Contemporary Diet Trends in Cardiology Sushma Koneru MD Disclosures None Objectives Address contemporary nutrition controversies and provide evidence based recommendations to facilitate dietary counseling by Clinicians ID: 919696
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Slide1
October 6, 2018
REACHING NEW HEIGHTS IN CARDIOVASCULAR CARE
Slide2Contemporary
Diet Trends in Cardiology Sushma
Koneru, MD
Slide3Disclosures
None
Slide4Objectives
Address contemporary nutrition controversies and provide evidence based recommendations to facilitate dietary counseling by Clinicians.
Slide5Prevalence of Obesity in U.S. Adults
Slide6Background
With rising rates of obesity, there is an increased interest in weight loss. Several diet programs have been developed, with varying dietary content.A number of controversial dietary patterns, foods, and nutrients have received significant media attention and are mired by “hype”.
The scientific evidence base for some of these diets is limited.
Slide7Dietary Patterns
Slide8Slide9Slide10Slide11Slide12Slide13Diet Evidence
The investigators pulled data from 45 studies, 39 of which were randomized, controlled
trials. The programs included Weight Watchers, Jenny Craig, Nutrisystem, Health Management Resources, Medifast, OPTIFAST, Atkins, The Biggest Loser Club, eDiets, Lose It!, and
SlimFast
.
Of those
11 diets,
only Weight Watchers and Jenny Craig had gone through studies showing that people not only lost weight but kept it off for at least a
year.
References:
Gudzune
K et al.
Ann Intern Med.
2015; doi:10.7326/M14-2238
Slide14160 overweight and obese patients randomized to the Atkins, Zone, Weight Watchers, or
Ornish
diets for 1 year
Weight loss is similar among diet programs, but hard to sustain because of poor long-term compliance
Source:
Dansinger
, ML et al.
JAMA
2005;293:43-53
20/40*
26/40*
26/40*
21/40*
0
3
6
9
Atkins
Zone
Weight Watchers
Ornish
Wt
loss (
lbs
)
Diet
Evidence
Slide15Slide16Source: Appel LJ et al.
NEJM
1997;336:1117-1124
Dietary Approaches to Stop Hypertension (DASH) Group
Diet low in fruits, vegetables, and dairy products
Diet enriched in fruits, vegetables, and fiber
Diet enriched in fruits and vegetables and low in fat and cholesterol
132
130
128
126
124
86
84
82
80
78
1
2
0
3
4
5
6
Systolic blood pressure
(mm Hg)
Diastolic blood pressure
(mm Hg)
Weeks
7/8
Diet
Evidence: Effect
on Blood Pressure
459 hypertensive patients randomized to 1 of 3 diets for 8 weeks
A diversified diet improves blood pressure
Slide17Slide18Joshipura
KJ et al.
Ann Intern Med
2001;134:1106-1114
Nurses’ Health Study and Health Professional’s Follow-up Study
Diet Evidence:
Benefits of Fruits and Vegetables
126,399 persons followed for 8-14 years to assess the relationship between fruit and vegetable intake and adverse CV outcomes*
Increased
fruit and vegetable intake reduces CV risk
Slide19Source: Pereira MA et al.
Arch
Int
Med
2004;164:370-376
RR=0.73, P<0.001
Diet Evidence:
Benefits of Whole Grains and Fiber
336,244 persons followed for 6-10 years to assess the relationship between dietary fiber intake and adverse CV outcomes
Increased
dietary fiber intake reduces CV risk
Slide20Source:
Trichopoulou
A et al.
NEJM
2003;348:2599-2608
Variable
# of Deaths/ # of Participants
Fully Adjusted Hazard Ratio (95% CI)
Death from any cause
275/22,043
0.75 (0.64-0.87)
Death from CHD
54/22,043
0.67 (0.47-0.94)
Death from cancer
97/22,043
0.76 (0.59-0.98)
Diet
Evidence: Primary
Prevention
22,043 adults evaluated for adherence to a Mediterranean diet, with points given for high consumption of vegetables, legumes, fruits, nuts, cereal, and fish and points subtracted for high consumption of meat, poultry, and dairy
High
adherence to a Mediterranean diet is associated with a reduction in death
Slide21In this study involving persons at high cardiovascular risk, the incidence of major cardiovascular events was lower among those
assigned
to a Mediterranean diet supplemented
with
extra-virgin olive oil or nuts than among those assigned to a reduced-fat diet
Diet
Evidence: Primary
Prevention
N
Engl J Med.
2018 Jun 21;378(25):e34. doi: 10.1056/NEJMoa1800389. Epub 2018 Jun
13
Slide22Lyon Diet Heart Study
Source: De
Lorgeril
M et al.
Circulation
1999;99:779-785
605 patients following a myocardial infarction randomized to a Mediterranean* or Western** diet for 4 years
A Mediterranean diet reduces cardiovascular events
Diet Evidence: Secondary Prevention
1
2
3
4
5
70
80
90
100
Year
P=0.0001
Mediterranean diet
Western diet
Freedom from cardiac death or myocardial infarction (%)
Slide23Diet
Evidence
In a recent international study of 15,482 patients with coronary heart disease (CHD), for example, a Mediterranean-style diet led to a reduction in major CV events.Dietary patterns and the risk of major adverse cardiovascular events in a global study of high-risk patients with stable coronary heart disease.
Eur
Heart J.
