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Perspectives in Nutrition, 8th Edition
Chapter 6 Outline: Lipids
After studying this chapter, you will be able to:
1. Explain the basic chemical structure of fatty acids and how they are named.
2. Describe the functions of triglycerides, fatty acids, phospholipids, and sterols in the body.
3. Classify and evaluate the different fatty acids based on their health benefits or
consequences.
4. Identify food sources of triglycerides, fatty acids, phospholipids, and sterols.
5. Describe the recommended intake of lipids.
6. Identify strategies for modifying total fat, saturated fat, and trans fat intake.
7. Explain the digestion, absorption, and transport of lipids in the body.
8. Discuss health concerns related to dietary fat intake.
9. Describe dietary measures to reduce the risk of developing cardiovascular disease.
6.1
Triglycerides
A.
General
1.
Family of lipids that contains fats, oils, triglycerides, phospholipids, and sterols
2.
All lipids contain carbon, hydrogen, and oxygen
3.
Do not dissolve in water; dissolve in organic solvents (e.g., chloroform, benzene,
ether)
4.
Triglycerides are most common type (95%) of lipids found in food and body
B.
Structure
1.
3 fatty acids bonded to glycerol backbone
2.
Fatty acids present in triglycerides may be same or different from each other
3.
Esterification: fatty acids bind to hydroxyl (-OH) groups on glycerol and release
1 molecule of water
4.
De-esterification: fatty acids released from glycerol, yielding free fatty acid(s)
and diglyceride or monoglyceride
5.
Re-esterification: reattaching a fatty acid to a mono- or diglyceride
6.
Fatty acids consist of a carbon chain flanked by hydrogen atoms
a.
Acid (carboxyl) group at one end
b.
Methyl group at one end
7.
Carbon Chain Length
a.
Long chain fatty acids: 12 or more carbon atoms
i.
E.g., beef, pork, lamb, and most plant oils
ii.
Lengthiest digestion process
iii.
Transported via lymphatic system
b.
Medium chain fatty acids: 6 - 10 carbon atoms
i.
E.g., coconut oil, palm oil
ii.
Digested almost as rapidly as glucose
C.
D.
iii.
Transported via circulatory system
c.
Short chain fatty acids: <6 carbon atoms
i.
E.g., dairy fats
ii.
Rapidly digested
iii.
Transported via circulatory system
8.
Saturation
a.
Saturated fats (see Figure 6-3): maximal number of bonds possible, all
single bonds
b.
Monounsaturated fats (see Figure 6-4): one carbon-carbon double bond
c.
Polyunsaturated fats (see Figure 6-5): two or more carbon-carbon double
bonds
9.
Shape (see Figure 6-7)
a.
Saturated and trans fatty acids have straight carbon chains
b.
Unsaturated cis fatty acids have bent (kinked) carbon chains
c.
Cis fatty acids: hydrogen atoms attached to double-bonded carbons are
on the same side of the carbon chain (e.g., most unprocessed, unsaturated
fatty acids)
d.
Trans fatty acids: hydrogen atoms attached to double-bonded carbons are
on opposite sides of the carbon chain; straighter chain resembles
saturated fatty acid (e.g., hydrogenated polyunsaturated fatty acids)
e.
Hydrogenation adds hydrogen to carbon chain of unsaturated fats
i.
Increases saturation
ii.
Becomes solid at room temperature
Naming fatty acids
1.
Omega (ω or n) system: indicates where first double bond closest to methyl
(omega) end of the chain occurs
2.
Delta (Δ) system: indicates the double bonds in relation to the carboxyl end of
the carbon chain
Essential Fatty Acids
1.
Cannot be synthesized by the human body; must be obtained through diet
2.
Alpha-linolenic acid (omega-3 fatty acid)
a.
Metabolized to eicosapentaenoic acid (EPA)
b.
Metabolized to docosahexaenoic acid (DHA)
3.
Linoleic acid (omega-6 fatty acid)
a.
Metabolized to dihomo-gamma-linolenic acid
b.
