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

Cost of Heart Disease and Diabetes 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

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

at risk 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)

at risk 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

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

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

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

Classification of Serum Triglycerides <150 (mg/dL)Normal Borderline High High >500Very High

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

LDL CHOLESTEROL <100Optimal Near optimal/above optimal Borderline high High  190 Very high TOTAL CHOLESTEROL <200Desirable Borderline high  240 High HDL CHOLESTEROL <40Low >60High (negates a risk factor)

Risk Category LDL Goal Level to Initiate Lifestyle Changes Consider Drug Therapy CHD or CHD Risk Equivalents (10 yr risk >20%) <100 mg/dL  100 mg/dL  130 mg/dL 2+Risk factors <130 mg/dL >130 mg/dL 10 yr risk>10%:  160 mg/dL 0-1 Risk factor <160 mg/dL  160 mg/Dl  190 mg/dL

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: minutes of moderate intensity activity on most, preferably all days of the week

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 mg/day Consider screening women with CHD for depression and treat when appropriate

2007 Guidelines for prevention of CVD in Women Limit saturated fat to <7% of calories ( 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

Saturated Fat Food Serving size Total Fat (g) Saturated Fat (g) Prime Rib3 oz2812 Sirloin Steak3 oz125 Ground beef,reg3 oz166 Ground beef, lean3 oz63 Milk, whole1 cup85 Milk, 1%1 cup2.52 Cheddar cheese1 oz9.56 Mozzarella1 oz4.53

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

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)

Clinical identification of Metabolic Syndrome (any 3 of the following) Risk FactorDefining level Abdominal Obesity Men Women Waist Circumference >102 cm(>40”) >88 cm (>35”) Triglycerides  150 mg/dL HDL Cholesterol Men Women <40 mg/dL <50 mg/dL Blood Pressure  130/  85 mmHg Fasting Glucose  110mg/dL

Diagnostic Criteria for Diabetes

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

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)

American Diabetes Association Nutrition related Goals for Diabetes 1.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 A 1 C <7.0% Fasting blood glucose: 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

American Diabetes Association Goals for Diabetes 2.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 3.Improve health through healthy food choices and physical activity