Nutrition Prescription For CVD

Medical Nutrition Therapy goals for cardiovascular disease...

1. To provide low fat diet
2. To provide low cholesterol diet
3. to provide low sodium restricted diet if necessary

The table below showed the National Cholesterol Education Panel (NCEP) recommendation steps in fat controlled diet...

	Recommended Intake
	Step1	Step 2
Total fat	Less than 30%
Saturated fat (SFA)	Less than 10% of total calories	Less than 7% of total calories
Monounsaturated fat (MUFA)	10-15% of the total calories
Polyunsaturated fat (PUFA)	Up to 10% of the total calories
Carbohydrate	50-60% of the total calories
Protein	10-20% of the total calories
Cholesterol	< 300mg/day	<200 mg/day
Total calories	To achieve and maintain desirable weight

LDL cholesterol is a main carrier of cholesterol in the blood while HDL cholesterol carries cholesterol from the arteries to the liver.So, its means increasing level of LDL cholesterol is bad for us.There is some nutritional factors that affect LDL cholesterol.

Increase LDL-C

• Saturated and trans fatty acid -coconut milk, animal fat,margerine, shortening
• dietary cholesterol
• Excess body weight

Decrease LDL-C

• Polyunsaturated fatty acid- omega-3, omega-6, plant source,corn oil
• Viscous fiber- oats, barley, beans         
• plant stanols
• Weight loss
• isoflavone

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Healthy modification of Local Malaysia Food

Generally, Malaysians, especially the Malay ethnics LOVE fatty foods. Common examples are nasi lemak, rendang, curry, laksam, roti canai, cendol and others. There are many local foods that use coconut milk as one of the important ingredients in their recipe. Most of the Malay cuisine are cooked using coconut milk. 
Do you know? Coconut milk is a kind of saturated fat that can increases the risk for cardiovascular disease. 

With little modification on the recipe and also food choices, We are still able to enjoy local delicacies and at the same time reduces our risk to CVD.

        

REPLACE COCONUT MILK WITH LOW FAT/ SKIM (0%) FAT MILK

So, how can we reduce the usage of coconut milk in cooking? We can start by replacing coconut milk with low-fat milk or 0% fat milk. Low fat and skim milk are easily available in the market. Although the price might be slightly higher than coconut milk, substituting coconut milk with these milk not only does not significantly alter the taste of the food but also reduces the cardiovascular heart disease risk in patients. So, let's change it now..

HEALTHY LOCAL FOOD

There are local foods that provides a  balanced, healthy nutrition served with fresh vegetables or salad that are suitable for patients with cardiovascular diseases. 

Examples are 

• kerabu tomato
• pau
• ketupat
• nasi kerabu
• laksa, ulam
• ikan masak singgang and many more.

COOKING METHOD & FOOD CHOICES

For those who cooks, you consider replacing the method of preparing dishes to more healthy style such as STEAMING, BOILING, BRAISING & GRILLING instead of frying which uses more amount of OIL.


Food choices should avoid deep fried and food that are highly sweet as these tend to increase the cholesterol level of the body. Instead, choose food that are less oily, less salty and less sugar.

THE FOOD THAT YOU EAT CAN BE EITHER THE SAFEST & MOST POWERFUL FORM OF MEDICINE OR THE SLOWEST FORM OF POISON. Start Changing Now! (^^)

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Diet Recommendations for Cardiovascular Disease Risk Reduction

• Balance calorie intake and physical activity to achieve and maintain a healthy body weight.

• The first step in exercise

• Consume a diet rich in vegetables and fruits

• More heart healthy vegetable here!

• Choose whole grain, high fiber foods.

• Choose the correct grain!

• 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 <300 mg/day by:

• Choosing lean meats and vegetable alternatives.
• Selecting fat-free (skim) or low-fat dairy products.
• Minimizing intake of partially hydrogenated fats.
• Learn more on cholesterol

• Minimize intake of beverages and foods with added sugars.

• Choose and prepare foods with little or no salts.

• When consuming alcohol, do so in moderation. 

• Alcohol raises both total triglycerides and HDL levels.
• Raises blood pressure.
• Limit to no more than 2 drinks per day for men and one for women.

Source: American heart association, 2006

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CVD DIAGNOSIS

In the past post, we have acknowledge  on how you will get the risk for CVD by knowing the risk factors. Now, let us get to know how the CVD will be diagnosed. When your doctor thinks that you might be developing risk for CVD , those diagnosis will be carried out;

1. Blood test

Blood test is one of the common laboratory test to diagnose most of diseases. This test may detect fat, cholestrol, lipid components in blood including LDL, HDL, Triglyceride and certain protein. Protein markers such as Apolipoprotein A1 and B will help in detection of inflammation that may lead to heart disease. During heart attack, muscle cell die and release protein into the booldstream. Cardiac Troponin-T is one of the protein markers to detect recent heart attack other than fibrinogen and PAI-1, high levels of homocycteine, elevated asymmetric dimethylarginine and brain natriuretic peptide (a.k.a. B-type or BNP).

2. Electrocardiogram (ECG)

This test is used to detect any irregularities on the heart beat and the heart rhythm through the electrical impulses.

3. Echocardiogram

A moving picture showing the size and shape of heart is used to see how the heart work and any injuries caused by poor blood flow. 

4. Stress Testing

This test will need the patient to exercise while the ECG/EKG leads are placed on the body. Exercise use to increase the heart rate. If the patient are not able to exercise due to some constraint, they will receive medicine or pills that may increase their heart rate. Possible signs and symptoms can be observed on the abnormal heart rate or blood pressure, shortness of breath or chest pain and abnormal in the heart rhythm or heart's electrical activity. 

5. Chest X-ray

The image of the heart can be observed to see if there are any abnormalities occur on the structure of the heart that may cause CVD.

6. Coronary Angiography / Cardiac Catherterization

This test is use by using dye that will be injected by using a tube (catheter) into the bloodstream threaded to the coronary artery . An image will be shown on the dye that indicate the flow of blood through heart and blood vessels and this is called coronary angiography. 

7. Cardiac Magnetic Resonance Imaging (MRI)

Cardiac MRI use radio wave, magnetic and computer to produce a 3D image of the heart. A signal will be produced indicate vary of the tissues will help the diagnosis process. 

References:

1. Coronary Heart Disease - Diagnosis 

2. National Heart Lung and Blood Institute : How is Heart Disease Diagnosed?

3. News Medical : Cardiovascular Disease Diagnosis 

4. Mayo Clinic : Heart Disease - Test and Diagnosis 

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