Sunday, 11 March 2012
A Hearty Diet
President of the Nutrition Society of Malaysia and nutritionist Dr Tee E Siong advises us to eat smart to prevent heart disease.
WHAT role does nutrition play in the causation of cardiovascular disease?
Unhealthy dietary habits have been recognised as a major leading cause of heart diseases. Excessive intake of energy (derived mostly from fat and simple sugars), animal fats, high cholesterol food and lack of dietary fibre can lead to overweight/obesity problems.
The overweight problem is a major risk factor for many diseases such as heart diseases, diabetes and other chronic diseases.
According to Dr Tee, to prevent heart disease, healthy eating must start at a very young age.
Thus, practising healthy eating habits is a crucial step that needs to be taken in order to reverse the development of heart diseases. Heart diseases are preventable if one practices healthy eating habits as well as lead an active lifestyle.
The prevalence of risk factors for heart diseases has also been on the rise in the past few decades. As president of Nutrition Society of Malaysia (NSM), what would your advice be to Malaysians in order to reduce their risk of heart diseases?
In order to reduce the risk of heart disease, one should always practise healthy eating. The Malaysian Dietary Guidelines have outlined 14 key approaches towards a healthy dietary pattern. Several of these approaches have direct relevance to reducing risk of heart disease.
First, one should limit intake of foods that are high in fats and oils. These include foods high in saturated fat (from animals), cholesterol (eg internal organ meats) and trans-fatty acids (hydrogenated margarines or foods prepared with “hardened fats”).
Other oily foods that are deep-fried should also be reduced to occasional treats. Practise healthier cooking methods like steaming or grilling instead of frying as much as possible in order to minimise fat intake.
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| The intake of deep-fried or oily foods should be reduced in order to reduce fat intake. |
The second key area to look at is salt. Salt is associated with raised blood pressure and this is one of the risk factors for heart diseases. Therefore, one should also choose foods that are less salty (avoid salted eggs, fish), avoid processed foods such as sausages, meat burgers and nuggets, as well as looking at the use of sauces in cooking.
Thirdly, sugar consumption should be kept to a minimum by avoiding foods that are prepared with high sugar (kuih, cakes, sweets) and replace with healthier options such as fruits.
Also, reduce consumption of drinks that are high in sugar content such as carbonated drinks, canned drinks, cordials, or drinks prepared with sweetened condensed milk such as teh tarik and coffee.
The fourth key area to pay attention to is to eat adequate amount of whole grains/cereals and increase fruits and vegetables consumption to two and three servings (per day) respectively. Plant-based foods contain healthy components other than nutrients such as plant sterols, phytochemicals and dietary fibres,
Finally, to eat healthily, one can use the Malaysian Food Pyramid as a guide to achieve a well balanced diet, to eat in moderate amounts, and to always aim for a variety of food choices.
Besides eating, being physically active every day is another important component in combating heart disease. Even 30 minutes of walking every day can help, rather than doing nothing at all.
Lastly, maintain a healthy body weight and a healthy lifestyle by avoiding smoking and alcohol as much as possible.
You mentioned the importance of healthy eating for the prevention of heart disease. At what age must a person start to be concerned about his eating habits so as to reduce the risk of heart disease?
To prevent heart disease, healthy eating must start at a very young age. If a child is overweight at 10 years old, he is very likely to remain overweight at 20 years and even 30 years, and he will be at risk of getting heart disease.
Fat and cholesterol build-up in the arteries have been known to commence from childhood.
Often, the dietary habits of a person is set from young. The influence of parents and the environment also shapes the eating habits of young children. Moreover, changing habits later on in life is a more challenging task as a lot more motivation is needed.
Hence, it is important that one starts practising healthy eating habits from childhood. The roles of parents are emphasised as they are important role models in cultivating healthy dietary habits in their children from young.
http://thestar.com.my/health/story.asp?file=/2011/10/2/health/9609507&sec=health
Less Salt Please
By Dr TEE E SIONG
Understanding salt and sodium
Reducing salt intake will lead to a decrease in blood pressure and reduce the risk of cardiovascular diseases.
SALT, or sodium chloride, is the main source of sodium in our diet. Sodium is an essential mineral that is required in minute amounts daily. However, excessive intake can increase risk of various adverse health effects.
Excessive dietary salt has been associated with high blood pressure and its related co-morbidities. Therefore, health authorities have recommended reducing salt intake so as to reduce health risks.
In this write up, I will highlight the ninth key message of the Malaysian Dietary Guidelines (MDG) 2010, which focuses on reducing excessive salt intake.
