STUDY - Technical - New Dacian's Medicine
Diet
Therapy (1)
Translation Draft
Diet is an important behavior of health. Nutritional education and good eating habits are essential to health, nutrition problems contribute substantially to the prevention of disease and premature death, while alterations in food intake and dietary habits are often essential parts of the development of the disease. Nutritional needs can be changed by disease and dietary problems have an impact on the quality of life and the evolution of acute or chronic diseases.
For example, dietary therapy plays a role both in the prevention of atherosclerosis and in the treatment of advanced coronary artery disease. In addition, treatment of the disease can bring major nutritional consequences, but nutrition and diet therapy are often a concern for the patient and his family, even when there is no solid evidence to support such therapy. In general, the futility of dietary therapies, whether new or traditional, is worth carrying out further scientific studies. As with other care behaviours, dietary treatment should be thoroughly documented and monitored in order to assess its impact on nutrition and health.
The first concept in dietary treatment is that dietary intake or nutritional needs can be altered as a result of the disease or by treatment, and modified needs must be met by changes to prevent malnutrition. The second concept is that nutritional intervention can be critical in the prevention, follow-up or treatment of the disease. One complication is that people consume food rather than nutrients, so the practical and psychosocial factors of dietary adjustments should be taken into account when drafting recommendations. Dietary treatment is harmless, and physical and psychological side effects can result from improper or poorly understood changes in the diet. The purposes of the following posts are to summarize the basic principles of diet therapy, describe its application under normal conditions, and outline strategies to strengthen adherence to diet recommendations.
Let's see what the basic dietary recommendations would be! Variety, balance and moderation are basic components of the dietary ideal. Food 'guidance' systems generally stress the need to increase consumption of cereal, vegetable and fruit products, as well as to decrease consumption of fats, saturated fats and cholesterol (also emphasizethe need for moderate consumption of sugar and sodium). By grouping foods into categories based on the main nutrient content, these guidelines can be converted into dietary prescriptions that are consistent with nutritional requirements at different levels of energy intake.
I will now present a small example of a (generally accepted) diet that satisfies daily nutritional requirements, as well as their energy intake level: 1. bread or starch-based food, one slice of bread, 30g instant cereals, 1/2 cup of rice or cooked pasta (6 servings/ day for low energy intake/ 1,600 kcal/day, 9 servings for moderate energy intake/ 2,200 kcal/day or 11 servings for high energy intake/ 2,800 kcal/day), 2. vegetable-based foods, a cup of raw vegetables (leafy), 1/2 cup other cooked or raw vegetables, but shredded (3 servings for low intake, 4 for moderate intake and 5 for high intake), 3. fruit-based foods, a medium-sized piece, 1/2 cup of shredded, cooked or preserved fruit (2 portions low intake, 3 for moderate and 4 for sea), 4. dairy, one cup milk or yogurt (2-3 servings per day), 5. meat or meat derivatives (150g/ day for low intake, 180g for moderate and 210g for sea), 6. total fats (50g/day for low intake, 70g for moderate and 90g for high) and 7. total sugar supplement (6 teaspoons/ day for low intake, 12 for moderate and 18 for high intake). In the case of the diet described, the following particulars should be made: 1. one egg, 1/2 cup cooked dried beans or 2 teaspoons of peanut butter are equivalent to 30g of lean meat, chicken or fish, cooked, 2. fats are mainly represented by the addition of fat (1 teaspoon, considered as a portion, brings 5g of fat), not taking into account dairy and meat group and 3. sugars are generally represented by added sugar, without taking into account those contained in the group of flours, fruits and dairy products. The lowest energy intake is usually satisfactory for sedentary women and for the mute among the elderly (the moderate level is for adolescents, active women and sedentary men, and the highest level is for adolescents, most active men and very active women). Alcohol contributes energetically, but slightly nutritionally, and consumption should be limited to no more than one, two drinks daily, to adults who choose to drink.
