Transcript Connor-Diet and Chronic Disease

DIETARY PREVENTION OF
CHRONIC DISEASE
Sonja L. Connor, MS, RD, LD
TYPICAL
Carbohydrate
45%
RECOMMENDED
Carbohydrate
60-65%
Protein
15%
Fat
40%
Cholesterol: 400-500 mg
Salt: 2 1/2 teaspoons
Fat
20-25%
Protein
15%
Cholesterol: 100 mg
Salt: 1 teaspoon
New Eng J Med 1995;332:481-487
Cholesterol, mg/3.5 oz
600
500
Cholesterol Content
Of Selected Foods
100
0
White
Fish &
Shellfish
Poultry
Red
Meat
Cheese
Shellfish
2 Lrg
Egg
Yolks
Liver
40
CSI per 3.5 oz
30
Cholesterol-Saturated
Fat Index
20
10
0
White
Fish
Clams
Oysters
Scallops
Poultry Red Meat Red Meat
Shrimp 10% fat
25% fat
Crab
Lobster
Cheese
2 Lrg
Egg
Yolks
Liver
CSI in Salad Dressings
Recipe Comparisons
CSI/Svg*
• Spinach Lasagna (low fat)**
8
• Meatless Lasagna (traditional)
16
• Lasagna with Meat Sauce
30
* 1 piece 3 x 4 1/3 inches
** From The New American Diet
LOVASTATIN & DIET
STUDY DESIGN
• 6 subjects
• 40 mg lovastatin per day
• 4 week diet periods (randomly assigned)
 cholesterol,  saturated fat ( CSI)
 cholesterol,  saturated fat ( CSI)
• Plasma lipids & lipoproteins
LIPIDS & LIPOPROTEINS
Cholesterol
High CSI
Low CSI
%
Total
325
280
-15%
LDL
207
174
-16%
HDL
62
49
-21%
Triglyceride
117
136
+16%
mg/dl
Reduce Fat Intake by One-Half
• Learn the art of skinny frying
• Reduce fat in baked goods by 1/3
• Limit added fat to 2-4 teaspoons/day
(margarine, mayonnaise, salad dressing)
• Include nuts but not too many
– Peanut butter sandwich
– Add crunch to casseroles, breads, desserts
Where Can I Get the Most?
Seafood – 3 ½ oz
Fat, g
Omega-3, g
Shellfish
2.5
0.9
Whitefish
2.1
0.9
Tuna, water-packed
0.8
0.3
Salmon, Chinook
12.0
2.0
Sardines, canned
20.1
3.3
1.0
0.3
Fish oil capsule, one
Eat More Fish
2 or more times a week
Polynesian
Fried Rice
Recipe from
Gourmet Magazine
Double Complex CHO Intake
• Eat 2 to 5 servings at each meal
(whole grain bread, brown rice, pasta, potatoes)
• Eat 3 to 5 cups legumes each week
• Eat 2 to 3 cups vegetables each day
Standby Favorite Dishes
1 cup servings
CSI Fat
Fat
g
tsp
kcals
Four Star Pasta Salad*
Typical Macaroni Salad
1
7
3
36
½
7
154
510
Potato Salad*
Typical Potato Salad
1
10
4
26
1
5
206
392
Skinny French Fries*
1
4
1
134
Typical French Fries
5
17
3½
392
* From The New American Diet
Phase 1 -- Substitutions
• Avoid foods high in cholesterol & saturated fat
Delete
egg yolk, butterfat, lard & organ meat
Substitute
vegetable oils & shortening for lard
skim milk for whole milk
egg whites for whole eggs
• Use Lite Salt
NCEP Step I diet, AHA Step I diet
Phase 2 – Try New Recipes
• Gradually transition to eating meat once a day
• Use less fat & cheese
• Eat more fruits, vegetables, grains & beans
• Use fewer products with large amounts of salt
• Acquire new recipes
Mediterranean, DASH, NCEP Step II & AHA Step II diets
Mediterranean Diet
The Lyon Diet Heart Study
• More bread, root & green vegetables, fish
• Fruit at least once daily
• Less red meat (replaced with poultry)
• Replace butter with margarine , use olive and
Canola oil
• Wine in moderation
Circulation2001;103:1823-1825; Lancet 1995;345:738
Phase 3 – Everyday Eating
•
•
•
•
Use meat as a condiment
Use only low CSI cheeses
Decrease amount of salt in cooking
Use these foods for special occasions
•
•
•
•
Extra meat
Regular cheese
Chocolate
Salty foods
Forks Over Knives; Beyond Phase 3 – Pritikin, Ornish
Newsletters
Magazines
Cookbooks
Translating Science to the Practical
IT IS POSSIBLE!!
