Download Nutrition and Heart Disease

Lipids in Heart
Disease & Cancer
By Jennifer Turley and Joan Thompson
© 2013 Cengage
Presentation Overview
Lipids in Heart Disease
• Incidence
• Contributing factors
• Prevention
• Blood lipids
• Dietary fat
• Oxidation & antioxidants
• Trans & omega 3 fatty
acids
• Other factors
Lipids in Cancer
• The cancer process
• Diet & lifestyle &
disease risk
• P:S ratio
• Dietary lipids &
disease risk
Heart Disease
Deaths per 100,000
• #1 cause of death in America.
• 1/3 die of atherosclerosis.
• Myocardial infarction and stroke risk
increase with atherosclerosis.
Diet
Related
Alcohol
Related
Non-Diet
Related
Atherosclerosis
• Plaques:
• Occlude arterial vessels.
• Form from arterial wall injury.
• Contain cholesterol (oxidized LDL), platelets, etc.
Hypertension
• Is high blood pressure.
• Is a leading cause of arterial wall
injury.
• Synergizes with atherosclerosis to
cause heart disease and stroke.
Blood Pressure
Classification of Measurements
Category
Systolic1
Optimal
<120
Pre-hypertension
120-139
or
80-89
Stage 1 hypertension
140-159
or
90-99
Stage 2 hypertension
≥ 160
or
≥ 100
1 Systolic
Conjunction
Blood Pressure in mm of mercury (Hg)
Blood Pressure in mm of mercury (Hg)
2 Diastolic
and
Diastolic2
<80
Reducing Blood Pressure
• DASH Diet (The Dietary Approach to
Stop Hypertension)
• Increase calcium, potassium and magnesium
• Low-fat, fiber-rich, moderate protein &
carbohydrate
• Aerobic exercise
• Healthy Body Weight
Who is Dying of Heart
Disease?
•
•
•
•
•
25-34 years: Men at 3X rate as Women
35-44 years: Men at 2X rate as Women
45-64 years: Women catching up to men
65-75 years: Women catching up to men
75-80 years: Women = Men
What are the Risk
Factors?
•
•
•
•
•
•
•
•
•
•
Elevated serum cholesterol
Genetics
Smoking tobacco & drinking alcohol
Hypertension
Diabetes
Obesity
Sedentary lifestyle
Stress
Male gender
Consuming a low fiber & high fat diet
How can it be prevented?
• Lifestyle changes
• Less stress, no smoking
• Healthy diet
• Healthy fats, nutritionally adequate
• Regular aerobic exercise
• An hour a day
• All positively affect blood lipid
values and blood pressure
Elevated Serum Cholesterol &
Increased Deaths from Heart Disease
mg/dl total cholesterol
Blood Lipids
Serum Triglycerides
• VLDL
• CHYLOMICRONS
Serum Cholesterol
• LDL (Bad, 77.5%)
• HDL (Good, 17.5%)
IDL (Neutral, 5%)
Lipid Carrier Molecules
Serum Triglycerides
• Elevated levels are associated with heart disease.
• High triglyceride levels thicken the blood causing
hypertriglyceridemia.
• Triglycerides are packaged primarily in
Chylomicrons and Very Low Density Lipoproteins
(VLDL).
• A fasting 12 hour blood test is needed to
determine an accurate triglyceride level.
• <150mg/dl is normal.
• 450 mg/dl is like pumping ketchup, causes arterial
damage contributing to heart disease and stroke.
Serum Cholesterol
• Elevated levels are associated with
atherosclerosis if 2 other risk factors exist.
• Cholesterol is packaged as Low Density
Lipoproteins (LDL) and High Density Lipoprotein
(HDL). Intermediate Density Lipoprotein (IDL) is
present to a minor extent.
• HDL’s return cholesterol to the liver for synthesis
of bile, hormones, and vitamins.
• LDL’s delivers cholesterol to tissue and therefore
have a higher plaque effect.
Blood Cholesterol Levels & Disease Risk
Total Cholesterol LDL Cholesterol
< 200 mg/dl
< 100 mg/dl
Desirable/Low Risk
Optimal
200-239 mg/dl
100-129 mg/dl
Borderline High Risk
Near optimal
≥ 240 mg/dl
130-159 mg/dl
High Risk
160-189 mg/dl
Borderline high
High
≥ 190 mg/dl
Very high
HDL Cholesterol
< 40 Low (indicates risk)
> 60 High
Blood Cholesterol Levels & Disease Risk
Metabolic Syndrome:
If Three or More of These Factors
1.
2.
3.
4.
5.
Fasting Blood Triglycerides: ≥150 mg/dl
HDL: <50 mg/dl ♀ <40 mg/dl ♂
Blood Pressure: ≥130/85 mm Hg
Fasting Blood Glucose: ≥110 mg/dl
Waist Circumference: >35” ♀ >40” ♂
Therapeutic Lifestyle Changes (TLC) Diet
Summary of the TLC Diet
Total Fat
SFA
PUFA
MUFA
Trans Fatty Acids
Carbohydrates
Proteins
Cholesterol
Plant stanols/sterols
Soluble Fiber
Total Calories
25%-35% of Calories
<7% of Calories
≤10% of Calories
≤20% of Calories
As low as possible
50%-60% of Calories
~15% of Calories
<200 mg/day
2 g/day
10g-25g/day
Balance energy intake and expenditure to maintain
desirable body weight and prevent weight gain.
