June 2018 - August 2018

MCI (P) 069/11/2017 fb.com/heartfoundationmyheart.org.sg twitter.com/heartSG

Official Publication of the Singapore Heart Foundation

@singaporeheartfoundation

03

大家好! 我是Xin Xin - 新加坡心脏基金的最新健康主张型机器人

15

21

Volunteering from the Heart

Cardiology for the Layman #7What is Preventive Cardiology?

PATRONESM Goh Chok Tong

CHAIRMAN EMERITUSDr Low Lip Ping

SHF 47TH

BOARD OF DIRECTORS

CHAIRMANProf Terrance Chua

VICE-CHAIRMENDr Tan Yong SengMs Tan Lee Chew

HONORARY SECRETARYProf Tan Huay Cheem

ASSISTANT HONORARYSECRETARYMr Goh Chiew Seng

HONORARY TREASURERMrs Elsie Foh

MEMBERSDr Chee Tek SiongMr Chong Chou YuenDr Goh Ping PingMdm Koh Teck SiewDr Bernard KwokMrs Regina LeeProf May LwinDr Mak Koon HouMr Peter SimDr C SivathasanAdj Asst Prof Jack Tan

HONORARY ADVISORSProf Koh Tian HaiMr Liak Teng LitMr Lim Soon HockA/Prof Lim Yean TengDr Lily NeoMr Tan Kin LianMr Wong Yew Meng

EDITORIAL COMMITTEE

EDITORMr Patrick Deroose

MEMBERSProf Terrance ChuaDr Chee Tek SiongDr C Sivathasan

SECRETARIATMr Vernon KangMs Stephanie HoMs Mabel Tang

2 Editor’s Note

heartline is a quarterly publication of the Singapore Heart Foundation.9 Bishan Place, #07-01 Junction 8 (Office Tower), Singapore 579837Tel: 6354 9340 • Fax: 6258 5240 • Email: info@heart.org.sg

The information provided in heartline is for educational purposes only. It should not be used for diagnosingor treating a heart problem or a disease, and should not be substituted for professional health care. Opinions expressed by contributors and advertisers do not necessarily reflect those of the SHF.The SHF does not endorse any products or services in heartline advertisements.

All rights reserved. Copyright is held by SHF.No portion of this publication can be reproduced without the permission of SHF.To advertise in heartline, please email info@heart.org.sg or call 6354 9340.Terms and conditions apply.

Want a copy of heartline delivered to your doorstep?Call 6354 9340 for a copy of the subscription form.Designed by: Vacain Design Pte Ltd • Printed by: A&D Printhub Pte. Ltd.

DEAR READERS,

In April 2018, USA’s former First Lady Barbara Bush passed away at the age of 92. A few days before, the family announced that she had decided not to seek additional medical treatment for congestive heart failure and chronic obstructive pulmonary disease (COPD), but will focus on comfort care instead. “The decision to seek comfort care was a very personal decision that she didn’t have to share, but hopefully it will encourage others to think about their choices, talk about their choices, document their choices and have their choices honoured,” said Nathan Kottkamp, Founder and Chair of National Healthcare Decisions Day.

But what is comfort care? Comfort care provides medical treatment and nursing care focused on allowing a natural death, making the patient pain-free and anxious-free along the way. It does not mean hastening death or prolonging death, but instead, allows one to die with dignity. This approach to the end of life is quite common in Western societies. In Asia however, this does not seem to be so widespread, as obvious from a 2014 study published in the International Journal of Nursing Practice on nurses’ knowledge and attitudes on comfort care for patients in a hospital in China. The study concludes that there was a large difference in the knowledge between nurses from different departments on comfort care. The authors Hou et al. suggest developing continuing education programmes to improve the knowledge and skills in comfort care. The South China Morning Post on 23 October 2017 headlines, “Hong Kong still offers limited options for end-of-life comfort and compassionate care”.

In Singapore, we are fortunate to have organisations like the Singapore Hospice Council which promotes comfort care for terminally ill patients, irrespective of the nature of their illness. This concept was even brought from the traditional institutional and home care setting into the Accident and Emergency (A&E) department at hospitals such as the National University Hospital, Changi General Hospital, Khoo Teck Puat Hospital, and many more in this region.

We are slowly moving away from the idea that the only way to express filial piety to a dying loved one is to invest large amounts of time and money in extraordinary measures to prolong life. Instead, quality of life, dying in comfort and peace, surrounded by family members and friends, can be equally acceptable too. Along the same lines, we are also moving away from the concept that comfort care is for terminally ill cancer patients only. The holistic patient-centred approach of comfort care applies to all terminally ill patients, irrespective of the cause of their illness, and this includes irreversible end-stage cardiac failure.

We are privileged to live in a country that is open to new ideas and is prepared to invest in education to make this happen, for the benefit of our terminally ill patients. To all Singapore nurses who work tirelessly every day to provide the best care, a very Happy Advanced Nurses’ Day on1st August 2018!

Patrick Deroose

3Feature

PREVENTIVE CARDIOLOGY?WHAT IS

Article contributed by Mr Tay Hung Yong, Principal Physiotherapist at SHF-Heart Wellness Centre

Cardiovascular disease (CVD) is the leading non-communicable disease (NCD) in the world, and it was one

of the top two causes of death in Singapore in 2016.