• If the masses can love tofu
TOBY’S TOFU PATÉ
www.tofupalace.com
Light Jalapeno
• The masses can find products & recipes
they like that fit a low-fat, high complex
carbohydrate eating style
_________________________
_______
Name
_________________________
_______
SELF-SCORED
SURVEY
Date
Dietitian-scored
___________________________________
_________
Name
Examining Your
Eating Habits!
___________________________________
_________
Date
J Amer Diet Assoc 1992;92:41-47
DHS QUESTION
How often do you eat fish?
1 Do not eat fish or eat fish less than
once a month
2 One to 3 time s a month
3 Once a week
4 Two times a week
5 Three or more times a week or eat
vegetarian with no added fat
DIET HABIT SURVEY
US Diet
Meat, Fish, Poultry
Dairy/Eggs
Fats/Oils
Sweets/Snacks
Grain/Bean/Veg/Frt
Beverages
Salt
Restaurants/Recipe
Seafood
TOTAL
30% fat
28% fat
20% fat
10% fat
DIET HABIT SURVEY
• Addresses all areas of eating (fat,
fiber, sugar, salt, recipes, eating out)
• Can be done at home (~30 minutes)
• Can be scored in less than 5 minutes
• Visit focused on patient’s ideas
about making changes
DIET HABIT SURVEY-Mr Win-Win
US Diet
30% fat
Meat, Fish, Poultry
28% fat
BL
Dairy/Eggs
BL
Fats/Oils
BL
Sweets/Snacks
BL
Grain/Bean/Veg/Frt
BL
Beverages
BL
Salt
BL
Restaurants/Recipe
Seafood
TOTAL
BL
BL
20% fat
10% fat
Tips for Low-Fat Eating-28%
• Entrée 10 grams fat or less
• Other dishes 5 grams fat or less
• Meat, Fish Poultry
– Limit chicken, very lean red meat and
low-fat cheese to a total of 6-8 ounces
(men) or 4-5 ounces (women) per day
– Choose chicken, turkey or low-fat
vegetarian dishes
DIET HABIT SURVEY-Mr Win-Win
US Diet
30% fat
Meat, Fish, Poultry
28% fat
BL
Dairy/Eggs
BL
Fats/Oils
BL
Sweets/Snacks
BL
Grain/Bean/Veg/Frt
BL
Beverages
BL
Salt
BL
Restaurants/Recipe
Seafood
TOTAL
BL
BL
20% fat
10% fat
IDEAS FOR CHANGING
EATING HABITS - 1 mo
• Cut down on evening snacks
• Eat breakfast
• Limit coffee and alcohol
• Try and use low-fat cheese
Typical Cheese 9 grams fat/oz
Trader Joe’s Celtic Cheddar 4 g/oz
Kraft Sharp Reduced Fat Cheddar 4.5 g/oz
Jarlsberg Light Reduced Fat Swiss 3.5 g/oz
Laughing Cow Light 3 g/oz
IDEAS FOR CHANGING
EATING HABITS - 2 mo
• Eat breakfast at home
• Limit coffee
• Eat low-fat cheese
• Increase veggies with summer
salads
IDEAS FOR CHANGING
EATING HABITS - 6 mo
• Try low-fat salad dressings (Best
Foods Low-fat)
• Try reduced fat Vermont Cabot
Cheddar Cheese
• Pack lunch when on the go
IDEAS FOR CHANGING
EATING HABITS - 12 mo
• Increase fruits and veggies
• Decrease coffee and tea
• Walk about 1 mile a day
DIET HABIT SURVEY-Mr Win-Win
US Diet
30% fat
Meat, Fish, Poultry
Dairy/Eggs
BL
Fats/Oils
BL
Sweets/Snacks
BL
Grain/Bean/Veg/Frt
BL
Beverages
BL
Salt
BL
20%
fat
BL
12 mo
12 mo
12 mo
12 mo
12 mo
12 mo
12 mo
BL, 12 mo
Restaurants/Recipe
Seafood
TOTAL
28% fat
BL
BL
12 mo
10% fat
Family
Heart
Study
Tarahumara
Indian
All That Makes Good Sense
Physical Activity
Healthy Eating
Normal Coronary Artery
Blocked Coronary Artery