Nutrition Science, Assessment and Prescription Guidelines Flashcards
(136 cards)
What was the key clinical takeaway of the BROAD study?
BMI was reduced more with a WFPB dietary pattern as compared to normal care (no dietary intervention)
This was a prospective, 2 arm, parallel superiority RCT.
What is the key clinical takeaway of the New DIETs (new dietary interventions to enhance the treatments?
vegan diets demonstrated greater weight loss compared to omnivorous, semi-vegetarian and pesco-vegetarian diets.
According to a mini review of RCTs that compared plant based diets to control how are health outcomes effected ( Weight, CV health, BP, glucose metabolism)?
Health outcomes such as weight, cardiovascular health, bp and glucose metabolism are improved on a plant-based diet, particularly in obese individuals
What does the WHO recommend both adults and children limit their daily consumption of added sugar to?
<10% of total calories. <200 kcal in a 2000kcal diet. up to 12 teaspoons or 48g with a goal amount of <5% calories, up to 6 teaspoons/24 g.
What are the recommendations from the AHA regarding sugar consumption?
AHA recommends a maximum of 100kcal, 6 teaspoons or 24 g of added sugar/ day for women, children, and teens and no more than 150kcal, 9 teaspoons/36 g of sugar/day for men.
Which foods have high concentrations of saturated fat?
higher fat cuts of beef, pork and lamb, salami, sausages, and other processed meats, lard, butter, cheese, coconut and coconut oil, palm oil and palm kernel oil.
What are the top 5 sources of percent saturated fat in the diets of US adults?
cheese 16.5%
beef 9.1%
other fats and oils 8.9%
milk 6.7%
Frankfurters, sausages and luncheon meats 6.7%
Which foods are NOT considered high in saturated fats but have more substantial levels of saturated fats?
nuts/seeds, brazil nuts are the highest
avocados
plant oils
Eggs
Fish
What was the INTERHEART study and what are the key takeaways?
It was a standardized case-control study about acute myocardial infarction risk factors.
There are 9 significant risk factors for AMI –> smoking, lipids, HTN,DM, obesity, physical inactivity, alcohol use, dietary pattern and psychosocial.
Psychosocial risk factors were comparable to the effect of high blood pressure, and abdominal obesity
According to the INTERHEART study what 5 risk factors account for 80% of the population attributable risk for AMI?
Smoking,
Lipids,
HTN,
DM
Obesity
What was the INTERSTROKE study?
prospective case-control study used to determine the stroke risk factors.
10 RF were identified, HTN, current smoking, abdominal obesity, unhealthy dietary pattern, physical inactivity, diabetes, alcohol intake, psychological stress, depression, cardiac causes and abnormal lipids.
These were associated with 90% of the risk of stroke in men and women of all ages.
What was the Chicago Heart Association Detection Project Industry?
Demonstrated that the risk of heart disease is determined by the number of cardiac risk factors a person has. It also showed an association btwn ppl who were lower in risk in middle age with a better quality of life at older ages and lower Medicare costs.
Making changes to modify which 6 factors can reduce the risk of heart disease as much as 90-95%?
50% decrease in total cholesterol
6 mmHG decrease in diastolic pressure
smoking cessation
maintain ideal body weight and waist size
>150 minutes per week of moderate exercise
>5 servings of fruits and vegetables per day
What was the Framingham Heart Study?
the study looked at the lifetime risk for atherosclerotic cardiovascular disease in ppl who were free of cardiovascular at age 50.
men with optimal risk had a 5% lifetime risk of atherosclerotic cardiovascular disease vs men who had 2 or more risk factors, who had a 69% lifetime risk.
women with optimal risk had 8% lifetime risk of atherosclerotic cardiovascular disease vs women with 2 or more risk factors, who had 50% lifetime risk
Explain the study Actual causes of death in the U.S by McGinnis
Objective: To identify and quantify the major external factors that contribute to death in the US.
Study design: article review utilizing data from 1977-1993
Key conclusions: approximately 1/2 of all deaths in the US could be contributed to following actual causes of death: tobacco, diet and physical activity patterns, alcohol, microbial agents, toxic agents, firearms, sexual behavior, motor vehicles, and illicit drug use.
Top 3–> tobacco, diet and physical activity and alcohol are all rooted in behavior choices.
Take home point: lifestyle behaviors are critically important to health in the US and represent modifiable risk factors that could significantly reduce premature mortality.
Describe the “Healthy livings is the best revenge: findings from european prospective investigation into cancer and nutrition-postdam” study, written by Ford ES and Bergmann.
Objective: To describes the reduction of the relative risk of developing chronic disease associated with 4 healthy lifestyle factors: never smoking, BMI <30, >3.5 hours/wk of physical activity and adhering to health diet principles.
Study design: prospective cohort
Sample population:German adults
Key findings: participants with four healthy lifestyle factors had a 78% reduction in risk compared with those with none.
Each lifestyle factor was associated with a reduction in risk of developing any chronic disease after adjusting for age, sex, educational status and occupational status.
The biggest impact of having all 4 healthy lifestyle factors as compared to none was seen on incident diabetes risk (93% reduction). The reduction in MI was 81%, stroke was 50%, and cancer was 36%.