This food group system can also provide the basis for meal planning in dietary treatment, as energy and macronutrients can be estimated based on the standard portion size. For example, here are the average nutritional values per serving: 1. pasta (80 kcal, 15g carbohydrates, 3g protein and 1g fat), 2. (25kcal, 5g carbohydrates and 2g protein), 3. fruit (65 kcal and 15g carbohydrates), 4. creamed milk (90 kcal, 12g carbohydrates, 8g protein and 3g fat), 5. low-fat milk (120 kcal, 12g carbohydrates, 8g protein and 5g fat), 6. whole milk (150 kcal, 12g carbohydrates, 8g protein and 8g fat), 7. meat and derived from very lean meat (35 kcal, 7g protein and 1g fat), 8. lean meat (35 kcal, 7g protein and 3g fat), 9. moderately fatty meat (75 kcal, 7g protein and 5g fat), 10. fatty meat (100 kcal, 7g protein and 8g fat) and 11. fats (45 kcal with 5g fat).
But, with many points of view in this regard, let's move on to specific dietary treatments!
Atherosclerotic cardiovascular disease has multiple etiologies and involves a variety of risk factors. Risk factors that may be influenced include smoking, high blood pressure, hyperlipidemia, glucose intolerance, obesity and sedentary isused. Increased plasma cholesterol, especially the fraction related to low-density lipoproteins (LDL-cholesterol), is a major risk factor, which can be at least partially modified by direct intervention. Studies identified a low risk at a total serum cholesterol concentration of less than 200 mg/ dl, a moderate risk in the range of 200-239 mg/ dl and an increased risk at levels above 240 mg/ dl. Hypertriglycerideemia and low cholesterol levels linked to high-density lipoproteins (HDL-cholesterol) are also risk factors.
Basic dietary treatment for patients with increases in LDL-cholesterol involves reducing total fat and saturated fat intake to less than 30% and 10% of total calories, respectively. Sources of saturated fats are animal fats (fat, bird skin, butter fat) and some vegetable fats (coconut oil, cocoa oil, palm oil). Cholesterol, found only in animal foods, is not as important a determinant for plasma cholesterol as saturated fats. However, cholesterol intake in the diet should be below 300 mg/ day. In patients whose serum cholesterol does not respond to this stage of dietary adaptation, the second recommended stage of studies involving a greater restriction of cholesterol and saturated fat intake should be prescribed.
Such a "prescription" could be the following scheme (against the background of a total energy intake needed to achieve and maintain the ideal weight - obesity being also a risk factor for cardiovascular disease): 1. total lipids, stage 1 and 2 less than 30% of total kcal, 2. saturated lipids, stage 1 with 8-10% of total kcal and stage 2 with a maximum of 7% of total kcal, 3. polyunsaturated lipids, stage 1 and 2 with a maximum of 10% of the total kcal, 4. monounsaturated lipids with a maximum of 10-15% of the total kcal, 5. carbohydrates with a maximum of 50-50% of the total kcal, 6. proteins with a maximum of 10-20% of the total kcal, 7. cholesterol, stage 1 with a maximum of 300 mg/ day and stage 2 with a maximum of 200 mg/ day. For each kilogram in excess of body weight, endogenous cholesterol synthesis is increased by 20 mg/ day, so that, a weight excess of 10 kg, results in an endogenous production of 200 mg of additional cholesterol, which enters the daily reserve that the body must catabolise, excrete or store. Obesity is also associated with hypertriglycerideemia, decreased HDL-cholesterol, increased production of LDL from very low-density lipoprotein (VLDL) and increased liver synthesis of VLDL.
Insulin resistance associated with obesity and secondary hyperinsulinemia, even improves to modest weight loss (5 to 10 kg). In some patients, dietary restriction of total fats decreases HDL-cholesterol and increases serum triglyceride concentration. Lowering HDL-cholesterol is a concern, especially when basal levels are low (less than 35 mg/ dL), the phenomenon seems to be related to increased carbohydrate intake and possibly increased polyunsaturated lipids. Monounsaturated lipids (e.g. rapeseed oil, olives, peanuts) maintain HDL-cholesterol concentration and decrease LDL-cholesterol.