While CVD can mostly be prevented and controlled through a comprehensive and integrated action plan, it is very expensive to treat. Hence, regular health screenings are important to identify the early signs of CVD. In addition, modifiable

behavioural risk factors namely a sedentary lifestyle, unhealthy diet, tobacco smoking and harmful consumption of alcohol are known to be associated with CVD.

This is where preventive cardiology is applicable – to help reduce the risk of developing CVD and prevent future heart events from recurring.

Cardiology for the Layman #7

In order to understand the concept of preventive cardiology better, we will use a case study to illustrate how it works. Mr A is an overweight 60 year-old Singaporean Indian man. He is a heavy smoker, has high blood pressure, high cholesterol levels

and a positive family history of heart disease (refer to Tables 1 & 2). Mr A is a full-time school attendant who walks about 6,000 steps per day.

Case Study

3 Levels of Prevention

Efforts taken to minimise the

development of cardiovascular risk factors in a society

or community

Treatment of risk factors to prevent heart diseases or a heart attack from

occurring

Treatment of existing conditions, thereby reducing recurrent heart

events

4 Feature

Table 1 - Mr A’s ‘non-modifiable risk factors’ interpretation

1SCRS: Singapore Cardiac Risk Score, 2011

Table 2 - Mr A’s ‘modifiable risk factors’ interpretation and targets

Non-modifiable risk factors Mr A What does it mean?

Age 60 years old The risk is higher for those aged over 60 years old

Gender Male Relative cardiac risk is higher than a woman of the same age

Origin Indian Very high chances of developing heart diseases

Family History Family history of premature atherosclerotic cardiovascular disease (his father died of a stroke at 57 years old)

First degree relative having a CVD event means a higher cardiac risk for Mr A

Modifiable Risk Factors Mr A Targets1 Interpretation1

Body Mass Index 29.8 kg/m2 <23kg/m2 Obese and at an increased risk of health complications

Waist Circumference 102cm 90cm Substantially increased risk of metabolic diseases such as diabetes

Diet Fats Mutton 3 portions/week (total 300g)

Opt for healthier cooking methods - steam, grill and bake; 1 portion of oily fish to replace red meat

Poor dietary habits = Increased CVD risk

Vegetables and Fruits

Average of 263g/day 400g/day (at least 4 portions per day)1 portion = 1 cup

Fish Less than 1 portion per week

2+ portions per week (one of which should be oily)1 portion = 1 palm-size and thickness

Salt >6g/day <6g/day

Snacks 8 sweet + 10 savoury portions/week

Avoid snacks

Alcohol None <21 units/week

Legumes and Pulses

4 -5 times per week Maintain

Nuts None 1 serving/week

Protein Red meat (300g/week)Milk (1,400ml/week)

Reduce protein intake, aim to consume about 3.5 portions of meat per day1 portion = 1 palm-size and thickness

Excessive intake of protein means excessive caloric intake leading to weight gain

Carbohydrates Daily rice at all meals, potatoes (fried) in curries, flat bread

Choose brown rice and other wholegrain products

Excessive intake of carbohydrates means excessive caloric intake leading to weight gain

Smoking Status Current heavy smoker

Quit smoking Substantial increased risk of CVD

Lipids TC 6.7 mmol/l < 4.1 mmol/l High cholesterol; Singapore cardiac risk score ≥ 20% (high risk)1LDL-C 4 mmol/l < 2.6 mmol/l

HDL-C 1.1mmol/l > 1 mmol/l

TG 1.3 mmol/l < 1.7 mmol/l

TC:HDL-C 6.1 < 6

Blood Pressure 160/90mmHg <140/90 mmHg High blood pressure

Glucose 6.0 mmol/l ≤6.0mmol/l Requires regular monitoring

5Feature

According to the Singapore Cardiac Risk Score (SCRS) assessment, Mr A is at a high risk of contracting coronary artery disease within the next 10 years. Since Mr A is a South Asian by origin, by World Health Organisation mortality stratum, he comes from a region with people having high risk of dying from heart diseases. Thus, active management is justified, namely professional lifestyle management and medical management to reduce his risk, prolong his lifespan and enhance his quality of life (MOH, 2011). In an ideal situation, he would be referred to a family-based multi-disciplinary vascular health programme, such as the rehabilitation programme in SHF - Heart Wellness Centre.

Behavioural and Psychosocial Management

As part of the preventive cardiology programme, a comprehensive assessment of Mr A’s health will be done. It involves a multi-disciplinary team to look into the different aspects of his lifestyle - smoking, diet, physical activity level, psychological status, socioeconomic environment and family history. Based on the initial assessment results (refer to Tables 1 & 2), there is an urgent need to manage his risk level.

Before embarking on any programme, it is important to assess Mr A’s motivation level, as it can affect the outcome of his programme. Information should be shared beforehand on the various conditions and interventions, to correct any misconceptions and doubts that he might have. The healthcare professional will also help him to set the goals.

Family involvement such as support from one’s spouse is equally important, as they are likely to share the same lifestyle. Mr A’s lifestyle and behavioural change might be more successful with his wife’s support. Do also check if any financial assistance is required.

