Transcript Trans-Fatty Acids

Coronary Heart Disease
(CHD)
Coronary Heart Disease (CHD)
 >58
million American have
at least one form of CHD.
 50% of all cardiac deaths
result from CHD
Mortality From Diseases of the Heart
by Race/Ethnicity
(Deaths/100,000)
Coronary Heart Disease
 The
major underlying cause is
atherosclerosis.
 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
 Age:
 Male > 45 years
 Female > 55 years or premature menopause
without estrogen replacement therapy
 Family
 Male
History of premature disease
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.

 Cigarette
#1
Smoking
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
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)
Cholesterol Metabolism
Liver
Diet
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.
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.
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.
Cholesterol and the CHD Patient
Goal:
 The
goal is a LDL-C level of
100 mg/dL
Treatment in CHD Patients
Diet Therapy of High Blood Cholesterol
Diet Therapy of High Blood Cholesterol
 Trans-Fatty Acids
 Increase
LDL Cholesterol and
decrease HDL Cholesterol
 Recommendations: Intakes of
trans-fatty acids should be as low
as possible
Trans fatty acid content of fast-food
Calories
Trans
Fatty
Acids
(g)
Saturated
Fatty
Acids (g)
Hamburger (7 oz)
660
3
14
McDonalds chicken McNuggets
(9 oz)
510
3
6
Burger King chicken sandwich (8
oz)
610
2
7
Burger King fries (6 oz King size)
540
7
6
Starbucks cinnamon scone (5 oz)
530
3
13
Food
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.
Treatment for CHD
Weight

Control
5-10# weight loss
Diet Therapy of High Blood Cholesterol
 Soluble
 10-20
Fiber
g/day
Drug Treatment
 Statins
 Bile Acid Sequestrants
 Nicotinic Acid
Dietary Issues Requiring Further
Research
 Elevated
levels of
homocysteine
 Elevated
homocysteine levels
may be present in 15% of
Americans.
Steps for Lowering LDL-C in the Diet
 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
Steps for Lowering LDL-C in the Diet
 Fats, oils:
 <6-8 tsp./day
Steps for Lowering LDL-C in the Diet
 Monounsaturated
 Canola,
Fats:
olive and peanut oil
 Avocado
 Olives: black and green
 Nuts: almonds, cashews, peanuts,
pecans
 Sesame seeds
Steps for Lowering LDL-C in the Diet
 Polyunsaturated
 Margarine
Fats
made with corn, soybean,
safflower, sesame oils
 Tub, squeeze or stick
 Nuts: walnuts and English
 Salad dressings
 Seeds: pumpkin, sunflower
Steps for Lowering LDL-C in the Diet
 Saturated
 Butter,
Fat:
Coconut & Coconut Oil, Palm Oil
 Cream, half and half
 Cream cheese
 Shortening or lard
 Sour cream
 Fat from animal products including milk
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
Steps for Lowering LDL-C in the Diet
 Meat,

Fish and Poultry
Select lean meat and poultry
 <6
oz/day for Step I diet and <5 oz/day
for Step II
 Eat
fish on a weekly basis
Steps for Lowering LDL-C in the Diet
 Breads and Cereals:
 6-11 servings/day
 Low
fat crackers
 Tortillas
 Hot and cold cereals excepts granola or
meusli
Steps for Lowering LDL-C in the Diet
 Vegetables:
 3-5 servings per day
 Fruits
 2-4 servings per day
 Use
sweets and modified fat desserts in
moderation
Reading The Label
 Extra
Lean
 <5
g total fat, 2 g saturated fat, and 95 mg
cholesterol
 Lean
<
10 g total fat, 4 g saturated fat and 95 mg
cholesterol
Guidelines for Selecting & Preparing Foods
 Try
reducing fat by 1/4 to 1/3 in baked
products. E.g. if recipe calls for 1 cup oil, try
2/3 C.
 In casseroles and main dishes, cut back or
eliminate the fat.
 Sauté or stir fry with very little fat or use
water, wine, or broth.
 Chill soups, gravies and stews and skim off
hardened fat before serving.