Metabolized to arachidonic acid
4.
Eicosanoids: hormone-like compounds metabolized from fatty acids; affect the
body in the region where they are produced
a.
Prostaglandins
b.
Prostacyclins
c.
Thromboxanes
d.
Leukotrienes
e.
Lipoxins
6.2
Food Sources of Triglycerides
A.
General
1.
Almost all foods contain some triglycerides
a.
High fat: animal fat, vegetable oils
b.
Moderate fat: bakery items, snack foods, dairy desserts
c.
Low fat: fat-free milk and yogurt, breakfast cereals, yeast breads, fruits
and vegetables (except for coconuts and avocados)
2.
Foods contain mixtures of fatty acids (see Figure 6-11)
a.
Primarily saturated
i.
Long chain: lard, beef, pork, lamb
ii.
Medium or short chain: milk fat, tropical oils (coconut, palm,
palm kernel)
b.
Primarily monounsaturated: olive oil, canola oil, peanut oil
c.
Primarily polyunsaturated: sunflower oil, corn oil, safflower oil, fish oil
d.
Sources of essential fatty acids
i.
Omega-3: cold water fish (salmon, tuna, sardines, mackerel),
walnuts, flaxseed, supplements containing fish or flaxseed oils,
hemp oil, canola oil, soybean oil
ii.
Omega-6: beef, poultry, safflower oil, sunflower oil, corn oil
e.
Sources of trans fatty acids: margarine, shortening
B.
Hidden Fats
1.
Examples: whole milk, cheese, pastries, cookies, cake, hot dogs, crackers, French
fries, ice cream
2.
Using Nutrition Facts labels helps identify fats in foods
3.
Lowering fat content of foods
a.
Replace fat with water (Dairy-Lo)
b.
Replace fat with carbohydrates (Z-trim)
c.
Replace fat with fiber (Maltrin, Stellar, Oatrim) and gums
d.
Engineered fats (Olean, Benefat) made with fat and sucrose, but are not
well digested, and thus contribute no or few calories
4.
Fat replacements are not extensively used
5.
Low-fat ≠ low-calorie because sugars are commonly used to improve product
characteristics
6.3
Functions of Triglycerides
A.
Provide Energy
1.
9 kcal/g
2.
Main fuel source for body cells (except CNS cells and RBCs, which prefer
glucose); provide 30 - 70% of energy at rest or during light activity
B.
Provide Compact Energy Source
1.
Excess calories from carbohydrate, fat, protein, and alcohol can be converted to
fatty acids and then to triglycerides
2.
3.
C.
D.
E.
6.4
Ideal energy storage because they are stable and calorie-dense
Fat cells contain 80% lipid and 20% water and protein (compared to muscle cells,
which are 73% water)
4.
Amount of fat that can be stored is limitless: adipose cells can expand in size and
number
Insulate and Protect the Body
1.
Subcutaneous fat lies just beneath skin
2.
Maintains constant body temperature
3.
Cushions body organs
Aid Fat-Soluble Vitamin Absorption and Transport
1.
Vitamins A, D, E, and K require dietary fat for absorption and transport
2.
Malabsorption may occur with:
a.
Extremely low-fat diet
b.
Use of mineral oil laxative
c.
Use of medications that block fat absorption (e.g., orlistat)
d.
Excessive consumption of Olestra
e.
Diseases that affect fat absorption (e.g., cystic fibrosis)
Essential Fatty Acid Functions
1.
Structural components of cells
2.
Maintain fluidity and flexibility of cell wall to allow transport of substances
through cell membranes
3.
Normal development of retina and nervous system during fetal life and infancy
4.
Nerve transmission and communication
5.
Eicosanoids, made from EFAs, have many regulatory roles
a.
Blood pressure
b.
Blood clotting
c.
Sleep/wake cycles
d.
Body temperature
e.
Inflammation
f.
Hypersensitivity reactions
g.
Stomach secretions
h.
Labor during childbirth
i.
