MEDICAL NUTRITION THERAPY IN CARDIOVASCULAR DISEASE

dr. Dina Keumala Sari, MG, SpGK Nutrition Department Medical Faculty USU

NCEP ATP III, 2001

Component Polyunsaturated fat Monounsaturated fat Total fat Carbohydrate Dietary fiber Protein

Recommendation Up to 10% of total calories Up to 20% of total calories 20-25% of total calories 50-60% of total calories 20-30 grams per day Approximately 15% of total calories

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

Recommendation Less than 7% of total calories Less than 200 mg/day

2 grams per day 10-25 grams per day Adjust total calories intake to maintain desireable weight/prevent weight gain Include enough moderate exercise to expand at least 200 kcal per day

Physical activity

Nutrients related to lipid profile

Type of fatty acids Fat intake Cholesterol intake Nutrients intake:
Dietary fiber Alcohol Coffee Antioxidant Phytochemical Homocystein and Folic acid Calsium Soy protein Omega-3 fatty acids Phytosterol/stanol

Type of fatty acids

SFA
PUFA

MUFA
TFA

SATURATED FATTY ACIDS (SFA)

SFAs tend to elevate blood cholesterol in all lipoprotein fractions Atherogenic SFAs are
Lauric 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-3 Predomimant 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 synthesis Sources: sesami oil, soybean oil, corn oil, sunflower oil

Monounsaturated Fatty Acids

Most prevalent: Oleic acids (C18:1) Mediterranean Diet Lower serum cholesterol, LDL, and triglycerides levels SFA: PUFA: MUFA= 1:1:1 EFFECTIVE 1:1:1.8 Sources: olive oil, non hidrogenated oil, canola oil, fruits-vegetables

Trans Fatty Acid

Hidrogenation process and food industry to harden unsaturated oils and soft margarines Raising CHD risk Raise LDL cholesterol, lower HDL chol. America: intake 7-8% total calories Stick margarine, shortening, commercial frying fats, and high baked goods

AMOUNT OF FAT
Related to Obesity ATHEROSCLEROSIS Low fat diets (<25% of total calories) raise triglycerides levels & lower HDL not related to CHD Not related to higher risk, because:
LDL levels are low VLDL triglycerides rich VLDL

DIETARY CHOLESTEROL
Raises total cholesterol and LDL cholesterol Lesser extent than SFAs 25 mg cholesterol 1 mg NCEP ATP III, 2001: < 200 mg per day Brain, liver, egg yolk, butter, shrimp, tuna

OTHER DIETARY FACTORS

FIBER
SOLUBLE FIBER Pectins, gum, mucilages, algal, polysaccharides Hypocholesterolemic effect (10-14%):
Bind bile acids lowers serum cholesterol to replete the bile acids pool Bacteria in the colon ferment the fiber to produce acetate, propionate, and butyrate inhibits cholesterol synthesis

legumes., oats, fruits, and psyllium

FIBER
INSOLUBLE FIBER Cellulose and lignin No effect on serum cholesterol level bulky effects Vegetables Total fiber recommended: 25-30 g/day (adults) and 6-10 g soluble fiber Another: 14 g/ 1000 cal per day WHO: 5 portions fruits and vegetables/day

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