The MDG 2010 is a set of advisory statements aimed at promoting appropriate dietary patterns and active living. I have summarised the 14 key messages contained in the MDG 2010 and dealt in detail eight of the key messages in previous write-ups.
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| Too much salt in the diet can lead to high blood pressure and its related co-morbidities. |
Salt, also known as common salt or table salt, is normally obtained from sea water or rock deposits. It is an inorganic compound consisting mainly of sodium and chloride ions, i.e. NaCl.
Both the sodium and chloride ions are needed by man in small amounts. The sodium component of salt is the element of concern in this key message of the dietary guideline.
Sodium (with the chemical symbol Na), is an essential mineral that is required daily in a minute amount. However, excessive intake is known to increase risk of adverse effects.
Salt is the major source of sodium in the Malaysian diet. One teaspoon or 5g of salt provides 2,000mg of sodium. It is, however, important to bear in mind that in addition to salt, sodium may also be present in food in other forms, such as monosodium glutamate (MSG), sodium nitrate and sodium benzoate.
Scientific basis for the recommendations
Two main types of scientific evidence have been used as the basis of the recommendations in MDG 2010. The first is data demonstrating that excessive intake of salt (sodium) is positively related to hypertension or high blood pressure.
Hypertension is a symptom, not a disease, but it is a strong risk factor for cardiovascular and kidney diseases. For over 15 years, the evidence of an association between dietary salt intake and blood pressure has been accumulating. Many epidemiological studies have demonstrated that high salt intake is associated with an increased risk of high blood pressure and its associated health conditions.
In Malaysia, the prevalence of high blood pressure has increased in the past decade. Results from the Second National Health and Morbidity Survey (NHMS) in 1996, indicated 33% of adults aged 30 years and above had hypertension. Ten years later, the figure has increased to even higher, at 43%, as reported by the Third NHMS in 2006. It is a major risk factor for cardiovascular disease and premature death. Heart diseases, diseases of the pulmonary circulation and cerebrovascular diseases contribute up to 25% of the cause of deaths in Health Ministry hospitals.
Excess sodium intake has also been associated with a number of health conditions other than raised blood pressure. It also increases the risk of stomach cancer; it increases the rate of deterioration in kidney function of patients with renal disease; it is associated with urinary stones; and it may aggravate asthma and osteoporosis.
The second type of evidence is data revealing that lowering the average salt intake of populations can decrease the problem of hypertension. It has been generally accepted that reducing the average population salt intake would proportionately lower population average blood pressure levels and reduce risk of cardiovascular diseases.
The greatest reduction in blood pressure has been observed when a diet rich in fruits, vegetables and low-fat dairy foods is combined with a low-salt diet. This reduction in blood pressure has been shown to result in a significant reduction in strokes and coronary heart disease.
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| Consumers should read the nutrition information panel (NIP) and find out the amount of sodium in foods they intend to purchase. |
Malaysians take too much salt
Data in the country show that the intake of salt and sodium amongst certain communities has exceeded the recommended amount. The Malaysian Adult Nutrition Survey reported that the mean sodium intake of Malaysian adults was about 2,575mg a day, with small differences between rural and urban population.
Not surprisingly, the Orang Asli were found to have the lowest daily intake of sodium of less than 1,000mg, whilst the Chinese had the highest mean intake of almost 3,000mg.
As will be discussed below, the recommendation is to limit sodium intake to 2,000mg per day.
The salt added in cooking and present in sauces and seasonings represent the major sources of sodium in our diet. Many of our dishes make use of ingredients such as soy, oyster and fish sauces as well as prawn paste, which are all high in sodium. Hence, this key message on reducing salt intake also includes cutting down on sauces.
Some dishes also use excessive amounts of flavour enhancers such as monosodium glutamate (MSG) and flavouring cubes. The consumption of highly salted fish, egg and vegetables are also not uncommon.
Malaysians also frequently eat “outside” foods, either as take-aways or eaten at the food premises itself. These foods could be rather salty, and are frequently added with various sauces and seasonings. These include various local dishes from coffee shops, cafes, restaurants as well as franchise fast food outlets.
Approaches to reducing salt/sodium intake
The Malaysian Dietary Guidelines have recommended limiting salt intake to no more than one teaspoon (2,000mg sodium) per day.
This should take into account total sodium intake from all dietary sources, for example, additives such as monosodium glutamate and preservatives such as sodium nitrate and sodium benzoate.
Various strategies are required to reduce salt intake. (For details of the dietary guideline recommendations, read MDG Key Message 9.)
The first approach would be to use less salt and seasonings in cooking at home. Instead, use various natural herbs and condiments to add flavour to your cooking. It is therefore recommended that you try preparing your meals such that you can control the amount of salt and sauces used.
