Smart Heart: Nutrition Advice for Diverse Groups

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Smart Heart Nutrition Advice for Diverse Groups

• David Grotto, RD, LDN
• Author of 101 Foods That Could Save Your Life!
• Mens Health and Fitness magazines nutrition
  advisor
• Ask the Guy-a-titian, Chicago Wellness Magazine
• Produce for Kids\PBS Kids Advisory Board Chair
• President, Nutrition Housecall, LLC

Society for Nutrition Education, July 20, 2008
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Agenda

• Illustrate gender, ethnic and cultural
  differences in heart health education strategies.
• Describe seven nutrition and lifestyle strategies
  that can be applied to anyone interested in
  developing more heart smarts.

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What we know
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Heart Smarts (what to eat less of)

• Saturated fat
• Trans fat
• Dietary Cholesterol

Van Horn L, et al. The Evidence for Dietary
Prevention and Treatment of Cardiovascular
Disease. J Am Diet Assoc. 2008108287-331.
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Diet Reduces Mortality in Primary Prevention
Trials

• 2002
• Physicians Health Study(N 20,551)

• 2003
• Cardiovascular Health Study(N 5,201)

• 2002
• Nurses Health Study(N 84,688)

• 2003
• European Prospective Investigation into Cancer
  and NutritionGreek cohort (N 22,043)

• 2005
• European Prospective Investigation into Cancer
  and Nutritionelderly cohort (N 74,607)

2004 The Healthy Aging A Longitudinal Study in
Europe (N 2,339)
Parikh P et al. J Am Coll Cardiol.
2005451379-87. Trichopoulou A et al. BMJ.
2005330991-7. Knoops KTB et al. JAMA.
20042921433-9.
Blood levels of n-3 fatty acids inversely
related to death Greater adherence associated
with lower mortality
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Majority have poor diets 1 year after CHD
diagnosis
About 80 of patients are not doing what they
are supposed to be doing. I think cardiology
patients are confusedkeeping the message simple
will be the key to improving dietary advice to
patients. --Dr. Barbara Olendzki, co-author
Ma Y, et al. Dietary Quality 1 Year after
Diagnosis of Coronary Heart Disease. J Am Diet
Assoc. 2008108240-246.
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Trend Surveys

• Aramark (over 2 billion meals served annually)
  survey revealed people have become tired of being
  told what not to eat.

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Messaging to Men
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Health Perceptions of Mexican American Men

• They have to be healthy to be good fathers,
  husbands, brothers, sons, workers, and community
  members.
• Pain and disability are motivating factors in
  finding ways to regain their health.

Machismo sustains health and illness beliefs of
Mexican American men .J Am Acad Nurse Pract. 2006
Aug18(8)348-50.
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Health Perceptions of African American Men

• Definitions of health went beyond the
  traditional "absence of disease."
• Physical, mental, emotional, economic and
  spiritual.
• Having a job provider.
• Stress was the dominant negative influence on
  health.
• Positive influences - supportive social network
  and feeling valued.

African-American men's perceptions of health a
focus group study. J Natl Med Assoc. 2006
Apr98(4)544-50.
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Messaging to Men What Not to Do!
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You shouldnt be eating that!
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Are You a Food Cop?

• I ask my partner what he/she has eaten when we
  arent together.
• I scold my partner for eating certain foods.
• I snoop around to see what he/she has eaten.
• I try to influence what or how much my partner
  eats.
• The words you shouldnt be eating that have
  come out of my mouth.

Source Your Diet is Driving Me Crazy by Cynthia
Sass, MS, RD. Da Capo Press-2004
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The Saboteur
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Messaging to Men What to Do!
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Humor
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Spokesperson
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K.I.S.S.
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Performance Based Approaches vs. Disease
Prevention Model
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How Can Health Professionals Help?
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Focus on New Priorities

• Taste
• Do-ability
• Positive Nutrition

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Seven Nutrition and Lifestyle Strategies That Can
Be Applied to Anyone
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1. Add in Before Ever Taking Away
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101 Food Philosophy

• No Bad Foods
• Research suggests adding in positively effects
  markers of health