Immune and allergic responses
j.
Cell division (possible applications for cancer research)
k.
Transport of oxygen from RBCs to body tissues
l.
Kidney function, fluid balance
m.
Hormone synthesis action
n.
Cellular transport
o.
Ovulation
Phospholipids
A.
General
1.
B.
C.
6.5
Structure is similar to triglyceride, except 1 fatty acid is replaced by a phosphatecontaining compound that often includes nitrogen
2.
Phospholipids have fat-soluble and water-soluble properties
a.
Fatty acid end is hydrophobic
b.
Phosphate end is hydrophilic
c.
In watery environment, hydrophobic tails cluster together and
hydrophilic heads interact with water
Phospholipid Functions
1.
Component of cell membranes: double-layered outer covering of cell that holds
cell contents and regulates movement of substances into and out of cells
2.
Emulsifier: compound that forms a shell around fat droplets to allow fat to be
suspended in water
a.
Essential for transport of fats in bloodstream
b.
Used in food manufacturing and preparation to lend fluffy texture and
prevent separation of oils from water (e.g., lecithin in egg yolks)
Sources of Phospholipids
1.
Synthesized in body
2.
Supplied by diet
a.
Egg yolks
b.
Wheat germ
c.
Peanuts
d.
Lecithin supplements (use for weight loss is not supported by evidence;
conflicting data on cholesterol reduction and risk for Alzheimer’s
disease)
Sterols
A.
Sterol Functions
1.
Synthesis of steroid hormones (e.g., testosterone, estrogen, active vitamin D,
corticosteroids)
2.
Synthesis of bile
3.
Cell membrane structure and function
4.
Transport of fat through bloodstream (component of lipoproteins)
B.
Sources of Sterols
1.
One-third (180 - 325 mg/d) of cholesterol comes from animal foods (e.g., meat,
fish, poultry, eggs, dairy products)
a.
Absorption efficiency is 40 - 60%
b.
Not necessary in diet
2.
Remaining cholesterol (~875 mg/d) is synthesized by the body
a.
Replenish bile stores (400 mg/d)
b.
Synthesis of steroid hormones (50 mg/d)
3.
Although plants do not synthesize cholesterol, they do contain other sterols
a.
Ergosterol
b.
Sitostanol (used in cholesterol-reducing margarine products)
6.6
Recommended Fat Intakes
A.
General
1.
No RDA, but AI is set for infants
2.
Infants and children under age 2 need about half of calories from fat for normal
brain development
3.
Children 2 - 3 years require 30 - 35% of total calories from fat
4.
Children 4 - 18 years require 25 - 35% of total calories from fat
5.
Institute of Medicine Recommendations
a.
AMDR for total fat is 20 - 35% of total calories for adults
i.
Prevent vitamin E and essential fatty acid deficiencies
ii.
Inadequate fat may increase triglycerides and lower HDL levels
b.
Saturated fat intake should be as low as possible
c.
Trans fat intake should be as low as possible
d.
Unsaturated fat intake should comprise most of fat intake
e.
Omega-6 fatty acids should comprise 5% of calories
f.
Omega-3 fatty acids should comprise 0.6 - 1.2% of calories
g.
Cholesterol intake should be as low as possible
6.
American Heart Association and Dietary Guidelines for Americans
recommendations
a.
Limit saturated fat to 10% of total calories
b.
Limit polyunsaturated fat to 10% of total calories
c.
Minimize trans fat intake
d.
Any fat intake above 30% of total calories should come from
monounsaturated sources
e.
Limit cholesterol intake to 300 mg/d
7.
American Heart Association recommendations for people at risk for heart disease
a.
Restrict dietary fat to 20% of total calories
b.
Limit saturated fat to 7% of total calories
c.
Limit cholesterol to 200 mg/d
8.
Ornish recommendations
a.
Limit dietary fat to 10% of total calories
b.
Physician monitoring is recommended for those following a diet with
less than 20% of total calories from fat
c.