When unsaturated lipids are reduced to less than 10% of calories, and monounsaturated lipids are prevalent in the diet, a significant reduction in total cholesterol can be achieved without decreasing total lipid intake or increasing the proportion of calories from carbohydrates. These patients should be advised to replace saturated lipids with monounsaturated lipids. It has been suggested that fatty acids in the "trans" configuration are a risk factor for cardiovascular disease. "Trans" fatty acids are formed with the hydrogenation of vegetable oils in order to solidify them at ambient temperature. Margarine is the most significant source of "trans" fatty acids in the diet.
Consumption of "trans" fatty acids at values above 7% of calories can cause a significant increase in LDL-total cholesterol levels and decrease in HDL-cholesterol. However, the effect is gradual, and the average consumption (less than 4% of calories being represented by fatty acids in the "trans" configuration) does not appear to have a harmful effect. Consequently, there should be no concern about this, except in the case of high consumption. Fish oils with polyunsaturated lipids of the omega3 type have a strong effect of lowering triglycerides, but do not decrease LDL-cholesterol. Any anti-theroogenic effects of fish consumption or fish oil are likely mediated by antithrombotic and anti-inflammatory actions of omega3 fatty acids (which is why they are sometimes used in the treatment of hypertriglycerideemia).
Effective dietary treatment in cardiovascular disease should not be based on the concept of "good food versus bad food", but should aim for changing dietary habits, achieving ideal body weight and reducing the intake of saturated fatty acids. There are methods that adapt to most lifestyles and increase compliance with dietary (lasting) changes throughout life, the change necessary to achieve this goal. In the prevention of cardiovascular disease, dietary therapy is the first line of intervention, and pharmacological agents are only adjuvant therapy.
I'll continue next time with specific dietary treatments...
Diet is an important behavior of health. Nutritional education and good eating habits are essential to health, nutrition problems contribute substantially to the prevention of disease and premature death, while alterations in food intake and dietary habits are often essential parts of the development of the disease. Nutritional needs can be changed by disease and dietary problems have an impact on the quality of life and the evolution of acute or chronic diseases.
For example, dietary therapy plays a role both in the prevention of atherosclerosis and in the treatment of advanced coronary artery disease. In addition, treatment of the disease can bring major nutritional consequences, but nutrition and diet therapy are often a concern for the patient and his family, even when there is no solid evidence to support such therapy. In general, the futility of dietary therapies, whether new or traditional, is worth carrying out further scientific studies. As with other care behaviours, dietary treatment should be thoroughly documented and monitored in order to assess its impact on nutrition and health.
The first concept in dietary treatment is that dietary intake or nutritional needs can be altered as a result of the disease or by treatment, and modified needs must be met by changes to prevent malnutrition. The second concept is that nutritional intervention can be critical in the prevention, follow-up or treatment of the disease. One complication is that people consume food rather than nutrients, so the practical and psychosocial factors of dietary adjustments should be taken into account when drafting recommendations. Dietary treatment is harmless, and physical and psychological side effects can result from improper or poorly understood changes in the diet. The purposes of the following posts are to summarize the basic principles of diet therapy, describe its application under normal conditions, and outline strategies to strengthen adherence to diet recommendations.
Let's see what the basic dietary recommendations would be! Variety, balance and moderation are basic components of the dietary ideal. Food 'guidance' systems generally stress the need to increase consumption of cereal, vegetable and fruit products, as well as to decrease consumption of fats, saturated fats and cholesterol (also emphasizethe need for moderate consumption of sugar and sodium). By grouping foods into categories based on the main nutrient content, these guidelines can be converted into dietary prescriptions that are consistent with nutritional requirements at different levels of energy intake.
