Understanding blood lipids and glucose

1. Understanding blood lipids and glucose How a Healthy Lifestyle can improve your numbers Susan Fullmer, PhD RD Associate Teaching Professor Nutrition, Dietetics, and Food Science

2. Heart disease is the leading cause of death in the U.S. and world 1 in 3 women worldwide will die of heart disease More women then men diet every year from heart disease in the U.S. $403 Billion was spent in 2006 on CVD 7% of population has diabetes Leading cause of blindness, lower limb amputation, and kidney failure in U.S. Major risk factor for stroke and heart attack Cost of Heart Disease and Diabetes

3. Factors that are considered a High Risk for CVD • Established heart disease • Chronic kidney disease/failure • Diabetes* • 10-year risk Framingham global risk >20%

4. Factors that place someone “at risk” for heart disease • One or more of the following risk factors: • Cigarette smoking • Poor diet • Physical inactivity • Obesity, especially central obesity • Family history of premature heart disease (<55 years of male relative, <65 years in female)

6. Factors that place someone “at risk” for heart disease continued • High blood pressure • Dyslipidemia* • Evidence of coronary calcification • Metabolic syndrome • Poor exercise capacity on a treadmill test

7. Factors called “optimal Risk” for heart disease • Framingham risk score of <10% • Healthy lifestyle • No risk factors

8. 2006 AHA Diet and Lifestyle Goals for CVD Risk Reduction • Consume an overall healthy diet • Aim for a healthy body weight • Aim for recommended levels for LDL, HDL, and triglycerides • Aim for a normal blood pressure • Aim for a normal blood glucose level • Be physically active • Avoid use of and exposure to tobacco products

9. Lipids • Triglycerides • Chylomicrons • VLDL • Total Cholesterol • LDL • HDL • Chol/HDL ratio— • <5:1 is goal • <3.5:1 is optimal

11. Overweight, obesity Physical inactivity High carbohydrate intake (>60% of calories) Type II Diabetes, kidney failure Certain medications Cigarette smoking Alcohol intake Genetics Factors associated with elevated TG’s

14. 2007 Lifestyle guidelines for prevention of CVD in Women • Do not smoke • Physical activity • A minimum of 30 minutes of moderate intensity activity (brisk walking) on most, preferably all days of the week • For weight loss or maintenance: 60-90 minutes of moderate intensity activity on most, preferably all days of the week

15. 2007 Lifestyle guidelines for prevention of CVD in Women • Consume a diet rich in: • Fruits and vegetables • Whole grains • High fiber foods • Consume fish, especially fatty fish at least twice/week (source of omega-3 fatty acids) • Women with heart disease, MAY want to consider omega-3 supplementation of 850-1000 mg/day • Consider screening women with CHD for depression and treat when appropriate

16. 2007 Guidelines for prevention of CVD in Women • Limit saturated fat to <7% of calories (15-20 grams/day) • Limit cholesterol intake to < 200 mg/day • Reduce sodium intake to < 2,300 mg/day • Achieve and maintain an appropriate weight through healthy behavior changes (physical activity, calorie intake, and formal behavior programs if indicated) • Manage diabetes, blood lipids and high blood pressure aggressively

17. Saturated Fat

19. Plant sources of omega-3 fatty acids • Canola oil • Flaxseed and flaxseed oil • Walnuts • Soybean oil, tofu

22. Ineffective or potentially harmful interventions • Hormone therapy to prevent or treat CVD • Use of anti-oxidant supplements (Vit E, C, beta carotene) to prevent or treat CVD • Folic acid • Routine use of Aspirin (in healthy women under 65 years of age)

23. Clinical identification of Metabolic Syndrome (any 3 of the following)

24. Diagnostic Criteria for Diabetes

25. Risk Factors for Type 2 Diabetes • Family History • Older age (though incidence is growing in adolescent population) • Obesity (esp. intra-abdominal obesity) • Prior history of gestational diabetes • Physical inactivity • Prediabetes, race, ethnicity

26. American Diabetes Recommendations for Prevention/delay of Type 2 Diabetes • Modest weight loss (5-10%) • Participate in regular physical activity • Close attention should be given to, and appropriate treatment given for, other CVD risk factors (tobacco use, hypertension, dyslipidemia)

27. American Diabetes Association Nutrition related Goals for Diabetes • Attain and maintain optimal metabolic outcomes including: • Blood glucose levels in the normal range or as close to normal as is safely possible to prevent or reduce the risk for complications of DM • A1C <7.0% • Fasting blood glucose: 90-130 mg/dL • A lipid and lipoprotein profile that reduces the risk for CVD disease • LDL <100 mg/dL • Triglycerides <180 mg/dL • HDL >40 mgldL • Blood pressure levels that reduce the risk for vascular disease • <130/80 mmHg

28. American Diabetes Association Goals for Diabetes • Prevent and treat the chronic complications of diabetes. Modify nutrient intake and lifestyle as appropriate for the prevention and treatment of obesity, dyslipidemia (abnormal blood lipids), CVD, hypertension, and kidney disease • Improve health through healthy food choices and physical activity