How should people with dyslipidemia eat?

Dyslipidemia is a medical condition when one or more lipid parameters are disturbed (elevated cholesterol or triglycerides, or increased LDL-c, or decreased HDL-c…).

Dyslipidemia is a common non-communicable chronic disease and a risk factor for cardiovascular diseases. In addition to drug treatment, diet and lifestyle changes are important in treating and reducing complications of the disease.

I. Overview of dyslipidemia

1. Components of blood fats and their roles

– Blood fats include free fatty acids, triglycerides, phospholipids, free cholesterol, esterified cholesterol.

+ Cholesterol: Cholesterol is the main component of cell membranes, helping to strengthen cell membranes. When cholesterol concentration is high, it will cause deposition in cell membranes, reducing elasticity, especially with cells in artery walls, causing high blood pressure.

Dietary cholesterol has an effect on serum total cholesterol and is associated with coronary heart disease. Therefore, it is not advisable to over consume foods high in cholesterol such as animal organs, brain, heart, liver, ovals, etc.

Since lipid components are insoluble in the blood, they are transported by combining with proteins into lipoprotein corpuscles. Based on the density of protein components in lipoproteins, they are divided into 5 types of lipoproteins:

+ Chylomicron: contains 80-90% triglycerides to transport triglycerides to the liver after meals.

+ Very low-density lipoprotein (VLDL): contains 55-65% of triglycerides, synthesized in the liver by the liver’s fat and carbohydrate stores.

+ Low-density lipoprotein (LDL): transports cholesterol to cells (also known as bad fat)

+ High-density lipoprotein (HDL): transports cholesterol from cells to the liver (also known as good fat)

+ Intermediate Density Lipoprotein (IDL): density between VLDL and LDL

The higher the ratio of LDL/HDL, the greater the rate of atherosclerosis and vice versa.

+ Triglycerides play an important role in transporting energy from food into cells.

+ Saturated fatty acids (saturated fats): Saturated fatty acids have the ability to increase total cholesterol and LDL-C and are related to clotting factors – factors that play an important role in the formation of blood clots and are considered a risk factor for atherosclerosis.

+ Trans fatty acids: found in fat, grass-fed milk and may increase the risk of coronary heart disease. The negative effect of trans fats on the cholesterol/HDL ratio was more than twice that of saturated fats.

+ Unsaturated fatty acids: increased use of dietary unsaturated fatty acids compared with saturated fatty acids helps to increase HDL-C and polyunsaturated fatty acids have a better double chain than saturated fatty acids. But they are less effective than polyunsaturated fatty acids on the cardiovascular system.

+ Polyunsaturated fatty acids: Omega-3 is a form of polyunsaturated fatty acids, which plays an active role in the prevention of cardiovascular diseases and control of dyslipidemia.

Fish oils and fish oils that are rich in these fatty acids, such as DHA and EPA, have been shown to reduce blood cholesterol and triglycerides in people with high triglyceride levels, preventing arrhythmias, ventricular fibrillation, thrombosis and partially regulating blood pressure in mild hypertension.

Supplementing with about 9-13g of natural fish oil/day (corresponding to 1.7-7g of omega-3 fatty acids/day) reduced triglycerides by 20-25% in people with normal triglyceride levels and 26-33% in people with elevated triglycerides.

2.Cause of dyslipidemia

2.1. Primary dyslipidemia

Genetic: Primary dyslipidemia due to mutations in genes that increase the synthesis of cholesterol (TC), triglycerides (TG), LDL-c or decrease the clearance of cholesterol, TG, LDL-c or decrease the synthesis of HDL-c or increase clearance of HDL-L.

Primary dyslipidemia usually occurs early in children and young people, rarely with obesity.

2.2. Secondary dyslipidemia

The cause of secondary dyslipidemia comes from a sedentary lifestyle, consuming a lot of beer-alcohol, foods rich in saturated fat.

Dyslipidemia is often detected at the same time as several cardiovascular-endocrine-metabolic diseases. At the same time, dyslipidemia is also a risk factor for this disease.

Other secondary causes of dyslipidemia are diseases such as diabetes, chronic kidney disease, hypothyroidism, cirrhosis of the liver, taking thiazides, corticosteroids, estrogens, beta-blockers.

+ Diabetes: often hypertriglyceridemia due to decreased activity of lipoprotein lipase enzyme. If blood glucose is well controlled, triglycerides should decrease after a few weeks. Hyperglycemia is a risk factor for atherosclerosis in patients with diabetes.

+ Hypercortisolism (Cushing’s syndrome): There is a decrease in the catabolism of lipoproteins due to a decrease in lipoprotein lipase enzyme activity. This situation is more pronounced in the case of insulin resistance and diabetes.

+ Use of estrogen: In women taking long-term estrogen, there is an increase in TG due to increased synthesis of VLDL. During pregnancy, increased estrogen levels also increment TG 2-3 times and will return to normal levels about 6 weeks after delivery.

+ Alcoholism: disordered blood lipids, mainly increased triglycerides. In particular, alcohol significantly increased blood triglyceride levels in individuals with primary or secondary increased TG production due to other causes.