The priorites for Mr A's health management are:• Stop smoking• Improve diet• Improve physical activity status and fitness level• Manage/reduce weight and abdominal circumference• Control blood pressure• Improve lipids profile

As aforementioned, the multi-disciplinary team will help Mr A on the various issues identified above and suggest ways to improve them.

It is important to note however, that the benefits of a management plan can only be seen if one adopts lifelong changes, in order to lower the risk of CVD.

The road to a healthy heart may not be a short journey, but with small steady steps and perseverance, you can certainly make a difference and lead a longer and better life!

*Disclaimer: For information purposes only. Not professional medical advice nor a substitute.

When should you go for health screening?

Sugar Level Fasting Plasma Glucose

Normal <6.0mmol/L

Pre-diabetes 6.0-6.9mmol/L

Diabetes >7.0mmol/L

Test Types

Total Cholesterol <5.2mmol/L

LDL Cholesterol (Bad) <3.4mmol/L

HDL Cholesterol (Good) more than 1.0mmol/L

Triglycerides <2.3

Weight Status

BMI

Healthy Weight

18.5 to below 23

Overweight 23 to below 27.5

Obese 30 & above

Risk Category

Low risk of getting diabetes, hypertension and high cholesterol

Female <80cm

Male <90cm

Waist CircumferenceBody Mass Index BP Normal Range

It is recommended when you are:

18 years old & above

once a year once every 2 years& more frequently

once every 3 years& more frequently

40 years old & above

once every 3 years& more frequently

Fasting Lipids(For high

cholesterol)

Fasting Glucose(For screening

diabetes mellitus)

Less than14090

mmHg

Scan here to read the full article

7BP Initiative @ Schools

SHF’s Newest Health Advocate RobotXin Xin is the Singapore Heart Foundation’s newest social robot that is involved in enhancing the interactivity of the Blood Pressure (BP) Initiative @ Schools programme. This programme is a 1-hour workshop targeted at Primary 5 students, to educate them on high BP and the importance of keeping their BP healthy. Xin Xin is part of a research collaboration with the Nanyang Technological University, to explore the use of social robots as a valuable tool to engage children and impart health messages more effectively.

About Xin Xin

Xin Xin is a direct translation from the Chinese words - 新心, which means new heart. It is also an interpretation of us embracing new technology to advocate for heart health.

Sight:

Using two cameras in her eyes, she can recognise:

• A variety of food pictures and identify the one with the lowest salt intake (Salt Intake Game).

• QR codes embedded with various BP numbers and identify the correct range via a QR code, to the posed question (Understanding your BP Numbers Game).

Interaction:

Xin Xin can read out BP measurement results from the BP monitor and analyse if the BP is normal.

Touch:

The numerous sensors in her head, hands and feet, enable her to perceive her environment and respond to touch during interactive games.

Communication:

She can speak via built-in speakers and share interesting key facts about blood pressure.

Mobility:

Xin Xin can move and interact like a human, due to her humanoid shape. She can also gesture as she speaks, to engage the children.

Gender: FemaleHeight: 58cmWeight: 4.3kg

Hi! I’m

For more information about Xin Xin and theBP Initiative @ Schools programme, please call

6354 9372/78 or email bp_initiative@heart.org.sg.

Your daily dose of morning fix may be doing more for you, than just providing that perk-me-up effect. Apart from the usual

coffee and tea, legume (plant-based) milk can be a nutritious and healthy beverage option for those who are lactose intolerant.

They include soya milk, almond milk, black bean milk, etc.

Derived from plants, legume milk is not only cholesterol-free but is also high in protein and dietary fibre, yet low in saturated fat. In particular, the protein level from soya beans is similar to that of animal protein such as eggs. Replacing animal proteins with plant-based proteins, can help to reduce your saturated fat intake.

There are many healthier beverage options in the market these days, with some being fortified or

enriched with calcium and omega-3. For those who do not drink fresh milk, soya milk is a good alternative

to increase calcium intake, which is essential for good bone health.

Embark on a healthy lifestyle today by choosing your morning fix wisely! Opt for unflavoured or no-added sugar beverages.

Note: Added sugar is sugar that is added to the food during manufacturing, cooking or at the table. They provide calories with little to no nutritional value. Added sugar should not exceed more than 10% of dietary energy, which translates to approximately 40-55g (8-11 tsp) daily.

Editorial8

9Health Bites

Do you wish to receive heart health related news on a regular basis? Subscribe to our newsletter heartline by emailing mabel@heart.org.sg with your name, email address and contact number.

Health Bites

According to the World Health Organization (WHO), 1.9 billion

adults worldwide are overweight or obese, putting them at an

increased risk for heart attacks. A new study has found that one’s

hip and waist size may be an early indication, especially for women.

Over 479,600 overweight European adults with no history of

heart disease, at an average age of 56 years old participated in the

study and 5,710 of them experienced heart attacks over a period

of 7 years. While heart attacks are more common in obese people,

the risk is significantly higher among those with an unusually large

waist circumference or a high waist-to-hip ratio. This is because

visceral fat (fat that is accumulated around the midsection) is more

active and can increase inflammation, which causes diabetes and

coronary artery disease. The WHO recommends a maximum

healthy waist-to-hip ratio of 0.9 for men and 0.85 for women.

