The Lecture 5- 8 October 2013 ATHEROSCLEROSIS 94/80

1. Schedule for projects-22 October and 19 November groups or single, titles (any including eg cancer),order of presentation, marking Student presentations (2) each worth 10 % - 20% any nutritional assessment topic of your choice 20 minutes in length (includes 5 minutes for questions) 5 marks for each of: a) grammar, spelling, punctuation, expression and presentation (presentation includes asking and answering questions) b) logic       c) relating topic to material presented in class d) conclusions

2. The new normal-Globe and Mail- 30 September 2012- parents do not recognise when they and/or others including kid(s) is/are overweight or obese Fat is the new normal

3. The Lecture 5- 8 October 2013 ATHEROSCLEROSIS 94/80

4. Outline of today’s talk • I. Pathology • II. Socioeconomic factors contributing to the diseases • Elementary nutritional approaches to be taken to avoid and treat these diseases including foods available to those at risk

5. I. Pathology MAIN PLAYERS BLOOD PLASMA LIPIDS BLOOD PLASMA LIPOPROTEINS PLATELETS BLOOD PRESSURE OBESITY SMOKING TYPE II DIABETES DIET

6. I. Pathology MAIN PLAYERS BLOOD PLASMA LIPIDS elevated cholesterol elevated triglycerides elevated free fatty acids

7. I. Pathology MAIN PLAYERS BLOOD PLASMA LIPOPROTEINS decreased high density lipoprotein (HDL) cholesterol increased low density lipoprotein (LDL) cholesterol and small dense LDL, very low density lipoprotein (VLDL) cholesterol and chylomicrons (CM) increased LDL oxidation

8. I. Pathology MAIN PLAYERS PLATELETS elevated platelet reactivity

9. I. Pathology MAIN PLAYERS BLOOD PRESSURE elevated blood pressure both systolic and diastolic pressures definition and significance of each of two types of pressure

10. I. Pathology MAIN PLAYERS OBESITY central obesity- apple versus pear shape waist circumference 94/80 cm BMI greater than 25- define BMI and its limitations

11. I. Pathology MAIN PLAYERS SMOKING CAUSES RISE IN BLOOD PRESSURE, LIPOPROTEIN OXIDATION

12. I. Pathology MAIN PLAYERS TYPE 2 DIABETES obesity causes pro-atherosclerotic stance of triglycerides, free fatty acids HDLc, LDL size, VLDL (triglycerides) and CM(triglycerides) and blood pressure

14. Break

15. Food and hence nutritional choices depend on: Personal preference acceptance of certain foods -saturated fats-lipids and lipoproteins -high caloric intake-obesity -salty foods- blood pressure Habit leads to acceptance of certain foods or is it acceptance of certain foods leads to habit ?

16. Food and hence nutritional choices depend on: Ethnic heritage or tradition which groups would prefer the offending foods? Social interaction -may encourage consumption of certain bad foods or overeating

17. Food and hence nutritional choices depend on: Availability of food contrast atherosclerosis here with traditional Japanese or Inuit diet why are there differences in rates of atherosclerosis Convenience of food movement of Inuit, Japanese and Mik’maq to foods that require less effort to prepare- why would this occur?

18. Food and hence nutritional choices depend on: Economy of food what are different definitions of economy here and how do they impact positively or negatively on the risk of atherosclerosis? Positive and negative associations positive-health outcome (positive or negative) negative-can can cause positive or negative health outcome- how is this possible?

19. Food and hence nutritional choices depend on: Emotional conflict avoid discussion of comfort food how else might conflict affect diet intake? Values -dietary restrictions- positive outcome in India -fasting may reduce post-prandial lipemic effects -values that allow high caloric consumption or high saturated fat intake encourage atherosclerosis

20. Food and hence nutritional choices depend on: Body image thin people contrast this with belief that overweight is beautiful Advertising fast food companies and companies producing fast home preparation foods- impact on all factors affecting atherosclerosis

22. More on socioeconomic factors Prestige -occupational hypothesis-stress is eased in high prestige occupations-comment on this and on the impact of stress levels in high prestige occupations in terms of diet and the general impact of stress on atherosclerosis -societal perceptions -perceptions of population about CEOs of large food corporations

23. More on socioeconomic factors Prestige -education-relate this to aspects of Cape Breton economy- 30 % aged 15-24 are not in school- ramifications for heart disease Unemployment rate among this age group in Cape Breton is 45 % and CBRM it is 26.5 % Overall unemployment in CBRM is about 16 % (Halifax 7.2 %) – less heart disease in Halifax compared to CBRM

24. More on socioeconomic factors Power -relate power or perceptions of power to stress levels Income -Cape Breton statistics-strong impact on life expectancy compared to metro Halifax- implications for atherosclerosis?