+ Renal disease: in nephrotic syndrome, VLDL and LDL are increased due to increased synthesis by the liver to compensate and decreased blood protein levels due to urinary excretion. TG increased due to decreased blood albumin, so the free fatty acids attached to albumin also decreased, free fatty acids increased attached to lipoproteins, causing TG hydrolysis of these lipoproteins to be reduced.

3. Diagnosis of dyslipidemia

Threshold for diagnosis of disorders in blood lipid metabolism:

• Increase plasma triglycerides: >2.26mmol/L (200 mg/dL)
• Increase plasma cholesterol: >5.3mmol/L (205 mg/dL)
• Elevate LDL-cholesterol: >4 mmol/L (154 mg/dL)
• Decrease HDL: <0.9 mmol/L (35 mg/dL)

II. Nutrition for people with dyslipidemia

1. Lipid

Reduce the amount of fat, fat should only make up 15-20% of the total energy intake.

– Energy from saturated fatty acids does not exceed 7% of dietary energy.

– Energy from trans fatty acids is less than 1%.

– The daily cholesterol intake is less than 200mg.

– Use vegetable oils such as peanut oil, olive oil, soybean oil instead of animal fat

– Omega-3 pharmacological dose is 2-3g/day and recommended diet with 2-3 times of fish/week.

– Eliminate foods high in saturated and trans fatty acids such as fat, butter, meat broth, processed foods and cholesterol-rich foods such as brains, intestines, viscera, fatty canned goods. Limit fried and fried foods and eat boiled and steamed foods.

2. Glucid

– Replacing saturated fatty acids with energy from glucose has a good effect on the risk of atherosclerosis.

– However, consuming too much carbohydrate can have negative effects on triglyceride and HDL-C levels. Besides, low-carbohydrate diets are not effective in helping to control dyslipidemia. A meta-analysis study on subjects showed that the group with energy from carbohydrates compared to total energy >70% and <40% had a higher rate of dyslipidemia and the group with the lowest risk with carbohydrate energy from 45-55%.

– The form of glucide used is very important and should be used in a complex form. Use cereals combined with potatoes high in fiber and antioxidants, whole grains such as brown rice, sprouted rice, black bread, etc.

– Avoid foods high in simple sugars and energy from simple sugars should not exceed 10% of total energy, including natural sugars from fruits and everyday foods, especially for patients who are in need of weight loss or hypertriglyceridemia.

3. Protein

Recent epidemiological studies have shown that a high-protein diet (24% of dietary energy) consisting of animal and vegetable protein significantly reduces the risk of cardiovascular disease (RR = 0.75) and controls dyslipidemia.

Plant proteins (beans, beans, etc.) help reduce the risk of cardiovascular disease, while animal protein is related to saturated fatty acids and cholesterol. Use low-fat meat and dairy products to replace fat.

4. Fiber
   

Fiber contributes to lowering blood cholesterol through 2 mechanisms:

– Fiber binds to bile acids, reducing the absorption of cholesterol and triglycerides.

– Bacteria in the colon feed on fiber to produce acetate, propionate and butyrate, which inhibit cholesterol synthesis.

The above effects are the basis for making recommendations to increase the consumption of foods rich in fiber. The American Society of Clinical Nutrition recommends that people consume a variety of plant-based foods, including fiber from fruits and vegetables and the hulls of whole grains.

General recommendations recommend eating 20-35g of fiber/day or 10-33 g/1000 kcal. However, the diet often does not provide enough fiber, so it is necessary to ensure a minimum of 300g of vegetables/day and 100g of fruit/day.

Fiber, especially soluble fiber, found in legumes, fruits, vegetables and grains (oats) has the effect of lowering blood cholesterol and controlling dyslipidemia.

5. Vitamins, minerals and antioxidants
   

Studies have shown the role of vitamins and minerals with antioxidant effects in the prevention of cardiovascular diseases, the process of atherosclerosis. Observations show that a diet rich in antioxidants reduces the risk of coronary heart disease by 20 to 40%.

Food choices:

• Foods rich in Vitamin E: bean sprouts, vegetable oil
• Foods rich in beta-carotene: carrots, pumpkin, gac, ripe papaya, mango, dark green vegetables
• Foods rich in vitamins: vegetables in general
• Foods rich in selenium: spinach, water spinach, cabbage…
• Some special ingredients: flavonoids found in green tea, neutralize the effects of free radicals. Isoflavones or phytoestrogens in soybean significantly reduce total cholesterol, LDL, and triglycerides.

6. Nutritional advice:

 

• Eat a variety of foods (15-20 foods a day)
• Eat 3-4 meals/day. Eat regularly, do not be too hungry, because if you are too hungry, you will eat more in the next meal, which will accumulate fat faster.
• Do not eat late at night before going to bed
• Drink enough water 2-2.5 liters/day.

References:

[1] Dr. N. T. H. Dr. Nguyen Thi Lam, Nutrition treatment of hypertension, dyslipidemia and diabetes. Institute of Nutrition: Medical Publishing House, 2004.

[2] https://vncdc.gov.vn/roi-loan-chuyen-hoa-lipid-mau-nd14588.html

Article source: Nutrition Research and Development Institute (https://inrd.vn/)

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