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Dietary Management
Low calorie, low fat particularly low saturated fat, low cholesterol, high in PUFA with appropriate n 3 - n 6 ratio, low carbohydrate, normal protein diet is advised. The diet should be rich in vitamins, minerals and fibre.

Nutritional Guidelines
Total Energy
  • Those whose weight is in the desirable level are permitted a maintenance level of calories during convalescence and their return to activity.
  • The total calories should be restricted so as to reduce weight to the expected normal height, age and sex.
  • A 1000 – 1200 kcal diet is suitable for an obese patient in bed.
  • Loss of weight by the obese leads to a considerable reduction in the work of the heart because the basal metabolism is at a lower level.
  • The heart rate slows, there is a drop in blood pressure and thereby improve cardiac efficiency.
Carbohydrate

Since total calories are restricted, carbohydrate intake should be reduced. By reducing intake of carbohydrates especially simple CHO would help reduce serum triglycerides.
Fat
  • Restriction of fat to 20% of the total calories is advised. 
  • Complete restriction of fat is not advised as it results in mental and physical restriction.
  • The proportion of Saturated to monounsaturated to polyunsaturated fat should be 1:1:1. Thus consumption of blended oil is advised.
Saturated fatty acids
  • SFA tend to elevate blood cholesterol in all lipoprotein fractions.
  • The most hypercholesterolemic or atherogenic SFA are lauric acid, myristic acid, palmatic acid. 
  • The food sources of these fatty acids are milk, animal fat, organ meat, egg yolk, sea food, cheese, butter, hydrogenated vegetable oils, lamb, bakery goods, and snack items.
Polyunsaturated fatty acids:
  • The important n 3 polyunsaturated fatty acids are alpha linolenic acid, eicosapentanoic acid and docosahexanoic acid.
  • The n 6 acids are linoleic acid and arachidonic acid. Omega 3 fatty acids lower LDL – C and total serum cholesterol levels but not HDL – C. The anti-antherogenic effect follows the following metabolism;
  • PUFA promotes the esterification of cholesterol and put it into easily utilization form.
  • They are precursors of substances that are vasoconstrictors or vasodialators. These substances also decrease stickiness of platelets (anti platelet aggregate factor) and decrease tendency of clotting (thrombosis).
  • Prevent accumulation of cholesterol in serum and blood vessels and play a key role in transport of cholesterol
  • Decrease the synthesis of precursor of VLDL which is associated with increased incidence of CHD
  • Decreases the production LDL and triglycerides and also clearance of LDL – C
Monounsaturated fatty acids
  • MUFA are present in vegetable oil sources like olive oil, canola oil, almond oil and groundnut oil.
  • They lower LDL without lowering HDL. Larger portion of MUFA in diet may be conducive to thrombolysis and anti – inflammatory.
  • Uncontrolled peroxidation of PUFA in cell membrane may lead to cellular damage while maintenance of a balance with MUFA will help maintain cell function.
SFA Oleic N 3 N 6
Cholesterol

HDL – C

Triglycerides

Platelet Aggregation

↓↓

Protein
A normal intake of protein is recommended but protein from animal sources is restricted as they are high in saturated fatty acids

Vitamins & Minerals
Need to be taken in adequate quantity especially from fruits and vegetables. Only sodium needs to be restricted.

Fibre
  • Pectin (apples, guavas) lowers serum cholesterol and enhances excretion of fecal steroids. It has no effect on TG and HDL cholesterol.
  • Guargum (extract of seeds of cluster beans) has cholesterol lowering effect.
  • Legumes, psyllium, vegetables and fruits can lower TC. Dietary fibre also reduces serum fibrinogen levels, which in turn lowers the risk of blood clot formation and heart attack.
  • Oats products has a high betaglucan one of the postulated theory is hat cholesterol synthesis is inhibited by acetic propionic and butyric acids, generated by the colon bacteria and clearance of LDL – C.
  • Fenugreek seeds are rich in fat, protein and fibre. It contains 20% mucilaginous fibre and 50% total fibre. Saponins of fenugreek have lipid lowering activity. It also increases the excretion of bile acid and neutral sterols and depletion of cholesterol stores in the liver.
Tips to Add fibre
  • Choose fresh fruits over canned fruits or juices
  • Choose whole grain pulses
  • Leave skins on fruits
  • Have a salad every day
  • Use brown rice rather than white rice
  • Choose raw vegetables and fresh fruits as snacks
  • Add as many vegetables to the meal as possible
 
 
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