Transcript Nutrition and Cardiovascular Disease (CVD)

Nutrition and Cardiovascular
Disease (CVD)
4 September 2015
DEAKIN MEDICAL SCHOOL
HME102 Public Health Medicine
Prof Caryl Nowson
Slide 1
Deakin University CRICOS Provider Code: 00113B
Learning Objectives
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Describe the nutritional risk factors contributing to CVD risk
Understand the evidence base indicating that lifestyle risk factors
contribute to CVD risk including:
• Dyslipidemia
• Hypertension
• Type 2 diabetes
• (Obesity covered elsewhere)
Describe the nutritional population approaches being implemented
worldwide to reduce CVD risk
Understand the systemic factors that prevent individual nutritional
behaviour change
Describe the recommended dietary approaches to reduce CVD risk at the
individual and population level in Australia
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Nutrition and Cardiovascular Disease (CVD) – Slide 2
Deakin University CRICOS Provider Code: 00113B
Cardiovascular Disease
• Heart, Stroke & Vascular Disease
• 30% of 58 million deaths globally (2005)
– equal to infectious diseases, nutritional deficiencies, maternal
and perinatal conditions combined
• 46% deaths < 70 years
– Kills more Australians than any other disease group
– 3.67 million Australians affected
– 1.10 million long term disability as a result
– Increased by 18.2% over last decade
– Aboriginal &Torres Strait Islanders 2.6x likely to die
– More disadvantaged groups more likely to die
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Nutrition and Cardiovascular Disease (CVD) – Slide 3
Deakin University CRICOS Provider Code: 00113B
CVD Risk factors
• 90% of all Australians have at least 1 risk factor for heart, stroke and
vascular disease
– 60% overweight or obese
– 54% insufficiently active
– 51% high blood cholesterol
– 30% high blood pressure
– 13% drink at levels harmful to health
– 8% have diabetes
(AIHW NHS 2004-2005)
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Nutrition and Cardiovascular Disease (CVD) – Slide 4
Deakin University CRICOS Provider Code: 00113B
Dyslipidemia
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Abnormal: Total cholesterol >5.5 mmol/L
HDL cholesterol <1.0 mmol/L men,< 1.3 mmol/L women
LDL cholesterol > 3.5 mmol/L
Serum total cholesterol = LDL + HDL + Triglycerides
High serum LDL cholesterol – atherogenic
High serum Triglycerides –atherogenic
Low HDL cholesterol – atherogoneic
http://www.abs.gov.au/ausstats/[email protected]/Lookup/4364.0.55.005Chapter3002011-12
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Nutrition and Cardiovascular Disease (CVD) – Slide 5
Deakin University CRICOS Provider Code: 00113B
Dyslipidemia: Australia
• 2011–12: 1/3 adults (32.8% or 5.6 million people) high
total cholesterol levels and high LDL levels
• Only 10.1% self-reported having high cholesterol as a
current long-term health condition
• Further 19.1%: total cholesterol level close to the
abnormal cut off (5.0–5.4 mmol/L range)
• Proportion of people with high total cholesterol peaked
at 55–64 years (47.8%)
• Overall there was no significant difference in rates of
total cholesterol for men and women.
http://www.abs.gov.au/ausstats/[email protected]/Lookup/4364.0.55.005Chapter3002011-12
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Nutrition and Cardiovascular Disease (CVD) – Slide 6
Deakin University CRICOS Provider Code: 00113B
Dyslipidemia: lifestyle risk factors
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Current smokers more likely high cholesterol (38.1% v never smoked
30.4%)
Obese adults (37.0% v 25.8% normal weight or underweight)
84.7% with high total cholesterol also high LDL cholesterol, and high
triglycerides (22.9% compared with 9.5%)
Hypertensives: higher total cholesterol that those with normal blood
pressure (40.8% v 31.0%)
High levels of LDL cholesterol were more common among men (35.0%)
than women (31.6%)
Those with high LDL cholesterol were more likely to have high triglycerides
than those with normal LDL levels (15.7% compared with 11.7%)
No association between high LDL cholesterol and lower than normal HDL
'good' cholesterol.
