Dietitian & Your Heart

Siti Khadijah
Dietitian
Institut Jantung Negara
Kuala Lumpur

Todays presentation..

Efficacy of nutrition therapy for heart health

Whats latest in nutrition therapy?
Cardio protective diet
Functional food
How Dietitians fit in the picture?

Is nutrition therapy effective in

reducing risk of CVD?
Improving diet and lifestyle is a critical
component of the American Heart Associations
strategy for cardiovascular disease risk
reduction (AHA Scientific Statement, 2006)

 The National Cholesterol Education Program

Adult Treatment Panel III (NCEP III)
recommends lifestyle changes as the primary
and most cost effective means of reducing the
risk of coronary heart disease
(JAMA, 2001)

Nutrition Counseling?

Low Fat
Low Calories
Low Salt
High Fiber

MORE THAN THIS !

Whats new?
Cardio Protective Diet
Food-based components of dietary patterns that improve
cardio metabolic health
(Mozaffarian D, Appel L & Van Horn L, 2011)

Functional Food
Foods that include whole foods and fortified, enriched or
enhanced foods that have a potentially beneficial effect on
health when consumed as part of a varied diet on a regular
basis at effective levels
(JADA, 2009)

Cardioprotective Diet
Food Components

Goal

Fruits

4 5 servings per day

Vegetables

4 5 servings per day

Whole grains

3+ servings per day (replace refined grains)

Fish & shellfish

2+ servings per week (preferably oily fish)

Nuts

4 5 servings per week

Dairy products

2 3 servings per day

Vegetable Oils

2 6 servings per day

Fiber Health & Satiety

Goal : 4 5 servings fruits / day
4 5 servings vegetables / day
Breakfast

Lunch

Dinner

Snack

Choose More of Whole grains

Whole grains contain all the essential parts of the
entire grain seed includes bran, endosperm and
germ.

Make The Switch

Per serving
(1 cup)

White
Rice

Brown
Rice

Per serving
(2 slices)

White
Bread

Brown
Bread

Calorie (kcal)

150

111

Calorie (kcal)

147

145

Protein (g)

4.0

3.0

Protein (g)

4.9

4.8

Fiber (g)

1.8

Fiber (g)

0.8

5.2

Goal : 3+ servings / day

Consume More Fish & Shellfish

Increase intake of Omega-3 Fatty Acids
Fish consumption reduces sudden cardiac death and
CHD mortality
(Albert et al, 1998, Kris-Etherton et al, 2002)
2 servings of fatty fish meals per week reduced 50%
primary cardiac arrest (Albert et al, 2002)

Go Nuts
Tree nuts eg : almonds, hazelnuts, walnuts,
pecan, cashew, pistachios
Eat 30 grams per day may reduce the risk of
coronary heart disease

Choose unsalted or without honey coated nuts

Choose Vegetable Oil

Monounsaturated Fats (MUFA)
Decreases LDL and total cholesterol.
Sources : Olive, Peanut, Rice Bran

 Polyunsaturated Fats (PUFA)

Decreases LDL and total cholesterol
Sources : Sunflower, Corn

 Trans Fat
Decreases HDL and increases LDL cholesterol
Created in an industrial process that adds hydrogen
to liquid vegetable oils to make them more solid
Give food a desirable taste and texture, cheap to
produce and last a long time.
Sources :
Shortening, hard margarines, bakery foods, processed foods

How To Spot For Trans Fat?

Read the ingredient list and look out for
terms
Hydrogenated / Partially Hydrogenated Oil
Vegetable Shortening

Look at nutrition facts panel trans fat

should be 0g or <0.5g per serving

 Saturated Fat
Increases LDL & total cholesterol
Sources

Blended Oil
To maximize the potential of palm oil by mixing with PUFA in
ratio 1:2
Stable for high temperature cooking

Functional Food
Foods that include whole foods and fortified,
enriched or enhanced foods that have a
potentially beneficial effect on health when
consumed as part of a varied diet on a regular
basis at effective levels (JADA, 2009)

Effectiveness of functional foods

Strong evidence Level A
Functional
ingredients

Sources

Potential benefits

Dietary fiber (functional & total)

