Understanding blood lipids and glucose

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Understanding blood lipids and glucose

• How a Healthy Lifestyle can improve your numbers

Susan Fullmer, PhD RD Associate Teaching
Professor Nutrition, Dietetics, and Food Science
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Cost of Heart Disease and Diabetes

• 7 of population has diabetes
• Leading cause of blindness, lower limb
  amputation, and kidney failure in U.S.
• Major risk factor for stroke and heart attack

• Heart disease is the leading cause of death in
  the U.S. and world
• 1 in 3 women worldwide will die of heart disease
• More women then men diet every year from heart
  disease in the U.S.
• 403 Billion was spent in 2006 on CVD

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Factors that are considered a High Risk for CVD

• Established heart disease
• Chronic kidney disease/failure
• Diabetes
• 10-year risk Framingham global risk gt20

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Factors that place someone at risk for heart
disease

• One or more of the following risk factors
• Cigarette smoking
• Poor diet
• Physical inactivity
• Obesity, especially central obesity
• Family history of premature heart disease (lt55
  years of male relative, lt65 years in female)

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Factors that place someone at risk for heart
disease continued

• High blood pressure
• Dyslipidemia
• Evidence of coronary calcification
• Metabolic syndrome
• Poor exercise capacity on a treadmill test

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Factors called optimal Risk for heart disease

• Framingham risk score of lt10
• Healthy lifestyle
• No risk factors

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2006 AHA Diet and Lifestyle Goals for CVD Risk
Reduction

• Consume an overall healthy diet
• Aim for a healthy body weight
• Aim for recommended levels for LDL, HDL, and
  triglycerides
• Aim for a normal blood pressure
• Aim for a normal blood glucose level
• Be physically active
• Avoid use of and exposure to tobacco products

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Lipids

• Triglycerides
• Chylomicrons
• VLDL
• Total Cholesterol
• LDL
• HDL
• Chol/HDL ratio
• lt51 is goal
• lt3.51 is optimal

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Classification of Serum Triglycerides Classification of Serum Triglycerides
lt150 (mg/dL) Normal
150-199 Borderline High
200-499 High
gt500 Very High
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Factors associated with elevated TGs

• Overweight, obesity
• Physical inactivity
• High carbohydrate intake (gt60 of calories)
• Type II Diabetes, kidney failure

• Certain medications
• Cigarette smoking
• Alcohol intake
• Genetics

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LDL CHOLESTEROL LDL CHOLESTEROL
lt100 Optimal
100-129 Near optimal/above optimal
130-159 Borderline high
160-189 High
?190 Very high
TOTAL CHOLESTEROL TOTAL CHOLESTEROL
lt200 Desirable
200-239 Borderline high
?240 High
HDL CHOLESTEROL HDL CHOLESTEROL
lt40 Low
gt60 High (negates a risk factor)
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Risk Category LDL Goal Level to Initiate Lifestyle Changes Consider Drug Therapy
CHD or CHD Risk Equivalents (10 yr risk gt20) lt100 mg/dL ?100 mg/dL ?130 mg/dL
2Risk factors lt130 mg/dL gt130 mg/dL 10 yr riskgt10 ?160 mg/dL
0-1 Risk factor lt160 mg/dL ?160 mg/Dl ?190 mg/dL
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2007 Lifestyle guidelines for prevention of CVD
in Women

• Do not smoke
• Physical activity
• A minimum of 30 minutes of moderate intensity
  activity (brisk walking) on most, preferably all
  days of the week
• For weight loss or maintenance 60-90 minutes of
  moderate intensity activity on most, preferably
  all days of the week

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2007 Lifestyle guidelines for prevention of CVD
in Women

• Consume a diet rich in
• Fruits and vegetables
• Whole grains
• High fiber foods
• Consume fish, especially fatty fish at least
  twice/week (source of omega-3 fatty acids)
• Women with heart disease, MAY want to consider
  omega-3 supplementation of 850-1000 mg/day
• Consider screening women with CHD for depression
  and treat when appropriate

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2007 Guidelines for prevention of CVD in Women

• Limit saturated fat to lt7 of calories (15-20
  grams/day)
• Limit cholesterol intake to lt 200 mg/day
• Reduce sodium intake to lt 2,300 mg/day
• Achieve and maintain an appropriate weight
  through healthy behavior changes (physical
  activity, calorie intake, and formal behavior
  programs if indicated)
• Manage diabetes, blood lipids and high blood
  pressure aggressively

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Saturated Fat
Food Serving size Total Fat (g) Saturated Fat (g)
Prime Rib 3 oz 28 12
Sirloin Steak 3 oz 12 5
Ground beef,reg 3 oz 16 6
Ground beef, lean 3 oz 6 3
Milk, whole 1 cup 8 5
Milk, 1 1 cup 2.5 2
Cheddar cheese 1 oz 9.5 6
Mozzarella 1 oz 4.5 3
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Plant sources of omega-3 fatty acids

• Canola oil
• Flaxseed and flaxseed oil
• Walnuts
• Soybean oil, tofu

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Ineffective or potentially harmful interventions

• Hormone therapy to prevent or treat CVD
• Use of anti-oxidant supplements (Vit E, C, beta
  carotene) to prevent or treat CVD
• Folic acid
• Routine use of Aspirin (in healthy women under 65
  years of age)

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Clinical identification of Metabolic Syndrome
(any 3 of the following)
Risk Factor Defining level
Abdominal Obesity Men Women Waist Circumference gt102 cm(gt40) gt88 cm (gt35)
Triglycerides ?150 mg/dL
HDL Cholesterol Men Women lt40 mg/dL lt50 mg/dL
Blood Pressure ?130/ ?85 mmHg
Fasting Glucose ?110mg/dL
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Diagnostic Criteria for Diabetes
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Risk Factors for Type 2 Diabetes

• Family History
• Older age (though incidence is growing in
  adolescent population)
• Obesity (esp. intra-abdominal obesity)
• Prior history of gestational diabetes
• Physical inactivity
• Prediabetes, race, ethnicity

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American Diabetes Recommendations for
Prevention/delay of Type 2 Diabetes

• Modest weight loss (5-10)
• Participate in regular physical activity
• Close attention should be given to, and
  appropriate treatment given for, other CVD risk
  factors (tobacco use, hypertension, dyslipidemia)

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American Diabetes Association Nutrition related
Goals for Diabetes

• Attain and maintain optimal metabolic outcomes
  including
• Blood glucose levels in the normal range or as
  close to normal as is safely possible to prevent
  or reduce the risk for complications of DM
• A1C lt7.0
• Fasting blood glucose 90-130 mg/dL
• A lipid and lipoprotein profile that reduces the
  risk for CVD disease
• LDL lt100 mg/dL
• Triglycerides lt180 mg/dL
• HDL gt40 mgldL
• Blood pressure levels that reduce the risk for
  vascular disease
• lt130/80 mmHg

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American Diabetes Association Goals for Diabetes

1. Prevent and treat the chronic complications of
   diabetes. Modify nutrient intake and lifestyle
   as appropriate for the prevention and treatment
   of obesity, dyslipidemia (abnormal blood lipids),
   CVD, hypertension, and kidney disease
2. Improve health through healthy food choices and
   physical activity