http://www.abs.gov.au/ausstats/[email protected]/Lookup/4364.0.55.005Chapter3002011-12
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Nutrition and Cardiovascular Disease (CVD) – Slide 7
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Dyslipidemia: lifestyle factors
• ↓ serum cholesterol - ↓ CHD
• ↓0.5mmol/L (about 10%) mean population serum cholesterol results in 12.6% ↓
coronary events
• ↓ 0.6 mmol/l serum cholesterol - ↓ IHD: 54% at 40 years, 39% 50yrs (Law)
• Saturated fats & Trans fats: ↑Total - LDL cholesterol
• Cochrane review: Small, potentially important CVD risk reduction with ↓
saturated fat
• Replacing saturated fat with polyunsaturated fat: useful strategy
• Obesity: ↑Total - LDL cholesterol
• Exercise: ↑HDL cholesterol
• Moderate Alcohol: ↑HDL cholesterol BUT !!
• Omega-3 fatty acids: inversely related: arrhythmia, sudden cardiac
death, thrombosis
Cochrane Database Syst Rev. 2015 Jun 10;6:CD011737. Reduction in saturated
fat intake for cardiovascular disease. (15 randomised controlled trials (RCTs))
Reviews lipid level alterations on cardiovascular morbidity and mortality indicating
that changes in blood lipids do affect cardiovascular risk (Briel 2009; De Caterina
2010; Robinson 2009; Rubins 1995; Walsh 1995)
Law MR, Wald NJ, Thompson SG. By how much and how quickly does reduction
in serum cholesterol concentration lower risk of ischaemic heart disease? BMJ.
1994; 308:3 BMJ. 1994 Feb 5;308(6925):367-72.
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Nutrition and Cardiovascular Disease (CVD) – Slide 8
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1. Which of the following foods does NOT contain
significant amounts of saturated fatty acids?
A.
B.
C.
D.
E.
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Whole roasted chicken
Shortbread biscuits
Full cream milk
Cheddar Cheese
Home cooked chips in Canola oil
Nutrition and Cardiovascular Disease (CVD) – Slide 9
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Saturated Fats
Stearic acid: C18:O
saturated fat
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Solid at room temperature.
mainly found in animal products
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Animal-based sources of saturated fats:
Dairy foods – such as butter, cream,
regular-fat milk and cheese
Oleic acid:C18:1w9
Meat – such as fatty cuts of beef, pork and mono unsaturated fat
lamb, processed meats like salami, and
chicken (especially chicken skin)
Plant-derived saturated fats:
Palm oil, Cooking margarine, Coconut,
Coconut milk and cream
Oleic acid:C18:2w6
Deep fried take away foods, Cakes,
poly unsaturated fat
Biscuits, Pastries and pies
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http://www.heartfoundation.org.au/healthy-eating/fats/Pages/saturated-fats.aspx
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Nutrition and Cardiovascular Disease (CVD) – Slide 10
Deakin University CRICOS Provider Code: 00113B
Trans fatty acids (TFA) in Australia
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Unsaturated fat that behaves like a saturated fat.
Naturally occurring TFA: dairy products, beef, veal, lamb
Artificial, synthetic, industrial or manufactured trans fats: hydrogenated or
partially hydrogenated vegetable fats
Since 2007, manufactured TFA intakes declined 25-45%
Mean manufactured TFA intake < 0.4 g/day
Mean total TFA from both ruminant and manufactured ~ 0.5-0.6% of total
dietary energy:,
>90% Aust. population TFA intakes <1% (WHO) pop. goal
60% to 75% of TFA intake derived from ruminant foods: low fat options
reduce intake
To Avoid trans fat
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Choose polyunsaturated and monounsaturated spreads and margarines,
lean meat trimmed all visible fat. low or no fat dairy foods
– limit foods and take-away meals (deep-fried and baked foods: biscuits,
pastries, pies)
– Avoid ”hydrogenated oils” or “partially hydrogenated vegetable oils” in
the ingredients list.
unsaturated fatty acid
molecule: trans
double bond between
carbon atoms, which
makes the molecule
kinked.
