Introduction

• Cardiovascular Disease (CVD) is the leading cause of death in Malaysia. Of the CVDs, Coronary Heart Disease (CHD) is the most prevalent cause of death, followed by stroke.
• Patient with hyperlipidemia are at high risk for a heart attack.
• Hyperlipidemia is an elevation of lipids (fats) in the bloodstream, largely cholesterol and triglycerides. They are re transported in the blood by carriers called lipoproteins.
• There are three types of lipoproteins in the body:
  • Low-density lipoprotein (LDL)
  • High-density lipoprotein (HDL)
  • Triglycerides (TG)
• Low-density lipoprotein or LDL is known as ‘bad cholesterol’. Excess LDL cholesterol contributes to the blockage of arteries which leads to heart attack.
• High-density lipoprotein or HDL is known as ‘good cholesterol’ because a high level of HDL seems to protect against heart attack.
• Blood cholesterol level is affected by what you eat and how quickly your body makes Low Density Lipoprotein (LDL) cholesterol.

Objective of Nutrition Management

• To reduce serum lipid levels by using diet, exercise and weight reduction approach.
• To provide a meal plan in management of cardiovascular disease.

Risk Factor

Risk factors for hyperlipidemia includes:

• Overweight or obese
• Diet
  • High in saturated fat and cholesterol
  • Low in fruits, vegetables and fiber
• Sedentary lifestyle
• Having a genetic factor
  • Familial hypercholesterolemia: LDL levels are high
  • Familial hypertriglyceridemia: Triglyceride levels are high
  • Familial combined hyperlipidemia: Levels of cholesterol, triglycerides or both are high and HDL is low.
• Having hormonal disease such as:
  • Diabetes mellitus
  • hypothyroidism
• Use of certain medication:
  • Birth control pills
  • Hormone therapy
  • Beta blockers to treat cardiovascular disease

Energy

• You have to know your weight status, physical activity level and diet history to estimate your daily energy requirement. It is important to plan and manage your total calorie intake to achieve the recommended body weight.
• For normal body weight, your daily energy requirement is 30-35 kcal/ kg/day.
• Your current body weight and height are used to calculate the Body Mass Index (BMI)
• The acceptable BMI is below 25kg/m2.
• See more at weight management.

Carbohydrate

• 1 gram of carbohydrate provides 4 kcal of energy.
• Carbohydrate should comprise 50% to 60% of total energy intake daily.
• Persons with metabolic syndrome who have elevated triglycerides (TG) or low HDL cholesterol, should be considered to lower the intake of carbohydrate at 50%.
• You need to take more whole grain or complex carbohydrate (at least 3 servings) such as brown rice, whole meal bread, chapatti, oats, bran, corn and whole grain cereals.
• Examples of 1 serving of complex carbohydrate are as below:-

Sugar

• You should limit your sugar intake to not more than 15%of your total daily energy requirement. High intake of sugar in place of fat is accompanied by reduction in HDL cholesterol and rise in triglycerides.
• It is advisable to limit your intake of high sugar containing foods such as sweets, jam, sweetened drinks, sweetened kuih, condensed milk, cordials, cookies and carbonated drinks.

Dietary Fiber

• The recommended intake of dietary fiber is 20-30g per day (of which at least 6 grams should be soluble fiber).
• The minimum recommended amount of dietary fiber is 3 servings of vegetables and 2 servings of fruits plus one serving of wholegrain foods every day.
• An increase in soluble or viscous fiber of 5-10g per day is accompanied by an approximately 5% reduction in LDL cholesterol.
• Soluble fiber is found in oats, oatmeal, oat bran, beans, legumes, barley and citrus fruits. Oats have the highest proportion of soluble fiber among cereals.
• 1/2 cup of oat bran provides 6 grams of soluble fibre a day.
• See more at Nutrient needs for elderly.

Below are examples of fibre content of rice and other cereal products, legumes and fruits and vegetables:-

Protein

• 1 gram of protein provides 4 kcal of energy.
• Your daily requirement of protein is 15% of your total daily energy intake. It is equal to 0.8 – 1.0g protein per kg of your body weight daily.
• Fish such as Kembung, Tenggiri, Kurau, Siakap, Tilapia and Keli can be eaten within the recommended 2 -3 servings per day.
• Choose only lean cuts of meat such as beef, mutton, lamb or pork. Remove skin and fat from poultry. Avoid wings, feet and other fatty parts.
• You should limit your egg yolk intake to not more than 2 per week as they contain 215 mg cholesterol per egg.
• Choose legumes, pulses, soy and soy products more often to replace animal protein. Nuts that are high in unsaturated fats be eaten a few times a week. Examples of 1 serving of protein from meat, fish, legumes and nuts are as follows:-

You should take 1-2 servings of dairy products every day. Choose low fat or non fat (skimmed) milk and milk products. However, this recommendations does not include sweetened condensed milk, evaporated creamer or non-diary creamer. An example of 1 serving of dairy products are stated below:-

Fat and cholesterol

• 1 gram of fat provides 9 kcal of energy.
• Your daily requirement of fats is 25-30% of your total energy intake.
• However fat intake should not be lower than 25% of total energy intake since this could involve replacing with excess carbohydrate and possibly resulting in higher triglycerides and lower HDL cholesterol.
• Fats are classified into three major groups depending on their chemical structure, which are satured, unsaturated (including polyunsaturated and monounsaturated) and trans fatty acids (chemically altered fats found in manufactured or processed foods)
  • Saturated Fatty Acids (SFA)
    • The requirement for SFAs is 7-10% of total energy intake. Diets high in saturated fats may raise serum LDL cholesterol levels.
    • Minimise the consumption of SFA sources such as ghee, butter, shortening, tallow (beef fat), lard (pork fat), cocoa powder and full cream dairy products.
    • Santan or coconut milk is one of the major contributors to saturated fat intake. Limit dishes that contain santan.
  • Polyunsaturated Fatty Acids (PUFA)
    • The requirement for PUFAs is 5-7% of energy intake.
    • Food sources of PUFAs are liquid vegetable oils (palm olein, corn, safflower, sunflower, soybean, rice bran, sesame) and deep sea cold water fish.
    • These oils are not recommended for deep fat frying due to their chemical composition and low smoking point.
  • Monounsaturated Fatty Acids (MUFA)
    • The requirement for MUFAs is 12-15% of energy intake.
    • Most MUFA are derived from vegetable sources including plant oils (canola, olive, peanut) and nuts.
    • These oils are recommended for deep frying.
  • Trans Fatty Acids (TFA)
• The intake for TFAs should be less than 1% of energy intake.
• TFAs are produced mainly by the commercial hydrogenation of PUFA-rich edible oils, a process which “hardens” these oils at a high temperature in the presence of metal catalyst for the purpose of solid-fat food applications (eg; shortening, margarine, vegetable ghee, bakery fat, etc)
• Intake of dietary cholesterol should be less than 300mg/day. See more at hypercholesterolemia.

Sodium

• You should take less than 2400mg sodium or 6g sodium chloride (table salt) a day.
• 2400mg of sodium is equivalent to 1 level teaspoon of table salt.
• Consuming less salt can reduce the chances of developing high blood pressure. High salt intakes is associated with higher blood pressure.

Alcohol

• Persons with hypertriglyceridemia should avoid taking alcohol in their daily diet.
• The recommendation for alcohol intake is less than 2 units a day. A unit is defined as 5 ounces of wine, 12 ounces of beer or 11/2 ounces of 80 proof whisky.