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【Heart Disease and Health】present common and professional knowledge on heart disease and health promotion, suitable for the general public, patients (to understand common knowledge 

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                                                      Healthy Diet

       Diet plays a major role in overall health and well being.  For health and normal function of the body, humans need to consume foods and drinks that are sources of energy and nutrients.  Furthermore, diet can prevent and manage the diseases such as obesity, hypertension, diabetes, cardiovascular disease, cancer, allergy, osteoporosis, gastrointestinal and immune disorders. 

Today, along with urbanization and economic growth, dietary changes favor a rise in calorie consumption and decline in overall diet quality.  Fast food is unhealthy diet with a high calorie content, large amounts of processed meat, highly refined carbohydrates, sugary beverages and unhealthy fats.  Supermarkets also replace fresh local food and farm shops and serve as a source of highly processed foods, high-energy snacks and sugary beverages.

       Healthy diet is now defined as one that maximizes both health and longevity.    Healthy diet composes of carbohydrates, proteins and fats, water, and a range of vitamins, minerals and trace elements. These macronutrients and micronutrients provide energy as well as provide for growth, maintenance and repair of cells.  Insufficiency or excess consumption can contribute to poor health or nutrition-related morbidity and mortality.

       Macronutrients are consumed in the largest quantities and provide bulk energy.  The three primary macronutrients include carbohydrates, proteins and fats. 

       Carbohydrates should make up of 45-65% of total calorie intake.  Carbohydrate quality can be evaluated by the glycemic response (blood glucose level) to carbohydrates, such as the glycemic index and the glycemic load (a product of glycemic index and the amount of carbohydrates of a food).  Low-glycemic index foods include vegetables, nuts, legumes and grains.  High-glycemic index foods include potatoes, candies, white bread and other refined products made from grains.  Diets high in glycemic index have high risk of developing diabetes, coronary artery disease and cancer 

       Proteins should make up 10-35% of total calorie intake.  Healthy protein-rich foods include fish, poultry, lean meat ,eggs, beans, peas, soy products, nuts and seeds.  Increased consumption of red and processed meat are associated with an increased risk of diabetes, stroke, colorectal cancer and cardiovascular disease.

       Fats should make up of 20-35% of total calorie intake.  Saturated fat and trans fat such as meats, cheese, margarines, baked goods, fast foods and ice cream contribute to cardiovascular disease, while mono- and polyunsaturated fats such as fish, olive oil, nuts are relatively protective.  Cook with oils that contain polyunsaturated and monounsaturated fats such as corn, olive and peanut oils. The quality of fat is more important than total fat intake, and diets that favor plant-based fats over animal fats are more advantageous. 

       Micronutrients are needed in very small amounts and include a variety of  minerals and vitamins.  Minerals form only 5% of the typical human diet but are essential for normal health and function.  Minerals are classified as macrominerals which include minerals required by adults in amounts greater than100mg per day such as sodium, potassium, calcium, magnesium and phosphorus.  Trace elements are minerals required in amounts 1-100mg per day by adults such as copper, fluoride, iodine, manganese, zinc.  Ultra-trace elements are minerals that are required less than1mg per day by adults such as chromium, selenium and arsenic.  A high intake of sodium is associated with hypertension and cardiovascular disease, stroke, stomach cancer and kidney disease.  Calcium and vitamin D are necessary for normal skeletal homeostasis and function.  Antioxidant vitamins include vitamins A, C, E and beta-carotene.  Many foods especially fruits and vegetables contain these vitamins.

       Multivitamin supplementation can be considered for patients at risk of vitamin deficiency such as alcoholism, poor-quality diets with low fruit and vegetable intake, malabsorption, a vegan diet, hemodialysis patients.  Unless there is a specific indication, multivitamin and mineral supplementation for primary prevention of chronic disease in people with adequate dietary intake is not recommended because of insufficient evidence of effectiveness.  Testing for vitamin blood levels is also not indicated in healthy adults and should be considered only if there is clinical suspicion of vitamin deficiency such as measurement of vitamin D and calcium levels in the evaluation of established osteoporosis.

       Fruits and vegetables are a rich source of fiber and essential vitamins and minerals, as well as carbohydrates with a low glycemic index.  Increased fruit and vegetable intake is associated with decreased risk for mortality, cardiovascular disease, stroke and cancers.

       The dairy food compose of milk and milk product such as cheese, yogurt.  Diary food are a good source of protein, calcium, vitamin D and potassium.  Diary products lower the risk of cardiovascular disease, stroke and cancer.

