Implementing Dietary Recommendations for Heart

Health: Moving from Ideal to Real

April 28, 2010

Presenters:

James M. Rippe, MD – Leading cardiologist, Founder and Director,

Rippe Lifestyle Institute

Lisa Cooper, MS, RD – Senior Research Dietitian, Rippe Lifestyle Institute

Moderator:

Barbara J. Ivens, MS, RD, FADA – Senior Nutrition Director, ConAgra Foods

SELECT SUMMARY SLIDES FOR DEVELOPING STAND ALONE PRESENTATIONS

Nutri-Bitessm Webinar Summary

Current landscape of authoritative recommendations for heart health converging on the need for a preventative approach.

Understanding influences on, and barriers to, heart healthy eating provides opportunities for developing effective strategies to help individuals make recommendations ‘real’ in their everyday lives.

Individualize the interventions; use Vital Signs of Cardiovascular Health to open counseling conversation; target those most receptive to dietary changes for heart health.

Implementing Dietary Recommendations for Heart Health: Moving from Ideal to Real

Prevention: THE Focus of Future Prevention: THE Focus of Future GuidelinesGuidelines

Nutrition and dietary patterns play a major role in the promotion of health and prevention of disease.

Diet is not “one factor but a complex constellation of multiple factors.”

These facts and observations of how they play out in lives of Americans are shaping new goals, guidelines and strategies for change.

A Welcome StepA Welcome Step

Lifestyle medicine practitioners and research scientists have Lifestyle medicine practitioners and research scientists have promoted for over two decadespromoted for over two decades

Part of the objectives of Dietary Guidelines for AmericansPart of the objectives of Dietary Guidelines for Americans

An objective of 2008 Guidelines for Physical ActivityAn objective of 2008 Guidelines for Physical Activity

The approach of professional organizations such as the The approach of professional organizations such as the American Dietetic Association (American Dietetic Association (www.eatright.org), ), Preventive Cardiovascular Nurses Association (Preventive Cardiovascular Nurses Association (www.pcna.net) )

and others have championed and others have championed

This approach to prevention is well-established.

Basics of Human Food Basics of Human Food BehaviorsBehaviors

Convenience Convenience Variety and choiceVariety and choice (The option of) Value(The option of) Value

Food taste or palatability also plays an important Food taste or palatability also plays an important role in food choices.role in food choices.

Research suggests that there are three principles of human behavior that cannot be changed. These relate to food choices and other choices.

As individuals and consumers we seek:

Sources: Brian Wansink. Marketing Nutrition: Soy, Functional Foods, Biotechnology and Obesity. Urbana and Chicago: University of Illinois Press, 2005. pp.86-87. 2) Dr. Wansink’s presentation to DGAC 2010. www.dietaryguidelines.gov

Many Influences on Food Many Influences on Food ChoicesChoices

Beyond internal determinants of food behaviors, a Beyond internal determinants of food behaviors, a growing body of research suggests that a complex growing body of research suggests that a complex mix of environmental factors influence individual mix of environmental factors influence individual food choices.food choices.

Better understanding of these factors may help us:Better understanding of these factors may help us: Answer Answer whywhy nutritional guidelines have not had as nutritional guidelines have not had as

great an impact on individual food choices and great an impact on individual food choices and public health as intended and hoped.public health as intended and hoped.

Develop more effective strategies Develop more effective strategies howhow to to promote individual and population change and promote individual and population change and adherence to healthful food choices and eating adherence to healthful food choices and eating patterns.patterns.

Hierarchy of Factors that Hierarchy of Factors that Influence Food ChoiceInfluence Food Choice

Adapted from AHA Scientific Statement: Implementing American Heart Association Pediatric and Adult Nutrition Guidelines. Circulation 2009;119:1161-1175.

Guidelines Continue Guidelines Continue Evolving . . .Evolving . . .