Beta glucan

Oats, barley

May risk of CHD &

improve blood glucose

Soluble fiber

Peas, beans, apples,

citrus fruits

May risk of CHD &

improve blood glucose

Whole grains

Brown rice, whole

meal bread /
biscuits, capati,
breakfast cereal

May risk of CHD &

improve blood glucose

Effectiveness of functional foods

Strong evidence level A
Functional
ingredients

Source

Potential benefits

Plant sterols / stanols

Free stanols
/sterols

Corn, soy, fortified foods

& beverages e.g. milk

May risk of CHD

Stanol/
sterol esters

Fortified margarines,
dietary supplements

May risk of CHD

Phytoestrogens
Soy proteins

Soybeans & soybean

products

May risk of CHD

Functional Food
Cholesterol Reducing Effect
Food Items

Evidence

Soy

25 gram of soy protein per day may reduce the risk of

heart disease, LDL cholesterol and triglycerides

Nuts

30 grams (a handful) of nuts may reduce the risk of

coronary heart disease.

Beta
Glucan

3 grams of beta glucan = 70 gram of oats per day

(10 tablespoon) reduces total and LDL cholesterol.

Plant Sterol

2 - 3 grams of plant sterols per day from plant sterol

enriched foods lowers total cholesterol by 4 - 11% and
LDL cholesterol by 7 - 15%

Soy Protein

25g of soy protein daily helps to TC, LDL, TG

levels (US FDA health claim)
Examples of soy protein sources:
1 cup tofu = 17g protein
1.5 piece tempe = 17g protein
1 glass soy milk = 5 g protein

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Go Nuts
Tree nuts eg : almonds, hazelnuts, walnuts,
pecan, cashew, hazelnuts, pistachio
Eat 30 grams per day may reduce the risk of
coronary heart disease

Choose unsalted or without honey coated nuts

Beta Glucan
Beta-glucan is a soluble fiber derived
from the cell walls of algae, bacteria,
fungi, yeasts, and plants.
3 grams beta-glucan daily may reduce
total cholesterol & LDL cholesterol

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Goal : 3 grams / day

10 tablespoon
oats daily

Plant sterols
In Malaysia, plant sterols are added to low fat milk
In other countries, plant sterols are added to
margarine, yogurt, fruit juices

Disclaimer: Photos are for education purpose only & not to endorse any brands.

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Challenges

Clients are not ready for change

Clients do not want to be told off
Poor long term adherence
Food Myths & unproven dietary practices

How do Dietitians solve the

puzzle?
Motivational Interview
Practical Healthy Eating Advice

Motivational Interview
A directive, patient-centered counseling
style that aims to help patients explore and
resolve their ambivalence about behaviour
change, NOT to tell them how to change
(Miller & Rollnick 1991)

MI to improve Health Behaviors

Traditional Approach

MI Approach

Emphasizes weakness

Emphasizes as strength

Try to fix the problem

Builds on what people already

know and what to do
Stimulates cognitive function
and perceptual accuracy

Triggers defensiveness and

shutting down

Key Techniques

Talk less, listen more

Ask permission to give advice
Use more open, than closed ended question
Affirm strengths, intentions, efforts & choices

Practical Healthy Eating Advice

Make HALF of the plate
FRUITS & VEGETABLES

QUARTER of
the plate STARCH

QUARTER
of the plate LEAN
MEAT/FISH/PROTEIN

Variety, Moderation & Eat Mindfully

Low Fat Signals

Soup

Grill

Steam

Stir Fry

Microwave

Make Your Call When Eating Out

Fried Fish

Grilled Fish

Roti bakar kopitiam

Curry Mee

Tuna sandwich

Souped Mee

Make Your Call When Eating Out

Ghee tosai with

chutney

Plain thosai with

dhal

Nasi lemak special

Nasi lemak

Hokkien Mee

Wantan Mi Sup

Cooking Demonstration

Recipe Booklet
(recipes contributed by Dietitians)

Conclusion
Lifestyle modification plays an important role in
reducing risk of cardiovascular disease
Nutrition counseling by Dietitians are not
addressing the basic advice only, but also
include the latest evident based updates
Refer your patients to dietitians for individualized
meal plan & practical healthy eating advice

Thank you..