nuts may reduce the risk ofcoronary heart disease.
Beta
Glucan3 grams of beta glucan = 70 gram of oats per day
(10 tablespoon) reduces total and LDL cholesterol.
Plant Sterol 2 - 3 grams of plant sterols per day from plant sterol
enriched foods lowers total cholesterol by 4 - 11% and
LDL cholesterol by 7 - 15%
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Soy Protein
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25g of soy protein daily helps to TC, LDL, TG
levels (US FDA health claim)
Examples of soy protein sources:
1 cup tofu = 17g protein
1.5 piece tempe = 17g protein
1 glass soy milk = 5 g protein
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Go Nuts
Tree nuts eg : almonds, hazelnuts,walnuts,
pecan, cashew, hazelnuts, pistachio
Eat 30 grams per day may reduce the risk of
coronary heart disease
Choose unsaltedor without h oney coated nuts
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Beta Glucan
Beta-glucan is a soluble fiber derivedfrom the cell walls of algae, bacteria,
fungi, yeasts, and plants.
3 grams beta-glucan daily may reducetotal cholesterol & LDL cholesterol
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Goal : 3 grams / day
10 tablespoonoats daily
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Plant sterols
In Malaysia, plant sterols are added to low fat milk
In other countries, plant sterols are added to
margarine, yogurt, fruit juices
Disclaimer: Photos are for education purpose only & not to endorse any brands.
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Challenges
Clients are not ready for change
Clients do not want to be told off
Poor long term adherence Food Myths & unproven dietary practices
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How do Dietitians solve the
puzzle?
Motivational Interview
Practical Healthy Eating Advice
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Motivational Interview
A directive, patient-centered counseling
style that aims to help patients explore and
resolve their ambivalence about behaviour
change, NOT to tell them how to change
(Miller & Rollnick 1991)
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MI to improve Health Behaviors
Traditional Approach MI Approach
Emphasizes weakness Emphasizes as strength
Try to fix the problem Builds on what people already
know and what to doTriggers defensiveness and
shutting down
Stimulates cognitive function
and perceptual accuracy
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Practical Healthy Eating Advice
Variety, Moderation & Eat Mindfully
Make HALFof the plateFRUITS & VEGETABLES
QUARTERof
the plate STARCH QUARTERof the plate LEAN
MEAT/FISH/PROTEIN
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Low Fat Signals
Microwave
Steam
Stir Fry
Grill Soup
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Make Your Call When Eating Out
Grilled Fish
Fried Fish Roti bakar kopitiam
Tuna sandwich
Curry Mee
Souped Mee
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Plain thosai with
dhal
Ghee tosai with
chutney
Nasi lemak special
Nasi lemak
Hokkien Mee
Wantan Mi Sup
Make Your Call When Eating Out
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Cooking Demonstration
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Recipe Booklet(recipes contributed by Dietitians)
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Conclusion
Lifestyle modification plays an important role in
reducing risk of cardiovascular disease
Nutrition counseling by Dietitians are not
addressing the basic advice only, but alsoinclude the latest evident based updates
Refer your patients to dietitians for individualized
meal plan & practical healthy eating advice
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