http://www.heartfoundation.org.au/healthy-eating/fats/Pages/trans-fats.aspx
http://www.health.gov.au/internet/main/publishing.nsf/Content/F5F93016C243672FCA2578A20019F090/$File/Trans-Fatty-Acids-in-the-Australia-and-NewZealand-Food-Supply%20-%20Att1.pdf
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Nutrition and Cardiovascular Disease (CVD) – Slide 11
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Diabetes Prevention: Lifestyle
Diabetes Prevention Program (DPP)
• 3,234 subjects, age 51, BMI 34.0 kg/m2
• impaired glucose tolerance
• Randomised to intensive lifestyle modification, metformin or placebo:
follow-up 2.8 yrs
• Diabetes incidence:
– 11.0% placebo
– 7.8% metformin
– 4.8% lifestyle intervention (58% reduction)
• Weight loss was only 7% of initial body weight
• >30mins per day activity
• <30% energy from fat
• <10% energy from saturated fat
• Fibre >15g/1000kj
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Nutrition and Cardiovascular Disease (CVD) – Slide 12
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Nutrition and Cardiovascular Disease (CVD) – Slide 13
13
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Nutrition and Cardiovascular Disease (CVD) – Slide 14
14
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Meta-analysis:
Lifestyle
Interventions
49% decrease in
incidence of T2DM for
lifestyle intervention vs
standard advice
Gillies et al. Pharmacological and lifestyle interventions to prevent or delay type 2
diabetes in people with impaired glucose tolerance: systematic review and metaanalysis BMJ 2007; 334
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Nutrition and Cardiovascular Disease (CVD) – Slide 15
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2. How often do you add salt in cooking?
A.
B.
C.
D.
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Never
Rarely
Sometimes
Often
Nutrition and Cardiovascular Disease (CVD) – Slide 16
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3. How often do you add salt at the table?
A. Never
B. Rarely
C. Sometimes
D. Often
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Nutrition and Cardiovascular Disease (CVD) – Slide 17
Deakin University CRICOS Provider Code: 00113B
4. What are the dietary recommendations for the
number of grams of salt per day for the general
population?
A. 1 gram (~17mmol sodium)
B. 2 grams (~35mmol sodium)
C. 3 grams (~52mmol sodium)
D. 4 grams (~70mmol sodium)
E. 5 grams (~86mmol sodium)
F. 6 grams (~100mmol sodium)
G. 7 grams (~120mmol sodium)
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Nutrition and Cardiovascular Disease (CVD) – Slide 18
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5. Which of the following the major food groups
make the largest contribution to average intakes of
dietary sodium in Australia?
A.
B.
C.
D.
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Vegemite and savoury spreads
Soft Drinks
Breads and Cereals
Fish and Seafood
Nutrition and Cardiovascular Disease (CVD) – Slide 19
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Hypertension Australia (>140/90mmHg)
• Men more likely to have
hypertension than women
(23.4% v 19.5%)
• Hypertension:
– 42.6% aged 65 years
– 5.5% aged 18-24 years
http://www.abs.gov.au/ausstats/[email protected]/Lookup/4364.0.55.005Chapter3002011-12
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Nutrition and Cardiovascular Disease (CVD) – Slide 20
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Effects of High Blood Pressure
• Relationship between BP and CVD is
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Stroke and usual BP
continuous, graded, independent, & causative
↑CVD by 2 - 4 times
Relative Risk
Hardening of the arteries
of Stroke
Stroke
Myocardial infarction
Congestive Heart Failure
Peripheral arterial disease
Kidney damage: Chronic Renal Failure
Retinopathy
Blindness
4.00
2.00
1.00
0.50
0.25
Usual SBP
123
136
148
162
175
Usual DBP
76
84
91
99
105
Approximate mean usual BP (mmHg)
No signs or symptoms until dangerously high
MMcMahon S, Peto R, Cutler J, Collins R, Sorlie P, Neaton J, Abbott R, Godwin
J, Dyer A, Stamler J. Blood pressure, stroke, and coronary heart disease. Lancet
1990;335:765-73.
