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Dietitian & Your Heart

Siti KhadijahDietitian

Institut Jantung Negara

Kuala Lumpur


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Is nutrition therapy effective in

reducing risk of CVD?

Improving diet and lifestyle is a critical

component of the American Heart Associations

strategy for cardiovascular disease riskreduction (AHA Scientific Statement, 2006)


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The National Cholesterol Education Program

Adult Treatment Panel III (NCEP III)recommends lifestyle changes as the primary

and most cost effective means of reducing the

risk of coronary heart disease(JAMA, 2001)


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Nutrition Counseling?

Low Fat

Low Calories

Low Salt High Fiber

MORE THAN THIS !


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Whats new?

Cardio Protective Diet Food-based components of dietary patterns that improve

cardio metabolic health

(Mozaffarian D, Appel L & Van Horn L, 2011)

Functional Food Foods that include whole foods and fortified, enriched or

enhanced foods that have a potentially beneficial effect onhealth when consumed as part of a varied diet on a regularbasis at effective levels

(JADA, 2009)


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FiberHealth & Satiety

Goal : 45 servings fruits / day

45 servings vegetables / day

Breakfast

Lunch

Dinner

Snack


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Choose More of Whole grains

Whole grains contain all the essential parts of the

entire grain seed includes bran, endosperm and

germ.
http://www.hpb.gov.sg/HOPPortal/content/conn/HOPUCM/uuid/dDocName:HPB-047342


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Make The Switch

Per serving

(1 cup)

White

Rice

Brown

Rice

Calorie (kcal) 150 111

Protein (g) 4.0 3.0

Fiber (g) 0 1.8

Per serving(2 slices) WhiteBread BrownBread

Calorie (kcal) 147 145

Protein (g) 4.9 4.8

Fiber (g) 0.8 5.2


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Goal : 3+ servings / day


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Consume More Fish & Shellfish

Increase intake of Omega-3 Fatty Acids Fish consumption reduces sudden cardiac death and

CHD mortality

(Albert et al, 1998, Kris-Etherton et al, 2002)

2 servings of fatty fish meals per week reduced 50%

primary cardiac arrest (Albert et al, 2002)


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Go Nuts

Tree nuts eg : almonds, hazelnuts,walnuts,

pecan, cashew, pistachios

Eat 30 grams per day may reduce the risk of

coronary heart disease

Choose unsaltedor without h oney coated nuts


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Monounsaturated Fats (MUFA)

Decreases LDL and total cholesterol.

Sources : Olive, Peanut, Rice Bran

Choose Vegetable Oil


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Polyunsaturated Fats (PUFA)

Decreases LDL and total cholesterol

Sources : Sunflower, Corn


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How To Spot For Trans Fat?

Read the ingredient list and look out for

terms

Hydrogenated / Partially Hydrogenated Oil

Vegetable Shortening

Look at nutrition facts paneltrans fat

should be 0g or


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Saturated Fat

Increases LDL & total cholesterol

Sources


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Blended Oil

To maximize the potential of palm oil by mixing with PUFA in

ratio 1:2 Stable for high temperature cooking


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Functional Food

Foods that include whole foods and fortified,

enriched or enhanced foods that have a

potentially beneficial effect on health when

consumed as part of a varied diet on a regularbasis at effective levels (JADA, 2009)


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Effectiveness of functional foodsStrong evidence Level A

Functional

ingredients

Sources Potential benefits

Dietary fiber (functional & total)

Betaglucan Oats, barley May risk of CHD &

improve blood glucose

Soluble fiber Peas, beans, apples,

citrus fruits

May risk of CHD &


Whole grains Brown rice, whole

meal bread /

biscuits, capati,

breakfast cereal

May risk of CHD &



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Functional

ingredients

Source Potential benefits

Plant sterols / stanols

Free stanols

/sterols

Corn, soy, fortified foods

& beverages e.g. milk

May risk of CHD

Stanol/

sterol esters

Fortified margarines,

dietary supplements

May risk of CHD

Phytoestrogens

Soy proteins Soybeans & soybeanproducts

May risk of CHD

Effectiveness of functional foodsStrong evidence level A


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Functional FoodCholesterol Reducing Effect

Food Items Evidence

Soy 25 gram of soy protein per day may reduce the risk of

heart disease, LDL cholesterol and triglycerides

Nuts 30 grams (a handful) of nuts may reduce the risk ofcoronary heart disease.

Beta

Glucan3 grams of beta glucan = 70 gram of oats per day

(10 tablespoon) reduces total and LDL cholesterol.

Plant Sterol 2 - 3 grams of plant sterols per day from plant sterol

enriched foods lowers total cholesterol by 4 - 11% and

LDL cholesterol by 7 - 15%


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Soy Protein

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25g of soy protein daily helps to TC, LDL, TG

levels (US FDA health claim)

Examples of soy protein sources:

1 cup tofu = 17g protein

1.5 piece tempe = 17g protein

1 glass soy milk = 5 g protein


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Go Nuts

Tree nuts eg : almonds, hazelnuts,walnuts,

pecan, cashew, hazelnuts, pistachio

Eat 30 grams per day may reduce the risk of

coronary heart disease

Choose unsaltedor without h oney coated nuts


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Beta Glucan

Beta-glucan is a soluble fiber derivedfrom the cell walls of algae, bacteria,

fungi, yeasts, and plants.

3 grams beta-glucan daily may reducetotal cholesterol & LDL cholesterol


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Goal : 3 grams / day

10 tablespoonoats daily


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Plant sterols

In Malaysia, plant sterols are added to low fat milk

In other countries, plant sterols are added to

margarine, yogurt, fruit juices

Disclaimer: Photos are for education purpose only & not to endorse any brands.


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Challenges

Clients are not ready for change

Clients do not want to be told off

Poor long term adherence Food Myths & unproven dietary practices


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How do Dietitians solve the

puzzle?

Motivational Interview

Practical Healthy Eating Advice


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Motivational Interview

A directive, patient-centered counseling

style that aims to help patients explore and

resolve their ambivalence about behaviour

change, NOT to tell them how to change

(Miller & Rollnick 1991)


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MI to improve Health Behaviors

Traditional Approach MI Approach

Emphasizes weakness Emphasizes as strength

Try to fix the problem Builds on what people already

know and what to doTriggers defensiveness and

shutting down

Stimulates cognitive function

and perceptual accuracy


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Practical Healthy Eating Advice

Variety, Moderation & Eat Mindfully

Make HALFof the plateFRUITS & VEGETABLES

QUARTERof

the plate STARCH QUARTERof the plate LEAN

MEAT/FISH/PROTEIN


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Low Fat Signals

Microwave

Steam

Stir Fry

Grill Soup


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Make Your Call When Eating Out

Grilled Fish

Fried Fish Roti bakar kopitiam

Tuna sandwich

Curry Mee

Souped Mee


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Plain thosai with

dhal

Ghee tosai with

chutney

Nasi lemak special

Nasi lemak

Hokkien Mee

Wantan Mi Sup

Make Your Call When Eating Out


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Cooking Demonstration


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Recipe Booklet(recipes contributed by Dietitians)


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Conclusion

Lifestyle modification plays an important role in

reducing risk of cardiovascular disease

Nutrition counseling by Dietitians are not

addressing the basic advice only, but alsoinclude the latest evident based updates

Refer your patients to dietitians for individualized

meal plan & practical healthy eating advice


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