PRESENTED BY

DTN. SOWOOLU-COATES

REGISTERED DIETITIAN

REGISTERED NUTRITIONIST

MSC.,BSC.[NUT$DIET]

HYPERCHOLESTEROLAEMIA

INTRODUCTION

The word cholesterol comes from the Greek word Chole meaning “bile” and the Greek word Stereos meaning “solid”, “Stiff.”

Cholesterol is a waxy fat- like substance that is made in the Liver and other cells of the body.

Each day our cells produce approximately 875mg of cholesterol of this about 400mg is used to make new bile acids to replenish those lost in the faeces.

In the just concluded Lagos state Health Screening Exercise 75.9% of the patients referred to the Dietetics department where referred on account of Hypercholesterolemia although some are with other disease conditions.

FUNCTIONS OF CHOLESTEROL

• It is involved in the production of sex hormones (Androgens & Oestrogen).

• It is essential for determining which molecules can pass into the cell and which cannot (Cell membrane permeability).

• It builds & Maintain cell membranes (Outer layer),It prevents crystallization of hydrocarbons in the membrane.

• It is important for the metabolism of fat soluble vitamins A D E K.

• It insulates nerve fibers.• It is essential for Vitamin D Production.• It is the precursor of bile acids which are needed for fat

digestion.

LIPOPROTEINS Cholesterol is carried in the blood by molecules called lipoprotein.

Lipoproteins are complex compound containing both Lipid (Fat) and protein.

There are 3 main types of Lipoproteins namely:

1. LDL (Low density Lipoprotein):often refer to as "Bad” cholesterol. LDL carries cholesterol from the Liver to cells. If too much is carried, too much for the cells to use, there can be harmful build up of LDL. This lipoprotein can increase the risk of arterial disease if levels rise too high.

2. HDL (High density Lipoprotein) : often refer to as “Good” cholesterol. HDL takes cholesterol away from the cells and back to the liver. In the liver it is either broken down or expelled from the body as waste. The higher the level of HDL cholesterol in the blood the lower the risk of getting heart disease.

3. TRIGLYCERIDES: these are chemical forms in which most fat exists in the body as well as in food. T.G in association with cholesterol form the plasma lipids (blood fat). T.G in plasma originate either from fats in our food or are made in the body from other energy sources such as carbohydrates.

HYPERCHOLESTEROLAEMIA

Hypercholesterolemia is defined as elevated amount of cholesterol in the blood.

Hypercholesterolemia could be familial & Non familial.

Familial hypercholesterolaemia: is an inherited genetic disorder, in which the level of LDL cholesterol in the blood is higher than normal from birth.

Non familial hypercholesterolaemia: this is the most common form of hypercholesterolaemia. It occurs in people with susceptible genotype which is aggravated by excessive intake of saturated fats and cholesterol.

CAUSES OF HYPERCHOLESTEROLAEMIA

A. LIFESTYLE CAUSES.• Nutrition• Sedentary lifestyle• Over weight/ Obese• Smoking• Alcohol .

B. TREATABLE MEDICAL CONDITIONS.

Some treatable medical conditions are known to cause LDL levels to rise.

These conditions include:• Diabetes• High B.P (Hypertension).• High levels of Triglycerides.• Kidney diseases• Liver diseases.

RISK FACTORS

There are some fixed risk factors that cannot be treated.

• GENES 1: people with close family members who have had either a coronary heart disease or a stroke have a greater risk of high blood cholesterol.

• GENES 2 : People who had brother or sister or parent with hypercholesterolemia have a greater chances of having high cholesterol.

• SEX: men have greater chance of having high blood cholesterol levels than woman.

• AGE: cholesterol levels rises with age particularly in older age adults.• EARLY MENOPAUSE: women whose menopause occurs early are

more susceptible to higher cholesterol levels compared to other women.

SYMPTOMS OF HYPERCHOLESTEROLEMIA

Symptoms of hypercholesterolemia do not exist alone in a way a patient or doctor can identify by touch or sight. Symptoms of high cholesterol are revealed if there are symptoms of atherosclerosis. These can include:

1. Narrowed coronary arteries in the heart (Angina).

2. Leg pain when exercising: this is because the arteries supplying the legs have narrowed.

3. Blood clots & ruptured blood vessels: these can cause stroke.

4. Ruptured Plaques: this can lead to coronary thrombosis ( a clot forming in one of the arteries that delivers blood to the heart). If this causes significant damage to heart muscle it could cause heart failure.

5. Xanthomas : thick yellow patches on the skin, especially around the eyes, they are in fact , deposits of cholesterol. This is commonly seen among people who have inherited high cholesterol susceptibility.

DIAGNOSIS OF HYPERCHOLESTEROL.

Cholesterol level may be measured by means of a simple blood test. The test is done after a 9 to 12 hours fast without food, liquids or pills. The blood sample will be tested for Total cholesterol,LDL, HDL, as well as T.G. The units are measured in mg/dl.

LIST OF CHOLESTEROL LEVELS

• Total cholesterol levels Category

Less than 200mg/dl Desirable

200 to 239mg/dl Borderline high

240mg/dl & Above High

• LDL cholesterol level Category

Less than 100mg/dl Optimal

100 to 129mg/dl Near or above optimal

130 to 159mg/dl Borderline high

160 to 189mg/dl High

190mg/dl and above Very high

LIST OF CHOLESTEROL LEVELS (CONTD.)