Expend 200 Calories/day in moderate physical activity.
Examples of Food in a 2200 Calorie One Day TLC Diet
Grains
Vegetables
Fruits
Low Fat Dairy
Lean
Meat/Fish/Alternatives
Eggs
Oils
7 ounce equivalents with ½ whole grains
3 cup equivalents
2 cup equivalents
3 cup equivalents
6 ounce equivalents, soy protein may replace some
animal product
<2 yolks/week
6 teaspoon equivalents
Dietary Fat & Lipoproteins
• SFA:
Increase LDL
• PUFA :
Decrease LDL & HDL
• MUFA:
Decrease LDL
• Cholesterol:
Can Increase LDL
• Phospholipids:
Not indicated in
heart disease
Fatty Acid Composition of Common Fats
Oxidation of Fat
• The double bonds of polyunsaturated
fatty acids are targets for oxidation
(damage by oxygen species).
• The double bond breaks with oxidation
generating lipid fragments that are very
sticky.
(-CH2CH=CHCH2- to CH2CHO + CH2CHO).
• The sticky fragments contribute to
atherosclerotic plaque formation.
Antioxidants
• Antioxidants: Prevent oxidation reactions, react
with oxygen radical species directly, & prevent
heart disease
• Antioxidants vitamins include: vitamin E
(alpha-tocopherol), vitamin C (L-ascorbic acid),
beta-carotene (provitamin A)
• Minerals with antioxidant cofactor functions
include: Zinc, Copper, & Iron
Hydrogenation of Fat
• Trans fatty acids levels are high in
processed foods containing partially
hydrogenated oils.
• The double bonds from PUFA & MUFA are
removed by hydrogenation (adding hydrogen).
• The fatty acid becomes more saturated.
• Is used in the process of making
margarine.
• The softer the margarine the less trans fat.
• Stick margarine & shortening are highly
hydrogenated and partially hydrogenated.
Hydrogenation of Fat
H+ H+ H+
H+ H+ H+
H+ H+
spotlight
Unsaturation
Saturation
+H2
Partial Hydrogenation
of Fat
• Is done in the food industry.
• Many of the double bonds from
PUFA & MUFA are removed and
many can be chemically modified
to a trans fatty acid (TFA)
configuration.
• TFAs contribute to heart disease.
Cis vs. Trans Fatty Acids
• Cis:
• The naturally occurring configuration in PUFA &
MUFA.
• Hydrogen atoms are on the same side of the double
bond in the fatty acid Carbon chain.
• Trans:
• Form during the partial hydrogenation process.
• A chemical “Fluke”
• Hydrogen atoms are on the opposite side of the
double bond in the fatty acid Carbon chain.
The Chemical Structure of
Cis & Trans Fatty Acids
spotlight
Trans Fatty Acids are
Detrimental to Health
• TFAs contribute to heart disease by
increasing LDL & decreasing HDL
cholesterol & increasing triglycerides.
• An intake of 2-3% of energy from TFAs
has greater than predicted negative
effects from the marked adverse blood
lipid changes. TFAs may also contribute to
inflammation, endothelial cell dysfunction,
and diabetes (insulin resistance).
• Intake should be < 1% of energy to as low
as possible.
Consumer Keys for
Avoiding Trans Fatty Acids
• Read the nutrition facts panel. TFA free is defined
as ≤0.5 gm/serving.
• Avoid foods with partially hydrogenated oils in the
ingredient list (such as cookies, chips,
doughnuts) on the food label.
• Bake with vegetable oils.
• Use margarines that are soft. Choose margarines
that are trans fatty acid free.
• Avoid deep-fat fried foods like french fries, corn
chips, doughnuts, & chicken nuggets.
• Avoid high meat and dairy product intake as a
natural TFA source from bacterial action on
unsaturated fatty acids in the ruminants stomach.
Omega-3 Fatty Acids
Heart Healthy
Omega carbon
Linoleic Acid
An Omega-6 fatty acid
Omega carbon
Alpha-Linolenic Acid
An Omega-3 fatty acid
How Do Omega-3
Fatty Acids Work?
• They affect the synthesis of eicosanoid hormone
like compounds such as prostaglandins &
leukotrienes.
• The compounds produced from omega 3 fatty
acids:
• Decrease blood clotting (prevent plaque build-up)
• Decrease blood pressure (prevent atherosclerosis)
• Decrease blood total cholesterol, LDL cholesterol, &
triglycerides & increase HDL cholesterol)
• Decrease inflammation (prevent arthritis, asthma)
• Increase immunity (prevent cancer)
American Heart Association
omega 3 fatty acid recommend
• Consume 0.5-1.8 grams of omega-3 fatty
acids per day as fatty fish or supplements.