The second approach relates to choosing foods with less salt and sauces when purchasing foods away from home, either as takeaways or when dining out. Malaysians eat out a lot, and with widespread use of salt and seasonings, large amounts of sodium can be ingested. It is therefore important to choose dishes wisely when dining out. Ask for less salt!
The third approach would be to reduce the salt content of processed foods and drinks. Consumers should read the nutrition information panel (NIP) and find out the amount of sodium in foods they intend to purchase.
Although it is currently not compulsory to include sodium content in NIPs, many food items have voluntarily included this in the list. Use the NIP to compare the sodium content of different brands of similar products.
As a further guide to food choice, you can look for claims on the label that say “low sodium”, “very low sodium” or “sodium free”.
These claims are permitted by the Health Ministry for products that contain low or very low amounts of sodium as specified by the food regulations.
You can do it
Those who are used to a higher salt intake will at first miss the taste of salt when they begin a lower salt intake. But the palate soon adapts to lower sodium levels, and people will eventually prefer foods with less salt.
Most people attempting to limit their salt intake are satisfied with many other ways of adding flavour to their foods and do not miss salt after their palates have adapted.
You can also do it. Make that change. Use less salt and sauces in your cooking. Ask for less salt when eating out. Read the NIP and purchase foods with less sodium.
Let the MDG 2010 guide you and your family members in adopting healthy eating habits and an active lifestyle.
The complete MDG is obtainable from the Health Ministry website: www.moh.gov.my/v/diet. The Nutrition Society of Malaysia has also made available leaflets of those MDG suitable for the public (www.nutriweb.org.my).
Dr Tee E Siong pens his thoughts as a nutritionist with over 30 years of experience in the research and public health arena. For more information, email starhealth@thestar.com.my.
Sunday February 19, 2012
Keeping Hearts Alive
The latest developments in stent technology for treating coronary heart disease.
Sunday March 4, 2012
http://thestar.com.my/news/story.asp?sec=health&file=/2012/3/4/health/10830306
BASED on the latest WHO data published in April 2011, the number of deaths from coronary heart disease (CHD) in Malaysia accounts for 22.18% of total deaths.
In this modern day and age, however, there are various treatments for CHD, which include medication, coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI).
PCI is also called balloon angioplasty, in which a doctor threads a catheter into the coronary artery and inflates a balloon at the tip. Then, a wire-mesh structure called a stent is left behind to keep the artery open and prevent it from narrowing again.
Between the two methods of revascularisation in treating CHD, PCI is much less invasive, has a lower risk of procedural stroke, shorter hospital stay and recovery period, and is done through a pin-hole compared to bypass surgery.
The survival to 10 years is similar for both procedures. As a result, PCI is performed more commonly than CABG in the treatment of patients with CHD.
In Washington state in the US, the prevalence of PCI is almost five times more than CABG.
The latest developments in PCI procedures were recently highlighted by consultant interventional cardiologist Dr Yap Yee Guan. According to Dr Yap, Malaysians are still not fully aware of the existence of various stents in the country. He also explained that many Malaysians are unaware of PCI as a treatment for heart attacks.
Describing the procedure used in PCI, where stents are inserted to keep the artery open, Dr Yap said, “There are various types of stents, which have distinctive properties, as well as advantages and disadvantages. Patients should seek proper consultation from their respective cardiologist on the suitable type of stent to be used, as the indication for each patient may be different.”
Dr Yap explained about the three types of coronary stents available, namely, bare metal stents (BMS), drug eluting stents (DES), and bio-engineered stents (BES). Clinically, DES and BES are more efficacious and have better long-term outcomes, though at a higher cost than BMS.
Dr Yap highlighted that there will be a new innovative stent that has a drug as well as a bioengineered surface, known as dual therapy stent (DTS), which will be available in Malaysia by mid-2012. DTS combines properties of a drug-eluting stent (DES) and bio-engineered stent (BES) to address the issue of restenosis (renarrowing of the artery) and to improve healing and safety.
According to Dr Yap, post-surgery medication treatment such as dual-antiplatelet therapy (DAPT) is vital as it reduces the chances of blood clot after stenting.
REMEDEE, the trial of the new DTS stent, was presented last year at a major conference in San Francisco. This is a multinational trial with participation from 17 sites and eight countries. Two sites from Malaysia that participated in this trial were Institut Jantung Negara, Kuala Lumpur, and Pusat Jantung Hospital Umum, Sarawak.
http://thestar.com.my/news/story.asp?sec=health&file=/2012/3/4/health/10830306