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Nutrition and Cardiovascular Disease (CVD) – Slide 21
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Stroke & Hypertension: Australia
• Strokes
– 40,000 stroke each year
– 70% first ever stroke
• leading cause of long-term disability in Adults
• Strokes cause 9% all deaths
• Risk of stroke (& CHD) increases with BP
• Hypertension
• Most common chronic disease
• 1 in 4 males & 1 in 6 females (25-65yrs)
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Nutrition and Cardiovascular Disease (CVD) – Slide 22
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Evidence based Guidelines
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Treat hypertensive persons > 60 yrs: BP <150/90 mm Hg
30 - 59 yrs diastolic goal < 90 mm Hg;
Others BP < 140/90 mm Hg (based on expert opinion)
Same goals are recommended for hypertensive adults
with diabetes or nondiabetic chronic kidney disease (CKD)
as for the general hypertensive population younger than
60 years
2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults
Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)
JAMA. 2014;311(5):507-520.http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf
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Nutrition and Cardiovascular Disease (CVD) – Slide 23
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Definition of Hypertension > 140/90 mmHg
Lifestyle
modifications
Abolition of age-adjusted targets: but treatment of elderly individualised
2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society
of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013 Jul;31(7):1281-357
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Nutrition and Cardiovascular Disease (CVD) – Slide 24
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Prevention: to reverse increasing
prevalence
Changes in the
Prevalence and Control
of Hypertension in the
United States (1988–2004).
Chobanian AV. Shattuck Lecture. The hypertension
paradox--more uncontrolled disease despite improved
therapy. N Engl J Med. 2009 Aug 27;361(9):878-87.
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2013 ESH/ESC Guidelines for the management of arterial hypertension: The
Task Force for the management of arterial hypertension of the European
Society of Hypertension (ESH) and of the European Society of Cardiology
(ESC). J Hypertens. 2013 Jul;31(7):1281-357
Nutrition and Cardiovascular Disease (CVD) – Slide 25
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US Guidelines: management of Hypertension
Lifestyle modification
Endorsed the recommendations of the Lifestyle Work Group: :
1. Combine Dietary Approaches to Stop Hypertension (DASH) diet with reduced sodium intake
< 2,400 mg of sodium (6g salt) per day, noting that limiting intake to 1,500 mg (4g salt/d) can result
in even greater reduction in BP
2. Even without achieving these goals, reducing sodium intake by 1,000 mg (2.5g salt)/day lowers
blood pressure.
Physical activity.
Moderate to vigorous physical activity for approximately 160 minutes per week (three to four sessions
a week, lasting ~40 minutes per session).
Weight loss. The JNC 8 panel endorsed maintaining a healthy weight in controlling blood pressure
Alcohol intake received no specific recommendations
Eckel RH, et al. 2013 AHA/ACC Guideline on Lifestyle
Management to Reduce Cardiovascular Risk: A Report of
the American College of Cardiology/American Heart
Association Task Force on Practice Guidelines. J Am Coll
Cardiol. 2013 Nov 7. pii: S0735-1097(13)06029-4. doi:
10.1016/j.jacc.2013.11.003.
Thomas G1, Shishehbor M, Brill D, Nally JV Jr New hypertension guidelines: one size fits most? Cleve Clin J Med. 2014 Mar;81(3):178-88. doi:
10.3949/ccjm.81a.14003.
James PA, Oparil S, Carter BL, et al. 2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel
members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2013;doi:10.1001/jama.2013.284427.
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Key Evidence-based AHA/ACC Guideline on Lifestyle
Management to Reduce BP
Eckel RH, et al. 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk: A Report of the American
College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 Nov 7. pii:
S0735-1097(13)06029-4. doi: 10.1016/j.jacc.2013.11.003.
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Nutrition and Cardiovascular Disease (CVD) – Slide 27
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Relationship between body weight, exercise
and BP in Australia
Of those with hypertension:
three-quarters (76.3%) were overweight/obese
42.7% reported doing no exercise in the last week
Of those without hypertension:
one-half (53.1%) were overweight/obese
32.5% reported doing no exercise in the last week.
