Cardiovascular Disease : Diet, Nutrition and Emerging Risk Factors (The Report of the British Nutrition Foundation Task Force)

This important and timely book comprises the comprehensive and authoritative independent report of the British Nutrition Foundation Task Force on the link between emerging aspects of diet and cardiovascular disease, a major cause of early death and disability. Written by leading experts in the area, Cardiovascular Disease: Diet, Nutrition and Emerging Risk Factors looks further than the well recognised factors such as high blood cholesterol and smoking to identify and explore more subtle markers of risk. Chapters include coverage of novel lipid factors, vascular function, clotting factors, inflammatory factors, oxidative stress and homocysteine and early origins of adult disease. The impact of obesity, insulin resistance, genetic predisposition and factors related to adipose tissue are also addressed. Of vital use to a wide range of health professionals this cutting-edge book provides the reader with: core information for health professionals as well as those involved in food formulation in the food industry a dedicated question and answer chapter important conclusions and recommendations with 'take-home messages' Dietitians, nutritionists, general and family practitioners, cardiologists, cardiovascular specialists, community nurses, personnel in the food industry involved in product formulation, production, labelling of packaging and marketing will find this a valuable reference. Lecturers, undergraduates and postgraduates in nutrition, dietetics, food science and medicine; libraries in all research establishments, commercial organisations, medical schools and universities where these subjects are studied or taught will also find this an important addition to their shelves. Contents......Page 5 Foreword......Page 15 Terms of Reference......Page 16 Task Force Membership......Page 17 1.1.2 Cerebrovascular disease......Page 21 1.2.1 Atherosclerosis......Page 22 1.2.2 Blood clotting......Page 23 1.2.4 Relationship of risk factors to the pathological processes......Page 24 1.3.2 Temporal trends......Page 25 1.3.3 Variation in cardiovascular disease in the UK......Page 28 1.4.2 Approaches used to investigate the relationship between risk factors and disease......Page 30 1.4.3 Interpretation of the association......Page 31 1.4.4 Conventional risk factors for CHD......Page 32 1.4.5 Conventional risk factors for cerebrovascular disease......Page 34 1.4.7 Trends in the classic cardiovascular risk factors......Page 35 1.5.1 Dietary recommendations to reduce cardiovascular disease......Page 36 1.5.3 Paradoxes in CHD epidemiology......Page 38 1.6 Structure of the report......Page 40 1.8 Key references......Page 41 2.3.1 Concept/definition of insulin resistance......Page 42 2.3.2 The insulin resistance syndrome......Page 43 2.3.3 Mechanism(s) of insulin resistance......Page 47 2.4 Obesity......Page 48 2.4.1 Definitions and measurement......Page 49 2.4.2 Body fat distribution, ethnic and gender issues......Page 50 2.4.3 Epidemiology of obesity......Page 51 2.4.4 Obesity and cardiovascular disease......Page 52 2.4.5 Cardiovascular disease and other co-morbidities of obesity......Page 53 2.4.6 Clinical manifestations of obesity-related cardiovascular disease......Page 55 2.4.7 Obesity as a cause of insulin resistance......Page 56 2.4.10 Childhood obesity......Page 57 2.5.1 Epidemiology......Page 60 2.5.2 Prevention of type 2 diabetes......Page 61 2.6 Hypertension......Page 63 2.7.2 Diet and insulin resistance......Page 64 2.8 Physical activity......Page 65 2.8.1 Effects of physical activity on cardiovascular disease......Page 66 2.9 Genetics......Page 67 2.11 Key points......Page 68 2.12 Key references......Page 69 3 Lipid-Related Factors......Page 70 3.2 Postprandial lipaemia – atherogenic lipoprotein phenotype......Page 71 3.2.2 The effect of fatty acid type......Page 74 3.3 Remnant-like particles......Page 75 3.4 Small, dense low-density lipoprotein (LDL)......Page 77 3.5 High-density lipoprotein (HDL) subfractions......Page 78 3.6 Free fatty acids......Page 79 3.7 Lipoprotein(a)......Page 80 3.8 Genetic variability and cardiovascular risk......Page 81 3.11 Key references......Page 82 4.2 Estimates of endothelial dysfunction......Page 83 4.2.1 Endothelium-dependent vasodilatation or ‘direct’ measures......Page 84 4.2.4 Measurement of excreted factors......Page 87 4.3.1 Classical risk factors (i.e. parameters incorporated in current risk factor stratification tables)......Page 88 4.3.2 Novel risk factors......Page 90 4.5 Endothelial function measures as independent predictors of CHD......Page 91 4.6 Relevant genetic studies......Page 92 4.8 Effects of CHD preventative modalities on other risk factor pathways......Page 93 4.9.2 Micronutrients......Page 94 4.10 Do nutrient-induced endothelial effects correlate with results from endpoint studies?......Page 95 4.11 Key points......Page 96 4.13 Key references......Page 97 5.2 The normal role of LDL......Page 98 5.3 Free radicals......Page 99 5.4.1 Protein oxidation......Page 100 5.5 Reactive nitrogen species......Page 101 5.6 Cardiovascular disease and oxidative reactions......Page 103 5.8 Nature of the oxidising species causing LDL oxidation......Page 104 5.9 Cardiovascular disease and the consumption of fruit and vegetables......Page 106 5.10 Therapeutic use of antioxidants: evidence from intervention trials......Page 108 5.12 Measurable factors for oxidative stress in cardiovascular disease......Page 110 5.12.1 Measurable products of lipid peroxidation......Page 111 5.12.2 Methods for detection of protein oxidation......Page 113 5.13 Markers of oxidant stress in cardiovascular disease......Page 114 5.14 Relationships of the markers of oxidant stress to general nutrition and antioxidants......Page 116 5.15 Conclusions......Page 117 5.17 Recommendations for future research......Page 118 5.18 Key references......Page 119 6 The Haemostatic System: Coagulation, Platelets and Fibrinolysis......Page 120 6.1 The haemostatic system......Page 121 6.1.1 The coagulation pathway......Page 122 6.1.3 Inhibitors of coagulation......Page 124 6.1.4 The platelet......Page 126 6.2.1 Fibrinolytic factors......Page 127 6.2.2 Inhibitors of fibrinolysis......Page 128 6.3 The concept of hypercoagulability......Page 129 6.4.3 Fibrinolytic factors......Page 130 6.4.4 Platelets......Page 131 6.5.1 Established tests of platelet function......Page 132 6.6.2 Factor IX and Factor X peptides......Page 133 6.8 Established and emerging phenotypic risk factors for venous thromboembolism......Page 134 6.9.3 Fibrinogen......Page 135 6.9.8 Plasminogen activator inhibitor......Page 136 6.10 Dietary characteristics and haemostasis......Page 137 6.10.2 Alcohol......Page 138 6.10.3 Dietary fat and coagulation......Page 139 6.10.4 Dietary fat and fibrinolysis......Page 140 6.10.5 Dietary fat and platelet function......Page 141 6.10.6 Dietary fish oil/supplements and haemostasis......Page 142 6.10.8 Micronutrients......Page 143 6.11 Key points......Page 145 6.12 Recommendations for future research......Page 146 6.13 Key references......Page 147 7.2 The immune system......Page 148 7.3 Inflammation and atherosclerosis......Page 149 7.4.1 C-reactive protein (CRP)......Page 150 7.4.3 Serum amyloid A......Page 153 7.4.7 Circulating immune complexes......Page 154 7.4.8 Cytokines, growth factors and other secreted products......Page 155 7.4.9 Adhesion molecules......Page 156 7.4.11 Phospholipase A2......Page 157 7.6 Infectious burden, inflammation and atherosclerosis......Page 158 7.7.2 Lipid lowering agents......Page 160 7.8.1 Fatty acids......Page 161 7.8.2 Antioxidants......Page 164 7.8.6 Micronutrients and the inflammatory response......Page 165 7.11 Key references......Page 166 8.2 Biochemistry......Page 167 8.3 Laboratory measurement of homocysteine......Page 168 8.4.1 Initial epidemiological evidence......Page 169 8.4.3 Relevance of genetically determined differences in homocysteine levels to risk of CHD......Page 170 8.5 Pathophysiology of vascular disease......Page 172 8.7 Genetic influences......Page 174 8.10 Large trials of homocysteine lowering vitamin supplements......Page 175 8.11 Folic acid fortification......Page 177 8.12 Key points......Page 178 8.14 Key references......Page 179 9.1.2 Adipose tissue-derived signals and cardiovascular disease......Page 180 9.2 Leptin......Page 181 9.2.1 Leptin and cardiovascular risk......Page 182 9.3.1 Acylation stimulating protein and cardiovascular disease......Page 183 9.4.1 Actions of adiponectin......Page 184 9.5.1 Cytokine receptors......Page 185 9.5.4 Effects of acute elevation in IL-6......Page 186 9.5.5 Effects of chronic elevation of IL-6......Page 187 9.5.6 IL-6 and CHD......Page 188 9.8 Peroxisome proliferator-activated receptors (PPARs)......Page 189 9.10 Nutritional regulation of adipocyte factors......Page 190 9.10.2 Regulation of acylation