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Macro- and Micro-nutrients:
Application to Chronic Diseases
Application to Chronic Diseases
Nutrition
Obesity
Cardiovascular
Disease
Diabetes
Mellitus
Cancer
Application to Chronic Diseases
Cardiovascular Disease (CVD):
Hypertension
Coronary
(abnormally high BP - 140/90)
Heart Disease (CHD) – degenerative changes
in the inner linings of the large arteries supplying the heart
Lesions (fatty streak)
Inflammation leads to
lipid filled plaques
and scar tissue
Atherosclerosis
Vascular degeneration can begin
early in life
Application to Chronic Diseases
Cardiovascular Disease (CVD):
Myocardial
Infarction (MI) – “heart attack”: Death of
heart muscle from blockage of one or more arteries
supplying heart (lack of blood flow and oxygen)
Angina
Pectoris – Temporary chest pains from coronary
artery narrowing and brief periods of inadequate blood flow
to heart (occurs during exertion)
Stroke
– Deprivation of oxygen to the brain due to blockage
(ischemic) or rupture (hemorrhagic) of arteries and blood
vessels supplying brain
Congestive
Heart Failure (CHF) – Progressive weakening
of the heart muscle and inability to pump oxygen rich blood
to tissues
Application to Chronic Diseases
Cardiovascular Disease
(CVD):
Since 1900, heart disease has
been the number one killer
in the U.S. every year except
for one (1918) - in both men
and women
At least 1 in 4 (58 million)
people in the U.S. suffer
from some form of CVD
Every 29 seconds, an American
suffers a coronary event,
each minute someone dies
(~2,500 each day)
34% of 5-10 year old children
have 1 risk factor and 26%
have 2 risk factors for CVD
(obesity, physical inactivity,
blood lipid profiles, genetics)
Application to Chronic Diseases
Major risk factor for CVD: Obesity
70% of all CVD is related to obesity
58 million Americans are overweight; 40 million are
obese, 3 million are morbidly obese (BMI: body mass
[kg]/height [m]2)
8 out of 10 Americans over 25 are overweight
35% of college students are overweight or obese
Obesity is the second leading cause of preventable
death in the U.S. (300,000 deaths yearly)
Application to Chronic Diseases
Obesity
Obesity has doubled over the past two decades (1 in
4 adults in U.S. are obese – 14% in 1980)
Why?
Increase in sedentary
activities
Community design
Less physical activity
Fast food epidemic
"Supersize Me"
Application to Chronic Diseases
Obesity
In children:
22 million children under 5 are overweight or obese
4% of children in U.S. were overweight in 1982;
16% in 1994; ~25% in 2001
Children spend 4.5 x more time in sedentary
activities than 50 years ago (45 hours - 27% of the
week)
How does what we eat
contribute to obesity?
Application to Chronic Diseases
How does nutrition contribute to Obesity?
Impressive
consistency in
energy balance
Increases in calorie
intake over time
can result in
substantial
increase in weight
gain –
Creeping obesity
Figure 3.14
Application to Chronic Diseases
Creeping Obesity
Just a 100 kcal (2 Fig Newtons) daily increase in
energy intake would substantially increase weight
gain in 1 year:
100 kcal x 365 days = 36,500 kcals
1 lb fat = 3,500 kcals
36,500 kcals / 3,500 kcals•lb = 10.4 lbs
Application to Chronic Diseases
If a college freshman ate two Fig Newtons (or drank
1 lite beer) above your daily caloric intake
(assuming energy balance), by graduation you would
gain ~42 lbs
*If you INCREASED energy expenditure by 100 kcals
(1 mile jog) and DECREASED energy intake by 100
kcals (one 12 oz soda), in one year you would lose 21
lbs of body fat
200 kcals x 365 = 73,000 kcals
73,000 kcals / 3,500 kcals•lb = 21 lbs
Application to Chronic Diseases
Three ways to “unbalance” the energy
equation to produce weight gain:
Increase caloric intake above daily
energy requirements
Maintain caloric intake, but reduce
daily energy expenditure
Increase caloric intake, and reduce
daily energy expenditure
Application to Chronic Diseases
Dietary fiber may play a role in reducing
obesity:
Fiber holds water, increasing “bulk” of food residues in small
intestine by 40-100%
Because the digestive tract can only handle so much bulk,
fiber-rich foods are more filling than other foods, so people
tend to eat less food
Study: Eating a fiber-rich meal at breakfast reduced the
overall number of calories consumed during that meal as
well as the next meal
Insoluble fiber passes through the digestive tract virtually
intact, contains few calories, and may reduce absorption of
calorie rich dietary fat.
