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Nutrition and Atherosclerosis Slide 10-21. Homocysteinuria is an inherited disease leading to marked homocysteine elevations above the normal range, and is associated with premature atherosclerosis. This can be due to any of three different inherited enzyme deficiencies. Folate is required for the conversion of homocysteine into methionine. The folate cycle demonstrates the utilization of folic acid for this purpose. Inadequate folic acid intake occurs commonly with an unsupplemented American diet. Dietary methionine, an amino acid present largely in animal protein increases homocystein after forming intermediates SAM (S-adenosyl methionine) and SAH (S-adenosylhomocystein). The combination of dietary folate deficiency, increased methionine intake and inherited metabolic changes in folate metabolism will lead to elevations in homocysteine. Supplementation with folic acid, vitamin B6 and vitamin B12 can lower homocysteine in such individuals. Slide 10-22. Effects of animal vs. vegetable protein on cholesterol levels have largely been related to the differences in lysine to arginine ratio. This study demonstrates the effects in animals to increase risk of atherosclerosis. Slide 10-23. The structure of a triglyceride and the associated fatty acids which determine whether the triglyceride is called saturated, monounsaturated or polyunsaturated. Both omega 6 (e.g. linoleic acid) and omega 3 fatty acids (linolenic acids, and fish oils) are polyunsaturated fatty acids. However the position of the double bonds in these two types of fats differ, giving them different structure-function properties in the body. Slide 10-24. Phytosterols are plant protein constituents which compete with cholesterol for intestinal uptake and thus lower the amount of cholesterol in the circulating pool. Phytosterols do not have significant effects in individuals not eating cholesterol-containing foods. Slide 10-25. Plant sterol (phytosterol) content is listed for a series of common foods. Since many of these foods have high calorie and fat content, supplements of sterols have been prepared and tested for their ability to lower cholesterol levels. Slide 10-26. Effects of dietary treatment with plant stanols, a class of phytosterols, in hypercholesterolemic subjects. These stanols have been sold in Europe in margarines designed to lower cholesterol . Products based on stanols are not yet available in the U.S. Slide 10-27. This slide show the effects of soy protein isolate on serum cholesterol levels when supplemented in the diet at levels of up 47 gm/day. The soy protein contains phytosterols and the soy protein has an effect by virtue of replacing animal protein due to its different lysine to arginine ratio. Slide 10-28. Dietary intervention is recommended according to the National Cholesterol Education Program when patients with known coronary heart disease have LDL cholesterol levels > 100 mg/dl or when patients with 2 or more risk factors have LDL cholesterol > 130 mg/dl or when patients with less than 2 risk factors have LDL cholesterol > 160 mg/dl. Slide 10-29. The Step I and Step II diets recommended by the National Cholesterol Education Program are shown here. Since obesity is a common cause of hypercholesterolemia, these diets have only modest effects on serum cholesterol levels, since obese patients can maintain their weight on a 30% fat diet in which calories are not restricted. Slide 10-30. Hyperinsulinemia affects cardiovascular disease risk. Hyperinsulinemia is the result of a gene-environment interaction and leads to increased blood pressure, hyperlipidemia (small dense LDL, increased triglycerides and decreased HDL cholesterol levels), glucose intolerance, hyperuricemia, and increased PAI-1. Intervention trials examining weight reduction in type II diabetics plan to examine reduction in cardiovascular risk as the primary outcome variable.
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Nutrition
101 - Natural
Remedies - Weight
Management - Physician
Education |
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