stimulating protein......Page 191 9.10.5 Regulation of angiotensinogen......Page 192 9.11 Physical activity and adipokines......Page 193 9.12.4 IL-6 genotype......Page 194 9.13 Conclusion......Page 195 10.5 Variation with ethnicity......Page 11 9.16 Key references......Page 196 10.1 Low birthweight and adult cardiovascular disease......Page 197 10.2.2 Lipids and clotting factors......Page 198 10.2.4 Obesity......Page 199 10.3 Post-natal growth and adult obesity......Page 201 10.4 Variation with sex......Page 203 10.6 The ‘Fetal Origins of Adult Disease (FOAD)’ hypothesis......Page 204 10.6.1 Genes versus environment......Page 206 10.7 Clinical importance of the effects of poor fetal growth......Page 208 10.8 The role of nutrition......Page 209 10.8.1 Maternal nutritional status and cardiovascular disease risk in the offspring......Page 210 10.9 Maternal diabetes and fetal macrosomia......Page 213 10.10 Key points......Page 214 10.12 Key references......Page 215 11.2 Structure of the chapter......Page 216 11.3 Diet and body fatness: amount and distribution......Page 217 11.3.2 Glycaemic index......Page 218 11.4 Diet and hypertension......Page 224 11.5 Diet and diabetes......Page 225 11.6.2 n-3 polyunsaturates and insulin sensitivity......Page 226 11.7 Amount of dietary fat......Page 229 11.7.1 Low fat versus moderate fat diets......Page 230 11.8 Type of dietary fat......Page 231 11.8.2 n-6 versus n-3 polyunsaturated fatty acids......Page 234 11.8.3 Long chain n-3 fatty acids......Page 235 11.8.5 Alpha-linolenic acid......Page 237 11.9.2 Dietary .bre......Page 238 11.9.7 Conjugated linoleic acid (CLA)......Page 241 11.10.2 Oxidative stress......Page 242 11.11 Conclusions......Page 249 11.11.1 Dietary fat......Page 250 11.11.4 Areas of uncertainty......Page 251 11.12 Key points......Page 252 12.1 Introduction......Page 254 12.2 Role of physical activity in promoting cardiovascular health......Page 255 12.2.1 Cardiovascular endpoints......Page 256 12.2.2 Cardiovascular risk factors......Page 259 12.2.3 Summary......Page 260 12.3 How much is required?......Page 261 12.5 Recent initiatives in the UK......Page 262 12.6 Key points......Page 263 12.8 Key references......Page 264 13.1.1 Approaches in the UK......Page 265 13.2 Current dietary recommendations for primary prevention in the UK......Page 266 13.3 Recommendations in other countries......Page 268 13.3.2 Finland......Page 270 13.4.2 Fat and fatty acids......Page 271 13.4.3 Sodium and salt......Page 273 13.4.4 Fruit and vegetables......Page 275 13.4.5 Starchy foods and dietary fibre......Page 276 13.5.1 Dietary fat......Page 277 13.5.3 Dietary patterns......Page 278 13.6.2 Obesity in children......Page 279 13.6.5 Summary......Page 280 13.7.2 Ethnic minority groups......Page 281 13.8 Barriers to change – the role of the food industry......Page 282 13.9.1 Approaches used for successful lifestyle/dietary modification......Page 283 13.10 Looking to the future: gene–nutrient interactions......Page 284 13.11 Key points......Page 285 14.1 Chapter 1......Page 286 14.4 Chapter 4......Page 287 14.6 Chapter 6......Page 288 14.8 Chapter 8......Page 289 14.11 Chapter 11......Page 290 14.13 Chapter 13......Page 292 15.1.1 Relationship between emerging risk factors, diet and cardiovascular disease......Page 294 15.1.3 Relationship between emerging cardiovascular disease risk factors and physical activity......Page 296 15.3 Priorities for future research: identifying effective dietary interventions......Page 297 15.4.1 Recommendations to policy makers......Page 298 15.4.4 Recommendations to caterers......Page 299 15.4.5 Recommendations to workplaces/employers......Page 14 15.5 Key references......Page 300 16.2 Epidemiology of cardiovascular disease......Page 301 16.3 Definitions and prevalence of diabetes, the insulin resistance syndrome and obesity......Page 304 16.4 Lipid-related factors......Page 306 16.5 The role of the endothelium......Page 308 16.6 Diet and oxidative stress......Page 309 16.7 Diet and blood clotting......Page 310 16.8 Inflammation......Page 311 16.9 Homocysteine......Page 312 16.10 Factors relating to adipose (fat) tissue......Page 313 16.11 Nutrition during pregnancy and fetal growth......Page 314 16.12 The effect of different diets on heart disease risk......Page 315 16.14 Public health recommendations to reduce cardiovascular disease risk......Page 316 16.15 Key references......Page 317 Glossary......Page 318 References......Page 332 Index......Page 391

