Marywood UniversityWeigh To Go

November 3, 2010

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?

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.

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

Natural Progression of Atherosclerosis

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

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

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.

Nutrient Composition of the Heart Healthy Diet

Nutrient Recommended Intake

Saturated fat* Less than 7% of total calories

Polyunsaturated fat Up to 10% of total calories

Monounsaturated fat Up to 20% of total calories

Total fat 25%-35% of total calories

Carbohydrate† 50% to 60% of total calories

Fiber 25-30 g/day

Protein Approximately 15% of total calories

Cholesterol Less than 200 mg/day

Total calories (energy) ‡

Balance energy intake and expenditure to maintain desirable body weight/prevent weight gain

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

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

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

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

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 (11th ed.). St. Louis, MO: Saunders.

• Calorie King: calorieking.com