Nutrition and Cardiovascular Disease: Atherosclerosis Risk Reduction

This report delves into the realm of public health nutrition, specifically examining the impact of nutrition on atherosclerosis, a progressive disease characterized by lipid and fibrous accumulation in arteries. It explores the pathophysiology of atherosclerosis, highlighting the role of inflammation and the disruption of protective mechanisms. The report emphasizes the significance of dietary interventions, such as incorporating fruits, vegetables, and a balanced diet, as preventive measures. It presents a literature review on the effects of various fruits and drinks on atherosclerosis, including citrus fruits, berries, and other bioactive compounds. A study is proposed to assess the effects of fruit and drink consumption on atherosclerosis risk reduction, with an emphasis on individuals aged 50 and above. The report concludes by underscoring the importance of public health programs in raising awareness about health risks and implementing strategies to mitigate them, while also acknowledging potential limitations such as the need for technical assistance for individuals with limited education.

PUBLIC HEALTH NUTRITION: POSSIBLE RISK REDUCTION IN
ATHEROSCLEROSIS
1.0 Introduction
Researchers and policymakers worldwide have demonstrated longstanding interest in health
inequality. Why are they interested in health inequality? Just as in any other scientific pursuit,
some of them may simply be interested in describing how health is distributed. Others may be
interested in understanding the mechanism of health inequality so they can improve
population health. The interest in health inequality, however, is not always limited to
describing and understanding it. Some health inequalities are of moral concern because of the
value we place on health (Whitehead, 1992). Inequalities and inequities in health care and
health outcomes continue to be in the center stage of health policy in many countries. The
inequivality issues can be observed in nutrition, socioeconomic status, poverty and education.
Such inequalities in cardiovascular disease mortality are a major public health problem in
most industrialized countries (Mackenbach et al., 2000). Therefore, the gaps shall be
indentified between the group of people who are associated with low and high nutrition and
socioeconomic groups too. This is to reduce the cardiovascular disease mortality. Accurate
measurement of inequalities and inequities is indispensable to track progress or to identify
needs for policy interventions (Truman et al., 2011). Regular reporting and monitoring of
health inequalities and inequities are needed based on the available data and methodological
improvement. Based on the evidences, the impact can be assessed on health to support the
organisations for the possible consequences. The system facilitates the organizations in
developing and implementing an integrated policies and programmes. The development and
use of health impact assessment will contribute to the ongoing development and
implementation of local health, social care and wellbeing strategies, which is a joint statutory
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responsibility for Local Health Boards and local authorities. It can also contribute to
Community Strategies which, given their overarching nature and breadth and depth, can
address social, economic and environmental determinants of health, and to the
implementation of communities (Dannenberg et al., 2006). In addition, the inequality issues
influence the health of population in general and over 50 years due to associated defects in
physiology. Lack of adequate diet with nutrients, habituation towards drinks and defects in
physiology can contribute for the 'inequity' related issues. Hence focus has to be given
towards identification the gaps by conducting surveys in the society and to implement
strategies to overcome the issues.
The present paper describes salient features of health inequality, strategies of estimation,
recommendations followed by a survey related to the nutrition that influences cardiovascular
disease. A model disease, atherosclerosis is selected as it is a progressive disease
characterized by the accumulation of lipids and fibrous elements in the large arteries (Lusis,
2000). Diverse fruits (Kalanuria, Nyquist & Ling, 2012) and drinks have cardio protective
property by controlling the low density lipoproteins. Hence a systematic evaluation is carried
out to assess the effect of fruits and drinks in reducing atherosclerosis.
2.0 Role of nutrition on atherosclerosis
2.1. Pathophysiology
Prior to discuss the nutrition role on atherosclerosis, it is required to understand the
pathophysiology of the disease. The major underlying inflammatory risk factor for the
pathogenesis is the destruction of endothelium. It leads to loss of (i) antithrombic and
fibrinolytic factors; (ii) increase in the production of vasoconstrictors (thromboxane A2 and
prostaglandins) and (iii) an increase in intracellular calcium-derived vasoconstriction factors.