• HDL Cholesterol level

Less than 40mg/dl (for Men)Less than 50mg/dl (for Women)

60mg/dl and above

• Triglycerides Level

Less than 100mg/dl

Less than 150mg/dl

150- 199mg/dl

200-499mg/dl

500mg/dl and above

Category

Low HDL cholesterol. A major risk factor for heart disease.

High HDL cholesterol. An HDLof 60mg/dl and above is Considered protective againstHeart disease.

Category

Optimal

Normal

Borderline high

High

Very high

DANGER/COMPLICATIONS OF HYPERCHOLESTEROL

• High cholesterol levels can cause:• Atherosclerosis – Narrowing of the arteries• High coronary heart disease• Heart attack: occurs when the supply of blood &

oxygen to an area of heart muscle is blocked.• Angina: chest pain or discomfort that occurs when

heart muscle does not get enough blood.• Stroke & mini Stroke : occurs when a blood clot

blocks an artery or vein, interrupting the flow to area of the brain.

MANAGEMENT OF HYPERCHOLESTEROLAEMIA

• MEDICATIONS: use of Statins ; these block an enzyme in the Liver that produces cholesterol.

• LIFESYLE MODIFICATIONS: Most people especially those whose only risk factor has been lifestyle can generally get their cholesterol and T.G levels back to normal by;

I. Exercise

II. Get plenty of sleep ( 8 hrs. each night).

III. Achieve weight loss

IV. Avoid Alcohol

V. Quit smoking

MANAGEMENT CONTD.

• DIETARY MANAGEMENT

Low cholesterol diet: cholesterol level in the diet should not exceed 300mg per day. People that have risk factor for heart disease should not consume more than 200mg of cholesterol per day

High fiber diet: fiber helps in binding cholesterol and increase excretion of cholesterol. Soluble fiber found in beans, oats& oat bran may help to lower total cholesterol levels by lowering LDL.

Avoid foods with high saturated fat. High saturated fat foods like butter, lard, Pastries, coconut oil, fatty beef etc. should be avoided

DIETARY SOURCES OF CHOLESTEROL

CHOLESTEROL CONTENT

High

Medium

FOOD

Liver, offal

Egg yolk., Mayonnaise

Shell fish.

Meat fat

Full fat milk and dairy products

e.g. cream, cheese, butter.

Meat & Fish products

Manufactured meat products e.g.

Pies.

DIETARY SOURCES OF CHOLE.(CONTD.)

Cholesterol content

Low

Cholesterol free

Food

Skinless poultry

Skimmed milk and dairy products,

e.g. cottage cheese, low fat

Yoghurt.

Fruit (including avocados) &

Vegetables.

Vegetable oils

Cereals and pastas

Egg white

sugar

LIST OF CHOLESTEROL CONTENT OF SOME FOODS.

ITEM PORTION CHOLESTEROL(mg) SATURATED FAT (g)

Milk (Skimmed) 1 cup 4 0

Milk (Low fat) 1 cup 10 2

Milk (whole) 1 cup 33 5

Yoghurt (non fat) 1 cup 10 0

Yoghurt (whole) 1 cup 29 5

Cheddar cheese 28.4g 30 6

Cottage cheese (low fat) 1 cup 10 2

Butter 1 tsp 11 3

Mayonnaise 1 tbsp 10

ITEM PORTION CHOLESTEROL (mg) SATURATED FAT (g)

Margarine 1tsp 0 1

Vegetable oils 1 tsp 0 1-2

Egg yolk 1 210 2

Crab 99.2g 52 0

Shrimp 99.2g 194 0

Beef (lean) 99.2g 78 7

Beef (Liver) 99.2g 389 2

Chicken (no skin) 99.2g 85 1

FRIED FOODS

Fried foods are usually tasty but dangerous.

Changes created by the frying process:

Frying is a complex process from physiochemical stand point in which changes takes place in the oil as well as in the food.

Saturation of fatty acids: unsaturated fatty acids are converted to saturated fats. Thus, losing their beneficial properties particularly that of lowering cholesterol

Formation of peroxides & hydroperoxides: these are derived from fatty acids and act as free radicals which promote arteriosclerosis.

Formation of trans fatty acid: these raises cholesterol.

RECCOMENDATION FOR FRYING

A. Use olive oil: because it remains stable at the higher temperature (160oc to 200oc). More stable than seed oils & it decomposes slower. It saturates food less than seed oils.

B. Avoid over heating: frying should be done at the lowest possible temperature. Temperature should not be above 170oc. Oil is over heated when:

(1) it smokes (2) turns dark in colour.

C. Change oil frequently: oil should not be used more than two or three times, especially if it has been heated to the smoking point.

D. Do not fry meat or meat products: this produces carcinogenic substances.

CONCLUSION

The first line of action against high cholesterol is a diet that is rich in foods that lower cholesterol. A healthy diet should include plenty of vegetables, fruits, whole grains and fiber, and be low in saturated fat, trans fat, and cholesterol. Eating healthy and losing excess weight are ideal ways to lower elevated cholesterol levels and keep those levels within a healthy range for life.

So choose your foods wisely, and if a particular food or supplement appears to help, be sure to include it. But remember : moderation is key. Don’t overdo it with any supplement or food because, in some cases that can cause just many problems as high blood cholesterol.

THANK YOU