Scan here to calculate

your waist and hip ratio

Women with bigger waist and hips

have higher heart attack riskWe have always been told that to lose weight, one should reduce the amount of calorie intake. However, a study has found that those who considered the quality of food they consumed without counting calories or limiting portion sizes, lost significant amount of weight in 1 year. Over 600 participants were separated into 2 groups – healthy low-carbohydrate and healthy low-fat diets. They reduced consumption of added sugar, refined grains and highly processed foods but instead, ate more vegetables and whole foods. Participants who lost the most weight had a changed ‘relationship with food’ – they no longer ate in their cars, in front of the TV and they cooked more. Both groups also saw improvements in other health markers, such as reductions in their waist sizes, body fat, blood sugar and blood pressure levels. The bottom line is - diet quality is important for both weight control and long term well-being.

The key to weight loss is diet quality, not quantity

A U.K. research has revealed that people with a family history of heart disease who

exercised more, are less likely to have heart attacks and stroke, as compared to

those who are inactive. Approximately half a million participants aged between 40

to 69 years old and without heart diseases, were recruited for the study and they

experienced 20,914 cardiovascular events (heart attacks, strokes, atrial fibrillation

and heart failure) over a period of 6 years. Researchers used a physical activity

questionnaire to assess their exercise intake. They also conducted treadmill tests

to determine fitness, used hand-held tools to test grip strength and collected

genetic data on most of the participants. Results found that exercise resulted in

a lower risk of heart problems. This could be because being physically fit leads to

more lean body mass, less fat mass and obesity - leading to less hypertension and

diabetes, better utilisation of glucose and insulin, and overall, better metabolic

health. Hence, always keep moving to keep diseases at bay!

When heart disease runs in the family,

exercise is tied to lower risk

Event Review 11

CPR+AED Certification Courseon International Women’s Day

Cardiovascular disease is the #1 killer of women worldwide and it is responsible for 1 in 3 deaths amongst women in Singapore. To shine a

spotlight on the disease, SHF organised a complimentary cardiopulmonary resuscitation (CPR) + automated external defibrillator (AED) certification course specially for women on International Women’s Day, 8th March 2018.

Held at the Roof Garden of Junction 8 Shopping Centre, the workshop was themed ‘Touch of Red’ where participants

were encouraged to dress in red attire, to show their support for International Women’s Day. The workshop aimed to promote the importance of taking care of one’s heart health and empowered the ladies with life-saving

skills. All 75 participants completed the assessment at the end of the workshop successfully and were

certified as CPR+AED providers.

To register for CPR+AED/BCLS+AED certification courses,visit www.myheart.org.sg, call 6354 9371/40 or email cpraed@heart.org.sg for more information.

13Event Review

Healthy Mummy,Healthy Family Symposium 2018

In conjunction with the annual Go Red for Women campaign and in celebration of Mother’s Day, SHF organised its

second installation of the ‘Healthy Mummy, Healthy Family Symposium’ on 12th May 2018, to empower women with the knowledge and tools to help them reduce their risk of cardiovascular disease. Almost 300 participants, many of whom are mothers, turned up for the event held at Keat Hong Community Club.

Cardiovascular disease is the one of the top 2 killers in Singapore but fortunately, it is mostly preventable by adopting positive lifestyle habits such as eating healthily. Tips on label reading were shared at the event and the first virtual supermarket tour in Singapore was launched by Dr Goh Ping Ping, Spokesperson for the Go Red for Women campaign.

The virtual supermarket tour is an interactive 360-degree virtual reality application that can be viewed on a smart phone or webpage, and aims to empower members of the public with the skills and knowledge to make better food choices. Users are able to move or click around the screen to compare each food item before making a selection. The symposium also featured two informative workshops on healthy eating and stress management. In addition, participants took part in a salt taste test to determine their salt threshold and tips were provided to help reduce salt intake.

Special guests – FLY Entertainment Artiste & Celebrity Mummy Florence Tan 陈秀丽 shared personal tips on cultivating healthy living habits in the family, while Celebrity Chef Daniel Koh demonstrated how to prepare a healthier version of Seafood Cioppino (stew). The event concluded with the Hearty MasterChef Challenge Finale, where 5 contestants battled it out in a mystery box challenge and Koa Yuet Lee emerged as the winner this year.

Our heartfelt thanks and appreciation goes to Agri-Food & Veterinary Authority of Singapore (AVA), Captain Oats, Colour Me Happy Cosmetics, Good Salt, Kang Kang, KitchenSq LLP, Knife, Naturel, Nestle, Omron, Philips, San Remo, UFC Velvet and Waiz, for making this event a great success!

Scan this QR code to have a go at the Virtual Supermarket Tour

If you do volunteer work, you would have experienced the emotional rewards of donating your time. What you might not realise however, is that volunteering may

offer some added advantages for your heart.

“There’s a growing body of research showing that volunteering is associated with better physical and mental health outcomes,” says Eric S. Kim, a research fellow at the Harvard T.H. Chan School of Public Health. A study he co-authored, published in Social Science and Medicine, found that volunteers were more likely to use preventive health care services. For instance, people who volunteered were 47% more likely to get cholesterol checks.