BMI <30 exerted the largest reduction risk of any chronic disease, diabetes, or stroke followed by never smoking.
Never smoking exerted the largest risk reduction for MI and cancer.
Conclusions: adopting health behaviors can have a major impact on the risk of morbidity. Having all 4 healthy lifestyle factors reduced the risk of major chronic disease by 80% compared with those with no healthy lifestyle factors in this population in Germany.
Healthy Lifestyle Heart Trial by Dean Ornish
Objective: to determine the feasibility of patients sustaining intensive lifestyle changes for a total of 5 years, and the effects of these changes on CHD without lipid lowering drugs.
Study design: RCT
Sample population: N=48
Intervention: Intensive lifestyle changes included a low-fat (10% of calories) vegetarian diet, aerobic exercise, smoking cessation, stress management, and group psychosocial support. No lipid lowering medications were used.
Key results: Mean relative reduction in stenoses of 7.9% for experimental group and increase in stenosis of 27.7% for control. There was a 46.7% relative increase in stenosis in the controls who were not taking lipid lowering medications.
There were 45 cardiac events in the control group vs 25 cardiac events in the experiment group.
More regression of CHD occurred after 5 years than after 1 year in the experimental group, meaning intervention continued to reverse CHD, whereas the control group had continued progression and more than double the rate of cardiac events.
Key conclusions: comprehensive lifestlye changes in ambulatory patients with moderate to severe CHD resulted in significant reductions in both LDL and anginal episodes after 1 year and showed more regression of coronary atherosclerosis after 5 years. In contrast patients following usual care showed even more progression of coronary atherosclerosis after 5 years then after 1 year, with more than twice as many cardiac events.
Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin by Knowler
objective: compare the effectiveness of a lifestyle intervention or treatment with metformin in preventing or delaying the onset of diabetes.
Study design: parallel- group randomized control trial with placebo group (placebo BID + standard lifestyle recommendations) metformin (850 mg of metformin BID + standard lifestyle recommendations) and life-style modification program.
Sample population: N 3234 adults without diabetes who had elevated fasting and post-load plasma glucose concentration.
Intervention: randomly assigned to 1 of 3 interventions. standard lifestyle recommendations plus metformin, standard lifestyle recommendations plus placebo twice daily, or an intensive program of lifestyle modification.
The goals of the participants in the intensive lifestyle modification intervention were to achieve and maintain a weight reduction of at least 7% of initial body weight through adopting a healthy low calorie, low fat diet and engage in moderate intensity physical activity for at least 150 minutes/wk.
Key results: Baseline characteristics were similar for all groups. Participants were follows for 2.8 years. 50% of participants in the lifestyle medicine intervention group had achieved the goal of weight loss of 7% or more by the end of the curriculum (24 wks) and 38% had weight loss of at least 7% by the time of their most recent visit.
74% of participants met the goal of 150 minutes of physical activity per week at 24 weeks. The cumulative incidence of of diabetes was lower in the metformin and life-style intervention groups than in the placebo group during the follow-up period.
The incidence of diabetes was 58% lower in the lifestyle intervention group and 31% lower in the metformin group as compared to placebo.
The incidence was 39% lower in the lifestyle-intervention group as compared to the metformin group. Based on these results 6.9 persons would need to be treated via lifestyle intervention for 3 years to prevent once case of diabetes, vs 13.9 persons who would need to be treated with metformin.
Significance for lifestyle medicine: demonstrated how a comprehensive and sufficiently intensive lifestyle intervention can be more effective than medication at treating pre-diabetes/preventing the development of diabetes. It highlights the importance of addressing multiple lifestyle medicine pillars and ensuring sufficient intensity to reach pre-specified goals.
Describe the Lyon heart study
1988-1993, N=605
Tested if the mediterranean diet is associated with reduced risk of recurrent MI vs the AHA step 1 diet. The study was stopped early bc of signifiant beneficial effects noted in the original cohort.
50-70% lower risk of recurrent heart disease. recommends step 1 diet–> fruit, root vegetables, leafy green vegetables, breads, cereals, fish, foods high in alpha linolenic acid.
Clinical trial of the effects of dietary patterns on BP (DASH diet)
Objective: study the different dietary patterns on BP.
Study design: parallel, RCT with 3 groups. control diet, fruits/vegetables and combination diet (fruits/vegetables and low fat dairy).
Sample population: N=459 adults, 22yo and older who were not taking anti-hypertensive medication.
key conclusions: a diet rich in fruits, vegetables and low-fat dairy products and with reduced saturated and total fat lowered SBP by 5.5mmHg and DBP by 3.0mmHG more than control diet.
These effects were more pronounced in subjects with HTN, lowering SBP by 11.4mmHg and DBP by 5.5mmHg.
A diet rich in fruits and vegetables also reduced bp but to a lesser extent. These changes occurred after 2 weeks and persisted for 6 weeks. These effects seem to be independent of weight loss and physical activity and they were not related to sodium or alcohol intake.
significance for lifestyle medicine: compared to control diet a combination diet was able to significantly decrease BP in subjects with mild to moderately elevated BP. This is comparable to results in trials of drug monotherapy for mild hypertension. Dietary pattern adjustment appears to be an effective strategy to help prevent, treat, and reverse elevated BP with effects that can be seen in a matter of weeks.
