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Victor Tambunan
Department of
Nutrition
Faculty of Medicine
Universitas Indonesia
April 2012
Atherosclerosis
- In atherosclerosis the
endothelium becomes
dysfunctional
- Some risk factors of endothelial
dysfunction are : dyslipidemia,
hypertemsion, smoking,
diabetes, obesity,
hyperhomocysteinemia, and
diets high in saturated fat and
cholesterol
Non
modifiable
Risk
Age Factor
Male sex
Ethic/Race
Family/Histo
ry
Elevated HDL
Cholesterol
Decreased
HDL
Cholesterol
Behavioral
Risk Factors
Sedentarianism
Diet
- % Saturated fat
- Salt
- Cholesterol
- Total energy content
Heavy alcoholconsumption
Smoking
Diabetes
Mellitus
Hypertension
Heart
Disease
Haemorragic
Stroke
Coronary
Heart
Disease
Atherosclerot
ic Stroke
Peripheral
Vascular Dis.
Nutrients for
(cont.)
Macronutrient
Carbohydrate: Glucose
Lipid: Fatty acids
Energy
- Contractile protein
- Cells regeneration
- Enzymes
Nutrients for
(cont.)
Micronutrient
Vitamins:
Thiamin, riboflavin, & niacin
coenzymes in energy metabolism
Vitamin B6 amino acids metabolism
Minerals:
Na, K, & Ca
cardiac muscle
contraction
Homocysteine, folic
acid,
and vitamins B6 & B12
Antioxidants
Plant stanols & sterols
Obesity
DIETARY LIPIDS
Lipids are water insoluble organic molecules, which
include all fats and oils in the diet. Lipids are
classified into two groups;
Complex lipids (e.g. triglycerides and
phospholipids)
Simple lipids (e.g. cholesterol)
Triglycerides consist of 2 major components;
glycerol and fatty acids
10
FATTY ACIDS
Fatty acids
Saturated FA/SAFA
Unsaturated FA
Poliene
(PUFA)
Essential FA
Monoene (-9)
(MUFA)
Enzyme desaturase+elongase
Arachidonic acid
(AA)
Eicosapentoenoat
(EPA)
Docosahexaenoat
(DHA)
11
14
15
Omega 3 FA
Metabolic conversion
in animals and humans
Arachidonic acid (AA)
(20:4 n-6)
DIET:
Saturated Fat, Cholesterol
Polyunsaturated Fat
Serum Cholesterol
Atheromatous
Plaque
Coronary Artery Narrowing
Myocardial Infarction
17
Oleic acid
Cis form
Elaidic acid
Trans form
20
Trans-fatty acids:
isomers of the normal cis fatty acids
produced when PUFAs are
hydrogenated
in the production of margarine &
vegetable shortening (cooking fats)
HDL-cholesterol
Evidence:
intake of trans fatty acids
the risk of CHD
Glycogen
Glucosa
Fatty acids
Steroid
Cholesterol
Pyruvat
Acetyl-CoA
Acetoacetyl-CoA
Amino acids
(glucogenic)
Lactic acid
TCA
cycle
Keton bodies
CO2
Figure 2.
Amino acids
(ketogenic)
22
CHOLESTEROL
Endogen
Exogen
Acetyl-CoA
Acetoacetyl-CoA
-Hidroksi-
Metilglutaril-CoA
HMG-CoA
Reduktase
Mevalonat acid
Squalen
Cholesterol
23
criteria
optimal
rearly optimal
borderline high
High
Very high
Desirable
Borderline high
High
Low
High
Source: National Cholesterol Education Program Adult Treatment Panel III (ATP24
III)
Meta-analysis of 38 studies:
Replacement of animal protein with soy
protein ( 47 g/day) without changing
dietary saturated fat or cholesterol,
resulted in 1012% in serum TC &
LDL-C levels and has no adverse effect
on HDL-C
Epidemiologic studies:
Moderate alcohol drinkers (12
drinks/day) have approx. 3040% lower
CHD mortality risk & 10% lower total
mortality risk than nondrinkers
Mechanism:
HDL-cholesterol levels
Antithrombotic effect
Recommendation:
red wine,
: 2 drinks/day
: 1 drink/day
26
Homocysteine, Folic
Acid,
and Vitamins B6 & B12
Homocysteine:
an amino acid metabolite of methionine
Recycling homocysteine
requires:
methionine
Folic acid
Vitamin B6
Vitamin B12
Homocysteine,
(cont.)
Metabolism of homocysteine
28
Homocysteine,
(cont.)
High levels of homocysteine adversely
affect endothelial cells & produce
abnormal clotting CHD risk
Folic acid has the most potent influence
on homocysteine levels. Doses of 0.41
mg especially when combined with
vitamins B6 & B12 serum
homocysteine levels
29
Homocysteine,
(cont.)
Diet:
vegetables & legumes (source o f
folic acid) intake can often
plasma homocysteine levels
30
LDL oxidation
31
Food source:
soybean oils
32
BW (kg)
H (m)2
34
Obesity (cont.
Proposed classification of
weight by
body mass index in adult 2
Classification
BMI (kg/m )
Asians
Underweight
<18.5
Normal range
18.522.9
Overweight
At risk
Obese I
Obese II
23
2324.9
2529.9
30
35
DEFINITION
Nutritional status :
Health status as influenced
by the intake and utilization
of nutrients
36
Waist Circumference is a
Surrogate Marker of Visceral
Fat
Women
Men
Obesity
(cont.)
BMI & CHD are positively
related; BMI the risk of
CHD also
Higher BMIs are associated
with higher triglyceride &
lower HDL-C levels than
average
39
Atherosclerosis
CHD development
Myocardial infarction
Stroke
LDL-C
PUFAs
Viscous fibre
Plant stanols &
sterols
Weight loss
Soy protein
41
Diet
Physical activity
42
Box 1.
Nutrient
Recommended intake
Nutrient composition of
(cont.)
Sodium
chloride
Potassium
Calcium
Magnesium
Alcohol
Lipids
Obesity
45
Classification
Diastolic
Systolic
(mmHg)
Optimal
80
Prehypertension
89
Stage I Hypertension
99
120
(mmHg)
and
121-139 or
81-
140-159 or
9046
47
Sodium
(cont.)
Mechanisms of BP induced by
NaCl
Dietary NaCl loading may cause:
Fluids retention plasma volume
stroke volume cardiac output
arterial pressure
vascular reactivity to norepinephrine
48
Potassium
Proposed mechanisms a high
dietary K intake may BP include:
Natriuretic effect of K
Direct vasodilatation
49
51
Alcohol:
sympathetic nervous system activity
Stimulates cortisol secretion
(1 drink of red wine 150 ml)
52
Lipids
Limited epidemiologic evidence:
BP
Mechanisms of obesity-related
hypertension:
Insulin resistance
54
modification
Weight reduction
Proper diet
Sodium restriction
Exercise
Moderation of alcohol consumption
55
56
Triglycerides Level
1. Normal (< 150 mg/dl)
2. Borderline High (150-199
mg/dl)
3. High Level of triglycerides
(200-499 mg/dl)
4. Very High (> 499 mg/dl)
60
....
Limiting intake of trans-fatty acid by
decrease of hydrogenated vegetable
oil (cookies, crackers, baked goods,
commercially prepared fried foods
and some margarine)
62
64
CONCLUSION
Maintaining normal plasma lipoprotein
66