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2. Eat Breakfast!
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Breakfast is a great place to start
People who skip breakfast are four to five times
more likely to gain unwanted weight compared to
morning eaters. --Yunsheng Ma, et al.,
American Journal of Epidemiology
Women who ate a big breakfast (610 kcal
breakfast, ?Carb ?Pro) lost more weight than
those who ate 1/3 of the calories.
Source Ma Y, et al. Association between Eating
Patterns and Obesity in a Free-living US Adult
Population. American Journal of Epidemiology.
2003158(1)85-92. Dr Daniela Jakubowicz, MD
2008 Endocrine Society Annual Meeting
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The Breakfast Calculator
www.BreakfastResearchInstitute.org
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3. Get in More Soluble Fiber!
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Oatmeal-Cholesterol Connection

• Jan/Feb 2008 American Journal of Lifestyle
  Medicine article confirmed health claim
  Oatmeal-Cholesterol Connection 10 years Later

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Oats

• 1st FDA approved healthclaim for a food
• Numerous clinical studies
• Acts like a sponge to absorbcholesterol-rich
  bile
• ? total blood cholesterol
• ? LDL
• No ? in HDL

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3 g oat soluble fiber/day ?

• 1-1/2 cups cooked oatmeal
• 3/4 cup dry oatmeal
• 3 cups oatmeal squares (ready-to-eat cereal)
• 1 cup or less of cooked oat bran, depending on
  beta-glucan content

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Protect the Protectors Program

• Firefighters are more likely to die from heart
  disease than smoke inhalation or burns.
• Heart disease causes 45 of the deaths that occur
  among firefighters while they are on duty
• Fire suppression
• Alarm response
• Physical training

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Protect the Protectors Program

• Recruited firefighters from four cities across
  the country
• Chicago, San Francisco, NYC, Denver
• Diverse groups
• Every firehouse had a nutrition coach
• Medical center/staff

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Results

• All firehouses did well
• Denver reduced cholesterol by 14 points
• Chicago and NYC by 12 points
• San Francisco by 3 points
• Developed healthy habits
• Learned that small steps can make a difference

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Results

• Dave Grotto did REAL well
• Reduced total cholesterol
• 70 points in 1 month!
• Lost 10 pounds in 1 month
• Gave up nothing
• Synergy?
• Reaffirmed 101 Foods Approach!

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4. Get in More Heart-Healthy Fats!
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Heart Healthy Fats

• Almonds
• MUFA
• Vitamin E
• EVOO
• CVD
• HTN
• Oleocanthal COX2 inhibitor
• Avocado
• MUFA
• Beta Sitosterol

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Omega-3 fatty acids

• Multiple healthful physiological effects
• ALA vs. EPA/DHA
• Problems with n6n3 ratio
• Food vs. supplements

Source Engler M and Engler M. Omega-3 Fatty
Acids Role in Cardiovascular Health and Disease.
Journal of Cardiovascular Nursing Vol. 21, No. 1,
pp 17-24.
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5. Get in More Potassium!
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Potassium-rich Foods

• Fruits
• Orange, orange juice
• Cantaloupe, honeydew melons
• Bananas, pears, apricots
• Dried fruit
• Vegetables
• Tomatoes, tomato juice
• Potatoes
• Dairy products
• Milk, yogurt, kefir

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OJ

• Orange juice is a good source of potassium
• 450 mg in 8 ounces or 13 DV
• No age group in the US consumes the recommended
  levels of potassium
• Potassium is essential in fighting HTN Stroke
• Over 60 million Americans have HTN - Stroke is
  3rd leading cause of death in US

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6. Get in More Polyphenolics!
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Polyphenolics
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7. Get in More Physical Activity!
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Exercise regularly

• 30 minutes/day is good, and more is
  better, to a reasonable extent

GOAL
Metabolic syndrome
Source Bassuk S, et al. Physical Activity and
Cardiovascular Disease Prevention in Women How
Much Is Good Enough? Exerc. Sport Sci. Rev., Vol.
31, No. 4, pp. 176181, 2003.
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Choose Your Icons Well!
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Thank You!!