Most risk factors for heart disease, both primary and secondary risk factors, lots of related directly or indirectly with the diet. Nutritional factors that will be discussed further in this chapter is cholesterol input, the number and kinds of overweight, energy, protein, vitamins A, E and C, dietary fiber and some minerals, Na, Fe, Ca, Mg, Cu, Zn and Se. While not the nutritional factors that are discussed are alcohol and coffee.
The cause of heart issues is multifactorial. In general it was agreed that high levels of cholesterol in the blood, hypertension, and smoking berperanan important in atherosclerosis, which is kind of heart issues.
Cholesterol in blood comes from sources, namely dietary or exogenous cholesterol and the cholesterol synthesis in the body or endogenous. Only about 25% -50% of dietary cholesterol that can be absorbed, the rest excreted through feces. If input increases cholesterol, cholesterol synthesis will be suppressed.
Input cholesterol
Clinical studies, epidemiological and experimental studies with animals showed that the cholesterol input is an important factor that determines the levels of cholesterol in the blood. Increased cholesterol in the blood is an important risk factor in heart issues. This risk is associated with elevated levels of low density cholesterol (LDL) in blood. Conversely decreased levels of high density cholesterol (HDL) is as well as a risk factor for heart issues.
Thus the idea of normal levels of total cholesterol in the blood have only minor significance; observational studies indicate that a population with average total cholesterol in the blood of 10% lower than other populations, will suffer a lower one-third of heart issues, and 30% difference in total cholesterol in blood is estimated to cause differences in heart issues up to times. LDL-HDL ratio is a more important risk factor than total cholesterol in the blood as well as LDL and HDL separately.
Keys et al in 1965 and Hegsted et al in the same year had developed a formula (formula) to estimate or predict changes in blood cholesterol. Both formulas are as follows:
delta Chol = one.35 (six delta S - delta P) + one.52 delta Z (9)
delta delta Chol = six.16 S - one.65 P + 0.0677 delta delta C - 0.53 (ten)
Delta Chol = estimate changes in blood cholesterol (mg / dl)
Delta S = change in percent energy from saturated overweight per day
Delta P = change in percent energy from polyunsaturated fatty
Delta Z = square root of the input changes in cholesterol in mg per 1000 Kilo calories
Delta C = input cholesterol (mg / day).
Formula or formula above applies in general, but each individual has a different response to inputs cholesterol. These response differences caused by genetic control of overweight metabolism. As a consequence there will be a group of individuals who do not experience increased levels of cholesterol in their blood cholesterol although inputs increased sharply. Group of people is called hiporesponder.
Overweight intake
Conversely there's also groups of individuals who experience an increase in blood levels of cholesterol sharply, although the input kholesterolnya only increased slightly. This group is called hiperresponder. Susilowati, 1991 in his research using laboratory mice found that high cholesterol input in the diet can affect blood levels of cholesterol and increased cholesterol in the liver dramatically.
Based on the source of overweight can be divided in to: vegetable and animal fats. In general, vegetable overweight contains more polyunsaturated fatty acids (PUFA = polyunsaturated fatty acids) or single (MUFA = Monounsaturated fatty acids), except overweight derived from coconuts. While animal fats usually contain lots of saturated overweight (SAFA = Saturated fatty acids), such as myristic acid (C14), palmitic acid (C16), stearic acid (C18).
In reviewing the relationship between overweight intake with heart issues, to note the proportion of energy derived from overweight and kind of overweight consumed.
Eating lots of saturated fatty acid will increase levels of cholesterol and triglycerides in the blood. Besides animal foods contain lots of saturated fats also contain cholesterol, whereas plant foods are low in saturated overweight, also contain no cholesterol.
Kinds of fats in the diet is the single factor most strongly in the diet affects cholesterol concentration. Studies in six countries showed a positive association between saturated overweight intake and incidence of heart issues for ten years. The population with an average saturated overweight intake of 3% and 10% of the input energy, characterized by total cholesterol in the blood of four.17 mmol / l (200 mg / dl), and mortality due to heart issues is also low. If the saturated overweight intake above 10% of energy input, will be seen increased mortality due to heart issues.
Among the various kinds of saturated fatty acids, palmitic acid (C16: 0) and myristic acid (C14: 0), has the strongest effect on total cholesterol in the blood. While saturated fatty acids with carbon chain under ten or over 18, less strong influence on total cholesterol in the blood. Lauric acid (C12: 0) and myristic acid (C14: 0) lots present in coconut oil, whereas palmitic acid (C16: 0) and stearic acid (C 18:0) are widely present in cocoa.
The role of unsaturated fatty acids such as monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFAs) either from the omega-3 and omega-6, in the prevention of heart issues remains not clear. Residents in the Mediterranean countries which consume overweight above 40% of energy input, has a low incidence of heart issues.