       Soft drinks and other sweetened beverages should be discouraged.  These beverages are a major source of refined sugar and calories in the diet, therefore a key contributor to weight gain and obesity.  Alcohol increases risk of breast cancer in women; cancers of the mouth, esophagus, throat, larynx and liver; other illness such as cirrhosis and alcoholism. Caffeine is the most consumed stimulant in the world, usually in the form of coffee and tea.  Based on available data, there is insufficient evidence for promoting or discouraging coffee and/or tea consumption in the daily diet.

       The World Health Organization (WHO) recommendation for a healthy diet emphasize reducing the intake of saturated and trans fatty acids, sugars and salt, while increasing the intake of fruits, vegetables, nuts and whole grains.

       A low-fat diet, low-carbohydrate diet, vegetarian diet, DASH diet and the Mediterranean diet are among the most commonly used eating patterns to maintain good health.  All of these eating patterns are associated with health benefits.

       Mediterranean diet is typically high in fruits, vegetables, whole grains, beans, nuts and seeds and include olive oil as an important source of fat.  It generally includes low to moderate amounts of fish, poultry and dairy products, with little red meat.

       DASH ( Dietary Approaches to Stop Hypertension ) diet is rich in fruits and vegetables, high in fiber, moderate in low-fat daily products, low in animal protein, and low saturated fat and contains many plant source of protein including legumes and nuts.

       Very-low-carbohydrate ketogenic diets have been used for many decades for weight reduction, epilepsy, diabetes, cardiovascular disease and neurological disease.

       In the past few decades, people worldwide have gained weight and adiposity, largely as a result of changes in dietary patterns and decreased exercise levels.  The risk of hypertension, diabetes, hyperlipidemia, obesity, cancer rises as excessive body fat increases, and increases in body mass index (BMI) and waist circumference.

       BMI is calculated simply by the body weight (in Kg) divided by the square of the height (in meter).  The normal body weight is a BMI 18.5 –24.9 Kg/m².  Overweight is a BMI of 25-29.9 Kg/m², and obesity is a BMI greater than30 Kg/m². Underweight is a BMI less than18.5 Kg/m².  In addition to measuring BMI, waist circumference in overweight and obese adults is also measured to assess abdominal obesity.  A waist circumference of greater than40 in(102 cm) for men and greater than35 in(88 cm) for women is considered elevated and indicative of increased cardiometabolic risk.  Patients with abdominal obesity are at increased risk for cardiovascular disease, diabetes, hypertension, dyslipidemia, and have higher overall mortality rates.  In clinical practice, both BMI and waist circumference should be monitored.  It has been shown that the risk associated with waist circumference is stronger than the risk associated with a higher BMI.  It is important to adjust your diet so as to maintain normal BMI and waist circumference.  If you are overweight, eat less.  If you are underweight, eat more.  The types and amount of carbohydrates consumed may have important implications for health. Diets that emphasize low or no carbohydrates are becoming popular for weight reduction.

       Hypertension is the leading risk factor for death worldwide, even surpassing cigarette, high blood glucose and lipid, and obesity.  Diet plays a crucial role in the effective prevention, treatment and control of hypertension.  A diet that is rich in fruits, vegetables, legumes, and low-fat dairy products and low in snacks, sugars and meats (such asMediterraneanand DASH diets) lower blood pressure and prevent hypertension and cardiovascular disease

Excess body weight is the most important risk factor for diabetes.  Diet that is rich in wholegrain foods, fruits and vegetables, and low in total fat especially animal fat, can prevent diabetes..

       About 70% old adults are at nutritional risk or are malnourished¹⁴.  Malnutrition is associated with increased mortality risk.  Routine supplementation with multivitamins and minerals is not indicated and is likely not beneficial unless the older adult has low overall intake.

       Chronic diseases are leading cause of morbidity and mortality worldwide.

Dietary interventions play a role in the etiology and evolution of many disease processes.  It has long been shown that diet modifications can prevent, slow, and even reverse some disease processes especially obesity and diabetes.  It is estimated that 30-35% of cancer can be prevented by healthy diet that includes vegetables, fruits, whole grains, fish and a reduced intake of red meat, animal fat and refined sugar.  Dietary modifications can also improve cancer treatment outcomes.  Mediterranean diet is also associated with less cognitive decline, dementia or Alzheimer’s disease.

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