REVIEW OF AHA DIETARY GUIDELINES

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REVIEW OF AHA DIETARY GUIDELINES

• Nita Purcell, MS, RD, LD, CDE

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Target Population

• These guidelines are designed for the general
  population and replace the Step 1 designation
  used in the past.
• More individualized medical nutrition therapy is
  used for specific groups and replaces the Step
  2 used previously.

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Guidelines are designed to

• Achieve Healthy Eating Pattern
• Healthy Body Weight
• Desirable Blood Cholesterol and Lipoprotein
  Profile
• Desirable Blood Pressure

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Healthy Eating Pattern

• Five or More Fruits and Vegetables Daily
• Consume Six or More Serving of a Variety of Grain
  Products including Whole Grains
• No More Than Six ounces of lean meat daily
• Enjoy at least 2 servings of baked or grilled
  fish weekly
• Use fats and oils sparingly and use the ones
  lowest in saturated fats

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Healthy Body Weight

• BMI of gt25.0 lt30.0 Overweight
• BMI gt30.0 but lt40.0 define Obesity
• BMI gt 40.0 Extreme Obesity
• Overweight is associated with increased incidence
  of Hypertension, Diabetes Mellitus and
  Cardiovascular Disease

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Waist Circumference

• Abdominal fat relates to increased risk of
  cardiovascular disease, sex specific cut points
  for waist circumference are
• Mens waist gt 40 inches
• Womans waist gt 35 inches

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Energy Balance Weight Loss

• Carbohydrates and Protein 4 kc/g
• Fats 9kc/g
• Alcohol 7 kc/g
• Diets low in carbohydrates and high in protein
  and fat are popular but there have been no
  studies of their long term efficacy and safety.

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Total Cholesterol Level

• Less than 200 mg/dl
• 200/239 mg/ld
• 240 mg/dl and above

• Desirable
• Borderline high
• High

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LDL Cholesterol

• Less than 100 mg/dl
• 100-129 mg/dl
• 130-159
• 160-189 mg/dl
• 190 mg/dl and above

• Optimal
• Near Optimal/above optimal
• Borderline high
• High
• Very High

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So Limit High Cholesterol Foods

• Dietary cholesterol can increase LDL cholesterol
  although to a lesser degree than saturated fat.
  This response varies greatly among individuals.
  Cholesterol rich foods include egg yolks and to a
  lesser extent shellfish.

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What about Eggs

• Epidemiological data have suggested that
  increased dietary cholesterol intake is
  associated with an increase in coronary disease
  risk independent of plasma cholesterol levels. A
  recent study has challenged this in the case of
  dietary cholesterol derived from the intake of
  up to one egg per day.

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Daily Intake of Cholesterol

• AHA recommends lt 300 mg/d on an average.
• Individuals with elevated LDL, diabetes or
  cardiovascular disease lt 200 mg/d.

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Triglycerides

• Less than 150
• 150 to 199
• gt 200

• Optimal
• Borderline High
• High and may need treatment

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Triglycerides

• Plasma triglyceride and VLDL cholesterol levels
  may contribute to increased risk for coronary
  artery disease and individuals with the
  combination of low HDL and elevated triglycerides
  are appropriate candidates for weight reduction,
  reduced carbohydrate intake and increase physical
  activity.

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Things that Increase Triglycerides

• Overweight
• Physical inactivity
• Cigarette smoking
• Excessive alcohol use
• Very high carbohydrate diet
• Certain diseases and drugs
• Genetic disorders

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Saturated Fats

• AHA advocates a population wide saturated fat
  intake of lt 10 of energy
• Achieved by limiting full fat dairy products,
  fatty meats and tropical oils.
• For individuals with elevated LDL cholesterol or
  cardiovascular disease a level of lt 7 fat of
  calories.

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Goal

• Individuals for whom any of these dietary
  measures are recommended should be under medical
  and nutritional supervision to monitor both the
  effectiveness of the diets in meeting or
  approaching NCEP targets and the overall
  nutritional adequacy of the food intake.

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Goal

• Patients with very low intake of total fat (lt15
  of total energy) and corresponding increase in
  carbohydrate should be monitored for possible
  increases in triglyceride and reductions in HDL
  cholesterol.

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Trans-Fatty Acids

• It has been established that dietary
  trans-unsaturated fatty acids can increase LDL
  cholesterol and reduce HDL cholesterol.
• The AHA recommends limiting the intake of
  trans-fatty acids, the major contributor is
  hydrogenated fat.
• New food labeling and increased foods that are
  trans-fat free will aid the consumer.

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Sources of Trans-fat in our Food

• Cookies, Crackers, and other Baked Goods
• Commercially prepared Fried Foods
• Some Margarines
• Oils used to prepare Fried foods in most
  restaurants and fast-food chains.

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Substitutions

• Eat grains, unsaturated fatty acids from fish,
  vegetables, legumes and nuts
• Certain Soluble fibers (eg, oat products,
  psyllium, pectin, and guar gum) reduce LDL
  cholesterol
• Recent study concluded for every gram increase in
  soluble fiber from these sources LDL cholesterol
  is expected to decrease by an average of 2.2
  mg/dl.

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A Special Population

• Advanced age does not obviate the need to follow
  a heart-healthy diet and lifestyle. Younger
  individuals, postmenopausal women and older men
  with elevated LDL cholesterol levels are at
  increased risk of developing cardiovascular
  disease. The guidelines described are
  appropriate for these age groups.

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Medical Nutrition Therapy

• Medical Nutrition Therapy may be needed to reduce
  cardiovascular disease risk factors in higher
  risk individuals, such as those with obesity,
  elevated LDL cholesterol, insulin resistance,
  high triglycerides and low HDL cholesterol.

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Omega 3 Fatty acids

• A number of investigators have reported on the
  benefits of increased omega 3 fatty acids for
  individuals with CAD.
• Recommendations of 850 mg to 2.9g/d up to 3 -4
  g/d have been made.
• One serving of fatty fish can result in intake of
  about 900mg/d of omega fatty acids.

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Stanol/Sterol Esters

• Stanol/sterol Ester containing foods have been
  documented to decrease plasma cholesterol. Plant
  sterols occur naturally and are isolated from
  soybean and tall oils. They are esterified to
  increase solubility.
• Intake of 2 to 3 g of plant sterols per day have
  been show to reduce total and LDL cholesterol
  levels by 9 to 20

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Medical Nutrition Therapy

• Increasing evidence supports the benefits of
  maintaining normal plasma lipoprotein levels,
  body weight and blood pressure for reducing risk
  of CVD. These dietary guidelines provide a means
  for achieving these goals.

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Medical Nutrition Therapy

• Adoption of these recommendations, together
  with other healthy practices such as regular
  exercise and abstinence from smoking, can
  contribute substantially to reducing the burden
  of cardiovascular disease in the general
  population.
• MNT is available to the patients of the
  Internal Medicine Clinic through a referral to
  the Out Patient Dietitian.

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Thank you !
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References

• American Heart Association Dietary Guidelines
  Revision 2000 a Statement for Health Care
  Professionals
• U.S. Department of Health Human services
  National Institutes of Health