Measurable Gains

Research has found that people who volunteered on a regular basis (at least 200 hours a year) were 40% less likely to develop high blood pressure over a four-year period than non-volunteers. Volunteers also had greater increases in psychological well-being and physical activity.

Another intriguing potential benefit is that volunteering may give people a greater sense of purpose in life. There are three elements to a sense of purpose: a sense of meaning, a sense of direction, and a goal to strive for. In recent years, research on health and longevity has expanded to focus more on such positive emotions.

“We know that stress, depression, and anger all have negative effects on the body, especially with regard to the risk of cardiovascular disease,” says Kim. The opposite emotions and mindsets — satisfaction and optimism — are closely linked to (but not necessarily synonymous with) a sense of purpose, he adds. Yet a sense of purpose is associated with better heart health above and beyond the effects of optimism and a positive outlook.

In fact, a report in Psychosomatic Medicine that pooled findings from 10 different studies found that people with a high sense of purpose in life had a lower risk of having a cardiovascular event (such as a heart attack or stroke) and of dying from any cause, compared with people who had a lower sense of purpose.

In addition, more than 75% of volunteers indicated that volunteering made them feel physically better and that they felt their health had improved over the previous year. This could be because volunteers are more likely to seek out information on their health, making them more engaged patients. Volunteers with chronic health issues are better able to manage their illness by staying active and keeping their mind focused on other tasks.

How To Get Started?

So should you choose to volunteer, remember not to overcommit. Start small and be honest with yourself about how much time you can spare. For instance, begin with a single event or project, instead of a long-term commitment. Once you are comfortable with the organisation and have a better idea of how much time you can reasonably give, you can then decide on what works best for you. Consider also your personal goals for learning and development. This will help you find the right volunteering experience and ensure that it is a fulfilling match.

Have fun and enjoy the meaningful experience that volunteering brings!

“Volunteers do not necessarily have the time; they just have the heart.”~ Elizabeth Andrew

HelpingHands,WillingHearts

Volunteerism14

Article adapted from Harvard Health Publishing & alive.com

15Volunteerism

As a non-profit charitable organisation with limited resources, SHF continuously recruits volunteers to help in administrative and office

support duties, as well as onsite event support for community outreach and fundraising activities.

Volunteers are the lifeblood of our fight against heart diseases! Our volunteers are of all ages and come from many walks of life. Dedicated and loyal, they serve as shining examples of community involvement and self-sacrifice. heartline speaks to two such volunteers, Christine and Darius.

1. How did you start your volunteering journey?

Darius: I was looking for an organisation that I could volunteer or help with. My attention was captured by a notice from the Singapore Heart Foundation, looking for volunteer photographers. I volunteered for 3 consecutive events as a photographer and I found it very fulfilling. Subsequently, my wife Christine joined me as a volunteer too. Most of the time, she volunteers as an usherette. From then on, we would volunteer at SHF events whenever our time permits.

2. How long have you been volunteering with SHF

and why did you choose to volunteer with us?

Christine: Darius and I started volunteering in May 2011. When I got pregnant in 2013, we took a hiatus as we were busy with our baby. But now that our baby is grown up, we have started to volunteer once again. We chose SHF as we see that there are many community-based events, in working towards a heart healthier nation.

Volunteeringfrom theHeart

3. How would your friends describe you?

This is what our friends have said:

4. Why do you enjoy doing volunteer work and what experience can you share?

When we volunteer, we think that it is our way of giving back to others. We feel so blessed that we need to find a way to be a blessing to others too.

We enjoyed raising funds via the tin cans during SHF’s Hearty Flag Day. All donations went straight to the heart of the problem, by enabling the Foundation to fight against cardiovascular disease through its life-saving programmes.

5. What is your advice to anyone who may be keen in volunteering?

When you have the passion to help and commit to what you are doing for the community, the results are worth it and your impact will be much bigger. So sign up as a volunteer today!

If you would like to volunteer with SHF,please email volunteer@heart.org.sg or call 6354 9340.

They arehardworking people, down to earth and always ready to help others in times of need. Truly an inspiration to us!

Darius and Christine are

both extremely generous,

always willing to lend a helping

hand to friends, families and their

community. They not only give of

their precious time doing volunteer

work, but also share their blessings

by helping the underprivileged

children. We are fortunate to

have them as friends!

The DIRECT DONOR DEBIT PROGRAMME (DDDP) is designed toencourage individuals to give small donations to SHF on a regular basis, for our life-

saving programmes. SHF would like to thank the following DDDP Event Site Sponsors, who have generously provided their venues for our various roadshows.

TOGETHER, WE CAN WORK TOWARDS A HEART HEALTHIER NATION!

Congratulationsto all winners* and

thank you foryour participation!

*Winners have been notified via phone or email.

ANSWERS (Mar – May 2018)

16 Nutrition

Post FestivePeriod Checklist

1.2.3.4.5.6.7.

8.

control is a good way to manage calorie intake.

Cut back on to avoid consuming empty calories.

Reduce the of sweetened beverages and snacks.

Exercise for at least 150 minutes a .

Try to eat a healthy and diet.

Spice up your meal with instead of condiments.

Replace fat and fat with

fats.

Choose instead of refined grains.