High carbohydrate intake associated with low-fat diet may lead to
elevations in triglycerides, which can be modulated by increased fiber
intake, maintenance of healthy weight, and regular exercise; usually
decline after several months on a low-fat diet
B.
Mediterranean Diet
1.
Up to 40% of calories from fat can be healthy if monounsaturated fats account
for most of the fat
2.
Mediterranean Diet was first studied by Ancel Keyes ~60 years ago
3.
Associated with lowest rates of chronic disease in the world
4.
C.
D.
Characteristics
a.
Olive oil is the main source of fat
b.
Abundant daily intake of fruits, vegetables (especially leafy greens),
whole grains, beans, nuts, and seeds
c.
Emphasis on minimally processed, seasonally fresh, and locally grown
foods
d.
Daily intake of small amounts of cheese and yogurt
e.
Weekly intake of low to moderate amounts of fish
f.
Limited use of eggs and red meat
g.
Regular exercise
h.
Moderate drinking of wine at mealtimes
Essential Fatty Acid Needs
1.
120 - 170 kcals/d (2 - 4 tsp/d of oils rich in EFAs)
2.
EFA deficiency is unlikely
3.
AI for linoleic acid
a.
Men:17 g/d
b.
Women: 12 g/d
4.
AI for alpha-linolenic acid
a.
Men: 1.6 g/d
b.
Women: 1.1 g/d
5.
Consequences of EFA deficiency
a.
Diarrhea
b.
Slowed growth
c.
Delayed healing of wounds and infections
d.
Flaky, itchy skin
Our Fat Intake
1.
Typical American diet supplies ample total dietary fat
2.
Over last 100 years, fat intake has doubled
3.
Typical American diet supplies too much SFA and too little MUFA and PUFA
4.
Main contributors of fat to American diet
a.
SFA: dairy products, beef, children, mayonnaise, and margarine
b.
Trans: margarine, baked goods made with shortening
c.
PUFA: vegetable oils
d.
Plentiful omega-6 fatty acid intake; suboptimal omega-3 fatty acid intake
5.
Sources of omega-3 fatty acids
a.
2 portions/week of cold-water fish
b.
Walnuts
c.
Flaxseeds
d.
Canola, soybean, or flaxseed oils
e.
Supplements (NIH recommends 650 mg EPA and 650 mg DHA)
6.
Consult physician about omega-3 fatty acid intake if:
a.
Bleeding disorder
b.
Pre-surgery
c.
Use of anticoagulant medications or supplements (e.g., aspirin, warfarin,
ginkgo biloba)
6.7
Fat Digestion and Absorption
A.
Digestion
1.
Mouth: lingual lipase digests triglycerides with short and medium chain fatty
acids (active during infancy, but minor role in adulthood)
2.
Stomach: gastric lipase digests triglycerides into monoglycerides, diglycerides,
and free fatty acids
3.
Small intestine: primary site for fat digestion
a.
Cholecystokinin (released from intestinal cells) stimulates release of bile
from gallbladder and lipase and colipase from the pancreas
b.
Bile from gallbladder emulsifies fats by formation of micelles
i.
Suspends lipids
ii.
Increases surface area for enzyme action
c.
Pancreatic lipase digests triglycerides into monoglycerides and free fatty
acids
d.
Colipase helps lipase bind to micelles
e.
Phospholipase from pancreas and enzymes from the small intestine
mucosa digest phospholipids to glycerol, fatty acids, phosphoric acid,
and other components
f.
Cholesterol esterase digests cholesterol esters to cholesterol and free
fatty acids
B.
Absorption
1.
Lipids are absorbed by brush border cells in duodenum and jejunum
2.
95% of dietary fat is absorbed
3.
Short and medium chain fatty acids enter the circulatory system via the portal
vein
4.
Long chain fatty acids are re-esterified into triglycerides and enter the lymphatic
system
5.
98% of bile is recycled by enterohepatic circulation: reabsorbed in ileum and
returned to liver by portal vein; 2% is excreted in feces
6.