I will now present a small example of a (generally accepted) diet that satisfies daily nutritional requirements, as well as their energy intake level: 1. bread or starch-based food, one slice of bread, 30g instant cereals, 1/2 cup of rice or cooked pasta (6 servings/ day for low energy intake/ 1,600 kcal/day, 9 servings for moderate energy intake/ 2,200 kcal/day or 11 servings for high energy intake/ 2,800 kcal/day), 2. vegetable-based foods, a cup of raw vegetables (leafy), 1/2 cup other cooked or raw vegetables, but shredded (3 servings for low intake, 4 for moderate intake and 5 for high intake), 3. fruit-based foods, a medium-sized piece, 1/2 cup of shredded, cooked or preserved fruit (2 portions low intake, 3 for moderate and 4 for sea), 4. dairy, one cup milk or yogurt (2-3 servings per day), 5. meat or meat derivatives (150g/ day for low intake, 180g for moderate and 210g for sea), 6. total fats (50g/day for low intake, 70g for moderate and 90g for high) and 7. total sugar supplement (6 teaspoons/ day for low intake, 12 for moderate and 18 for high intake). In the case of the diet described, the following particulars should be made: 1. one egg, 1/2 cup cooked dried beans or 2 teaspoons of peanut butter are equivalent to 30g of lean meat, chicken or fish, cooked, 2. fats are mainly represented by the addition of fat (1 teaspoon, considered as a portion, brings 5g of fat), not taking into account dairy and meat group and 3. sugars are generally represented by added sugar, without taking into account those contained in the group of flours, fruits and dairy products. The lowest energy intake is usually satisfactory for sedentary women and for the mute among the elderly (the moderate level is for adolescents, active women and sedentary men, and the highest level is for adolescents, most active men and very active women). Alcohol contributes energetically, but slightly nutritionally, and consumption should be limited to no more than one, two drinks daily, to adults who choose to drink.
This food group system can also provide the basis for meal planning in dietary treatment, as energy and macronutrients can be estimated based on the standard portion size. For example, here are the average nutritional values per serving: 1. pasta (80 kcal, 15g carbohydrates, 3g protein and 1g fat), 2. (25kcal, 5g carbohydrates and 2g protein), 3. fruit (65 kcal and 15g carbohydrates), 4. creamed milk (90 kcal, 12g carbohydrates, 8g protein and 3g fat), 5. low-fat milk (120 kcal, 12g carbohydrates, 8g protein and 5g fat), 6. whole milk (150 kcal, 12g carbohydrates, 8g protein and 8g fat), 7. meat and derived from very lean meat (35 kcal, 7g protein and 1g fat), 8. lean meat (35 kcal, 7g protein and 3g fat), 9. moderately fatty meat (75 kcal, 7g protein and 5g fat), 10. fatty meat (100 kcal, 7g protein and 8g fat) and 11. fats (45 kcal with 5g fat).
But, with many points of view in this regard, let's move on to specific dietary treatments!
Atherosclerotic cardiovascular disease has multiple etiologies and involves a variety of risk factors. Risk factors that may be influenced include smoking, high blood pressure, hyperlipidemia, glucose intolerance, obesity and sedentary isused. Increased plasma cholesterol, especially the fraction related to low-density lipoproteins (LDL-cholesterol), is a major risk factor, which can be at least partially modified by direct intervention. Studies identified a low risk at a total serum cholesterol concentration of less than 200 mg/ dl, a moderate risk in the range of 200-239 mg/ dl and an increased risk at levels above 240 mg/ dl. Hypertriglycerideemia and low cholesterol levels linked to high-density lipoproteins (HDL-cholesterol) are also risk factors.
Basic dietary treatment for patients with increases in LDL-cholesterol involves reducing total fat and saturated fat intake to less than 30% and 10% of total calories, respectively. Sources of saturated fats are animal fats (fat, bird skin, butter fat) and some vegetable fats (coconut oil, cocoa oil, palm oil). Cholesterol, found only in animal foods, is not as important a determinant for plasma cholesterol as saturated fats. However, cholesterol intake in the diet should be below 300 mg/ day. In patients whose serum cholesterol does not respond to this stage of dietary adaptation, the second recommended stage of studies involving a greater restriction of cholesterol and saturated fat intake should be prescribed.