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Nutrition and Cardiovascular Disease (CVD) – Slide 28
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Lifestyle modifications: BP
• BP-lowering effects of targeted lifestyle modifications
can be equivalent to drug monotherapy
• Major drawback: low level of adherence over time
• Lifestyle changes may safely and effectively:
• delay or prevent hypertension in those without
hypertension
• delay/prevent medical therapy in grade 1
hypertensive patients
• contribute to BP reduction in hypertensives already
on medication
• reduce number and doses of antihypertensive
agents
2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial
hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013
Jul;31(7):1281-357
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20 ‘salt free’ societies
Intersalt study: average (mean) blood pressure of about
200 people of all ages from three of the ‘salt free’ societies
Yanomama, Brazil
96/61mmHg
Xingu, Brazil
99/62 mmHg
Asaro, Papua-New Guinea
108/63 mmHg
Courtesy Dr. Trevor Beard (deceased)
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Tukisenta in PNG have
lifelong normal BP living at home
Courtesy Dr. Trevor Beard (deceased)
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Prehypertension in Port Moresby
Courtesy Dr. Trevor Beard (deceased)
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Nutrition and Cardiovascular Disease (CVD) – Slide 32
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Link to video summary
http://www.nejm.org/doi/full/10.1056/NEJMoa1304127?query=TOC
Sodium to salt
To convert sodium to salt, multiply the sodium figure
in milligrams (mg) by 2.5 and then divide by 1,000.
sodium (mg)
salt (g)
sodium (mmol) 100.0
sodium (mg)
2300
salt (g)
5.8
87.0
2000
5.0
65.2
1500
3.8
43.5
1000
2.5
26.1
600
1.5
17.4
400
1.0
6000
15.0
13.0
300
0.8
8.7
200
0.5
Recommended intake general population ~<6g salt/day
Recommended intake at risk population ~<5g salt/day
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Nutrition and Cardiovascular Disease (CVD) – Slide 33
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Salt and cardiovascular outcomes
• 10-15yr follow-up of patients in the
Trials of Hypertension
– Prevention I and II (TOHP I and
TOHP: effects of lifestyle
modifications including salt
restriction
• 10-15yrs post trial: salt reduction 25%
lower incidence CV events
The effects of nonpharmacologic interventions on blood pressure of
persons with high normal levels: results of the Trials of Hypertension
Prevention, phase I. JAMA 1992;267:1213-20. Effects of weight loss and
sodium reduction intervention on blood pressure and hypertension
incidence in overweight people with high-normal blood pressure: the
Trials of Hypertension Prevention, phase II. Arch Intern Med
1997;157:657- 67. Cook NR, Cutler JA, Obarzanek E, et al. Long term
effects of dietary sodium reduction on cardiovascular disease outcomes:
observational follow-up of the Trials of Hypertension Prevention
(TOHP).BMJ 2007;334:885-92.
Cumulative incidence CVD by salt intervention group (TOHP) I and II adjusted for age, sex, and clinic.
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Salt-Sensitivity
• A family history of high blood
pressure
 high resting heart rate
 >15% of ideal body weight
• Elevated blood pressure (older)
 >50% those over age 60
hypertensive
 black Americans
 low plasma renin activity
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35
Nutrition and Cardiovascular Disease (CVD) – Slide 35
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Nutrients associated with BP
Sodium
Potassium
Calcium
Magnesium
Chloride
Alcohol
Vegetarian diet
Fibre
Fat (total) P:S ratio
Fish oils
Caffeine
Variety of vitamins eg. Vit C ?
Other dietary factors eg. Garlic ?
