Chapter 18 diet and health

Cardiovascular Disease • Leading cause of death • US: greater in young men than young women 35-50 yo • Similar incidence after 65 yo... • The most risk factors you have, higher the ri

Diet and Health

Which are the main causes

of death in the United

States?

• Genetics

• Environment

• Diet

Four are Nutrition

Cardiovascular

Disease

• Leading cause of death

• US: greater in young men than

young women (35-50 yo)

• Similar incidence after 65 yo.

Images from W.H Freeman and Sinauer Associates

Heart

Coronary Heart

Disease

• Is mainly caused by Atherosclerosis

• Hypertension

How Atherosclerosis

Develops?

http://www.youtube.com/watch?v=OHE1ig4k64M&feature=related

http://www.youtube.com/watch?v=fLonh7ZesKs

Normal Blood Vessel

Images from W.H Freeman and Sinauer Associates

Normal Blood Vessel

Starting process of plaque formation

Atherosclerotic Plaque

Then, what happens?

• Lose elasticity

• Then, Blood pressure increases

• Platelets start clotting process

• clot breaks loose and blocks

passage robbing tissues of oxygen.

– Myocardial infarction

– Cerebral infarction

Normal Lumen of a Blood Vessel

Coronary artery with atherosclerotic plaque

At this point!

• Coronary Thrombosis

• Cerebral Thrombosis

• Heart Attack

Which are the risk

Factors?

Very Very Important!!!

Risk Factors!

• Some we cannot change

• Some we can change

• So

Risk Factors that we

cannot change!!

Risk Factors

GENDER

Risk Factors

AGE

Men > 45 yo

Women > 55 yo

Risk Factors

HEREDITY

Family history

Risk Factors we can

change!

Blood Pressure > 140/90 mm Hg

Diabetes Mellitus

Obesity

Lack of Exercise

Smoking

Cholesterol

Total Cholesterol

• < 200 mg/dL Desirable

• 200-239 mg/dL Borderline

• >240 mg/dL High Risk

What do we use to

transport Lipids in the

body ?

Lipoproteins!!

LDL Cholesterol

• Low Density Lipoprotein Cholesterol

• “Less Healthy”

HDL Cholesterol

• High density lipoprotein Cholesterol

• “Healthy”

• > 60 mg/dL Desirable

• 59-40 mg/dL Borderline

• < 40 mg/dL High Risk

HDL:LDL ratio

• Men > 5 Increased risk

• Women > 4.5 increased risk

Can we do something?

• Diet

• Exercise

• Control your weight

• Decrease Saturated fat

• Decrease total fat

If these changes do

not help!

•Drug Therapy

• The most risk factors you have,

higher the risk of Cardiovascular disease.

Hypertension

• Affects 1/3 of adult population

• Sustained elevated blood pressure (>

Essential hypertension (95%)

• Related to obesity and familial

tendencies

• Can be controlled

Secondary Hypertension

(5-10%)

• Occurs as a result of renal disease,

endocrine imbalances, pregnancy,

etc.

• Eliminating the disorder cures the

accompanying hypertension

The lethal effects of hypertension are caused by:

• Excessive workload on the heart

which can lead to early development

of heart disease

Risk Factors for Hypertension

Risk Factors for Hypertension

• Salt sensitivity: 30-50%

• Alcohol intake

Dietary Management

• Limit Caffeine

• Calcium may be protective against

hypertension

Additional Management Tools

• Weight loss

• Drug therapy

• Physical Activity

Recommendations for

Reducing Disease Risk

• Make permanent lifestyle changes in

diet

– Limit total fat, saturated fat and

cholesterol

– Control kcal intake

– Increase fiber, especially soluble fiber

Cancer and Diet

• Is the growth of malignant tissue

• Second cause of death in the USA

Incidence

• 20 million worldwide

• 500,000 die in the U.S each year

• Primarily a disease of the elderly

How cancer develops

http://www.youtube.com/watch?v=LEpTTolebqo

Causes of Cancer

• 1/3 due to dietary factors

• 1/3 due to cigarette smoking

• 1/3 due to a combination of factors

Non Dietary Risk

Factors

• Genetics

– Family history

Non Dietary Risk

Dietary Factors

• Cancer Initiators

– Nitrosamines (Smoked foods) and

stomach Ca

– Alcohol has been associated to

mouth, throat, and breast Cancer

– High consumption of red meats and

colon Ca

• Risk of cancer can be reduced by

changing eating habits

– Variety and moderation

– Vitamin A (beta carotenes)

