Which of the following dietary interventions reduces the fuher risk in MI patientsaEUR'
n3 polyunsaturated fatty acids American Hea association has recommended guidelines for reducing the risk of cardiovascular disease by dietary and other lifestyle practices. Summary of Dietary Guidelines Population Goals Overall Healthy Eating Appropriate Body Desirable Cholesterol Desirable Blood Pattern Weight Profile Pressure Major guidelines Include a variety of fruits, vegetables, grains, low-fat or nonfat dairy products, fish, legumes, poultry, lean meats. Match energy intake to energy needs, with appropriate changes to achieve weight loss when indicated. Limit foods high in saturated fat and cholesterol; and substitute unsaturated fat from vegetables, fish, legumes, nuts. Limit salt and alcohol; maintain a healthy body weight and a diet with emphasis on vegetables, fruits, and low-fat or non-fat dairy products. AHA Guidelines about the Riven options: About n-3 Fatty Acid Supplements A number of investigators have repoed on beneficial effects of increased fatty acid intake in patients with coronary aery disease. Several of these studies used supplements containing long-chain fatty acids (EPA and DHA, or ''fish oil") at doses ranging from 850 mg to 2.9 g/d. Other studies have shown that higher doses (3 to 4 g/d) provided as supplements can reduce plasma triglyceride levels in patients with hyperiglyceridemia.21 High intakes of fatty fish (1 serving per day) can result in intakes of EPA and DHA of :1%.-900 mg/d. Fuher studies are needed to establish optimal doses of fatty acids (including EPA, DHA, and rr-linolenic acid) for both primary and secondary prevention of coronary disease as well as the treatment of hyperiglyceridemia. For secondary prevention, beneficial effects of a high dose of fatty acids on recurrent events have been repoed in the GISSI trial. A 20% reduction in overall moality (P=0.01) and a 45% reduction in sudden death (P<0.05) after 3.5 years was repoed in subjects with preexisting coronary hea disease (who were being treated with conventional drugs) given 850 mg of fatty acid ethyl esters (as EPA and DHA) either with or without vitamin E (300 mg/d). Other studies have demonstrated beneficial effects of fatty acids EPA, DHA (1.9 g/d),2 u-and :/-linolenic acid (0.8% of energy)ll 71 in subjects with coronary hea disease. Consumption of 1 fatty fish meal per day (or alternatively, a fish oil supplement) could result in an fatty acid intake (ie, EPA and DHA) of kc900 mg/d, an amount shown to beneficially affect coronary hea disease moality rates in patients with coronary disease. About high fibre diet The AHA recommendation is to increase fiber intake in the diet. This goal can be achieved through the guidelines for food consumption, for example, emphasis on vegetables, cereals, grains, and fruits. Although there are studies showing that specific fiber supplements are associated with lowered LDL or glucose, there are no long-term trials showing relations between these supplements and cardiovascular disease. Therefore, at this time, fiber supplements are not recommended for hea disease risk reduction. About Stanol/Sterol Ester-Containing Foods Stanol/sterol ester (plant sterols)-containing foods have been documented to decrease plasma cholesterol levels. Plant sterols, as a class of compounds, are poorly absorbed and appear to compete with cholesterol for absorption, hence decreasing the efficacy of absorption. Intakes of 2 to 3 g of plant sterols per day have been repoed to decrease total and LDL cholesterol levels by 9% to 20%. Considerable variability in response exists among individuals. Little effect of plant sterols on HDL cholesterol or triglyceride levels has been repoed. Intakes of plant sterols >3 g/d confer no additional benefit with respect to total or LDL cholesterol lowering. Plasma levels of plant sterols are not or only minimally elevated after daily ingestion. Recent concern has been raised regarding the tendency of plant sterol-containing foods to decrease plasma fx- plus 13-carotene, Lr-tocopherol, and/or lycopene levels. The physiological significance of these changes is unclear at this time, but it appears prudent to recommend additional monitoring. Until long-term studies are performed to ensure the absence of adverse effects in individuals chronically ingesting plant sterol-containing foods, the use of these products should be reserved for adults requiring lowering of total and LDL cholesterol levels because of hypercholesterolemia or the need for secondary prevention after an atherosclerotic event. About Potassium Supplement A recent meta-analysis found that on average, supplementation of diets with 60 to 120 mmol of potassium per day reduced systolic and diastolic blood pressure, respectively, by 4.4 and 2.5 mm Hg in hypeensives and by 1.8 and 1.0 mm Hg in normotensives. Diets rich in potassium have also been associated with a reduced risk of stroke. Because a high dietary intake of potassium, magnesium, and calcium can he achieved from food sources and because diets rich in these minerals provide a variety of other nutrients, the preferred strategy for increasing mineral intake is through foods rather than supplements. Beneficial cardiovascular effects of selected dietry components . Folic Acid Vitamin B6 JHontocystine levels . High fibre Diet ..1 Total cholesterol, .1 LDL Cholesterol . Omega 3 fatty, Acids .G.l Triglycerides, ,1 Platelet Aggregation . Soy protein J Triglycerides, J LDL Cholesterol . Moderate Alcohol Consumption t HDL Cholesterol ,1Blood clotting coagulation . Vitamin E .1 LDL Oxidative susceptibility * Vitamin C Recyles Vitamin E * Sterol esters (Psytosterols) JTotal cholesterol, J LDL Cholesterol
High fibre diet
Sterol esters
Potassium supplements
n3 polyunsaturated fatty acids