Moving from nutrients and components to Moving from nutrients and components to emphasize whole foods and eating patterns emphasize whole foods and eating patterns

Providing simple messages about foodProviding simple messages about food– Eat more fruits, vegetables and whole grainsEat more fruits, vegetables and whole grains– Get two fish meals weekly; eat healthy fatsGet two fish meals weekly; eat healthy fats– Limit sodiumLimit sodium

Positive messages when possible – Positive messages when possible – “ “Do” rather than “Don’t”Do” rather than “Don’t”

Linking nutrition and physical activityLinking nutrition and physical activity

to Meet the Challengesto Meet the Challenges

Strategies for ChangeStrategies for Change

Start with the individual client (or focused group)Start with the individual client (or focused group) Assess client readiness to changeAssess client readiness to change Assess barriers that may block successAssess barriers that may block success Use counseling techniques that foster clients Use counseling techniques that foster clients

making their own decisions and choosing steps making their own decisions and choosing steps for changefor change– Motivational interviewingMotivational interviewing– Five A’s: Assess, Advise, Agree, Assist, ArrangeFive A’s: Assess, Advise, Agree, Assist, Arrange

Provide tools for changeProvide tools for change Provide supportProvide supportGoal: Empower client self efficacy

What do we know works?

Giddings et al. Circulation 2009; Martins & McNeil. CliinPsychRev 2009; Searight, AmFamPhys 2009; Henson et al. Appetite 2010

Vital Signs of Heart Healthy Diet – AHA Healthy Diet Vital Signs of Heart Healthy Diet – AHA Healthy Diet

ScoreScore

Vital Signs of ObesityVital Signs of Obesity

Vital Signs of Physical ActivityVital Signs of Physical Activity

Use Vital Signs of Heart HealthUse Vital Signs of Heart Health

Taking each vital sign provides a cost-effective opportunity to Taking each vital sign provides a cost-effective opportunity to discuss heart healthy behaviors and strategies for change. discuss heart healthy behaviors and strategies for change.

Fruits and vegetablesFruits and vegetables 4.5 cups/day4.5 cups/day

FishFish two 3.5 oz svgs/wk (preferably oily fish)two 3.5 oz svgs/wk (preferably oily fish)

Fiber rich whole grainsFiber rich whole grains three 1 oz. equiv/daythree 1 oz. equiv/day

SodiumSodium <1500 mg/day<1500 mg/day

Sugar-sweetened beveragesSugar-sweetened beverages 450 cal (36 oz)/wk [1/4 of a week’s discretionary 450 cal (36 oz)/wk [1/4 of a week’s discretionary cal.]cal.]

Weight BMI Waist circumference

Stanford Brief Activity Survey (SBAS) or other brief, validated checklist.

2000 kcal/day basis

Resource Links on Implementing Heart Health Recommendations

American Heart Association www.americanheart.org

Vital Signs of Heart Healthy Diet - Lloyd-Jones et al. Defining and Setting National Goals for Cardiovascular Health Promotion and Disease Reduction. Circulation 2010; epub Jan 10, 2010, Abstract.

Vital Signs of Obesity - de Koning L et al. Eur Heart J. 2007 Apr;28(7):850-6. Epub 2007 Abstract; Craigie AM et al. Obes Facts. 2009;2(3):150-156. Abstract; Dunkley AJ et al. Obes. Facts 2009, Abstract; Ness-Abramof R, Apovian CM. Nutr Clin Pract. 2008 Aug-Sep;23(4):397-404, Abstract; Lemieux I, et al. Can J Cardiol. 2007 Oct;23 Suppl B:23B-31B Abstract; Schneider HJ et al. J Clin Endocrinol Metab 2010, Abstract.

Vital Signs of Physical Activity - Pate et al. AJLM 2010 Abstract; Dunn AL. AJLM 2009 Abstract; Taylor-Piliae et al. J Cardio Rehabil Prev 2007, Abstract; Taylor-Piliae et al. J Phys Act Health. 2010, Abstract.

Original recording of April 28, 2010 webinar and PDF download of PowerPoint available at:

www.startmakingchoices.com/health-professionals

Implementing Dietary Recommendations for Heart Health: Moving from Ideal to Real