Portion

sugars

frequency

week

balanced

herbs and spices

saturated

unsaturated

wholegrains

trans

Simply email/fax this page to heartline@heart.org.sg / 6258 5240 by 31 August 2018.

Name: ______________________________________________ NRIC: ______________________________________________

Email: ______________________________________________ Mobile: ______________________________________________

All winners will be notified via phone or email. Good luck!Look out for the answers in the next issue of heartline or visit www.myheart.org.sg after 1 September 2018.

Circle the correct answer!Note: It is important to exercise portion control and consume all food in moderation.

Submit your correct answersand 5 lucky winners will receive a limited edition SHF Heart Smart

Eating Plate in our lucky draw!

Do you know the truth about

1. Whole fruits have more nutrients than blended/squeezed juices.

True / False

2. A well-balanced diet and active lifestyle are the best formula to combat diabetes and other health issues.

True / False

3. Eating sugar can cause diabetes. True / False

4. Wholegrain food (e.g. wholemeal bread) contains more nutrients than refined grain food (e.g. white bread).

True / False

5. Foods that are labelled “no added sugar” do not contain any sugar.

True / False

6. If you are diabetic, you can consume desserts in moderation.

True / False

17Nutrition

预防性心病学?什么是

本文由新加坡心脏基金心脏健康中心的高级物理治疗师郑汉扬先生撰写而成

心血管疾病(Cardiovascular disease, CVD)是全球主要的非

传染性疾病(non-communicable disease, NCD)，也是 2016 年新加坡的两大主要致死因素之一。

虽然大多数的心血管疾病都可以通过全面综合的行动计

划来进行预防和控制，但其治疗费用相当昂贵。因此，

定期的健康检查对于识别心血管疾病的早期症状来说是

非常重要的。此外，可改变的行为风险因素，即久坐不

动、非健康饮食、吸烟以及有害饮酒经证实都会引发心

血管疾病。

这些都是预防性心病学适用的地方，可以此来帮助降低

患上心血管疾病的风险并防止未来心病事件的复发。

为了更好地理解预防性心病学的概念，我们会通过一个

病历来诠释它的作用机制。A先生是一位60岁的超重新加

坡印度人。他是一位重度吸烟者，身患高血压、高胆固

醇以及明确的心脏病家族史(参见表1和表2)。A先生是一

位全职学校服务人员，每天大约走路 6,000 步。

案例研究

三级预防

为预防心脏病

或心脏病发作

而对风险因素

作出的治疗

对已有的病症进

行治疗，从而减

少复发性心病事

件的发生

为最大程度地降

低某个社会或社

区的心血管风险

因素的发展而作

出的努力

外行人的心脏病学(七)

18 特写

19特写

表1 - A 先生的‘不可变风险因素’说明

表2 - A 先生的‘可变风险因素’说明及指标

不可变风险因素 A先生 代表了什么？

年龄 60岁 60岁以上人群的患病风险要更高

性别 男性 男性的相对心脏风险要高于同一年纪的女性

血统 印箱人士 发展心脏病的几率很高

家族史 早发动脉粥样硬化性心血管疾病的家族史(父亲在57岁时死于卒中)

一级亲属出现过心血管疾病事件意味着A先生具有更高的心脏风险

可变风险因素 A先生 指标1 说明1

体重指数 29.8公斤/平方米 <23公斤/平方米 属于肥胖水平，且出现健康并发症的风险会增加

腰围 102厘米 90厘米 患上代谢并发症(如糖尿病)的风险会大幅增加

饮食 脂肪 羊肉 3 份/周(总计 300 克)

选择更健康的烹饪方法: 蒸或烤; 用1份油性鱼代替红肉

不良饮食习惯=心血管疾病风险增加

果蔬 平均每天263克 400 克/天(每天至少 4 份)1份= 1杯

鱼类 每周少于1份 每周至少2份(其中一份应为油性鱼)1部分= 1手掌大小和厚度

盐 >6克/天 >6克/天

零食 每周8份甜食+10 份咸食

避免零食

酒精 无 <21计量单位/每周

蔬菜和豆类 每周4～5次 保持原样

坚果 无 每周1份

蛋白质 红肉(300克/周)牛奶(1400毫升/周)

