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Chapter 3

Chapter 3. Nutrition & Plant-Based Diets. Serum Lipids Blood Pressure Body Mass Blood Glucose. Antioxidant Status Homocysteine Endothelial Function Fibrinolytic Activity. Nutrition Effects on CVD. New Dietary Component Evidence. Isoflavones (soybeans) Garlic (allicin) Plant sterols

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Chapter 3

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  1. Chapter 3 Nutrition & Plant-Based Diets

  2. Serum Lipids Blood Pressure Body Mass Blood Glucose Antioxidant Status Homocysteine Endothelial Function Fibrinolytic Activity Nutrition Effects on CVD

  3. New Dietary Component Evidence • Isoflavones (soybeans) • Garlic (allicin) • Plant sterols • Amino Acids • B Vitamins (folate) • B-12 (Selenium) • Potassium & Magnesium • Flavonoids & Carotenoids

  4. Plant-Based Diets & Phytochemicals • Refers to a pattern of food selections derived in greater proportion from vegetables, grains, legumes, nuts, seeds, and fruits than from meats, poultry, fish, dairy products, & eggs. • Contain no cholesterol. Animal foods contain no fiber. • Therefore, plant-based foods provide optimal health for CVD.

  5. Promoting Plant-based diets • Does not exclude non-plant nutrients • Does not have to be vegetarian • Foundation of nutrient dense foods (cardioprotective fats, fiber, vitamins, minerals, and phytochemicals) • Problem – phytochemicals simply means chemicals found in foods that do not have recommended daily allowance or daily intake

  6. Plant Based Diet Evidence • Women’s Health Study • 40,000 female health professionals • 32% lower relative risk • 5 years • Iowa Women’s Health Study • 35,000 postmenopausal women • 9 years • Lowest risk whole grain intake

  7. Evidence Continued • Nurses’ Health Study • 85,000 nurses • 14 years ; 35% lower risk • 5 oz nuts vs 1 oz nuts • Health Prof. Follow-up Study • 45,000; 8 yr follow-up • 30% lower relative risk

  8. Clinical Trial Evidence • DASH Study • Reduced BP • Reduced Lipids • 1. Control • 2. High fruit and vegetable • 3. Comb. w/ low-fat dairy

  9. Lyon Heart Study • Post MI • Mediterranean diet • 67% risk reduction • NO single pattern; multiple dietary differences

  10. SHIFT: Avoidance to Inclusion • Currently instructing patients to Limit, Restrict, or Avoid • Some foods contain foods they are truly trying to avoid • What to include?

  11. Dietary Supplements • Best way to get nutrients is through diet • Augmentation • Figure 3.1

  12. Plant Sterols • Supplement example of a plant component to effectively lower cholesterol. (Commercial forms such as margarines) • Dose relationship – lowered cholesterol by 8-14%.

  13. Antioxidants • Inverse relationship to CAD prevention • Possible improvements for certain antioxidants for plaque stability, vasomotor function, and thrombotic tendency.

  14. Vitamin E • CAD Mortality • Diverse Populations • Synthetic vs Natural

  15. Beta Carotene • No benefits and some adverse results • Excess lung cancer • Risk for smokers and alcohol

  16. B Vitamins – B6, B12, Folate • Increase Homocysteine – B Vitamin deficiencies • NHS- (Folate and B6) – 45% decrease in CAD • More protective w/ one alcoholic drink p/d • Daily supplementation .5-5.0 mg folate decreased 25% and .5mg B12 • RDA folic acid increased 600 ug/d pregnancy w/ B12 of 1 mg

  17. Homocysteine • Now recognized as an important CVD risk factor, and increase folate can lower homocysteine levels. (Multivitamins or B Complex vitamins, fortified foods (such as cereals), and natural foods (such as beans and leafy greens).

  18. Fish Oils • Evidence to support benefits from the daily intake of fish is more compelling than that for garlic or vitamin E. • Fish contains n-3 fatty acids and can lower LDL, Triglycerides, and raise HDL

  19. Dietary Supplements • Est. the appropriate dose • Est. the appropriate sources (natural vs. syn) • Limited standardization and regulation • Effects of overall health • Potentially different reactions from subgroups of population • Interactions

  20. Garlic Supplements • Contain active ingredient (allium) • Only modest, if any, benefits w/ supplemental intake. • One half to one clove per day (900 mg)

  21. Ginkgo Biloba • Proven in the tx of memory deficit and dementia • Intermittent Claudication – Modest improvements

  22. Hawthorn • Used in 17th century in England for edema. • Commonly used for hypertension, angina, heart failure, and palpitations • Current large trial underway

  23. Soy Derived Isoflavone Phytoestrogens • 1995 – Meta-analysis • 47 g/day of a soy protein associated with a 13% reduction in LDL • Other studies underway

  24. Practical Suggestions • Consult RD or diet professional • Transition at slow pace • Cultural Foods • Convenience

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