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Appel, et al. Effects of Protein, Monounsaturated Fat,
and Carbohydrate Intake on Blood Pressure and
Serum Lipids: Results of the OmniHeart Randomized
Trial. JAMA 2005:294(19), p 2455–2464
Nutrition and Cardiovascular Disease (CVD) – Slide 36
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Past Diet versus Current Diets
300
Na & K mmol/day
282
250
200
150
150
Na (mmol)
K (mmol)
100
70
50
30
0
Past
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Present
Nutrition and Cardiovascular Disease (CVD) – Slide 37
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DASH (Study 1)
• Dietary patterns, rather than of individual nutrients (NEJM,
1997): significantly and quickly lowered blood pressure (n=459)
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Hypertensives: Fall 11/5 mmHg
Normotensives: Fall 6/3 mmHg
• DASH diet: low in saturated fat, total fat, and cholesterol
• more fruits, vegetables, and low fat dairy foods, includes whole
grains, poultry, fish, and nuts. Reduced in red meat, sweets,
and sugar- containing beverages, rich in K, Ca, Mg, protein,
fibre
• BP reductions: no change in weight, alcohol or Na intake
• 3,000mg sodium/day 7.5g salt Na(130mmol/day)
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Nutrition and Cardiovascular Disease (CVD) – Slide 38
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Dietary Pattern: DASH
SERVES PER DAY
2-3 serves
Mono/poly oils
(avoid butter)
3 serves Low Fat Dairy
(3 cups)
3-4 Fruit
4-5 Vegetables
8-10 serves wholegrain bread/cereals
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Nutrition and Cardiovascular Disease (CVD) – Slide 39
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Dietary Pattern: DASH
SERVES PER WEEK
3 red meat
(max)
3 fish
4 nuts/seeds
1 legume
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Maximum: 2 alcohol drinks/day
Maximum: 4 caffeine drinks/day
Nutrition and Cardiovascular Disease (CVD) – Slide 40
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DASH-sodium (Study 2)
• 2 different eating patterns
• 412 participants
• 57% women, 57% African Americans
• SBP 120-159 mmHg, DBP 80-95 mmHg (41%
hypertensive)
• “Usual” diet or the DASH diet
‒ 3,300mg (143mmol) sodium (~8g salt)
‒ 2,400mg (104mmol) sodium (~6g salt)
‒ 1,500mg (65mmol) sodium (~4g salt)
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Nutrition and Cardiovascular Disease (CVD) – Slide 41
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Sacks FM, et al. Effects on blood pressure of reduced
dietary sodium and the Dietary Approachesto Stop
Hypertension (DASH) diet. DASH-Sodium Collaborative
Research Group. N Engl J Med. 2000
DASH-Sodium
135
-7***
Control
130
-2***
-6***
-5***
-5***
DASH
-2*
-1*
125
-3
143
8g salt
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-2**
104
65
6g salt
4g salt
Na (mmol)
Nutrition and Cardiovascular Disease (CVD) – Slide 42
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Salt & Health: Population Approach
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Nutrition and Cardiovascular Disease (CVD) – Slide 43
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Effect of processing on salt content/100g
bacon
5g salt
lean ham
25 times
4g salt
lean pork
20 times
0.2g salt
Range 0.7-1.5g salt
bread
500 times
1.5g salt
wheat
0g salt
processed cheese
4 g salt
milk
0.1 g salt
cornflakes
0g salt
corn
0
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2.0 g
500 times
0g salt
mg sodium/100g
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40 times
500
1000
1500
2000
2500
Nutrition and Cardiovascular Disease (CVD) – Slide 44
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Salt in foods
• Low salt product
– <120mg/100gm
• have a look at
– Bread
– Pasta sauces
– Cheese slices
– Breakfast cereals
– Biscuits
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Nutrition and Cardiovascular Disease (CVD) – Slide 45
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Sodium/ salt targets: Adults (4-6g/day)
• World Health Organization
– < 5 g salt/d (<87 mmol Na+) as a population nutrient intake goal
• Australian division of World Action on Salt & Health (AWASH)
- less than 6g salt/d (< 100 mmol Na+)
• National Heart Foundation
– less than 6g salt/d (< 100 mmol Na+)
– less than 4g salt/d (< 70 mmol Na+) if high BP or existing CVD
• Suggested Dietary target (NH&MRC)
http://www.who.int/dietphysicalactivity/publications/trs916/
- less than 4g salt/day (< 70 mmol Na+)
download/en/
Diet Nutrition and the Prevention of Chronic Disease
– Upper Limit (NH&MRC)
Report of the joint WHO/FAO expert consultation WHO
Technical Report Series, No. 916 (TRS 916
- less than 6g/d (100mmol Na+)
NHMRC. Nutrient Reference Values for Australia and New
Zealand including Recommended Dietary Intakes. National
Health and Medical Research Council, 2004 National Heart
Foundation of Australia Position Statement The relationships
between dietary electrolytes and cardiovascular disease
November 2006)
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Nutrition and Cardiovascular Disease (CVD) – Slide 46
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% meeting salt/sodium targets MCC
study (2008/09)
Men 178 (67) ~ 10g salt
N=376
6g
salt/d
31
11
women 134 (51) ~ 8g salt
N=407
women
4g
salt/d
8
2
0
men
10
20
30
40
AWASH & NHF < 6g salt/d (< 100 mmol Na+) Huggins et al. MJA 2011;195(3):128-32.
