Health Professional's 2020

Nutrition Recommendations

Sandy Duxbury

Heart Health Co-ordinator, Nutrition & Equity

Heart Foundation

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The Heart Foundation acknowledges the

Traditional Owners and custodians of Country throughout Australia and

their continuing connection to land, waters and community.

We pay our respect to them and

their cultures, and Elders past, present and future.

© 2019 National Heart Foundation of Australia

Artwork was designed and developed by Kyra Edwards, a proud Gunandji woman from a community near Cairns called

Yarrabah. The design represents communities that surround the Balga Tree within Balga, Perth. Kyra completed a career

trackers internship at the Heart Foundation in 2019.

Today’s session

1. Current situation regarding health and nutrition in Australia

2. Our evidence and recommendations

3. Practical advice for patients

4. Questions

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CRSP 20th August 2020, Nutrition for Heart Health

Please don't forget to evaluate

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Why Food?

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Dietary Risks

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• For Australians aged 2 years and over:

• <4% meet recommended amounts of vegetables and legumes

• 31% meet recommended amounts of fruit

• 10% meet recommended amounts of dairy

• 30% meet the recommended guidelines for wholegrains

• At the same time, 30% of our energy intake comes from discretionary foods.

What are Australians currently eating?

Reference: Australian Bureau of Statistics (2016) 4364.0.55.012 - Australian Health Survey: Consumption of Food Groups from the Australian Dietary Guidelines, 2011-12.

What is it?

Where does it come from?

How do we use it?

Our Evidence

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• 2009: Dietary fats and dietary cholesterol for cardiovascular health

• 2015: Indications for omega 3 in primary and secondary prevention of cardiovascular disease

• 2016: Trans fat in the Australian food supply

• 2017: Dietary patterns and cardiovascular disease outcomes

• 2017: Dietary fats and cardiovascular disease

• 2019: Eggs and cardiovascular health

• 2019: Dairy and cardiovascular health

• 2019: Animal sourced protein (meat and poultry) and heart health

Evidence Reviews

Evidence

Identify, assess and

summarise evidence

Position

Interpret evidence

within context of local

environment,

translation and creation

of recommendations

Sign off

Internal and external

expert committees and

HF board

Dissemination

Aim to increase

knowledge, awareness

and influence behaviour

change

10 © 2019 National Heart Foundation of Australia

Evolution of the understanding of diet and CVD

Source: Nita G Farouhi et al, BMJ 2018

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Nutrients Dietary patterns

“Based on the current evidence, the

optimal dietary pattern to reduce CVD

is one that emphasizes:

wholegrains, fruits and vegetables,

legumes, nuts, fish, poultry, and

moderate dairy and heart-healthy

vegetable oil intake;

this pattern will likely reduce the CVD

risk by about a third.”8

Food

Source: Harvard Nutrition Group6; Mozaffarian 2016, Circulation 1337; Anand et al 20158 © 2019 National Heart Foundation of Australia

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Dietary Patterns Evidence

Collins CE, Burrows TL, Rollo ME. Dietary Patterns and Cardiovascular Disease Outcomes: an Evidence Check rapid review brokered by the Sax Institute for the National Heart Foundation of Australia, 2017.

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The similarities are more important than differences

Dietary patterns which recommend:

Fruits, Vegetables, Whole grains - 100%

Beans/Legumes - 85%

Fish and Reduced-fat Dairy - 60%

Nuts/Seeds - 50%

Olive oil as main cooking oil - 40%

low intake of Red Meat and Processed Meat Products - 25%

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Heart Healthy Eating Patterns

Plenty of fruit, vegetables and

wholegrain cereals

A variety of healthy protein sources,

especially fish, seafood, legumes, nuts and seeds. Smaller amounts of eggs

and poultry. Lean red meat should be limited to

1-3 times per week.

