5-10% of energy from PUFA Up to 20% MUFA
Calories to maintain IBW Calories to maintain IBW
Diet Therapy of High Blood Cholesterol
Trans-Fatty Acids
Increase LDL Cholesterol and decrease HDL Cholesterol
(9 oz) Burger King chicken sandwich
(8 oz) Burger King fries (6 oz King
size) Starbucks cinnamon scone (5
oz)
Calories
660 510 610 540 530
Trans Fatty Acids
Steps for Lowering LDL-C in the Diet
Fats, oils:
<6-8 tsp./day
Steps for Lowering LDL-C in the Diet
Monounsaturated Fats:
Canola, olive and peanut oil Avocado Olives: black and green Nuts: almonds, cashews, peanuts,
Cholesterol and the CHD Patient
Goal:
The goal is a LDL-C level of 100 mg/dL
Blood Lipid
Cholesterol: <200 mg/dl 200-239 mg/dl >240 mg/dl HDL Cholesterol <40 mg/dl >60 mgl/dl
Atherosclerosis is a slow, progressive disease which begins in childhood and takes decades to advance
Coronary Heart Disease
Plaque (the build-up of lipid/cholesterol) in the artery wall forms as a response to injury to the endothelium in the artery wall.
Risk Factors for Coronary Heart Disease
Inactivity
Sedentary person has 2x risk for developing CHD as a person who is active.
Risk Factors for Coronary Heart Disease
Obesity
Risk Factors for Coronary Heart Disease
Abnormal Blood Lipids
LDL Cholesterol (low density lipoprotein)
HDL Cholesterol (high density lipoprotein)
Eggs:
<300 mg. cholesterol: < 4 yolks/wk
< 200 mg. Cholesterol: < 2 yolks/wk
Guidelines for Selecting & Preparing Foods
Milk and Milk Products:
2-3 servings/day
Recommendations: Intakes of trans-fatty acids should be as low as possible
Trans fatty acid content of fastfood
Food
Hamburger (7 oz) McDonalds chicken McNuggets
pecans Sesame seeds
Steps for Lowering LDL-C in the Diet
Polyunsaturated Fats
Margarine made with corn, soybean, safflower, sesame oils
Tub, squeeze or stick Nuts: walnuts and English Salad dressings Seeds: pumpkin, sunflower
Cigarette Smoking
#1 cause of preventable death in US 1 in 5 CHD deaths attributable to
smoking
Risk Factors for Coronary Heart Disease
Diabetes
50% of deaths related to DM is due to CHD
and meats
Steps for Lowering LDL-C in the Diet
Plant Sterols and Stanols:
Natural substances derived from wood, vegetables, vegetable oils and other plants - sitosterol and sitostanol
(g)
3 3
2
7
3
Saturated Fatty Acids (g)
14 6
7
6
13
Treatment for CHD
Physical Activity prescribed by physician for patients with CHD When aerobic activity is appropriate, activity that places moderate stress on the cardio-respiratory system can be included.
Blood Lipids and Lipoproteins
HDL-C IS INCREASED:
Exercise, loss of weight, and moderate consumption of ETOH.
HDL-C is lowered: Obesity, inactivity, cigarette smoking, some oral contraceptives and steroids, hypertriglyceridemia and some genetic factors.
Desirable Above optimal Borderline High High Risk
Treatment in CHD Patients
LDL-C
Diet & Life Drug
Levels
Habits
Therapy
<100 mg/dL Yes
No
100-129 Yes mg/dL >130 mg/dL Yes
LDL Cholesterol <100 mg/dl 100 – 129 mg/dl 130-159 mg/dL >160 mg/dl
Classification
Desirable Borderline high-risk High-risk
Low High, negates one risk factor
Male first-degree relative <55 years Female first-degree relative < 65 years)
Risk Factors for Coronary Heart Disease
Hypertension
Appears to weaken the artery wall at points of high pressure leading to injury and invasion of cholesterol.
Blood Lipids and Lipoproteins
HDL-C is thought to be involved in the transport of excess cholesterol from membranes to the liver for removal from the body.
Clinic al Judgment Yes
Diet Therapy of High Blood Cholesterol
Healthy Heart Diet
Therapeutic Lifestyle
Change Diet (TLC)
8-10% calories from
<7% calories from
Cholesterol Metabolism
Diet
Liver
Cholesterol
15%
75%
Blood Lipids and Lipoproteins
Some LDL-C can be oxidized and takes up by endothelial cells and macrophages in the arterial wall, which leads to the first stages of atherosclerosis.
Risk Factors for Coronary Heart Disease
Age:
Male > 45 years Female > 55 years or premature menopause