Macro- and Micro-nutrients: Application to Chronic Diseases

1. Macro- and Micro-nutrients:Application to Chronic Diseases

2. Application to Chronic Diseases Nutrition Obesity Cardiovascular Disease Diabetes Mellitus Cancer

3. Cardiovascular Disease (CVD): Hypertension (abnormally high BP - 140/90) Coronary Heart Disease (CHD) – degenerative changes in the inner linings of the large arteries supplying the heart Application to Chronic Diseases Lesions (fatty streak) Inflammation leads to lipid filled plaques and scar tissue Atherosclerosis Vascular degeneration can begin early in life

4. 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

5. 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) Application to Chronic Diseases 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)

6. 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

7. Obesity Obesity has doubled over the past two decades(1 in 4 adults in U.S. are obese – 14% in 1980) Application to Chronic Diseases Why? Increase in sedentary activities Community design Less physical activity Fast food epidemic "Supersize Me"

8. 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) Application to Chronic Diseases

9. How does what we eat contribute to obesity?

10. 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 Application to Chronic Diseases Figure 3.14

11. 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 = 36,500kcals 1 lb fat = 3,500kcals 36,500 kcals / 3,500 kcals•lb = 10.4 lbs Application to Chronic Diseases

12. 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

13. 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

14. 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. Application to Chronic Diseases

15. How does what we eat contribute to, or improve, our risk of developing chronic diseases?

16. Application to Chronic Diseases How does nutrition impact CVD? 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 Cholesterol levels are highly associated with risk of death from CHD Dietary fiber may have modest impact on serum cholesterol

17. 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%

18. 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

19. 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

20. 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

21. 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 preventing blood clot formation on artery walls Also recommended: Tofu, soybeans because these contain linolenic acids (omega 3s)

22. 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

23. Application to Chronic Diseases Figure 31.27