The Concept of CMR
Slides, videos and moreManaging CMR
Managing Cardiometabolic Risk in Abdominally Obese Patients
Nutrition
- 1Key Points (1 page)
- 2Managing Abdominally Obese Patients at Increased Cardiometabolic Risk: the Nutritional Perspective (1 page)
- 3Targeting Excess Body Weight (1 page)
- 4CVD and Its Nutritional Components (2 pages)
- 5Reducing Blood Pressure (1 page)
- 6Moderate Alcohol Consumption (1 page)
- 7The Mediterranean Diet (1 page)
- 8Other Dietary Measures to Lower CVD Risk and Cholesterol Levels (2 pages)
- 9References (1 page)
CVD and Its Nutritional Components
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The OMNIHEART trial recently evaluated optimal macronutrient substitution for saturated fat (carbohydrates, protein, or unsaturated fat (13). Three different diets were assessed: a high-carbohydrate diet, a high-protein diet (10% higher in protein than the other two diets), and an unsaturated fat diet (10% higher in unsaturated fat sources such as olive oil, canola, and safflower oil). The trial found that partial substitution of carbohydrates with either protein or monounsaturated fat could further lower BP, improve lipid levels, and reduce CVD risk (13). In addition, protein should be derived either from plants or lean animal protein and should provide approximately 15% of total calories.
Long-chain omega-3 fatty acids (omega-3), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA)/fish oil and omega-3 fatty acid supplements have been shown to reduce mortality from coronary heart disease (CHD) and sudden cardiac death in both animal models and patients with and without coronary artery disease (14-18). Current guidelines recommend at least 2 servings of fatty fish per week (such as mackerel, lake trout, herring, sardines, albacore tuna, and salmon) and the inclusion of vegetable oils and food sources high in alpha-linolenic acids (canola, soybean oils, flaxseed, walnuts) for most individuals (5, 17). Evidence suggests that EPA and DHA supplementation from 0.5 to 1.8 g per day from fatty fish or supplements can significantly reduce subsequent cardiac and all-cause mortality (17). In patients with documented CVD, EPA and DHA supplements can be of benefit, as can consuming 1 g daily of EPA+DHA from a variety of fatty fishes. In patients with high levels of triglycerides, 2 to 4 g of EPA+DHA daily is recommended, ideally from supplements under medical supervision (17).
There are a number of hypotheses about how omega-3 fatty acids work to reduce CVD risk: 1) they reduce susceptibility to ventricular arrhythmias, 2) they have antithrombogenic properties, 3) they enable nitric oxide-induced endothelial relaxation, 4) they retard atherosclerotic plaque growth, 5) they have hypotriglyceridemic properties, and 6) they have hypotensive effects (19). The Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico (GISSI)-Prevenzione trial reported a 20% reduction in overall mortality and a 45% reduction in sudden death after 3.5 years with 850 mg of EPA and DHA omega-3 fatty acid supplementation (either with and without vitamin E) in subjects with preexisting CHD (14, 16). The Diet and Angina Randomized Trial (DART) trial reported a 29% reduction in all-cause mortality over a 2 year period after individuals with previous myocardial infarction increased their fatty fish intake to 200 to 400 g per week (18). Omega-3 fatty acids decrease triglyceride levels by 25% to 30% while also raising HDL cholesterol 1% to 3% and LDL cholesterol 5% to 10% (20). Though omega-3 fatty acids provide many health benefits, patients may not be aware of them. Dietitian involvement is crucial in order to educate patients and encourage them to increase their omega-3 fatty acid intake.
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