Transcript Medical Nutrition Therapy in - BYU Wellness

Understanding blood
lipids and glucose
How a Healthy Lifestyle can
improve your numbers
Susan Fullmer, PhD RD
Associate Teaching Professor
Nutrition, Dietetics, and Food Science
Cost of Heart Disease
and Diabetes
• 7% of population has
• Heart disease is the
diabetes
leading cause of death
• Leading cause of
in the U.S. and world
blindness, lower limb
• 1 in 3 women worldwide
amputation, and kidney
will die of heart disease
failure in U.S.
• More women then men
• Major risk factor for
diet every year from
stroke and heart
heart disease in the
attack
U.S.
• $403 Billion was spent
in 2006 on CVD
Factors that are considered
a High Risk for CVD
•
•
•
•
Established heart disease
Chronic kidney disease/failure
Diabetes*
10-year risk Framingham global
risk >20%
Factors that place someone
“at risk” for heart disease
• One or more of the following risk
factors:
–
–
–
–
–
Cigarette smoking
Poor diet
Physical inactivity
Obesity, especially central obesity
Family history of premature heart
disease (<55 years of male relative, <65
years in female)
Factors that place someone “at
risk” for heart disease continued
–
–
–
–
–
High blood pressure
Dyslipidemia*
Evidence of coronary calcification
Metabolic syndrome
Poor exercise capacity on a treadmill
test
Factors called “optimal
Risk” for heart disease
• Framingham risk score of <10%
• Healthy lifestyle
• No risk factors
2006 AHA Diet and Lifestyle
Goals for CVD Risk Reduction
• Consume an overall healthy diet
• Aim for a healthy body weight
• Aim for recommended levels for LDL, HDL,
and triglycerides
• Aim for a normal blood pressure
• Aim for a normal blood glucose level
• Be physically active
• Avoid use of and exposure to tobacco
products
Lipids
• Triglycerides
– Chylomicrons
– VLDL
• Total Cholesterol
– LDL
– HDL
– Chol/HDL ratio—
• <5:1 is goal
• <3.5:1 is optimal
Classification of Serum Triglycerides
<150 (mg/dL)
Normal
150-199
Borderline High
200-499
High
>500
Very High
Factors associated with
elevated TG’s
• Overweight,
obesity
• Physical inactivity
• High carbohydrate
intake (>60% of
calories)
• Type II Diabetes,
kidney failure
• Certain
medications
• Cigarette smoking
• Alcohol intake
• Genetics
LDL CHOLESTEROL
<100
Optimal
100-129
Near optimal/above optimal
130-159
Borderline high
160-189
High
190
Very high
TOTAL CHOLESTEROL
<200
Desirable
200-239
Borderline high
240
High
HDL CHOLESTEROL
<40
Low
>60
High (negates a risk factor)
Risk Category
LDL
Goal
Level to
Initiate
Lifestyle
Changes
Consider
Drug
Therapy
CHD or CHD
Risk Equivalents
(10 yr risk
>20%)
<100
mg/dL
100 mg/dL
130 mg/dL
2+Risk factors
<130
mg/dL
>130 mg/dL
10 yr risk>10%:
160 mg/dL
0-1 Risk factor
<160
mg/dL
160 mg/Dl
190 mg/dL
2007 Lifestyle guidelines for
prevention of CVD in Women
• Do not smoke
• Physical activity
– A minimum of 30 minutes of moderate
intensity activity (brisk walking) on
most, preferably all days of the week
– For weight loss or maintenance: 60-90
minutes of moderate intensity activity
on most, preferably all days of the week
2007 Lifestyle guidelines for
prevention of CVD in Women
• Consume a diet rich in:
– Fruits and vegetables
– Whole grains
– High fiber foods
• Consume fish, especially fatty fish at least
twice/week (source of omega-3 fatty acids)
• Women with heart disease, MAY want to
consider omega-3 supplementation of 8501000 mg/day
• Consider screening women with CHD for
depression and treat when appropriate
2007 Guidelines for
prevention of CVD in Women
• Limit saturated fat to <7% of calories (1520 grams/day)
• Limit cholesterol intake to < 200 mg/day
• Reduce sodium intake to < 2,300 mg/day
• Achieve and maintain an appropriate
weight through healthy behavior changes
(physical activity, calorie intake, and
formal behavior programs if indicated)
• Manage diabetes, blood lipids and high
blood pressure aggressively
Saturated Fat
Food
Prime Rib
Sirloin Steak
Ground beef,reg
Ground beef, lean
Milk, whole
Milk, 1%
Cheddar cheese
Mozzarella
Serving
size
3 oz
3 oz
3 oz
3 oz
1 cup
1 cup
1 oz
1 oz
Total
Fat (g)
Saturated
Fat (g)
28
12
16
6
8
2.5
9.5
4.5
12
5
6
3
5
2
6
3
Plant sources of omega-3
fatty acids
•
•
•
•
Canola oil
Flaxseed and flaxseed oil
Walnuts
Soybean oil, tofu
Ineffective or potentially
harmful interventions
• Hormone therapy to prevent or treat
CVD
• Use of anti-oxidant supplements (Vit
E, C, beta carotene) to prevent or
treat CVD
• Folic acid
• Routine use of Aspirin (in healthy
women under 65 years of age)
Clinical identification of Metabolic
Syndrome (any 3 of the following)
Risk Factor
Defining level
Abdominal Obesity
Waist Circumference
Men
Women
Triglycerides
HDL Cholesterol
Men
Women
Blood Pressure
Fasting Glucose
>102 cm(>40”)
>88 cm (>35”)
150 mg/dL
<40 mg/dL
<50 mg/dL
130/ 85 mmHg
110mg/dL
Diagnostic Criteria for
Diabetes
Stage
Casual
Glucose
<150
2-OGTT
Normal
Fasting
Glucose
<110
Diabetic
>126
>200
>200
Impaired >100-125
Glucose
Tolerance
---
<140
>140 and
< 200
Risk Factors for Type 2
Diabetes
• Family History
• Older age (though incidence is growing
in adolescent population)
• Obesity (esp. intra-abdominal obesity)
• Prior history of gestational diabetes
• Physical inactivity
• Prediabetes, race, ethnicity
American Diabetes Recommendations for
Prevention/delay of Type 2 Diabetes
• Modest weight loss (5-10%)
• Participate in regular physical
activity
• Close attention should be given to,
and appropriate treatment given for,
other CVD risk factors (tobacco use,
hypertension, dyslipidemia)
American Diabetes Association Nutrition
related Goals for Diabetes
1.
Attain and maintain optimal metabolic outcomes
including:
•
Blood glucose levels in the normal range or as close to normal as
is safely possible to prevent or reduce the risk for complications
of DM
•
•
•
A lipid and lipoprotein profile that reduces the risk for CVD
disease
•
•
•
•
A1C <7.0%
Fasting blood glucose: 90-130 mg/dL
LDL <100 mg/dL
Triglycerides <180 mg/dL
HDL >40 mgldL
Blood pressure levels that reduce the risk for vascular disease
•
<130/80 mmHg
American Diabetes Association
Goals for Diabetes
2. Prevent and treat the chronic
complications of diabetes. Modify
nutrient intake and lifestyle as
appropriate for the prevention and
treatment of obesity, dyslipidemia
(abnormal blood lipids), CVD,
hypertension, and kidney disease
3. Improve health through healthy food
choices and physical activity