How does what we eat
contribute to, or improve, our
risk of developing chronic
diseases?
Application to Chronic Diseases
How does nutrition impact CVD?
Cholesterol levels are highly
associated with risk of death
from CHD
Dietary fiber may have
modest impact on serum
cholesterol
When soluble fiber is eaten as part of a diet low in saturated
fat and cholesterol, it has been shown to reduce blood
cholesterol (LDLs, but not HDLs)
Insoluble fiber does not appear to reduce cholesterol
Application to Chronic Diseases
• Studies supporting the role of fiber in CVD:
Adding 100 g Oat Bran to diet of men with high cholesterol
reduced cholesterol 13% and favorably affected ratio of
LDL/HDL
Finnish study of 21,900 smokers (50-69) – Men who ate the
most fiber rich foods (35 g/day) had 1/3 fewer heart attacks
than those who had the lowest fiber intake (15 g/day)
Each 10 g increase reduced risk of dying of CVD by 17%
U.S. study - 43,757 male health professionals – Those who ate
more than 25 g fiber/day had a 36% lower risk of
developing CVD than those who ate the lowest amount of
fiber (15 g/day)
Each 10 g increase reduced risk of dying of CVD by 29%
Application to Chronic Diseases
Nurses Health Study (10 year prospective study):
69,000 middle age nurses (age 37-64)
Each 5 g/day increase in cereal fiber (1/2 cup of bran flake
cereal) reduced risk of MI and CHD 37%
*Clear evidence that in both men and women, dietary fiber
reduced risk of CVD
Application to Chronic Diseases
How does Fiber reduce cholesterol and risk
of CVD?
Dietary fiber may simply replace cholesterol rich
food
Fiber may hinder absorption of cholesterol in the
intestines
Soluble fiber binds cholesterol in the gut and
excretes cholesterol-bound fiber in feces
Dietary fiber may have affect on CHD by reducing
blood pressure (hypertension) and improving
blood clotting characteristics
Application to Chronic Diseases
How do fatty acids contribute to CVD?
TC
HDL
LDL
Monounsaturated
Polyunsaturated
Saturated
Trans
*Dietary lipid intake can impact risk of CHD by increasing
cholesterol levels and ratio of LDL/HDL
*1% reduction in cholesterol = 2% reduction in CVD risk
Application to Chronic Diseases
How do fatty acids reduce risk of CVD?
Omega-3 fatty acids
(polyunsaturated) are
found in shellfish, cold
water tuna, herring,
sardines, mackerel, sea
mammals
Fish oils may improve blood
lipids (triglycerides) and
heart disease risk by
Also recommended: Tofu,
preventing blood clot
soybeans because these
formation on artery walls
contain linolenic acids
(omega 3s)
Application to Chronic Diseases
How does vitamin deficiency and amino acid
metabolism contribute to CVD?
Vitamin B6, B12 and Folic acid play a major role in
preventing atherosclerosis through their role in
enzymatic processes involved with the amino acid
Methionine
Homocysteine is an intermediate product in the
metabolism of Methionine and promotes
cholesterol damaging effects on artery walls
Application to Chronic Diseases
Figure
31.27