this Important And Timely Book Comprises The Comprehensive And Authoritative Independent Report Of The British Nutrition Foundation Task Force On The Link Between Emerging Aspects Of Diet And Cardiovascular Disease, A Major Cause Of Early Death And Disability.



Written By Leading Experts In The Area, Cardiovascular Disease: Diet, Nutrition And Emerging Risk Factors Looks Further Than The Well Recognised Factors Such As High Blood Cholesterol And Smoking To Identify And Explore More Subtle Markers Of Risk.



Chapters Include Coverage Of Novel Lipid Factors, Vascular Function, Clotting Factors, Inflammatory Factors, Oxidative Stress And Homocysteine And Early Origins Of Adult Disease. The Impact Of Obesity, Insulin Resistance, Genetic Predisposition And Factors Related To Adipose Tissue Are Also Addressed. Of Vital Use To A Wide Range Of Health Professionals This Cutting-edge Book Provides The Reader With:



* Core Information For Health Professionals As Well As Those Involved In Food Formulation In The Food Industry

* A Dedicated Question And Answer Chapter

* Important Conclusions And Recommendations With 'take-home Messages'



Dietitians, Nutritionists, General And Family Practitioners, Cardiologists, Cardiovascular Specialists, Community Nurses, Personnel In The Food Industry Involved In Product Formulation, Production, Labelling Of Packaging And Marketing Will Find This A Valuable Reference. Lecturers, Undergraduates And Postgraduates In Nutrition, Dietetics, Food Science And Medicine; Libraries In All Research Establishments, Commercial Organisations, Medical Schools And Universitieswhere These Subjects Are Studied Or Taught Will Also Find This An Important Addition To Their Shelves.

This important and timely book comprises the comprehensive and authoritative independent report of the British Nutrition Foundation Task Force on the link between emerging aspects of diet and cardiovascular disease, a major cause of early death and disability. Written by leading experts in the area, Cardiovascular Disease: Diet, Nutrition and Emerging Risk Factors looks further than the well recognised factors such as high blood cholesterol and smoking to identify and explore more subtle markers of risk. Chapters include coverage of novel lipid factors, vascular function, clotting factors, inflammatory factors, oxidative stress and homocysteine and early origins of adult disease. The impact of obesity, insulin resistance, genetic predisposition and factors related to adipose tissue are also addressed. Of vital use to a wide range of health professionals this cutting-edge book provides the reader with:* core information for health professionals as well as those involved in food formulation in the food industry* a dedicated question and answer chapter* important conclusions and recommendations with 'take-home messages'Dietitians, nutritionists, general and family practitioners, cardiologists, cardiovascular specialists, community nurses, personnel in the food industry involved in product formulation, production, labelling of packaging and marketing will find this a valuable reference. Lecturers, undergraduates and postgraduates in nutrition, dietetics, food science and medicine; libraries in all research establishments, commercial organisations, medical schools and universities where these subjects are studied or taught will also find this an important addition to their shelves The aetiology and epidemiology of cardiovascular disease / Keith Frayn and Sara Stanner Metabolic syndrome: insulin resistance, obesity, diabetes mellitus, hypertension, physical activity and genetic factors / Simon Coppack, Vidya Mohamed-Ali, and Fredrik Karpe Lipid-related factors / Fredrik Karpe Endothelial dysfunction / Naveed Sattar and Gordon Ferns Oxidative stress / K. Richard Bruckdorfer The haemostatic system: coagulation, platelets and fibrinolysis / George Miller and K. Richard Bruckdorfer Inflammation-related factors / Parveen Yaqoob and Gordon Ferns Homocysteine / Robert Clarke Adipoes tissue-derived factors / Vidya Mohamed-Ali and Simon Coppack Fetal and maternal nutrition / Caroline Fall Diet and cardiovascular disease: where are we now? / Judith Buttriss Physical activity: where are we now? / Judith Buttriss and Adrianne Hardman A public health approach to cardiovascular disease risk reduction / Judith Buttriss. "This important and timely book comprises the comprehensive and authoritative independent report of the British Nutrition Foundation Task Force on the link between emerging aspects of diet and cardiovascular disease, a major cause of early death and disability." "Dietitians, nutritionists, general and family practitioners, cardiologists, cardiovascular specialists, community nurses, and personnel in the food industry involved in product formulation, production, labelling of packaging and marketing will find this a valuable reference, as will lecturers, undergraduates and postgraduates in nutrition, dietetics, food science and medicine. Libraries in all research establishments, commercial organisations, medical schools and universities where these subjects are studied or taught will also find this an important addition to their shelves."--BOOK JACKET