• The omega-3 fatty acids in fish are called
EPA & DHA.
• Consume 1.5-3.0 grams alpha-linolenic
acid (an omega-3 fatty acid) per day.
• Plant sources of omega-three fatty acids flax
seed, walnuts, & canola oil.
Omega-3 Fatty Acids in Fish
• Best Sources:
•
•
•
•
•
• Good Sources:
Salmon
Herring
Mackerel
Tuna
Whitefish
To avoid mercury contamination,
eat fish that live closer to the surface
and have a shorter lifespan.
•
•
•
•
•
•
•
•
Cod
Flounder
Halibut
Mahi Mahi
Orange Roughy
Sea Bass
Clams
Scallops
Homocysteine in Heart Disease
• Homocysteine is an amino acid intermediate of
cysteine & methionine metabolism.
• Elevated levels of homocysteine cause arterial
wall damage & contribute to heart disease.
• Folic acid (folate), B6 & B12 function as cofactors
for the enzymes driving the inter conversion of
cysteine & methionine, thus adequate intakes
prevent hyperhomocystemia.
methionine
homocysteine
cysteine
Other Factors in Heart Disease
• High doses of Niacin: Increases HDL, decreases
LDL.
• Statin type cholesterol lowering drugs: Reduce
the synthesis of cholesterol in the liver.
• Cholesterol absorption inhibitor drugs.
• Benecol spreads: Contain plant stanol esters that
reduce the absorption of cholesterol in the
digestive tract.
• Wine: Reduces blood viscosity. Red wine and/or
grape juice increases HDL.
• Alcohol: 1 serving per day decreases risk of a
cardiovascular accident. It is an anticoagulant.
• Aerobic Activity: Increases HDL, decreases LDL.
• Soluble Fiber: Decreases LDL.
• Soy Protein: Increases HDL, decreases LDL.
Lipids in Cancer
• Cancer is the 2nd leading cause of death
in Americans.
• It is characterized by uncontrolled cell
growth.
• It occurs through a process of initiation,
promotion, and progression.
Carcinogenesis
Cancer Risk
• Increased Cancer Risk by Lifestyle
Practices
– Smoking tobacco, UV light, Obesity,
Sedentary Lifestyle
• Increased Cancer Risk by Dietary
Practices
–
–
–
–
–
~ 45% of all cancer deaths are diet-related
Low F&V, antioxidant nutrient, & fiber intake
High total fat and PUFA, sodium intake
P:S ≥3:1 + high fat diet = cancer risk
P:S ≤0.33:1 (or ≤1:3) + high fat diet = heart
disease risk
Sample P:S Ratio Calculation
• Kathy ate a high fat diet.
– 104 gm PUFA & 30 gm SFA
• What is her P:S ratio?
 104 ÷ 30 = 3.47. This # is placed in the P
position of the ratio
– The S position is always assigned the # 1
• The P:S is 3.47:1
• Is the ratio increasing disease risk?
– This P:S ratio is increasing risk for cancer
– Remember that you do want enough PUFA to
get your essential (linoleic and alpha-linolenic)
fatty acid needs met.
Dietary Lipids & Disease Risk
Dietary Factor
Heart Disease Cancer
Low fat intake
Prevents
disease
Prevents
disease
Does not
contribute to
disease
Does not
contribute to
disease
Contributes to
disease
Contributes to
disease
(20-25% of total Calories)
Moderate fat
intake
(25-35% of total Calories)
High fat intake
(>35% of total Calories)
Fatty Acids & Disease Risk
High SFA
Low MUFA
Low PUFA
Increases total blood
cholesterol, LDL
(is not ideal)
Is associated with
heart disease
(is atherogenic)
Low SFA
Low MUFA
High PUFA
Decreases total blood
Increases cancer risk
cholesterol, HDL & LDL (is tumorgenic)
(is not ideal)
Low SFA
High MUFA
Adequate PUFA
Decreases total blood
cholesterol, LDL
(is ideal)
Is not associated with
cancer or heart
disease risk (is not
tumorgenic or
atherogenic)
Summary
How to prevent heart disease
• Avoid dietary cholesterol & saturated fat.
• Avoid hydrogenated or partially
hydrogenated fat (trans-fatty acids).
• Consume MUFA and omega 3 fatty acids.
• Protect PUFA, MUFA, & LDL with
antioxidants.
• Consume adequate folate to prevent
hyperhomocystemia.
• Consume soluble fiber, soy, and plant
stanols/sterols.
• Avoid cigarette smoking.
• Exercise (especially aerobic).
Summary
How to prevent cancer
• Choose to eat mostly plant foods.
– Eat plenty & a variety of whole
grains, fruits, & vegetables!
• Avoid high fat diets especially saturated
fat & omega-6 fatty acids.
• Consume an antioxidant-rich diet.
• Practice all aspects of a sound diet:
Calorie control, adequacy, balance,
moderation, and variety.
References for this presentation are the same as those for this topic found in module 3 of the textbook