Certain medications and diets rich in soluble fiber increase excretion of bile and
thereby cause liver to remove more cholesterol from the blood to make bile
6.8
Transporting Fat in the Blood
A.
Lipoprotein structure
1.
Lipid core
2.
Shell composed of protein, phospholipid, and cholesterol
3.
Apolipoproteins on shell of lipoproteins
a.
Activate lipid transfer enzymes
b.
Assist in binding of lipoproteins to receptors on cell surfaces,
c.
Assist enzymes of fat metabolism
B.
C.
D.
E.
Transporting Dietary Fats Utilizes Chylomicrons
1.
Dietary fats are packaged into chylomicrons
2.
Lacteals from intestinal villi empty into lymphatic vessels, which connect to the
thoracic duct
3.
Thoracic duct empties into circulatory system at the left subclavian vein
4.
Lipoprotein lipase inside most cells is activated by apolipoprotein C-II, transfers
triglycerides from chylomicrons to cells, and cells can metabolize triglycerides
for energy (muscle cells) or store for later use (adipose cells)
5.
Clearance of chylomicrons from blood takes 2 - 10 hours after a meal
Transporting Lipids Mostly Made by the Body Utilizes Very-Low-Density Lipoproteins
1.
Liver synthesizes fat from carbon, hydrogen, and energy
2.
Synthesized triglycerides and cholesterol are coated with shell of protein and
lipids to produce very-low-density lipoproteins (VLDLs)
3.
LPL in cells lining blood vessels transfers triglycerides from VLDLs into body
cells for energy or storage
4.
As triglycerides are removed from VLDLs, they become less dense and are
known as intermediate-density lipoproteins (IDLs)
5.
Hepatic triglyceride lipase on the endothelial surface of the liver and LPL remove
additional triglycerides from IDLs to produce low-density lipoproteins, which
have lost most of their triglycerides and are composed primarily of cholesterol
Pathways for Cholesterol Uptake
1.
Receptor pathway for cholesterol uptake
a.
LDL is removed from blood by cells with B-100 receptor (e.g., on liver)
b.
Inside cells, LDL is metabolized to protein and free cholesterol, used to
maintain cell membrane or synthesize compounds within cell
c.
When cholesterol concentration inside cells increases, B-100 receptor is
inactivated and LDL remains in blood
d.
LDL in blood can be oxidized by free radicals; oxidation limited by
antioxidants
2.
Scavenger pathway for cholesterol uptake
a.
Scavenger white blood cells become embedded in blood vessels, then
detect, engulf, and digest oxidized LDL
b.
Over time, uptake of oxidized LDL by scavenger cells leads to
development of plaques in blood vessel walls
c.
Plaque formation is encouraged by diets high in saturated fat, trans fat,
and cholesterol
d.
Plaque is covered with smooth fibrous muscle cells and calcium, which
decrease arterial flexibility (atherosclerosis) and can lead to blood clots
and heart attacks
High density lipoprotein (“good” cholesterol)
1.
Liver and intestine produce most HDL, which has a high proportion of protein
2.
Picks up cholesterol from dying cells and other sources, donates cholesterol to
other lipoproteins for transport back to the liver
3.
4.
6.9
Blocks oxidation of LDL
Low HDL predicts risk for CVD
a.
Before menopause, HDL is usually high in women
b.
Men and post-menopausal women typically have lower HDL
Health Concerns Related to Fat Intake
A.
High Polyunsaturated Fat Intake
1.
PUFA intake >10% of total calories is associated with increased cholesterol
deposition in the arteries
2.
May impair immune function
B.
Excessive Omega-3 Fatty Acid Intake
1.
8 oz (2 servings) of omega-3 fatty acid-rich fish/week reduce blood clotting and
favorably affect heart rhythm
2.
4 - 8 oz fish/d can lower blood triglycerides
3.
Excessive intake of omega-3 fatty acids (e.g., from supplement overuse) can
impair immune function and restrict blood clotting (hemorrhagic stroke)
C.