Unflavoured milk, yoghurt and cheese

Healthy fat choices such as nuts, seeds,

avocados, olives and their oils for

cooking

Herbs and spices to flavour foods, instead

of adding salt

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“…not an essential or necessary part of our dietary patterns.”1 Meaning there is a zero requirement; yet make up >30% of average energy intake2

No discretionary foods feature in research on healthy eating patterns.3

Goal: Make occasional foods truly occasional

Discretionary Foods

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Heart Foundation Position Statements

• Heart Healthy Eating Patterns

• Meat & Heart Healthy Eating

• Eggs & Heart Healthy Eating

• Dairy & Heart Healthy Eating

• Dietary Fat & Heart Healthy Eating

• Salt

• Fish & Seafood

• Phytosterols/stanol enriched foods

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Background

• Role of eggs in cardiovascular health widely debated over the years

• Eggs are a source of dietary cholesterol

• Dietary cholesterol increases LDL cholesterol. This led to global guidelines and recommendations limiting food sources of cholesterol, including eggs.

• However, the impact of dietary cholesterol on plasma cholesterol in most people is minimal.

• Foods high in saturated and trans-fat are responsible for the greatest impact on plasma cholesterol levels

Eggs and Heart Health

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KEY FINDINGS

• Evidence is mixed, but it appears eggs are “neutral” for heart health

• No strong evidence for a maximum limit but should not be interpreted as uniquely beneficial to cardiovascular health.

• Mixed evidence on the relationship between egg consumption and the risk of developing T2DM although more research is needed in this area as many cofounders exist in this relationship

• A growing body of evidence shows a link between egg consumption and increased risk of cardiovascular disease in people with T2DM

Evidence review

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• Eggs can be included in a heart

healthy eating pattern, as one

of a variety of healthy protein

foods

• People with Type 2 Diabetes

Mellitus should limit

consumption to 7 eggs per week

as a growing body of evidence

shows a link between egg

consumption and increased risk

of cardiovascular disease in

people with T2DM.

• People who require cholesterol-

lowering interventions should

limit consumption to

7 eggs/week

Heart Foundation

Recommendations

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Background

• Role of meat in cardiovascular health widely debated over the years

• Meat is a source of saturated and trans-fat (along with unsaturated fat)

• Saturated and trans-fat increases LDL cholesterol.

• There is established evidence between red meat and processed meat consumption and cancer.

• Meat also important source of iron and high-quality protein

• Growing community discussion on role of meat in diets including paleo, ketogenic, vegan

Meat and Heart Health

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KEY FINDINGS Key Findings

• Unprocessed red meat likely has moderately adverse effects on cardiovascular outcomes, particularly related to weight gain and stroke risk

• Evidence from prospective cohorts and intervention studies suggest limiting unprocessed meat to <50g per day.

• White meat has relatively neutral effects on cardiovascular outcomes

Evidence review

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• Eat a variety of healthy protein sources including fish and seafood, legumes, nuts and seeds.

• Smaller amounts of lean poultry can also be included in a Heart Healthy Eating Pattern.

• Less than 350g (cooked) of lean red meat/week (1-3 meat meals p/week)

• Avoid processed/deli meats

Healthy Protein Scale Heart Foundation

Recommendations

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Background

• Role of dairy in cardiovascular health widely debated over the years

• Dairy products are a source of saturated and ruminant trans-fat

• Saturated fat and ruminant trans fat increases LDL cholesterol.

• Recent observational studies of both reduced fat and full fat dairy products have provided conflicting results

Dairy and Heart Health

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KEY FINDINGS • Evidence is mixed, but on balance it appears milk, yoghurt and cheese are neutral for cardiovascular health.

• Dairy fat raises LDL-C, this relationship depends on the type of product and the person

• Not enough evidence to recommend full fat over reduced fat products, or reduced fat over full fat products for the general population.

• For the overall eating pattern, it appears the type is more important than whether milk is reduced fat or not.