Clinical research and research using animal experiments proved that the omega-6 fatty acid that is used to replace saturated fatty acids, can lower total cholesterol, LDL, and HDL in the blood. Fish oil rich in omega-3 fatty acids in strict principle of lowering blood triglycerides and improved blood clotting.
While the Eskimo individuals who also consume high overweight, from the type of omega-3 fats, the incidence of heart issues is also low. Keep in mind that the characteristic composition of the Eskimo diet and the Mediterranean is low in saturated fatty acids. Not obtainable information about the effect of diets containing omega-6 fatty acids in the top 7% of the input energy in the long term within a population.
Effect of omega-3 fatty acids on LDL varied. Information on the effect of omega-3 fatty acids high dose of health in the long term, is still limited. An epidemiological study in the Netherlands showed that eating fish at least 30 g with a frequency of 1-2 times per week can lower risk of disease kardiovaskulat.
Clinical studies and studies using animal models indicate that the replacement of saturated fatty acids with monounsaturated fatty acids (MUFA) in the diet, had lower levels of total cholesterol and LDL cholesterol without decreasing HDL. Lately in the recommended diet is widely used ratio between PUFA, SAFA, and MUFA, one:1:1.
Among the monounsaturated fatty acid (MUFA), oleic acid (C18: one) most often present in nature. Acid is widely present in olive seed oil (rape seed oil), sun seed oil, safflower seed oil is derived from plants Erasia with content between 65-85%. Of the group of polyunsaturated fatty acids (PUFAs), omega-6, linoleic acid (C18: one) is the most widely encountered. These fatty acids present in lots of vegetable oils such as sun seed oil (65%), soft margarine (60%), corn oil (60%) and soybean oil (55%).
While omega-3 fatty acids are also present in vegetable oils such as linseed oil (50%), soybean oil (10%). Omega-3 fatty acids with long chain C atoms and double bonds four (eikosapentanoat acid = EPA) or 6 (dokosaheksanoat acid = DHA) are often present in fish.
Input energy
Both excessive energy inputs of energy from carbohydrates, fats, protein and alcohol, can heighten triglyceride and cholesterol in the blood. In studying the relationship between energy input with heart issues, can not only see the energy inputs alone, but must be thought about the proportion of energy derived from overweight, saturated overweight and its relation to obesity and physical activity.
The role of obesity in the etiology of atherosclerosis and heart issues remains not clear. Adiposity correlated inversely with HDL concentrations. Increased adipos network which will also mean increased body weight, will be followed by a later decrease in HDL risk of getting heart issues will increase.
Obesity or overweight is closely related to a definite lifestyle, including diet or excessive food and less physical exercise. Thus the weight control with physical exercise as well as a balanced diet is a lovely work to reduce or minimize the risk of heart issues.
In studies with experimental animals found that high-protein diet containing chiefly animal proteins will speed up atherosclerosis. Casein has hiperkholesterolemik effects and more atherogenic than soy protein. In studies using experimental animals, soy protein is still able to suppress the increase in blood cholesterol, although in diet and 1% cholesterol.
Protein
Other studies using soy protein and other vegetable proteins to replace the casein, also gave similar results. It seems that the influence of different proteins (soy protein) to the decrease of cholesterol in the blood is stronger than the effect of omega-6 fatty acids or omega-3 fatty acids, although there is interaction between the.
Vitamin A, E and C
Gey (1991) in his research concluded that there is a powerful negative correlation between concentrations of vitamin E in the blood with death due to heart disease iskhemik (ISPs), also found a negative correlation is not so strong between the levels of vitamin A in blood with death due to ISPs. If the risk factors for heart issues is cholesterol, hypertension and smoking, are controlled, the combination of vitamins E and A has a slightly negative correlation is stronger than vitamin E alone. In the final conclusion said that the protective effect of vitamin E can be enhanced by vitamin A, carotene, and vitamin C.
Vitamin A and E play a role in defending the endothelium and is also an antioxidant that protects overweight peroxidation. Vitamin A and E can protect against platelet aggregation, affects oxygen transport and utilization, increase HDL and increase the ability of nicotinic acid in lowering blood lipids. Vitamin A and E may play a role in primary prevention of metabolic disorders which are the cause hiperlipoproteinemia, and can also play a role in secondary prevention to reduce blood lipids that may cause risk aterogenesis.
Observation on the use of high doses of vitamin C to lower blood cholesterol in animals (rabbits and pigs) fed cholesterol diet inspired an idea that vitamin C can reduce blood cholesterol sufferers hiperkholesterolemia. To examine this, conducted clinical studies that are not controlled (uncontrolled clinical trials). Clinical studies showed conflicting results, that is not proven that vitamin C is associated with heart issues.
Mineral
In rabbits and rats suffering from calcium deficiency, increased levels of cholesterol in their blood. Calcium supplementation in animal studies to lower blood lipids is close to or even lower than controls, but also associated with the incidence of cardiac lesions and kidney lesions.