Imbalances in Omega-3 and Omega-6 Fatty Acids
1.
Typical American diet supplies n-6:n-3 ratio of 20:1
2.
Ratio of dietary fats affects synthesis of eicosanoids, which may affect risk for
various inflammatory diseases (e.g., arthritis)
D.
Intake of Rancid Fats
1.
Unpleasant odor and flavor
2.
Contain peroxides and aldehydes that can damage cells
3.
PUFAs are more susceptible to damage by oxygen, heat, metals, or light because
they have more double bonds than saturated or trans fats
4.
Foods prone to rancidity
a.
Fish and vegetable oils
b.
Packaged fried foods
c.
Fatty foods with large surface area (e.g., powdered egg yolks)
5.
Preventing rancidity
a.
Sealing in airtight packaging
b.
Hydrogenation of PUFAs
c.
Addition of antioxidants or other food additives (e.g., BHA or BHT)
E.
Diets High in Trans Fat
1.
Trans fats have been used to produce high-quality baked and fried products
without cholesterol and with extended shelf-life
2.
Consumption of trans fatty acids raises blood cholesterol levels and increases
risk for CVD
3.
Trans fats lower HDL
4.
Trans fats increase inflammation
5.
Animal studies indicated that trans fats increase deposition of visceral fat, which
increases chronic disease risk
6.
Reduction of trans fat intake
a.
b.
c.
d.
F.
6.10
Identification of trans fats on Nutrition Facts panel
Reformulation of food products
Limit fried foods, pastries, flaky bread products, and cookies
Use little or no stick margarine or shortening; substitute vegetable oils,
tub margarine, fruit purees
e.
Bake, pan-fry, broil, steam, grill, or stir-fry instead of deep-fat frying
f.
Replace nondairy creamers with reduced-fat milk or non-fat dry milk
Diets High in Total Fat
1.
Increased risk for obesity
2.
Increased risk of cancer (e.g., colon, breast, prostate)
a.
For colon cancer, may be related to increased secretion of bile, which
irritates intestinal cells
b.
For breast and prostate cancer, high fat diet leads to higher estrogen
production
c.
High-fat diets are usually low in fiber and other phytonutrients that
protect against cancer
3.
Increased risk of CVD
Expert Perspective: Nuts for Your Heart
A.
Although nuts are high in fat, it is primarily MUFA
B.
American Heart Association encourages substitution of unsaturated fats found in nuts,
avocados, canola oil, and olive oil for saturated fats
C.
1 oz of nuts 5 times per week linked to many health benefits
1.
Decreased risk for coronary heart disease by 30 - 50%
a.
Reduced total cholesterol and LDL
b.
No change in HDL or triglycerides
2.
Lowered risk for type 2 diabetes and gallstones by 25% among women
3.
Regulation of body weight
D.
Possible mechanisms
1.
MUFAs
2.
PUFAs
3.
Protein
4.
Fiber
5.
Vitamin E
6.
Folic acid
7.
Vitamin B-6
8.
Niacin
9.
Magnesium
10.
Copper
11.
Zinc
12.
Potassium
13.
Phytochemicals (e.g., ellagic acid, flavonoids, phenols, isoflavones)
14.
Sterols
E.
6.11
15.
Omega-3 fatty acids
Allowable health claim: “Scientific evidence suggests but does not prove that eating 1.5
ounces of nuts per day as a part of a diet low in saturated fat and cholesterol may reduce
the risk for heart disease.”
Medical Perspective: Cardiovascular Disease
A.
General
1.
Major reason for death in North America
a.
500,000 deaths annually in US (60% more than cancer)
b.
1.5 million heart attacks annually in US
c.
2:1 ratio for heart attacks among men:women
d.
Women develop CVD 10 years later than men
e.
For each person who dies of CVD, 20 more have symptoms
2.
Symptoms are not obvious and are slow to develop
B.
Development of CVD
1.
Arterial lining damaged by smoking, diabetes, hypertension, homocysteine, viral
and bacterial infections, and chronic inflammation
2.