2016;37(25):1993-2001
A
prospective study of 44,561 people showed that vegetarians had fewer CV risk factors and a 32% lower risk of
CHD
compared with
non-vegetarians.
Risk
of hospitalization or death from ischemic heart disease among British vegetarians and
nonvegetarians
: results from the EPIC-Oxford cohort study.
Am J
Clin
Nutr
.
2013; 97(3):597-603.
Slide24Nutrition Myths and
Controversies
Slide25Eggs and Dietary Cholesterol Blood Cholesterol concentrations rise in response to cholesterol in food.
RECOMMEND patients to significantly limit intake of dietary cholesterol in form of eggs or any high cholesterol foods to as little as possible
Slide26Vegetable Oils Vegetable oils vary greatly in the content of saturated fatty acids, monounsaturated fatty oils and polyunsaturated fatty oils.
Solid fats (at room temperature) such as coconut oil and palm oil have deleterious effects on ASCVD risk factors.Liquid vegetable oils have beneficial effect on lipids and lipoproteins. They decrease LDL, increase HDL and decrease triglycerides.
There is clear evidence for Olive oil for a benefit in ASCVD risk reduction.
Slide27AntioxidantsCurrent evidence suggest that fruits and vegetables are the healthiest and most beneficial source of antioxidants for ASCVD risk reduction.
There is no benefit with the addition of high dose antioxidant dietary supplements.
Slide28Nuts for CV healthIncorporation of nuts into healthy dietary pattern has been associated with improvement with ASCVD risk factors.
Portion control is necessary to avoid excess calorie consumption.RECOMMEND patients to incorporate nuts isocalorically
in the diet by substitution of other foods ( foods that provide empty calories).
Slide29Green Leafy Vegetables
Has significant beneficial effects on ASCVD risk factors and is associated with reduced ASCVD risk.Studies have shown decrease in BP, reduce atherosclerosis due to antioxidant and anti-inflammatory properties, reduce incidence of DM.
Slide30JuicingData is insufficient.
Whole food consumption is preferred.Juicing concentrates calories, leading to ingestion of excess calories and it is important to avoid the addition of sugars.
Slide31Plant based DietEvidence indicates improved ASCVD risk factors, reduced CHD progression and beneficial effects on ASCVD.
A vegan diet is devoid of all animal products and eggs.A vegetarian diet is typically a nonmeat diet, but can include milk products and eggs.
All plants contain protein in variable amounts.
Slide32Slide33Slide34GlutenIn patients with no Gluten related disorders, many of the claims for health benefits are unsubstantiated.
For patients with gluten-related disorders, a gluten-free diet that is rich in fruits and vegetables, legumes and dried beans, lean protein sources, nuts and seeds, low-fat dairy or nondairy alternatives rich in calcium and vitamin D, and healthy fats, including omega-3 fatty acids, plays an important role in management of symptoms.
Slide35Slide36DiaryFull fat diary products are major source of saturated fat and sodium and should be limited.
Reduced fat diary products are convenient source of some essential vitamins and minerals and high quality protein.
Slide37Added Sugars
Evidence suggest that added sugars lead to cardiometabolic and ASCVD risk.Limit added sugar intake to < 10% of calories. <100 calories daily for women and <150 calories daily for men.
The principal dietary added sugars are the granular sweetener, sucrose and liquid such as high fructose corn syrup.
Slide38Coffee and Tea
Coffee intake is correlated with a dose response protective benefitHabitual consumption of coffee is associated with lower risk of all cause mortality and CVD mortality with no increased risk of arrhythmias, HTN or hyperlipidemiaTea consumption is associated with improved CVD health and lipids
Slide39LegumesLegumes are an affordable and sustainable source of protein and fiber.
Reduce CHD incidence, improve blood glucose, LDL,systolic BP and weight
Slide40Alcohol and Energy DrinksEnergy drinks should be avoided as there appears to be some evidence of harm.
Research has some benefits of alcohol consumption, however there is not sufficient high quality evidence to recommend specific alcoholic beverages for CV healthIt is not recommended to initiate alcohol consumption for CV benefit.
Consumption should be limited to recommended amounts (<1 ounce), preferably consumed with meals.
Slide41Mushrooms There is no high quality evidence.
Mushrooms may be associated with improvement of inflammatory and antioxidative pathways and may have beneficial effects on known CVD comorbid risk factors.Caution – some wild mushrooms may be poisonous.
Slide42Fermented foods and SeaweedThere is no high quality evidence of CVD outcome benefits.
There is also no evidence of harm from their consumption.Examples of fermented food: Kimchi,milk based
Kefir,Yogutt,Kombucha etc.
Slide43Omega 3 fatty acidsThere are 2 classes of Omega 3 fatty acids
1. Long chain n-3 polyunsaturated fatty acids of marine origin2.Alpha linoleic acid of plant origin ( Sources: Green leafy vegetables, walnuts, Canola oil, flax seed etc)
There is some evidence favoring incorporation of plant or marine based OM3 daily into a heart healthy diet, in non supplemental form.There is some concerns regarding fish based sources.
Slide44Slide45Dietary Guidelines by USDA
The 2015 to 2020 dietary guidelines for Americans recommend 3 Healthy eating patterns-Healthy US style eating patterns-
Healthy Mediterranean eating pattern-Healthy Vegetarian style eating PatternCurrent evidence strongly suggest that above dietary patterns show risk reduction of ASCVD and improvement of ASCVD risk factors for adults and children 2 years of age or older
Slide46Slide47Slide48Slide49
Slide50Thank You!