Regarding the role of salt Sodium (Na) in relation to heart issues, hypertension, until now still not reached unanimous agreement. Lots of epidemiological studies and studies using animal models revealed the existence of that relationship.
Uncontrolled study of ten patients with hyperlipidemia showed that the addition of 800 mg of calcium per day (in the kind of calcium carbonate) for year, can reduce cholesterol in the blood as much as 25%. Another study of a group of older ladies, supplementation with 750 mg of calcium per day can lower blood cholesterol 36 mg / dl from an average of 266 mg / dl.
Magnesium and calcium may interact with the overweight in the promotion of atherosclerotic lesions. In animal experiments, an increased incidence of cardiac lesions and kidney lesions associated with high calcium intake, and this can be reduced or even eliminated with a diet high in magnesium. This protective effect applies only if calcium intake is high (0.6 wt%), and only applies if there is an increase of blood cholesterol.
The increase of Zn in the diet will increase the necessity for Mg. On this basis made postulations that the Zn-Cu ratios are high on the American diet, could be a risk factor for heart issues. Zn supplementation given to kids in the long term, not associated with increased cholesterol in the blood. Although Zn supplementation in high doses has been reported to lower HDL cholesterol, physiological doses had no effect on blood lipids.
In animal experiments, copper deficiency (Cu) associated with cardiovascular destroy and abnormal cholesterol metabolism. In study in humans, copper deficiency will lead to an increase in blood cholesterol. This increase may be because Cu is a co factor for an enzyme involved in cholesterol synthesis and degradation of lipoproteins.
Selenium (Se) is low in the Chinese diet, have been associated with the incidence of cardiomyopathy in kids. Although the role of Se as the cause is not clear, epidemiological studies indicate the role of Se deficiency in heart issues. In the United States, death from heart issues found to be lower in areas where the land has a high Se content. Something similar is present in Sweden, that mortality due to heart issues is lower in areas that receive water with higher Se content.
However, other studies failed to demonstrate any difference in Se concentrations in serum and urine of patients with hypertension or coronary heart disease patients who died of myocardial infarction and atherosclerosis compared to controls. Se in human platelets contain over any other network. This gives an indication that Se deficiency can affect the thrombosis. From the study suggested that Se deficiency reduces the antioxidant activity of platelets, and this activity recovered with Se supplementation.
In a potential study in Finland, found relationships between low Se concentration in blood with clinical manifestations of heart issues. In case-control studies of other populations, also in Finland, found a high correlation between high levels of Se in blood with eikosapentanoat acid (EPA). In the study, it is difficult to separate atherogenic effects of Se and omega-3 fatty acids, because the fish is the main source of Se as well as a source of omega-3 fatty acids in the diet of people in Finland.
The role of iron (Fe) in heart issues became stunning because of its contribution to the aterogenesis and / or vulnerability of the myocardium become ishkemik. The high iron stores in the liver is a risk factor alone or in combination with a lipoprotein. Iron acts as a catalyst in the hydroxyl radical (OH.) through the Haber-Weiss reaction, and the important role of overweight peroxidation.
The relationship between alcohol consumption with heart issues is complex. Input high alcohol associated with death from heart issues. High alcohol consumption increases blood pressure and triglycerides in the blood.
Alcohol and coffee
Several studies of large numbers of individuals have shown that drinking coffee can increase cholesterol in the blood. The mechanism of this increase is still not clear, but the coffee is made by way of extraction has fewer side effects compared with historicallyin the past prepared coffee (brewed coffee).
Several studies have demonstrated that consumption of alcohol (ethanol) in the number of low or medium, will increase HDL cholesterol in the blood, and naturally is beneficial for the prevention of heart issues. Although alcohol consumption appeared low or moderate amounts of heart health benefits, but is not recommended to the public.
Dietary fiber
Dietary fiber has the ability to reduce cholesterol in the blood. Pectin, lots of dietary fiber present in apples and other fruits, can lower LDL, total cholesterol, and suppress the synthesis of cholesterol in the tiny intestine in experimental animals.
Diet Guidelines
Consumption of carbohydrates, sucrose can increase triglycerides in the blood, while complex carbohydrates (starch / flour) are less atherogenic than other simple carbohydrates (mono and disaccharides).
Taking in to account the risk factors of heart issues and the role of nutrition in reducing the risk, then the principle of diet may be recommended are as follows:
Not all risk factors for heart issues can be controlled, the diabetes management is of the strategic efforts to minimize the risk of heart issues.
* Input of energy balance, in the sense according to require.
* The energy derived from overweight is not over 30%.
* The proportion of PUFA: SAFA: MUFA is one:1:1.
* Limit consumption of alcohol and coffee.
* Increasingly varied use of vegetables and fruit.
* Restrict the use of processed or preserved food, and multiply the fresh food.
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