– Vitamin C

– Fiber

– Folate, Selenium, and vitamin E

Nutrition in the Individual

with Cancer

• Excessive weight loss (emaciated)

• Decreased food intake

• Metabolism is altered

– Energy Expenditure

– Protein

Diabetes

• More than 20 million people in the

USA

• 7th place - Cause of Death

• Contributes to Heart Disease, stroke,

blindness, and kidney failure

• Definition: A chronic disorder

characterized by elevated blood

glucose levels related to the absolute

or relative deficiency of insulin

Insulin Dependent DM

Type 1

• Less common 5-10%

• Lack of insulin from the pancreas

• Glucose remains in the blood

Insulin Dependent DM

Type 1

• Fat and Protein are used for energy

• Insulin must be injected- why?

• Causes changes in the body

– Blood vessels, organs, other tissues

Insulin Dependent DM

Type 1

• Death from arteriosclerosis is 50%

greater

• Other complications include

amputations and blindness

Non Insulin Dependent DM

Type 2

• More common (90%)

• People over 40

Non Insulin Dependent DM

Type 2

• Strongly correlated with obesity

• Characterized by normal or above

normal insulin levels

Non Insulin Dependent DM

Type 2

• Cells become resistant to insulin and

respond less

• Results in inefficient glucose

production and decreased glucose

uptake by the cells

Who is likely to develop

NIDDM (Type 2)?

• Overweight (80%)

• Female (2x)

Who is likely to develop

NIDDM (Type 2)?

• African American (2x)

• Hispanic (5x)

• Native Americans

Who is likely to develop

NIDDM ?

• Elderly

• Family history

– Cuts/bruises that are slow to heal

– Tingling/numbness in the hands or feet – Recurring skin, gum or bladder infections

• Neuropathy (nerve damage)

• Nephropathy (kidney disease)

• Hypertension (high blood pressure)

• Cardiac Problems

Dietary Recommendations

• Total CHO intake:

– not too much - not too little

• CHO sources:

– high fiber sources

– moderate intake of simple sugars

Dietary Recommendations for

IDDM

• Maintain a healthy weight

• Time of feeding is important

• Know how to adjust insulin doses

Dietary Recommendations for

NIDDM

• Weight control

• Low fat diets and > MUFA

• Increase Physical Activity

Nutrition and Infectious

Diseases

Immune System

• If a foreign substance penetrates, it

elicit a immune response

Immune System

• Second line of Defense:

– Innate Immuno system

• Macrophage: secrete cytokines

–Phagocytosis

• Natural killer cells

• Complement System - proteins

Immune System

• Adaptive Immuno System

• B-cells: antibodies - Immunoglobulins

• T-cells: Helper, Killer, Suppressor

Immune System

• Personal strategies to prevent

infectious disease are important

• Bioterrorism.

Nutrition and Immunity

• Malnutrition compromises immunity

• Infectious disease ⇑ nutrient needs and ⇓ food intake.

• 1981

• HIV (human immunodeficiency virus) is

the infection that attacks the immune system and disables the body’s

defenses

• Attack T Helper cells

• Transmitted by sexual contact and

direct contact with blood

• mother to infant during pregnancy,

birth or breastfeeding

• AIDS (acquired immune deficiency

syndrome) is an infectious disease.

• Epidemic

• Early detection and early intervention

are critical.

http://www.unaids.org/en/dataanalysis/epidemiology/epidemiologyslides /

Global estimates for adults and children  2012

People living with HIV 35.3 million [32.2 million – 38.8

Source: CDC Diagnoses of HIV infection in the United States and dependent areas, 2014 HIV Surveillance Report 2015;26.

Which would be some recommendations to decrease the Risk of Chronic Diseases?

Recommendations for

Chronic Diseases

Leading Causes of Death