Download Dietary management of Dyslipidaemia

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HEALTH
HEALTH
Dietary management
of Dyslipidaemia
SATURATED FATS
The deleterious effects of saturated fats on blood
lipid profiles have been long established. Saturated fats
increase both TC and LDL-C and sources include fatty
meats, processed meats, whole dairy products, pastries,
biscuits, cakes, confectionery and fast food. All vegetable
oils are low in saturated fats, with the exception of
palm oil & coconut oil. In fact, coconut oil contains 92%
saturated fat. These days coconuts and their products are
heavily promoted as healthy; however, recent reviews of
evidence show that coconut oil consumption raises total
blood cholesterol (both LDL and HDL). Based on current
evidence, it is still preferable to use unsaturated plant oils
over coconut oil.
TRANS FATS
CONSTANTINE DEAN MERCURIO APD
Cardiac Rehabilitation Dietitian and Student
Placement Co-ordinator at Fairfield Hospital in
Sydney. He also convenes the Dietitians Association
of Australia Cardiology Discussion Group.
DIET THERAPY IS AN INTEGRAL
PART OF MANAGING ALL PATIENTS
WITH DYSLIPIDAEMIA. IT IS EFFECTIVE
AS A STAND-ALONE TREATMENT AND ALSO
AS AN ADJUNCT TO PHARMACOLOGICAL
INTERVENTIONS. ALTHOUGH DYSLIPIDAEMIA IS A
RISK FACTOR FOR CARDIOVASCULAR DISEASE, IT IS
MODIFIABLE; HENCE THE IMPORTANCE OF DIETARY GUIDANCE.
DISCUSSED ARE THE KEY COMPONENTS OF A CARDIO-PROTECTIVE
DIET THAT CAN ASSIST IN OPTIMISING BLOOD LIPID PROFILES —
DECREASING LOW DENSITY LIPOPROTEIN CHOLESTEROL (LDL-C),
TOTAL CHOLESTEROL (TC) AND TRIGLYCERIDES (TG), AND
INCREASING HIGH DENSITY LIPOPROTEIN CHOLESTEROL
(HDL-C) — AND REDUCE CARDIOVASCULAR DISEASE RISK.
GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 46 : FEBRUARY/MARCH 2016
Trans fats are formed by partial hydrogenation
(hardening) of vegetable oils in food processing. They are
also found naturally in butter, milk fat, beef and lamb.
Trans fats are often found in foods also high in saturated
fats, such as pies, pastries and fast food. Trans fats
increase LDL-C, decrease HDL-C and increase fasting
TG levels. They are associated with increased risk and
incidence of Coronary Heart Disease (CHD) and Myocardial
Infarction (MI). The Heart Foundation (Australia)
recommends all Australians reduce their trans fats intake
to <1% of total energy intake. On average this level is
achieved in Australia, largely due to food manufacturers
altering procedures to reduce the trans fat content of
foods.
UNSATURATED FATS
There are two main forms of unsaturated fat found
in food – Polyunsaturated (PUFA) and Monounsaturated
(MUFA). PUFA and MUFA fats are considered healthy fats,
and should replace saturated fat where possible. When
substituted for saturated fats, PUFAs reduce TC and LDL-C,
and significantly reduce heart disease risk. Sources
include sunflower oil, corn oil, sesame oil, walnuts, brazil
nuts and oily fish. When substituted for saturated fats,
MUFAs lower TC and LDL-C, although not to the same
extent as PUFA. Sources include olive oil, canola oil, olives,
avocado and most nuts.
Research has highlighted the cardio-protective benefit
of nuts. Two small handfuls of nuts daily (67g) can reduce
total cholesterol and LDL-C by five and seven per cent
respectively. Epidemiologic studies have also shown
a 35% reduced risk of CHD for groups with highest nut
intakes.
Antioxidants have many positive effects on our health
including the prevention and reduction of heart and blood
vessel diseases. Extra virgin olive oil (EVOO) contains
predominately monounsaturated fats and is also naturally
rich in antioxidants. These antioxidants are believed to
be at least partially responsible for the low death rates
from cardiovascular disease seen in populations lining
the Mediterranean Sea that habitually use EVOO. Several
varieties of high quality, antioxidant rich EVOOs are now
produced in Australia.
MARINE OMEGA-3 FATS
Fish is a rich source of marine omega-3 PUFAs. Current
evidence supports that a higher fish intake is associated
with lower rates of sudden cardiac death and heart attack.
The same benefits are not conferred from the consumption
of marine omega-3 PUFAs through supplements; however,
marine omega-3 PUFA supplements can play a beneficial
role in the treatment of those with high triglyceride
levels. The consumption of 1000–4000mg of combined
Eicosapentanoic acid (EPA) and docosohexanoic acid
(DHA) through marine omega-3 PUFA supplementation
can decrease serum triglyceride levels by 25–30%. This
effect is independent of statins. The Heart Foundation
recommends that all Australians aim to include 2–3
servings of fish (including oily fish) per week which
provides about 250–500mg of marine-sourced omega-3s.
Fish with the highest levels of omega-3 include salmon,
canned sardines, herring, blue mackerel, blue-eye trevalla,
and some varieties of tinned tuna.
PLANT STEROLS
The Heart Foundation recommends people with high
cholesterol include plant sterols in their diet to reduce their
risk of heart disease. Eating two grams of plant sterols
daily lowers TC by an average of 10% in three weeks, while
not affecting HDL-C. Plant sterols have additive effects
to statins and must be consumed daily to maintain their
effect. Consuming more than two grams of plant sterols per
day will not further lower TC, that is, two grams per day is
the optimal amount. Two grams per day can be obtained
from 25g of plant sterol enriched margarine spread.
Other key dietary considerations that can assist in
achieving optimal blood lipid control and a reduction in
cardiovascular disease risk include:
•• Quantity and quality of dietary carbohydrate
(CHO) – Nutritious CHO containing foods with
a low glycaemic index (GI) are encouraged.
It is imperative to limit added sugars and
foods with a high GI.
•• Dietary Fibre intake – A diet rich in fibre,
particularly soluble fibre, is strongly
recommended. This can be achieved through
daily consumption of wholegrain breads and
cereals, fruits and vegetables.
In a climate where there are seemingly endless
avenues to attain dietary advice, patients seeking
expert dietary advice should be referred to an Accredited
Practising Dietitian (APD). APDs are University-trained
experts who provide evidence-based dietary advice,
tailored to the specific needs of each individual client.
Pharmacists can be a key referral agent to APDs and are
well positioned to ensure that both medications and the
dietary advice are followed.
GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 46 : FEBRUARY/MARCH 2016
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