View source for 1. Role of nutrition in prevention of cardiovascular diseases

* Cardiovascular disease = CVD
** Ischaemic heart disease
** Stroke
* Epidemiology of cardiovascular disease
** CVD is the leading cause of death in the world
* Risk factors for CVD
** Behavioural (modifiable)
*** Behavioural risk factors are responsible for about 80% of CVD
*** Unhealthy diet
*** Physical inactivity
*** Tobacco use
*** Harmful use of alcohol
** Non-modifiable
*** Family history
*** Old age
* 2018 study in British Medical Journal (BMJ):
** Healthy dietary patterns can decrease the effect of genetic factors that would otherwise predispose to obesity.
** Also, improved diet quality had a more significant effect on people with high genetic risk for obesity.
* 2012 Cochrane review:
** Reducing saturated fat in diet decreases risk for cardiovascular disease by 14%
* 2014 study in BMJ:
** Replacing saturated fat in diet with polyunsaturated fat did not decrease risk for cardiovascular disease (later studies contradict this, but those studies are not mentioned in the lecture)
* Oslo diet heart study:
** Diet low in saturated fat, cholesterol and high in polyunsaturated fat -> reduced serum cholesterol, reduced cardiovascular disease
* Lyon diet heart study:
** Diet low in saturated fat, high in unsaturated fat -> reduced cardiovascular mortality
* Stanford coronary risk intervention project (SCRIP):
** Low fat, saturated fat, cholesterol diet + exercise -> decreased dyslipidaemia, decreased cardiovascular disease

Cardiometabolic risk

* The risk for developing diabetes, heart disease or stroke (basically metabolic syndrome)
* The risk factors for atherosclerosis, obesity, and cardiovascular disease are all the same or very similar
* Risk factors:
** Hypertension
** Inflammation
** Age
** Race
** Gender
** Family history
** Dyslipidaemia
** Overweight
** Insulin resistance
** Smoking
** Physical inactivity
** Unhealthy eating

Benefits of fish oils:

* Fish oils contain omega-3 (n-3, ω-3) polyunsaturated fatty acids (PUFAs)
* DART trial: Men with cardiovascular disease who increased intake of fish or used fish oil tablets had reduced cardiovascular mortality
* GISSI trial: Men and women with cardiovascular disease who took 1 g omega-3 daily decreased the number of cardiovascular events

Other nutrients

* Nurses health study:
** Increased nut intake -> decreased risk for cardiovascular events
* PREDIMED study:
** Increased nut intake -> decreased cardiovascular mortality
* Zhaoli meta-analysis:
** Increased soy intake -> decreased cardiovascular risk
* Phytosterol-supplemented foods intake -> decreased LDL-cholesterol
* Increased intake of garlic -> decreased total cholesterol

Recent changes in the view of associated between diet and cardiovascular disease

* Dietary cholesterol is not the major determinant of blood cholesterol
* Individual nutrients may not be responsible for risk, but rather complex foods
** Example: Increased consumption of fish is better than omega-3 fat supplementation

Vitamin D

* High serum vitamin D concentration -> decreased cardiovascular events
* Hypovitaminosis D leads to:
** Decreased anti-inflammatory cytokines
** Increased pro-inflammatory cytokines
** Increased inflammation -> increased atherosclerosis
** Increased angiotensin II activity -> increased myocardial remodelling
** Increased insulin resistance

Therapeutic lifestyle changes (TLC) in LDL-lowering therapy:
{| class="wikitable"
|'''Nutrients'''
|'''Recommended intake'''
|-
|Saturated fat
|< 7% of total calories
|-
|Polyunsaturated fat
|< 10% of total calories
|-
|Monounsaturated fat
|< 20% of total calories
|-
|Total fat
|25 – 35% of total calories
|-
|Carbohydrate
|50 – 60% of total calories
|-
|Fibre
|20 – 30g daily
|-
|Protein
|15% of total calories
|-
|Cholesterol
|< 200mg/day
|-
|Total calories
|Balanced so that body weight is stable or reached desirable levels
|}

* TLC can reduce LDL levels by 20 – 30%

Summary:

* Reducing LDL levels is beneficial for preventing cardiovascular disease or events
* Decreased saturated fat intake
* Decreased total fat intake
* Decreased trans fat intake
* Increase unsaturated fat intake
* Increased fibre intake
* Sufficient vitamin D intake
* Increased fish consumption
* Decreased weight
* Increased intake of plant sterols
* Decreased dietary cholesterol
* Increased physical activtiy
* See also Mediterranean diet, DASH diet

[[Category:Public health 4 - Preventive medicine]]