减少蛋白质摄入量，每天吃大约3.5份肉1部分= 1手掌大小和厚度

过度摄入蛋白质意味着摄入了过度的热量，从而会导致体重增加

碳水化合物 每餐都有米饭，外加咖喱土豆(油炸)和扁平面包

选择食用糙米等全麦制品 碳水化合物摄入过多意味着热量摄入过多，而这会导致体重增加

吸烟情况 目前为重度吸烟者 戒烟 患心血管疾病的风险大幅增加

脂类 总胆固醇量 6.7毫摩尔/升 < 4.1毫摩尔/升 高胆固醇；新加坡心脏风险评分≥20%(高风险)1

低密度脂蛋白-胆固醇

4毫摩尔/升 < 2.6毫摩尔/升

高密度脂蛋白-胆固醇

1.1毫摩尔/升 > 1毫摩尔/升

热重 1.3毫摩尔/升 < 1.7毫摩尔/升

总胆固醇:高密度脂蛋白-胆固醇

6.1 < 6

血压 160/90毫米汞柱 <140/90毫米汞柱 高血压

葡萄糖 6.0毫摩尔/升 ≤6.0毫摩尔/升 需要定期监测

1SCRS: 新加坡心脏风险评分, 2011

20 特写

根据新加坡心脏风险评分(Singapore Cardiac Risk Score, SCRS)的评估来看，A先生在未来10年内患上冠状动脉疾病的风险很高。由于A先生为南亚裔出身，根据世界卫生组织的死亡率阶层来看，他来自拥有较高/非常高成人死亡率的地区。因此，积极进行管理对他来说是合理的，即对职业生活方式的管理和医疗管理，从而降低自身的患病风险、延长寿命以及提高生活质量(卫生部，2011年)。在理想情况下，他将被移交至以家庭为基础的多元学科血管健康计划中，如新加坡心脏基金 - 心脏健康中心的康复计划。

行为与社会心理管理

作为预防性心病学计划的一部分，A先生的健康状况将得到全面的评估。它涉及一个多学科团队，他们会研究A先生生活方式的不同方面——吸烟、饮食、体育活动水平、心理状态、社会经济环境以及家族史。根据初步评估结果(参见表1和表2)来看，他迫切需要控制自身的风险水平。

在开始任何计划之前，对A先生的动机水平进行评估是很重要的，因为这会影响他的计划结果。另外，还应提前与其分享各种情况和干预措施信息，以纠正他可能存在的任何误解和疑虑。医疗保健专业人员也将帮助他设定目标。

家人的参与，如配偶的支持同样重要，因为他们可能会共享同样的生活方式。有了妻子的支持，A先生的生活方式和行为改变可能会更为成功。另外，还要检查其是否需要获得任何财务援助。

A先生的健康管理优先事项是：• 停止吸烟• 改善饮食• 改善体育活动现状和健康水平• 控制/减轻体重和腹围• 控制血压• 改善脂质分布

如前所述，多学科团队将帮助A先生解决上述各种问题并提出改进方法。

无论如何，重要的是要注意，只有在采取终身改变的情况下，才能见证为了降低心血管疾病风险而采取的管理计划所带来的益处。

获得健康心脏的道路可能并不是一段短暂的旅程，但是只要稳步前进并坚持不懈，就一定能有所作为，并能拥有更长寿且更美好的生活！

*免责声明：仅供参考。这不是专业的医疗建议或替代意见。

什么时候去做健康检查？

糖水平 空腹血糖

正常 <6.0毫摩尔/升

糖尿病前期 6.0-6.9毫摩尔/升

糖尿病 >7.0毫摩尔/升

测验 类别

总胆固醇 <5.2毫摩尔/升

低密度脂蛋白胆固醇(坏)

<3.4毫摩尔/升

高密度脂蛋白胆固醇(好)

1.0毫摩尔/升以上

甘油三酯 <2.3

重量状态 体重指数

健康体重 18.5至23以下

超重 23至27.5 以下

痴肥 30以上

风险类别 低风险得糖尿病，高血压和高脂血症

女 <80公分

男 <90公分

腰围 正常血压体重指数

建议如果您是：

18岁及以上

一年一次 每两年一次并且经常 每三年一次并且经常

40岁及以上

每三年一次并且经常

空腹血脂(筛查高胆固醇)空腹血糖(筛查糖尿病)

毫米汞柱以下14090

要更深入地阅读，请在此处扫描

新加坡心脏基金的最新健康主张型机器人Xin Xin是来自新加坡心脏基金的‘血压知识计划’(BP Initiative @ Schools programme) 的最新型社交机器人，用于提高血压的知识和学生之间的互动。该计划是对小学五年级学生的一个专题讨论会，为时1小时，旨在向他们讲解高血压以及保持血压健康的重要性。Xin Xin是新加坡心脏基金与南洋理工大学合作开展的一项研究的一部分，用于探讨将社交型机器人用作一种有价值的工具来吸引儿童并更有效地传达健康讯息。

关于 Xin Xin

Xin Xin由中文单词“新心”直接翻译而来，其代表全新心脏的意思，也指代了我们通过拥抱新技术来主张心脏健康的意思。

视力：

通过眼内的两台照相机，她可以识别：

• 各种食物图片，并确定盐摄入量最低的食物(盐摄入量游戏)。

• 同时嵌入了 QR 码与各种血压数值，并通过 QR 码识别适用于所提问题的正确血压范围(了解个人血压值游戏)。

交互：

Xin Xin 可从血压监视器上读取血压测量结果，并分析该血压是否属于正常水平。

触觉：

她头部、手部和足部的众多传感器使得她可以感知周遭环境并在交互游戏中对触觉做出回应。

沟通：

她可以通过内置的扬声器进行沟通，并分享关于血压的有趣关键真相。

可动性：

由于自身的拟人体型，Xin Xin 可以像人一样行走和交流，也可以在说话时作出手势，以此来吸引儿童。

性别：女身高：58 公分体重：4.3 公斤

大家好! 我是

欲知更多有关 Xin Xin 和血压倡议@学校计划的信息，

请致电 6354 9372/78 或发邮件至bp_initiative@heart.org.sg。

21特写

Sweet Potato Chips with Guacamole

红薯片配鳄梨果酱

Method 做法: Sweet potato chips 红薯片1. Slice the sweet potatoes thinly. 将红薯切成薄片。2. Combine the sweet potato slices with

olive oil in a large bowl, sprinkle a pinch of salt (optional) and toss to coat.

