UGEB 2362 NUTRITION FOR

HEALTHY LIVING
Nutrition and Cardiovascular Diseases (CVDs)

Peggy Yip, MPH, RDN(US), RNutr(UKVRN), AD(HKAAD)

World Health Organization Statistics
• Cardiovascular diseases (CVDs) are the number one
cause of death in the world1

• An estimated of 17.9 million people died from CVDs in

20191,2

1 Cardiovascular Diseases, World Health Organization, Available at https://www.who.int/health-

topics/cardiovascular-diseases#tab=tab_1. Accessed on May 2022.
2 Cardiovascular diseases (CVDs) Fact Sheet, World Health Organization, Available at

https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds). Accessed on May 2022.

HK Department of Health Statistics
• The third leading cause of deaths and accounting for 13%
of all deaths in 2020 in Hong Kong.3

• Coronary heart disease was the dominating component

(58.8% of heart diseases deaths)

• Stroke was the 4th leading causes of death in HK.4

3 Non-Communicable Diseases and Healthy Living – Heart Diseases, Centre for Health Protection, HKSAR Department
of Health. Available at https://www.chp.gov.hk/en/healthtopics/content/25/57.html. Accessed on May 2022.
4 Leading Cause of all Deaths, Healthy HK. Available at https://www.healthyhk.gov.hk/phisweb/en/chart_detail/22/.

Accessed on May 2022.

Leading Cause of Death (Male) 2020

4 Leading Cause of all Deaths, Healthy HK. Available at

https://www.healthyhk.gov.hk/phisweb/en/chart_detail/22/. Accessed on May 2022.
Leading Cause of Death (Female) 2020

4 Leading Cause of all Deaths, Healthy HK. Available at

https://www.healthyhk.gov.hk/phisweb/en/chart_detail/22/. Accessed on May 2022.
Cardiovascular Diseases (CVDs)
• Diseases or disorders of the heart and blood vessels

• Diet-related CVDs commonly seen:

• High blood sugar, high cholesterol, high blood pressure (“3-high”)
• Coronary heart disease
• Cerebrovascular disease (stroke)
“3-high”
• High blood sugar
• Unable to regular blood sugar due to excessive weight, unhealthy
diet, insufficient physical activity level, etc. (covered in the last
lecture)

• High cholesterol
• Excessive saturated fat and trans fat intake.

• High blood pressure

• Caused by excessive weight and sodium intake.
High Cholesterol
• Cholesterol in blood comes from diet and made by the liver.

• Some individuals, as intake of cholesterol increases, liver

cholesterol synthesis decreases so that blood level does not
change.

• In others, liver synthesis does not decrease in response to an

increase intake in the diet; thus blood cholesterol level rise.

• Risk factors include: excessive saturated and trans fat

intake, unhealthy body weight, sedentary lifestyle, family
history, etc.
High Blood Pressure
• Blood pressure in the arteries is chronically elevated.

• A “silent killer” due to no noticeable symptoms.

• In over 90% of cases, no specific cause can be identified.

• Risk factors include: excessive salt intake, unhealthy body

weight, sedentary lifestyle, smoking, heavy drinking,
inadequate sleep, stress, family history and increasing
age, etc.
Coronary Heart Disease (CHD)
• Sometimes called coronary artery
disease or ischemic heart disease.

• Plaque build up in the artery walls causes

the inside of the arteries to narrow.

• The arteries can be partially or totally Photo obtained from:

www.cdc.gov/heartdisease/facts.htm
block the blood flow (atherosclerosis).

• Plaque mainly is made up of deposits

of cholesterol.
Cerebrovascular disease (stroke)
• The arteries of the brain are blocked by blood clots.

• Ischemic stroke is a condition that blood clot blocks a

blood vessel in the brain.

• Hemorrhagic stroke is a condition caused by a blood

vessel that breaks and bleeds into the brain with
disruption of brain tissue.
Common Risk Factors of CVDs
• Genes & family history • Diet / nutrition

• Age • Obesity & diabetes

• Gender • Low physical activity

level
• Contribute to weight gain,
• Ethnicity unhealthy lipid profile

• Tobacco use
• endothelial dysfunction,
increases oxidative stress,
promoting oxidation of LDLs
Pathology
• Slow process that over a prolonged period

• Atherosclerotic plaque development within the arterial wall

and rupture eventually

• The vascular endothelium, the inner layer of blood vessel,

has many self-regulating properties

• Dysfunction causes the endothelium becomes more

permeable to lipids and proteins
• Low-density lipoproteins (LDLs) in the blood readily pass
into the arterial wall to deliver cholesterol to the tissues

• Formation of atherosclerotic plaque, blood coagulation,

and blood clot (thrombosis) result
Nutrition and CVDs
Cholesterol
• Cholesterol in blood comes from both consumed in the diet and
made by the liver

• Some individual, as dietary cholesterol increases, liver

cholesterol synthesis decreases so that blood level does not
change

• In others, liver synthesis does not decrease in response to an

increase in dietary cholesterol, blood cholesterol level rise

Storytelling time
sharing a case of a person with high blood cholesterol level
Cholesterol in diet
• Only found in animals products, and recommended not to
exceed 300mg in a day.

• Examples of food sources:

• One egg yolk – 213mg
• 3oz organ meat – 300mg
• 3oz meat – 90mg
• 3oz fish – 50mg

• However, saturated fat and trans fat have bigger impact

on blood cholesterol level.
U.S. Dietary Guideline 2015-2020
“The Key Recommendation from the 2010 Dietary
Guidelines to limit consumption of dietary cholesterol to
300 mg per day is not included in the 2015 edition, but this
change does not suggest that dietary cholesterol is no
longer important to consider when building healthy eating
patterns.”

