DIETARY PREVENTION OF CHRONIC DISEASE

1. DIETARY PREVENTION OF CHRONIC DISEASE Sonja L. Connor, MS, RD, LD

4. New Eng J Med 1995;332:481-487

5. Cholesterol Content Of Selected Foods White Fish & Shell- fish Poultry Red Meat Cheese Shell- fish 2 Lrg Egg Yolks Liver

6. Cholesterol-Saturated Fat Index White Fish Clams OystersScallops Poultry Shrimp Crab Lobster Red Meat 10% fat Red Meat 25% fat Cheese 2 Lrg Egg Yolks Liver

7. CSI in Salad Dressings

8. Recipe Comparisons CSI/Svg* • Spinach Lasagna (low fat)** 8 • Meatless Lasagna (traditional) 16 • Lasagna with Meat Sauce 30 * 1 piece 3 x 4 1/3 inches ** From The New American Diet

9. LOVASTATIN & DIETSTUDY DESIGN • 6 subjects • 40 mg lovastatin per day • 4 week diet periods (randomly assigned) cholesterol,  saturated fat ( CSI)  cholesterol,  saturated fat ( CSI) • Plasma lipids & lipoproteins

10. LIPIDS & LIPOPROTEINS

14. Reduce Fat Intake by One-Half • Learn the art of skinny frying • Reduce fat in baked goods by 1/3 • Limit added fat to 2-4 teaspoons/day(margarine, mayonnaise, salad dressing) • Include nuts but not too many • Peanut butter sandwich • Add crunch to casseroles, breads, desserts

16. Where Can I Get the Most?

17. Eat More Fish 2 or more times a week

18. Polynesian Fried Rice Recipe from Gourmet Magazine

19. Double Complex CHO Intake • Eat 2 to 5 servings at each meal(whole grain bread, brown rice, pasta, potatoes) • Eat 3 to 5 cups legumes each week • Eat 2 to 3 cups vegetables each day

20. Standby Favorite Dishes1 cup servings * From The New American Diet

21. Phase 1 -- Substitutions • Avoid foods high in cholesterol & saturated fat Delete egg yolk, butterfat, lard & organ meat Substitute vegetable oils & shortening for lard skim milk for whole milk egg whites for whole eggs • Use Lite Salt NCEP Step I diet, AHA Step I diet

22. Phase 2 – Try New Recipes • Gradually transition to eating meat once a day • Use less fat & cheese • Eat more fruits, vegetables, grains & beans • Use fewer products with large amounts of salt • Acquire new recipes Mediterranean, DASH, NCEP Step II & AHA Step II diets

23. Mediterranean DietThe Lyon Diet Heart Study • More bread, root & green vegetables, fish • Fruit at least once daily • Less red meat (replaced with poultry) • Replace butter with margarine , use olive and Canola oil • Wine in moderation Circulation2001;103:1823-1825; Lancet 1995;345:738

24. Phase 3 – Everyday Eating • Use meat as a condiment • Use only low CSI cheeses • Decrease amount of salt in cooking • Use these foods for special occasions • Extra meat • Regular cheese • Chocolate • Salty foods Forks Over Knives; Beyond Phase 3 – Pritikin, Ornish

26. Newsletters

27. Magazines Cookbooks

28. Translating Science to the Practical

30. IT IS POSSIBLE!! • If the masses can love tofu TOBY’S TOFU PATÉwww.tofupalace.com • The masses can find products & recipes they like that fit a low-fat, high complex carbohydrate eating style Light Jalapeno

32. THE DIET HABIT SURVEY THE DIET HABIT SURVEY • SELF-SCORED SURVEY • ____________________________________________ • Name • ____________________________________________ • Date ________________________________ Name ________________________________ Date Dietitian-scored Examining Your Eating Habits! J Amer Diet Assoc 1992;92:41-47

33. DHS QUESTION How often do you eat fish? 1 Do not eat fish or eat fish less than once a month 2 One to 3 time s a month 3 Once a week 4 Two times a week 5 Three or more times a week or eat vegetarian with no added fat

34. DIET HABIT SURVEY

35. DIET HABIT SURVEY • Addresses all areas of eating (fat, fiber, sugar, salt, recipes, eating out) • Can be done at home (~30 minutes) • Can be scored in less than 5 minutes • Visit focused on patient’s ideas about making changes

36. DIET HABIT SURVEY-Mr Win-Win

37. Tips for Low-Fat Eating-28% • Entrée 10 grams fat or less • Other dishes 5 grams fat or less • Meat, Fish Poultry • Limit chicken, very lean red meat and low-fat cheese to a total of 6-8 ounces (men) or 4-5 ounces (women) per day • Choose chicken, turkey or low-fat vegetarian dishes

38. DIET HABIT SURVEY-Mr Win-Win

39. IDEAS FOR CHANGING EATING HABITS - 1 mo • Cut down on evening snacks • Eat breakfast • Limit coffee and alcohol • Try and use low-fat cheese

40. Discover Low-Fat Cheese Alternatives Typical Cheese 9 grams fat/oz Trader Joe’s Celtic Cheddar 4 g/oz Kraft Sharp Reduced Fat Cheddar 4.5 g/oz Jarlsberg Light Reduced Fat Swiss 3.5 g/ozLaughing Cow Light 3 g/oz

41. IDEAS FOR CHANGING EATING HABITS - 2 mo • Eat breakfast at home • Limit coffee • Eat low-fat cheese • Increase veggies with summer salads

42. IDEAS FOR CHANGING EATING HABITS - 6 mo • Try low-fat salad dressings (Best Foods Low-fat) • Try reduced fat Vermont Cabot Cheddar Cheese • Pack lunch when on the go

43. IDEAS FOR CHANGING EATING HABITS - 12 mo • Increase fruits and veggies • Decrease coffee and tea • Walk about 1 mile a day

44. DIET HABIT SURVEY-Mr Win-Win

46. Family Heart Study

47. Tarahumara Indian

48. All That Makes Good Sense Physical Activity Healthy Eating

49. Normal Coronary Artery

50. Blocked Coronary Artery