把红薯片放入大碗中，倒入橄榄油进行混合，并撒上少许盐(可选)，上下颠动大碗使红薯片裹上佐料。

3. Arrange the sweet potato slices in a single layer, on a large microwave-safe plate.

将红薯片单层分开放置于一个可在微波炉内安全使用的大盘子中。4. Cook them in a microwave oven at 190°C (high heat) until the slices are dry and crisp. Set aside to cool. 把大盘子放入微波炉中进行烹饪，温度设置为 190°C（高温），直至红薯片变干脆。将成品

放于一边等待冷却。Guacamole 鳄梨果酱1. Use half an avocado and remove the flesh. Then, mash the flesh in a large bowl until smooth. 将半个鳄梨果肉放入大碗捣碎，直至稠度均匀。2. Add in the freshly squeezed lime juice and mix well. 加入鲜榨酸柑汁，并将两者均匀混合。3. Add onions and tomatoes into the avocado mash and combine the mixture. 将洋葱和番茄加入鳄梨果混合物中，随后混合这些佐料。 4. Scoop a small spoonful of the mixture and spread it onto the sweet potato chips to serve. 舀一小勺混合后的佐料，把它倒在红薯片上即可食用。

Ingredients 材料:• Sweetpotatoes,150g 红薯, 150 克• Onions,10g(diced) 洋葱, 10 克(切成丁)• Tomatoes,30g(diced) 番茄, 30 克(切成丁)• Oliveoil,1/2 tbsp 橄榄油, 半汤匙• Avocado,1/2 whole 鳄梨果, 半个• Limejuice,1/2 whole (large) 酸柑汁, 大半个• Salt(optional),toflavour 盐(可选), 根据个人口味

酌情添加

Nutrients per Serving 每份营养

Energy 能量: 89.1 kcal 千卡

Protein 蛋白质: 1.0 g 克

Fat (Saturated fat) 脂肪(饱和脂肪): 5.8 g 克 (0.9 g 克)

Carbohydrate 碳水化合物: 9.4 g 克

Sodium 钠: 15.8 mg 毫克

Cholesterol 胆固醇: 0 mg 毫克

Dietary fibre 膳食纤维: 2.5 g 克

22 Recipes

Recipe contributed by Ms Amanda Goh, nutritionist intern at Singapore Heart Foundation.本食谱由新加坡心脏基金(SHF)的营养学家实习生吴恩琪女士提供。

Preparation Time 准备时间:30 minutes 分钟

Cooking Time 烹饪时间:3 minutes 分钟

Serves 份量: 4 人份

TIP! 提示!Leave the sweet potato

chips to cool totally before serving it with guacamole spread, to enhance the crispiness of the chips.

在倒上鳄梨果酱之前，请先充分冷却红薯片，以便能提高薯

片的脆度。

Nutrients per Serving 每份营养

Energy 能量: 187.8 kcal 千卡

Protein 蛋白质: 16.6 g 克

Fat (Saturated fat) 脂肪(饱和脂肪): 10 g 克 (4.4 g 克)

Carbohydrate 碳水化合物: 8.1 g 克

Sodium 钠: 214.6 mg 毫克

Cholesterol 胆固醇: 192 mg 毫克

Dietary fibre 膳食纤维: 0.5 g 克

23食谱

杯子里煎蛋卷

Recipe contributed by Ms Amanda Goh, nutritionist intern atSingapore Heart Foundation.本食谱由新加坡心脏基金(SHF)的营养学家实习生吴恩琪女士提供。

Ingredients 材料:• Spinach,80g(chopped) 菠菜, 80 克(切碎)• Tomatoes,220g(diced) 番茄, 220 克(切丁)• Eggs,4whole 鸡蛋, 4 粒• Lowfatmilk,12tbsp 低脂牛奶, 12 汤匙• Cheddarcheese,40g 切达奶酪, 40 克• Eggwhites,4whole 蛋白, 4 整份

Method 做法: 1. Beat the eggs and egg whites together in a microwave-safe mug, until smooth. 将鸡蛋和蛋白倒入可在微波炉中安全使用的杯子里，混合至稠度均匀。 2. Mix in the milk, tomatoes, cheese and spinach. 加入牛奶、番茄、奶酪和菠菜。3. Leavethemuguncovered,placeitinamicrowaveovenandcookonhighheatfor1minute. 揭开杯盖，将其放入微波炉，高温烹饪1分钟。4. Remove the mug and stir, then cook for another 2 minutes or until the mixture is completely set

(Caution: hot!). 取出杯子并搅拌混合物，再放入微波炉烹饪2分钟，或微波至混合物完全凝固 (小心烫手!) 。

Preparation Time 准备时间: 20 minutes 分钟

Cooking Time 烹饪时间: 3 minutes 分钟

Serves 份量: 4 人份

Omelettein a Mug

TIP! 提示!Add in some

mushrooms, herbs or spices for more

flavour and texture!可加入一些蘑菇、香草或香料来获得更多的味

道和口感！