Plaque forms to repair arterial injury
3.
Plaque thickens over time, causing arteries to harden and lose elasticity
4.
Blood pressure increases
5.
Clot or spasm in narrowed artery restricts blood flow and leads to heart attack or
stroke
6.
Factors that may precipitate a heart attack
a.
Dehydration
b.
Severe emotional stress
c.
Unusual strenuous physical activity
d.
Sudden awakening
e.
High-fat meal
C.
Risk Factors for CVD
1.
Non-modifiable risk factors
a.
Age >65 years
b.
Male gender
c.
Genetics
i.
Close relative who died prematurely (before age 50) from CVD
ii.
Defects that affect lipoprotein metabolism or blood clotting
d.
Race
i.
African-American
ii.
Hispanic/Latino
iii.
Native American
iv.
Native Hawaiian
v.
Some Asian groups
2.
Modifiable risk factors
a.
High-fat diet
b.
D.
E.
F.
Blood lipids (see Table 6-4)
i.
Total cholesterol >200 mg/dl
ii.
LDL >160 mg/dl
iii.
Hypertriglyceridemia: triglycerides >150 mg/dl
c.
Hypertension
i.
Systolic blood pressure >140 mmHg (pressure in arteries when
heart contracts)
ii.
Diastolic blood pressure >90 mmHg (pressure in arteries when
heart relaxes)
d.
Smoking (2 - 4 times increased risk)
i.
Boosts genetically-linked risk for CVD
ii.
Increases risk even when blood lipids are low
iii.
Makes blood more likely to clot
iv.
Negates female advantage, especially in combination with oral
contraceptive use
e.
Physical inactivity
f.
Obesity
g.
Diabetes
h.
Liver disease
i.
Kidney disease
j.
Low thyroid hormone levels
Assessing CVD Risk
1.
National Cholesterol Education Program recommends that all adults over 20
years of age have blood lipid profile every 5 years (fast 12 - 14 hours prior to
test)
2.
NCEP tables calculate risk based on age, total and HDL cholesterol levels, blood
pressure, smoking
Preventing CVD
1.
Keep total fat intake between 20 and 35% of kcal
2.
Keep saturated fat intake to less than 7% of kcal
3.
Keep trans fat intake low
4.
Keep PUFA intake under 10% of kcal
5.
Keep MUFA intake under 20% of kcal
6.
Lower cholesterol intake to <200 mg/d
7.
Include 2 g/d of plant stanols/sterols
8.
Increase soluble fiber intake to 20 - 30 g/d
9.
Keep body weight at healthy level
10.
Increase physical activity
11.
Eat foods rich in antioxidants (e.g., fruits, vegetables, nuts, plant oils)
12.
Possible vitamin E supplementation under physician supervision
Heart Attack Symptoms
1.
Symptoms may be sudden and severe or vague
2.
At first sign of heart attack, take aspirin to reduce blood clotting and call 911
3.
G.
Warning signs
a.
Intense, prolonged chest pain or pressure, sometimes radiating to other
parts of the upper body (men and women)
b.
Shortness of breath (men and women)
c.
Sweating (men and women)
d.
Weakness (men and women)
e.
Nausea and vomiting (especially women)
f.
Dizziness (especially women)
g.
Jaw, neck, and shoulder pain (especially women)
h.
Irregular heartbeat (men and women)
Symptoms of Stroke
1.
Blood clot blocks flow of blood to brain (ischemic stroke) or blood vessel bursts
in brain (hemorrhagic stroke)
2.
Major risk factor is high blood pressure
3.
Early medical treatment increases survival
4.
Warning signs
a.
Sudden numbness or weakness in face, arm, or leg, especially on one
side of body
b.
Sudden confusion and/or trouble speaking or understanding
c.
Sudden trouble seeing in one or both eyes
d.
Sudden trouble walking, dizziness, and/or loss of balance or coordination
e.
Sudden, severe headache with no known cause