行为干预：饮食控制、锻炼、控制体重.ppt

Lifestyle Interventions: Dietary Therapy, Physical Activity, Weight ControlNeil J. Stone, M.D. Primary Prevention: Status and Goals in 2010 Primary Prevention: Status and Goals in 2010 Primary Prevention: Crucial Opportunity to Reduce the Burden of CHD Primary Prevention: Adverse Life Habit Changes Atherogenic diet Sedentary lifestyle Obesity Primary Prevention—Rx: Therapeutic Lifestyle Changes (TLC) Therapeutic diet to lower LDL-C Physically active on a daily basis Weight control Primary Prevention—Rx: TLC Measures to Lower LDL-C Saturated fats (7% total calories) and cholesterol (200 mg/d) Also therapeutic options: Plant stanols/sterols (2 g/d) Increased viscous fiber (10–25 g/d) Total Fat...Why a range? Primary emphasis is to reduce saturated fats Total fat should range 25–30% for most cases Those with metabolic syndrome Avoid very high fat intakes Avoid very low fat intake (low HDL-C, high TG) Total fat intake can range from 30–35% if extra fat is unsaturated May reduce some lipid and nonlipid risk factors Clinical judgment required.? Therapeutic Lifestyle Changes:Nutrient Composition of TLC Diet LDL-C Response to Step II Diet: beFIT 178 Women / 231 MenDietary fat 25%; saturated fat 7.5% LDL reduction ? High cholesterol only: –7.6 to 8.8% LDL reduction ? Combined hyperlipidemia:–8.1% DELTA I Dietary Trial Subjects: age 22 to 67 Different groups of subjects: White, black Women: younger and postmenopausal Men: younger, older New Options to Lower LDL-C Avoid Trans fatty acids* Add Dietary fiber Plant sterol/stanol ester margarines Trans Fatty Acids (TFA) TFA more densely packed than cis forms Usual intake: only 2–3% of energy If consumed in high amounts: ? LDL-C; ? HDL-C Examples of TFAStick margarine, cookies, biscuits, white bread Plant Sterol/Stanol Esters Sterols are essential components of cell membranes Cholesterol exclusively an animal sterol We ingest almost as much plant sterols as we do dietary cholesterol Stanols absorbed even