Reference: Dietary Guideline 2015-2020. https://health.gov/dietaryguidelines/2015/guidelines/chapter-1/a-

closer-look-inside-healthy-eating-patterns/. Accessed on 13Feb2019
• So, can I eat eggs as much as I want?

• Do I still need to watch my cholesterol intake?

Fat and lipid
• Diet low in trans fat and saturated fat lower the risks of “3-
high” and CVDs

• Diet focuses on monounsaturated and polyunsaturated fat

may help preventing CVDs

Required Reading
The Nutrition Source – Coconut Oil, Harvard University.
https://www.hsph.harvard.edu/nutritionsource/food-
features/coconut-oil/.
Fats/Lipids: 4 types of saturation
 Saturated - animal origin and palm oils

 Trans fats - partially hydrogenated processed food fats,

solid margarines, fast foods, commercial baked goods

 Monounsaturated – mainly olive oil and canola oil

 Polyunsaturated - plant and fish sources

• Omega-6
• Omega-3
 Fat
Cholesterol Trans Fat Saturated Fat

Egg Yolk LDL, HDL LDL, HDL

Unsaturated Fat
Organ Meat Cake Fatty Meat
Cream Monoun- Polyun-
Biscuit
saturated saturated
Instant noodles Palm Oil Fat Fat
Coffee creamer Coconut Oil
LDL LDL, HDL
Olive Oil
Fish Oil
Canola Oil
LDL and HDL
• Low-density lipoprotein (LDL) and high-density lipoprotein
(HDL)

• The ratio of protein to fat determines the density (e.g.,

HDLs have more protein than LDLs).

• LDL is the unhealthy cholesterol. HDL is the healthy

cholesterol.
How do HDL and LDL affect the
cholesterol level in blood?
• Cholesterol is delivered into arterial walls by LDL; thus,
high LDL cholesterol is associated with atherosclerosis.

• HDL helps to remove cholesterol from the arterial wall to

the liver for excretion or repackaging.

• This process prevents the build-up and oxidation of

cholesterol in the arteries.
Soluble fiber
• Soluble fiber reduces absorption of cholesterol and bile
acids (made from cholesterol)

• binds cholesterol and bile acids (made from cholesterol)

How soluble fiber affect cholesterol level
in blood?
• Bile acid in digestive tract are normally absorbed and
reused.

• Soluble fiber binds with cholesterol and bile acid, and they
are being excreted.

• Therefore, the liver must then use cholesterol from the

blood to synthesize new bile acid.

• This eliminates cholesterol from the body and reducing

blood cholesterol levels.
• Bacteria in the colon ferment the fiber to produce acetate,
propionate, and butyrate, which inhibit cholesterol
synthesis

• So, what food contains soluble fiber?

Reference: Mahan, L. Kathleen; Raymond, Janice L. Krause's Food & the Nutrition Care Process - E-Book (Krause's
Food & Nutrition Therapy) (p. 658). Elsevier Health Sciences. Kindle Edition.
DASH diet
• DASH diet (Dietary Approach to Stop Hypertension) – an
eating plan lowering high blood pressure and improve
cholesterol level; thus, lower risk of CVDs

• Lots of fruit, vegetable and whole grain (low in sodium,

high in potassium and magnesium)

• Encourage low-fat diary products (rich in calcium)

• Limit fatty meat, full-fat dairy, tropical oil (low in saturated

fat, cholesterol, and total fat)
Sodium & Potassium
• Combination of high sodium intake (covered in the 1st lecture)
and lower potassium intake increase blood pressure.

• Increase potassium intake lower blood pressure.

• “The more potassium you eat, the more sodium you lose
through urine.”

Centers for Disease Control and Prevention. The role of sodium and potassium in your diet.
https://www.cdc.gov/salt/potassium.htm. Accessed on 13Feb2019

American Heart Association. How Potassium Can Help Control High Blood Pressure.
https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-
blood-pressure/how-potassium-can-help-control-high-blood-pressure. Accessed on 13Feb2019
Magnesium
• High magnesium in diet is associated with lower blood
pressure

• It plays a role in blood pressure regulation as a

vasodilator

• Magnesium are found in green leafy vegetable, nuts, and

whole grains
Calcium
• Calcium from low-fat (not full-fat) dairy products lower
blood pressure

• Dairy intake increase intracellular calcium, causing

calcium influx into vascular smooth muscle cells and
greater vascular resistance

• In addition, calcium inhibits lipogenesis in the fat tissue

Reference: Mahan, L. Kathleen; Raymond, Janice L. Krause's Food & the Nutrition Care Process - E-Book
(Krause's Food & Nutrition Therapy) (p. 664). Elsevier Health Sciences. Kindle Edition.
Mediterranean diet
• A traditional cooking style of countries bordering the
Mediterranean Sea

• No uniform definition

• A healthy eating with emphases on olive oil and red wine,

that is,
• with lots of fruit, vegetables, whole grain, nuts and seeds
• Limit red meat, encourage fatty fish and poultry
• Low fat dairy products
• Drink red wine in moderations (optional)
Diet modification after a stroke incident
• Dysphagia (abnormally swallowing) is common in patients
suffered from a stroke incident

• Depending on the level of damage, swallowing ability

varies

• Some may be able to eat regular food, others may require

food consistency modification
Dysphagia Diet
• Soft diet – soft or chopped food

• Pureed diet – blended food, using pureed food molds can

improve attractiveness

• Tube feeding – insert of a tube to stomach, feed through the

tube
Storytelling time
sharing a case of a person with stroke that required dysphagia
diet
In conclusion
• CVDs share similar dietary risk factors

• CVDs require diet intervention for disease management

• In general, diet with lots of fruit, vegetable, and whole

grain, and limit fatty meat intake prevent and control
CVDs