Such a "prescription" could be the following scheme (against the background of a total energy intake needed to achieve and maintain the ideal weight - obesity being also a risk factor for cardiovascular disease): 1. total lipids, stage 1 and 2 less than 30% of total kcal, 2. saturated lipids, stage 1 with 8-10% of total kcal and stage 2 with a maximum of 7% of total kcal, 3. polyunsaturated lipids, stage 1 and 2 with a maximum of 10% of the total kcal, 4. monounsaturated lipids with a maximum of 10-15% of the total kcal, 5. carbohydrates with a maximum of 50-50% of the total kcal, 6. proteins with a maximum of 10-20% of the total kcal, 7. cholesterol, stage 1 with a maximum of 300 mg/ day and stage 2 with a maximum of 200 mg/ day. For each kilogram in excess of body weight, endogenous cholesterol synthesis is increased by 20 mg/ day, so that, a weight excess of 10 kg, results in an endogenous production of 200 mg of additional cholesterol, which enters the daily reserve that the body must catabolise, excrete or store. Obesity is also associated with hypertriglycerideemia, decreased HDL-cholesterol, increased production of LDL from very low-density lipoprotein (VLDL) and increased liver synthesis of VLDL.
Insulin resistance associated with obesity and secondary hyperinsulinemia, even improves to modest weight loss (5 to 10 kg). In some patients, dietary restriction of total fats decreases HDL-cholesterol and increases serum triglyceride concentration. Lowering HDL-cholesterol is a concern, especially when basal levels are low (less than 35 mg/ dL), the phenomenon seems to be related to increased carbohydrate intake and possibly increased polyunsaturated lipids. Monounsaturated lipids (e.g. rapeseed oil, olives, peanuts) maintain HDL-cholesterol concentration and decrease LDL-cholesterol.
When unsaturated lipids are reduced to less than 10% of calories, and monounsaturated lipids are prevalent in the diet, a significant reduction in total cholesterol can be achieved without decreasing total lipid intake or increasing the proportion of calories from carbohydrates. These patients should be advised to replace saturated lipids with monounsaturated lipids. It has been suggested that fatty acids in the "trans" configuration are a risk factor for cardiovascular disease. "Trans" fatty acids are formed with the hydrogenation of vegetable oils in order to solidify them at ambient temperature. Margarine is the most significant source of "trans" fatty acids in the diet.
Consumption of "trans" fatty acids at values above 7% of calories can cause a significant increase in LDL-total cholesterol levels and decrease in HDL-cholesterol. However, the effect is gradual, and the average consumption (less than 4% of calories being represented by fatty acids in the "trans" configuration) does not appear to have a harmful effect. Consequently, there should be no concern about this, except in the case of high consumption. Fish oils with polyunsaturated lipids of the omega3 type have a strong effect of lowering triglycerides, but do not decrease LDL-cholesterol. Any anti-theroogenic effects of fish consumption or fish oil are likely mediated by antithrombotic and anti-inflammatory actions of omega3 fatty acids (which is why they are sometimes used in the treatment of hypertriglycerideemia).
Effective dietary treatment in cardiovascular disease should not be based on the concept of "good food versus bad food", but should aim for changing dietary habits, achieving ideal body weight and reducing the intake of saturated fatty acids. There are methods that adapt to most lifestyles and increase compliance with dietary (lasting) changes throughout life, the change necessary to achieve this goal. In the prevention of cardiovascular disease, dietary therapy is the first line of intervention, and pharmacological agents are only adjuvant therapy.
I'll continue next time with specific dietary treatments...
Until then, let's have
Understanding, Love and Gratitude!!! Understanding = Knowledge =
Consciousness = Energy, Energy = Love x Gratitude x Gratitude
(i.e. Gratitude squared).
Dorin, Merticaru