2- year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring vs. control to prevent cognitive decline in at risk elderly people (FINGER) RCT
Objective: to assess a 2 year multidomain approach to prevent cognitive declined in at risk elderly ppl from the general population.
Study design: double blind, parallel, rct
Sample population: N =1260 adults aged 60-77 years
Control group attended visits with nurse/physician at 6,12, and 24 months and relieved regular healthcare advice on health diet, physical, cognitive and social activites beneficial for managements of vascular risk factors and disability prevention
The intervention group attended the same visits as the control group and received 4 intervention components- nutritional guidance, physical exercise, cognitive training and social activity and management of metabolic and vascular risk factors
Key conclusions: suggest that a multi-domain intervention could improve or maintain cognitive functioning in at risk elderly people from the general population.
Significance for lifestyle medicine: one of the first trials of this scope and scale that demonstrate the impact that a comprehensive lifestyle medicine intervention can have on reducing global cognitive decline, executive functioning and processing speed scores in elderly adults with early signs of cognitive decline.
Reversal of type 2 diabetes: normalization of beta cell function in association with decrease pancreas and liver triacyglycerol by Lim EL.
Objective: to test the hypothesis that both beta cell failure and insulin resistance can be reversed by dietary restriction of energy intake. to test the hypothesis that acute negative energy balance alone reverses type 2 diabetes by normalizing both beta cell function and insulin sensitivity.
Study design: intervention study with matched control group.
Sample population: n= 11 ppl with diabetes
Key conclusions: normalization of both beta cell function and hepatic insulin sensitivity in type 2 diabetes was achieved by dietary energy restriction alone. This was associated with decreased pancreatic and liver triacylglycerol stores. The abnormalities underlying type 2 diabetes are reversible by reducing dietary energy intake.
The first phase insulin response increased during the study period and approached control values.
Significance for lifestyle medicine: dietary energy restriction alone can lead to the reversal of abnormalities underlying type 2 diabetes within weeks. Specifically dietary caloric restriction can lead to normalization of both beta cell function and hepatic insulin sensitivity in patients with type 2 diabetes with a wk
Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease by Hambrecht R.
Objective: to determine if patients with stable CAD can improve myocardial perfusion and reduce disease progression and to compare the effects of exercise training to standard percutaneous coronary intervention with stenting on: clinical symptoms, angina-free exercise, myocardial perfusion, cost-effectiveness, frequency of a combined clinical endpoint
Study design: randomized control trail over 12 month period.
Intervention: 20 minutes of bicycle ergometry per day.
Key results: exercise training was associated with higher event free survival, increased maximal oxygen uptake, increased exercise tolerance, elevated ischemic threshold by 30%, significantly increased HDL serum levels after 12 months, whereas HDL dropped in the control group. LDL levels remained unchanged during the study period.
clinical symptoms significantly improved in both groups during the study period.
Key conclusions: after 12 months of exercise training, maximal exercise tolerance was increased significantly along with the ischemic threshold. Exercise training was associated with a 16% increase in maximal oxygen uptake. expenses for 1 year of exercise training averaged $3708, compared with $6086 per PCI patient, both groups clinical symptoms improved during the study period.
Significance for lifestyle medicine: compared with PCI 12 month program of regular physical exercise in selected patients with stable CAD resulted in superior event free-survival and improved exercise capacity at lower cots, as well as reduced hospitalizations and fewer repeated revascularizations.
More than double was spent to lessen angina in the PCI group. clearly demonstrates that lifestyle medicine in this case exercise can be more effective and affordable than a conventional medical procedure.
Comparison of the atkins, ornish, weight watchers and zone diets for weight loss and heart disease risk reduction.
Objective: Sought to provide a valuable comparison of popular diets for both patients and clinicians.
Study design: RCT for 1 year
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ample popuation: N=160 overweight or obese patients btwn the ages of 22-72 who had diagnosed HTN, dyslipidemia or fasting hyperglycemia.
Key results: each of the various dietary approaches can be used to reduce weight and improve markers of CV risk. All 4 diets resulted in modest weight loss at 1 year. no statistically significant difference btwn diets. as adherence scores increase, weight loss increased, regardless of the dietary program. each diet significantly reduced the LDL to HDL cholesterol ratio by approximately 10% with no significant effects on BP or glucose at 1 year. for each diet weight loss was significantly associated with decreasing levels of total to HDL cholesterol ratios, crp, and insulin.
Key conclusions: all 4 diets resulted in modest weight loss at 1 year. Adherence to diet not diet type largely determined treatment effects and weight- loss.
Significance for lifestyle medicine: demonstrates that one of the most important predictors of successful weight loss, with any diet is the ability of the patient to adhere to that dietary program. losing weight is more related to consistent caloric restriction and can be achieved in a variety of ways. long term success will require persistent adherence to that dietary plan to lose the weight and keep it off.
