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02nd October 2016

Looking After Our Hearts – The Facts

Age is the dominant driver of cardiovascular risk, that is the risk of conditions that affect the heart (cardio) and blood vessels (vascular) like heart disease, heart attacks and stroke.

Most individuals are already at high risk at the age of 65 years, but in the oldest old, cardiovascular risk management is controversial. Opponents argue that risk should not be treated when it is essentially age-driven. Proponents, on the other hand, point out that many preventive treatments are still effective at advanced age in terms of postponing morbidity and mortality.

There is limited data around the effectiveness of medical management of risk, with regards for examples prescription of statins, in people aged over 80 years. So perhaps there is even more call for consideration of non-pharmaceutical management like diet that may help prevent cardiovascular disease (CVD) in the older old. This week the blog looks at this in relation to new 2016 European Guidelines on CVD prevention.

These guidelines were recently issued by the Joint Task Force of the European Society of Cardiology and represent an evidence-based consensus involving 10 professional societies. The Task Force appraised the current evidence in managing CVD prevention.

What did they say about Dietary Guidelines?

Dietary habits influence the risk of CVD and other chronic diseases such as cancer, and the guidelines lay out that a healthy diet is recommended as the cornerstone of CVD prevention for all individuals.

The nutrients of interest as reported in the guidelines with respect to CVD are:-

  • fatty acids (which affect cholesterol levels), we can think of fatty acids as the types of fats we consume in foods like saturated  and unsaturated fats;
  • minerals (which affect blood pressure);
  • vitamins and

They also looked at the evidence for some foods such as nuts, fish and fruit and vegetables.

We will look at these dietary factors in turn and suggest what this may mean for catering practice.

Fatty Acids

For prevention of CVD, the types of fatty acids consumed are more important than the total fat content. The guidelines report that reducing saturated fatty acids and replacing with unsaturated fatty acids is beneficial to blood cholesterol levels and therefore heart health.

An interesting question surrounds dairy products because although they provide saturated fats, current evidence does not support an adverse effect of dairy products on CVD risk. This suggests that other dairy components may be protective and counteract the effects of the saturated fatty acids in these products.

What does this mean in practice?

  • Use oils rich in unsaturated fats for cooking – like olive, rapeseed or sunflower oil.
  • Include foods like oily fish and nut butters.
  • Provide low fat dairy products (but full fat dairy products where weight loss or risk of malnutrition is a concern).

Minerals

The minerals explored in the Guidelines are sodium (sodium chloride is salt) and potassium. This is because of the association of these minerals with blood pressure, and we know that high blood pressure is a key risk factor for CVD. Reference is made to studies that show that reduction of sodium intake is associated with reduction in blood pressure, and that the totality of evidence warrants salt reduction as an important part of dietary management to reduce risk of CVD.

In contrast to sodium, potassium has favourable effects on blood pressure.

What does this mean in practice?

  • Reduce salt by using low salt stocks, gravies and sauces and using other seasonings to flavour foods in cooking such as herbs and spices.
  • Ensure potassium rich foods are on the menu like vegetables, potatoes, bananas, fish and poultry.

Vitamins

Although researchers have suggested an association between higher intakes of the antioxidant vitamins like A, C and E and lower risk of CVD, vitamin supplement trials have been disappointing.

There is insufficiently conclusive evidence to recommend vitamin D supplementation to lower risk of CVD, although we know vitamin D is important for bone and muscle health.

What does this mean in practice?

  • A balanced, healthy diet providing essential vitamins is important but evidence would suggest that multivitamin supplements in people having sufficient intake from their diet is not likely to reduce risk of cardiovascular disease.

Fibre

Recent reviews show that a higher intake of total fibre is associated with lower risk of heart disease, stroke and type 2 diabetes. This evidence formed the basis of the recent increase in the UK recommendations for dietary fibre  to 30g day in adults.

What does this mean in practice?

  • Make sure foods that a variety of sources of fibre are included in the diet. This could include wholegrains such as porridge oats and wholemeal bread and high fibre starchy carbohydrates like serving potatoes with skins.
Fruits and vegetables

Studies have shown a protective effect of the consumption of fruits and vegetables on CVD, with decreased risk of mortality from heart disease, and a risk reduction for stoke, and a greater reduction reported for additional servings, for example 5 servings compared with 3 or less.

What does this mean in practice?

  • Include fruit and veg at every meal, this could be in stewed fruit with hot cereals, veg in soups and sauces as well as traditional ‘2 veg’ accompaniments to meals.
Nuts

Some evidence suggests that daily consumption of 30g (small handful) of nuts reduces the risk of CVD.  This suggests that including a modest amount of nuts as part of a well-balanced diet may be of benefit.

What does this mean in practice?

  • People should not start eating large quantities of nuts, or eat salted nuts in the hope that it will protect them from heart disease, but including small portions of unsalted nuts (or smooth nut butters where there is risk of choking) can be part of a healthy diet.
Fish

The protective effect of fish on CVD is partly attributed to the long chain omega-3 fatty acid content. Looking at pooled results of the evidence, the Task Force reported that eating fish may help reduce the risk of heart disease and stroke. However, a recent meta-analysis of studies mostly in prevention of recurrent cardiovascular events (i.e. secondary prevention)   showed no benefit of fish oil supplementation on cardiovascular outcomes. It is therefore possible that other components/nutrients in fish may be beneficial.

What does this mean in practice?

  • Diets should include at least 2 portions of fish, 1 of which should be oily.
Lastly to alcoholic drinks

Although previous results suggest a lower risk of CVD in those consuming moderate amounts of alcohol (one to two units per day) compared with non-drinkers, more recent studies have shed doubt on any beneficial effect of moderate alcohol consumption, and drinking three or more alcoholic drinks per day is associated with elevated CVD risk.

What does this mean in practice?

  • On the basis of more recent evidence the UK government changed its alcohol guidelines in 2016, recommending low levels of alcohol – no more than 14 units a week for both men and women.
  • 14 units is about
    • 6 x pints of beer (4% ABV)
    • 6 x 175ml glasses of wine (13% ABV)
    • 14 x 25ml single measures of spirits

Gaps in Evidence

The biggest challenge in dietary prevention of CVD is to develop more effective strategies to make people change their diet (both quantitatively and qualitatively) to meet existing advice and to sustain these changes in the longer term. Research into the substances in foods that underlie the protective effects on heart disease is ongoing.

*All information is correct at the time of publishing

Ayela Spiro

Nutrition Science Manager, British Nutrition Foundation

Ayela is a nutrition scientist at the British Nutrition Foundation, where her role involves providing expert advice on nutrition and health issues to a number of key audiences including consumers, health professionals, charities, the media and the food industry. At the heart of her work is the communication of nutrition science that promotes understanding of nutrition and health and contributes to the improved wellbeing of all.

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