Suggested Dietary target (NH&MRC) & NHF: high BP or existing CVD <4g
salt/d
(< 70 mmol Na+, (~2000mg Na+)
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Nutrition and Cardiovascular Disease (CVD) – Slide 47
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Salt: Population Effect
• Average Australian/NZ Intake:
• >9.0g salt
• 5g salt (2300mg Na+) reduction
– ↓ 5mmHg SBP
– ↓ 3mmHg DBP (J Hum Hyper 2000;18(4s)s126
• 3 g/day (51mmol Na) reduction in salt:
– In hypertensives:
• ↓ stroke deaths 14%
• ↓ coronary deaths 9%
– In normotensives:
• ↓ stroke deaths 6%
• ↓ coronary deaths 4%
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http://www.salt.gov.uk/in_the_body.shtml
He F, MacGregor G. Effect of longer-term modest reduction on
blood pressure. A meta-analysis.
Implications for public health. J Human Hypertens 2000;18
(Suppl. 4):S126
Nutrition and Cardiovascular Disease (CVD) – Slide 48
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UK Trend of mean estimated salt intake (g/day)
and 95% confidence intervals
12
Australia
The UK Food Standards Agency (FSA) started working
with the food industry in 2003 and launched its consumer
education campaign in 2005
Salt intake (g/day)
2011/12
11
Mean Salt intake (g/day)
10
GB 9.5g
Both
9.1
men
9.8
women
7.1
Scotland
England
9
UK
Scotland
England
Wales 8.6g
8
8.1g
a The
mean and 95% confidence limits for each point are as calculated according
to the protocol in place at the time. Different methods of assessment of
completeness of 24 hour urine collections may contribute slightly (1- 3%) to the
decrease from 2006 to 2011. These differences fall within the 95% confidence
limits for each point. The slope of the trend is not substantially affected by these
differences.
7
Target
6
Aug-00
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5 years
Nov-01
Jan-03
4 years
Apr-04
Jul-05
Oct-06
Time
Jan-08
3 years
Mar-09
Jun-10
12 years
Sep-11
Nutrition and Cardiovascular Disease (CVD) – Slide 49
Deakin University CRICOS Provider Code: 00113B
Recent Australian Initiatives
The Victorian Health Promotion
Foundation: Salt Reduction
Partnership Group - George Institute for
Global Health, The Heart Foundation, Deakin
University, and the Victorian Department of Health,
The action plan has the ambitious
goal of reducing the average daily salt
intake of Victorian adults and children
by 1 gram by 2018 with four
intervention strategies: generating
public debate, raising consumer
awareness, strengthening policy
initiatives, and supporting food
industry innovation. The action plan,
launched in March 2014, is supported
by significant investment and a robust
evaluation strategy.
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Nutrition and Cardiovascular Disease (CVD) – Slide 50
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Nutrition and Cardiovascular Disease (CVD) – Slide 51
Deakin University CRICOS Provider Code: 00113B
Key Lifestyle Changes: reduce CVD
•
•
•
•
•
•
•
•
Low intake trans fats, saturated fats
Saturated fat <10% Energy, Monounsaturated fat 7-10% Energy
– <1% energy trans fats
– Omega-6 Fatty acids 5-8% Energy,
Omega-3 Fatty acids 1-2% Energy
• Fish 1-2 serves/week
Reduce Daily Salt by 1/3
– Maximum 5g/day or 100mmol Na+
Eat at least 7 serves/day (400g
fruit/vegetables)
Wholegrain breads/cereals & pulses
– >20g dietary fibre
Maintain body weight in normal range:
Reduce body weight if overweight
Maximum of 3 standard alcohol
drinks/day
Physical Activity at least 30min/day
moderate level most days
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Population wide approaches
Food supply low trans fats, saturated
fats
Food supply lower sodium content
Cheap readily available
fruit/vegetables/education
Systems approach: healthy
environments for eating and physical
activity
Nutrition and Cardiovascular Disease (CVD) – Slide 52
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