Evidence review

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• Unflavoured milk, yoghurt and

cheese can be included in a

heart healthy dietary pattern

• For people who require LDL-c

lowering therapies and those

with existing coronary heart

disease – reduced fat varieties

should be chosen

• Butter, cream, ice cream and

dairy-based desserts should be

limited

Heart Foundation

Recommendations

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Heart Healthy Eating Principles

Condenses the current on foods and eating patterns into simple, positive messages

1. Plenty of vegetables, fruits and wholegrains

2. Variety of healthy protein sources, especially fish, seafood, legumes, nuts and seeds. Smaller amounts of eggs and poultry can be included as part of a heart healthy diet. Lean red meat should be limited to 1-3 times per week.

3. Unflavoured milk, yoghurt and cheese

4. Healthy fat choices with nuts, seeds, avocados and their oils for cooking

5. Choose herbs and spices to flavour foods instead of adding salt.

Water is the preferred beverage of choice

Summary of Recommendations

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Dietary Fats & Heart Health

• Replace saturated fat with polyunsaturated and monounsaturated fats and wholegrains.

• Limit sugars and refined carbohydrates

• Consider supplementation with 2-3g plant sterols per day for those at high absolute risk of CVD

• Target 2-3 servings of fish a week to achieve omega-3 intake recommendations.

• Consider omega-3 supplementation in those with raised triglycerides or heart failure

Summary of Recommendations

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What about sugar?

• 80% of free sugar in Australian diets comes from discretionary foods, of this:

• Soft drinks, sports drinks and energy drinks: 19%

• Fruit juice and fruit drinks: 13%

• Sugar added to tea and coffee: 7.3%

• Cordials: 4.9%

• Cakes, muffins, scones: 8.7%

• Confectionary and cereal/nut/fruit bars: 8.7%

• Breakfast cereals: 2.5%

• Flavoured milks and milkshakes: 2.3%

Frequently asked questions

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What about salt?

Frequently asked questions

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•Healthy eating information on COVID-19 and heart disease website

•Media releases

COVID-19

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Top tips

1. Aim for 5 servings of vegetables a day. Add vegetables to salads, soups and casseroles or try them as a snack.

2. Go for grain. Replace white bread and rice with wholegrain and seeded bread, brown rice and high fiber breakfast cereals.

3. Eat more legumes like lentils, chickpeas and beans. Use dried and cooked or canned varieties either alone or add to dishes to reduce the amount of meat

4. Aim for 2-3 servings of fish a week. Canned fish in spring water or olive oil is best.

5. Try introducing at least one meat-free day a week. Don’t forget to check out the Heart Foundation recipes as well.

Practical advice for patients

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Healthy Plate Model

Practical advice for patients

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What about Fat?

• The foods we eat contain many different fats; some healthier than others.

• Try to swap unhealthy fats to healthy fats in your diet.

Practical advice for patients

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Protein intake across the week

Practical advice for patients

Try to eat a variety of different protein sources over the week.

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More information

• Position statements

• Evidence summaries and reviews.

• www.heartfoundation.org.au/activities-finding-

or-opinion/food-and-nutrition-position-

statements

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More information

• Resources for practices

• https://www.heartfoundation.org.au/getmedia/aa

35051a-fe0e-48ca-bf9d-a550b33c9450/Eating-

well-to-protect-your-heart.pdf

• Health professional webinars

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Healthy Eating Principles in Practice

• Themed mini recipe booklets

www.heartfoundation.org.au/heart-health-education/healthy-eating

• Heart healthy eating plate visuals

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Healthy Eating Principles in Practice

Recipes

www.heartfoundation.org.au/heart-health-education/healthy-eating

Recipe stop motion videos

Healthy Eating Blog

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Cook with Heart Challenge

https://www.cookwithheart.com.au/event/cook-with-heart-challenge

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Next steps for you

• Know where to find Heart

Foundation healthy eating

resources

• Review and update your resources

to reflect nutrition positions

• Contact us if you need additional

information or if you are unsure how

to apply the information

• Communicate nutrition positions

and share healthy eating resources

with your team or local services.

sandy.duxbury@heartfoundation.org.au

Heart Foundation Helpline. 13 11 12

https://www.heartfoundation.org.au/for-professionals/food-and-nutrition/position-statements

Questions

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CRSP 20th August 2020, Nutrition for Heart Health

Please don't forget to evaluate