1. Marywood University Weigh To Go November 3, 2010

2. Cholesterol Quiz Only adults need to have their cholesterol checked. Children can’t have high cholesterol? All I really need to know about my cholesterol levels is my total blood cholesterol number? If I have high cholesterol the only thing I can do about it is take medication? High cholesterol levels put me at risk for atherosclerosis? Thin people don’t have to worry about high cholesterol?

3. Cholesterol Approximately 1 in every 6 adults—16.3% of the U.S. adult population—has high total cholesterol. The level defined as high total cholesterol is 240 mg/dL and above. People with high total cholesterol have approximately twice the risk of heart disease as people with optimal levels. A desirable level is lower than 200 mg/dL. For adult Americans, the average level is about 200 mg/dL, which is borderline high risk. More women than men have high cholesterol in the United States.

4. Cardiovascular Disease (CVD) CVD has been the leading cause of death in the United States for every year since 1900, except 1918 – More than 71 million Americans have at least one form of CVD (e.g., hypertension, CHD, stroke, or congestive heart failure) Includes deaths from CHD and stroke – Atherosclerosis most common cause of CHD One third of deaths occur before age 65 – Prevalence doubles from 35-44 years to 65-74 years Risk reduction; major breakthroughs in prevention and treatment

5. Natural Progression of Atherosclerosis

6. Blood Markers for CHD Lipoprotein profile – Total cholesterol >200 mg/dl – LDL cholesterol >130 mg/dl – HDL cholesterol <40 mg/dl – Triglycerides >150 mg/dl

7. Lifestyle Risk Factors Tobacco use – influences acute coronary events (thrombus formation, plaque instability and arrhythmias) Physical inactivity – same risk as high blood cholesterol, HTN or smoking Poor diet Stress – type A personality shows increased risk Alcohol consumption – above moderate consumption raises BP, TG and HDL

8. AHA Diet Recommendations for CVD Risk Reduction Balance calorie intake and physical activity to achieve or maintain a healthy body weight. Consume a diet rich in vegetables and fruits. Choose whole grain, high-fiber foods. Consume fish, especially oily fish, at least twice a week. Limit intake of saturated fat to <7% of energy, trans-fat to <1% of energy, and cholesterol to <300 mg/day by: – Choosing lean meats and vegetable alternatives. – Selecting fat-free (skim), 1%-fat, and low-fat dairy products. – Minimizing intake of partially hydrogenated fats. Minimize your intake of beverages and foods with added sugars. Choose and prepare foods with little or no salt. When consuming alcohol, do so in moderation. When eating food that is prepared outside of the home, follow the American Heart Association Diet and Lifestyle Recommendations.

9. Nutrient Composition of the Heart Healthy Diet NutrientRecommended Intake Saturated fat*Less than 7% of total calories Polyunsaturated fatUp to 10% of total calories Monounsaturated fatUp to 20% of total calories Total fat25%-35% of total calories Carbohydrate † 50% to 60% of total calories Fiber25-30 g/day ProteinApproximately 15% of total calories CholesterolLess than 200 mg/day Total calories (energy) ‡ Balance energy intake and expenditure to maintain desirable body weight/prevent weight gain

10. Foods with Fat Saturated Fats Saturated fats – Meats, Organ meats, Egg yolk, Whole milk cheese, Whole milk, Cream, Butter, Lard, Palm oil, Coconut oil Trans fatty acids – Cookies, Crackers, Cakes, Fried Foods, Donuts Unsaturated Monounsaturated – Olive oil, Olives, Canola oil, Peanut oil, Avocados Polyunsaturated – Safflower oil, Sunflower oil, Corn oil, Sesame oil, Nuts, Seeds

11. Food Examples Peanut Butter Serving Size – 2 tablespoons Calories – 190 Fat – 16 g Saturated fat – 3 g (16%) Carbohydrate – 6 g Cholesterol – 0 mg Protein – 8 g Fiber – 2 g Whole Milk Serving Size – 1 cup Calories – 150 Fat – 8 g Saturated fat – 5 g (23%) Carbohydrate – 13 g Cholesterol – 25 mg Protein – 8 g Fiber – 0 g

12. Dietary Factors Saturated fatty acids – most potent effect on LDL chol Monounsaturated fatty acids – when used to replace SFA they lower total chol, LDL & TG; may increase HDL Trans fatty acids – raise LDL chol Polyunsaturated fatty acids - when used to replace SFA they lower LDL & HDL Omega-3 fatty acids – decreased CVD risk with fatty fish 2 times/week Amount of dietary fat – low fat diets (<25% of kcals) raise TG and lower HDL

13. Dietary Factors–cont’d Dietary cholesterol – raise total chol and LDL Fiber – soluble fibers (pectins, gums, mucilages) lower LDL Antioxidants – affect oxidative potential of LDL Soy protein – large intakes of soy may decrease LDL Stanols and sterols – lower total chol and LDL Weight loss - improves endothelial function

14. References American Heart Association: americanheart.org Centers for Disease Control and Prevention: cdc.org Mahan, L.K., & Escott-Stump, S. (2008). Krause's food & nutrition therapy (11 th ed.). St. Louis, MO: Saunders. Calorie King: calorieking.com