25. More on socioeconomic factors Wealth -Cape Breton statistics-strong impact of income on life expectancy compared to metro Halifax- implications for wealth and atherosclerosis? Education impact of job loss on stress and dietary choices relative to type and level of education

26. More on socioeconomic factors Social stratification -ancestry-relate this to Cape Breton and diet -gender-Cape Breton statistics -hormonal protection against atherosclerosis- mechanism involved -men are much more affected in terms of effect of heart disease on life expectancy in metro Cape Breton than women –this gap narrows in rural Cape Breton

27. More on socioeconomic factors Social stratification -race -ethnicity

28. More on socioeconomic factors Social stratification -mobility-ability to get to heart healthy foods -mental and physical activity-impact of mental illness on atherosclerosis physical activity-mechanisms of protection

29. More on socioeconomic factors Class-income distribution in Cape Breton -uppers -lower uppers -upper middles -average middles -working class -lower class

30. More on socioeconomic factors Average employment income in Cape Breton is $19,000 and in 2 parent families it is $45,000 -what is the significance of this for atherosclerosis? Average hourly wage in CBRM is about the same as the rest of Nova Scotia- significance for atherosclerosis?

31. More on socioeconomic factors Global economy-effect on Cape Breton and on dietary habits here Government-impact of government policy what approaches are taken to improve diet here in Cape Breton

32. More on socioeconomic factors Business - what changes are taking place here in Cape Breton? Psychology -impact of Stephen Harper’s comment about Atlantic Canadians having a defeatist attitude-how would this affect atherosclerosis rates? History -history of government/private investment here in Cape Breton- how does that history impact atherosclerosis on the island?

33. Break

34. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Planning a healthy diet To do this bear in mind Adequacy Balance Energy control Nutrient density Moderation Variety

35. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Planning a healthy diet To do this bear in mind Adequacy-sufficient energy and enough of the nutrients

36. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Planning a healthy diet To do this bear in mind Balance-enough but not too much of each food

37. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Planning a healthy diet To do this bear in mind Energy control-adequate, balanced diet without overeating

38. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Planning a healthy diet To do this bear in mind Nutrient density-select foods that deliver the most nutrients for the least food energy

39. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Planning a healthy diet To do this bear in mind Moderation-eat low nutrient dense foods rarely

40. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Planning a healthy diet To do this bear in mind Variety-select foods in Canada’s 4 food groups each day and vary those choices in each food group from day to day

41. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Prevention Lower saturated fat, total fat, carbohydrates Increase polyunsaturated (especially omega 3) fats Why? Impact on lipids and lipoproteins including post-prandial lipemia, platelets and bp

42. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Prevention Lower total calorie intake- why? relative to physical activity and impact on risk factors Lower salt intake- why?

43. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Post-onset Lower saturated fat, total fat, carbohydrates Increase polyunsaturated (especially omega 3) Why? Impact on lipids and lipoproteins including post-prandial lipemia, platelets and bp

44. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Post-onset Lower total calorie intake- why? relative to physical activity and impact on risk factors Lower salt intake- why?

45. Summary of lecture and lead into next lecture IV. First Nations and other Cape Breton individuals at risk

46. Summary of lecture and lead into next lecture V. How is nutritional assessment made relative to atherosclerosis? Nutrient Intake Analysis             Daily Food Record/Diary             Retrospective Data             24 hour recall             Anthropometry             Nutrition focussed physical exam             Skin Testing             Biochemical analysis             Classifying Malnutrition

47. Summary of lecture and lead into next lecture VI. How would one assess from a nutritional perspective the socioeconomics, pathology and success of nutritional interventions relative to atherosclerosis?