Transcript AHA Guideline

REVIEW OF AHA DIETARY
GUIDELINES
Nita Purcell, MS, RD, LD, CDE
Target Population
These guidelines are designed for the
general population and replace the “Step
1” designation used in the past.
More individualized medical nutrition therapy
is used for specific groups and replaces
the “Step 2” used previously.
Guidelines are designed to:
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Achieve Healthy Eating Pattern
Healthy Body Weight
Desirable Blood Cholesterol and
Lipoprotein Profile
Desirable Blood Pressure
Healthy Eating Pattern
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Five or More Fruits and Vegetables Daily
Consume Six or More Serving of a Variety of
Grain Products including Whole Grains
No More Than Six ounces of lean meat daily
Enjoy at least 2 servings of baked or grilled fish
weekly
Use fats and oils sparingly and use the ones
lowest in saturated fats
Healthy Body Weight
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BMI of >25.0 <30.0 Overweight
BMI >30.0 but <40.0 define Obesity
BMI > 40.0 Extreme Obesity
Overweight is associated with increased
incidence of Hypertension, Diabetes
Mellitus and Cardiovascular Disease
Waist Circumference
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Abdominal fat relates to increased risk of
cardiovascular disease, sex specific cut
points for waist circumference are :
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Men’s waist > 40 inches
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Woman’s waist > 35 inches
Energy Balance & Weight Loss
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Carbohydrates and Protein = 4 kc/g
Fats = 9kc/g
Alcohol = 7 kc/g
Diets low in carbohydrates and high in
protein and fat are popular but there have
been no studies of their long term efficacy
and safety.
Total Cholesterol Level
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Less than 200 mg/dl
200/239 mg/ld
240 mg/dl and above
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Desirable
Borderline high
High
LDL Cholesterol
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Less than 100 mg/dl
100-129 mg/dl
130-159
160-189 mg/dl
190 mg/dl and above
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Optimal
Near Optimal/above
optimal
Borderline high
High
Very High
So Limit High Cholesterol Foods
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Dietary cholesterol can increase LDL
cholesterol although to a lesser degree than
saturated fat. This response varies greatly
among individuals. Cholesterol rich foods
include egg yolks and to a lesser extent
shellfish.
What about Eggs
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Epidemiological data have suggested that
increased dietary cholesterol intake is
associated with an increase in coronary
disease risk independent of plasma
cholesterol levels. A recent study has
challenged this in the case of dietary
cholesterol derived from the intake of up
to one egg per day.
Daily Intake of Cholesterol
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AHA recommends < 300 mg/d on an
average.
Individuals with elevated LDL, diabetes or
cardiovascular disease < 200 mg/d.
Triglycerides
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Less than 150
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Optimal
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150 to 199
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Borderline High
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> 200
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High and may need
treatment
Triglycerides
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Plasma triglyceride and VLDL cholesterol
levels may contribute to increased risk for
coronary artery disease and individuals
with the combination of low HDL and
elevated triglycerides are appropriate
candidates for weight reduction, reduced
carbohydrate intake and increase physical
activity.
Things that Increase Triglycerides
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Overweight
Physical inactivity
Cigarette smoking
Excessive alcohol use
Very high carbohydrate diet
Certain diseases and drugs
Genetic disorders
Saturated Fats
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AHA advocates a population wide
saturated fat intake of < 10% of energy
Achieved by limiting full fat dairy products,
fatty meats and tropical oils.
For individuals with elevated LDL
cholesterol or cardiovascular disease a
level of < 7% fat of calories.
Goal
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Individuals for whom any of these dietary
measures are recommended should be
under medical and nutritional supervision
to monitor both the effectiveness of the
diets in meeting or approaching NCEP
targets and the overall nutritional
adequacy of the food intake.
Goal
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Patients with very low intake of total fat
(<15% of total energy) and corresponding
increase in carbohydrate should be
monitored for possible increases in
triglyceride and reductions in HDL
cholesterol.
Trans-Fatty Acids
It has been established that dietary transunsaturated fatty acids can increase LDL
cholesterol and reduce HDL cholesterol.
 The AHA recommends limiting the intake of
trans-fatty acids, the major contributor is
hydrogenated fat.
 New food labeling and increased foods that are
trans-fat free will aid the consumer.
Sources of Trans-fat in our Food
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Cookies, Crackers, and other Baked Goods
Commercially prepared Fried Foods
Some Margarines
Oils used to prepare Fried foods in most
restaurants and fast-food chains.
Substitutions
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Eat grains, unsaturated fatty acids from fish,
vegetables, legumes and nuts
Certain Soluble fibers (eg, oat products,
psyllium, pectin, and guar gum) reduce LDL
cholesterol
Recent study concluded for every gram increase
in soluble fiber from these sources LDL
cholesterol is expected to decrease by an
average of 2.2 mg/dl.
A Special Population
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Advanced age does not obviate the need
to follow a heart-healthy diet and lifestyle.
Younger individuals, postmenopausal
women and older men with elevated LDL
cholesterol levels are at increased risk of
developing cardiovascular disease. The
guidelines described are appropriate for
these age groups.
Medical Nutrition Therapy
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Medical Nutrition Therapy may be needed
to reduce cardiovascular disease risk
factors in higher risk individuals, such as
those with obesity, elevated LDL
cholesterol, insulin resistance, high
triglycerides and low HDL cholesterol.
Omega 3 Fatty acids
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A number of investigators have reported
on the benefits of increased omega 3 fatty
acids for individuals with CAD.
Recommendations of 850 mg to 2.9g/d up
to 3 -4 g/d have been made.
One serving of fatty fish can result in
intake of about 900mg/d of omega fatty
acids.
Stanol/Sterol Esters
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Stanol/sterol Ester containing foods have been
documented to decrease plasma cholesterol.
Plant sterols occur naturally and are isolated
from soybean and tall oils. They are esterified
to increase solubility.
Intake of 2 to 3 g of plant sterols per day have
been show to reduce total and LDL cholesterol
levels by 9 to 20%
Medical Nutrition Therapy
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Increasing evidence supports the benefits
of maintaining normal plasma lipoprotein
levels, body weight and blood pressure for
reducing risk of CVD. These dietary
guidelines provide a means for achieving
these goals.
Medical Nutrition Therapy
Adoption of these recommendations, together
with other healthy practices such as regular
exercise and abstinence from smoking, can
contribute substantially to reducing the burden
of cardiovascular disease in the general
population.
MNT is available to the patients of the Internal
Medicine Clinic through a referral to the Out
Patient Dietitian.
Thank you !
References
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American Heart Association Dietary
Guidelines: Revision 2000: a Statement for
Health Care Professionals
U.S. Department of Health & Human
services – National Institutes of Health