Some of the actions are mediated via nitrous oxide. The events propels the aggregation of
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platelets causing monocytes to enter the intima. Intracellular lipid peroxidation leads to
formation of lipoperoxides, which are toxic to plasma membranes and combine with
apolipoprotein (apo) B and phospholipids to prevent low-density lipoprotein (LDL) from
binding to the LDL receptor (Fleming, 2002). In addition, the following also contributes for
pathogenicity
o Disruption of inherent protective mechanisms leads to the formation of plaque and
thrombosis. Coronary artery occlusion is the direct effect of thrombus formation on
ruptured and unruptured plaques at the site of atherosclerosis. Inflammation-mediated
neovascularization and intra-plaque hemorrhage, along with necrosis in the lipid core
are the cause of thrombogenesis (Shah, 2007)
o Plaque formation is a zone of absence of shear stress, which occurs mostly at arterial
bifurcations due to the absence of elastin and the presence of collagen-proteoglycan
complexes. Eventually leads to the retention and accumulation of LDL (Sanz, Moreno
& Fuster, 2009)
2.2. Preventive measures: Role of diet
The major cause for the atherosclerosis is uncontrolled diet in terms of diet with high lipids,
cholesterol and low proportion of antioxidants and fruits. It is estimated that
hypercholesterolemia, familial hypertriglyceridemia, or familial combined hyperlipidemia
contributes for atherosclerosis (Glueck & Connor, 1979). The accumulation of VLDL and
LDL took place for years together, if the individual do not take adequate nutrition can pose to
risk to the life. The following are the generalized recommendations to reduce the risk of
cardiovascular diseases (Gidding, et al., 2009)
o Achieve and maintain a healthy body weight
o Balance calorie intake and adequate physical activities
o Diet should be rich in vegetables and fruits
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o Choose whole-grain, high-fiber diet
o Fish oil or food containing fish should be consumed at least twice a week
o Diet with saturated fat (should be <7%, trans fat to <1%, and cholesterol to <300
mg/d); lean meats and vegetables should be preferred; skimmed milk products (1%
fat); restriction for the intake of partially hydrogenated fats
o Intake of products with added sugars should be minimized
o Little or no salt should be used to cook food
o Alcohol should be consumed in moderation
2.3. Reduction of risk: Possible mechanisms
Fruits and vegetables are the main sources of bioactive and antioxidant compounds. The
presence of antioxidant vitamins, enzymes, and some poly-phenolic compounds comprise the
human's total antioxidant defence system (Niki, & Noguchi, 2002). Certain fruits such as
citrus fruits contain flavonoids (hesperidin, naringenin and eriocitrin) as one of the important
bioactive components contribute towards protection against the diseases by enhancing the
human immune system (Hirano et al., 2001). Pectin, a component of grapefruit shows
inhibition of hypercholesterolemia and thus atherogenesis (Boshtam et al., 2013). The
components of berries such as blackberry, mulberry are anthocyanins exhibited antioxidative
and antiatherogenic effects by inhibiting the oxidation of LDL (Liu et al., 2008). The
evidences indicate that the components of fruits and vegetables can reduces the risk of
atherosclerosis by inhibiting lipid peroxidation and improving the elasticity of vessels
3.0 Methods
Extensive literature search was done for the sources in terms of methods utilized for the
investigation of 'fruits' effect on atherosclerosis. Adequate precautions were taken to filter the
research question in order to sort relevant source. The outcome of the literature is shown in
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Table-1: Summary of findings based on literature
Source Keywords Outcome Reference
Pubmed Fruits, food effect on CVD,
atherosclerosis, risk
Numerous articles found,
relevant is cited
Gorinstein et al.,
2004
Scincedirect Fruits, protective effect,
atherosclerosis
Most relevant source is cited
among the articles
Sozanski et al.,
2014
ACS
Publications
Fruits, reduction of atherosclerosis,
antioxidant effect
Relevant article is cited Rosenblat et al.,
2006
Springer Fruits, drinks, effect on
hyperlipidemia
Relevant article is cited Singh et al.,
1995
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Based on the available sources and methods, a study can be initiated utilizing on-line
resources to update the health and wellbeing information. The individuals from a defined
location can be enrolled and instructed for the procedure and to record the observations
pertaining to fruits and drinks consumption for a month. The recordings from each eligible
individual can be pooled and collated in order to analyze for descriptive statistics.
4.0 Discussion
Gorinstein et al (2004) investigated effect of diet supplemented with a new citrus based fruits
on atherosclerosis in 66 patients. The diet supplemented with peeled sweeties positively
influence plasma lipid metabolism and plasma antioxidant capacity in patients suffering from
hypercholesterolemia. Cornelian cherry fruits (Sozanski et al., 2014) showed about 44%
significant decrease in serum triglyceride levels with the prevention of athermanous tissue in
thoracic aorta. The byproduct of pomegranate showed significant reduction in atherosclerotic
lesion in mice. The by product (Rosenblat et al., 2006) showed about 42% reduction of
oxidative stress mediated via cellular lipid peroxide and increased glutathione levels (53%).
The effect of guava and papaya fruit (100 g/day) along with vegetables, mustard oil and
antioxidant vitamins were evaluated in rabbits for a period of 36 weeks (Singh et al., 1995).
The fruit and vegetable-enriched prudent diet caused a significant decline in blood lipids at
24 and 36 weeks in comparison to control group. The outcome indicates that there is a
significant reduction of atherosclerotic symptoms with diet containing fruits. Most fruits used
in the studies are consumed routinely and on daily basis. Therefore study was conducted to
check the risk reduction for the atherosclerosis in a population with age 50 years and above.
The population was selected based on the potential of occurrence of atherosclerosis and based
on the interview i.e., one to one interaction. The potential risk is more in individuals with 50
years and above. Following criteria was used for the conduct of study and the outcome of the
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study was shown in Apendix-1. Such health check programmes are desired to bring
awareness of the individuals towards health risk and 'inequity'. The population with 50 and
above years are chosen as they are tending to face diverse cardiovascular disease and certain
diseases are avoidable. The programme is part of a longer-term vision to support people of all
ages to gain greater control over their own health. The programmes also facilitate the
government to understand the risk and implement strategies for mitigation of the risk. The
major limitation of programme include as all the individuals should be able to understand the
features of study and operation of computer assisted procedures. The procedures are not so
useful for the individual with poor educational background. In such instances, a technical
assistant should support him in understanding the study procedures
5.0 Conclusions
The salient features and methods of public health nutrition are discussed. The programmes
are required to understand the fruits and drinks effect in particular on cardiovascular disease
such as atherosclerosis
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Appendix-1: Proposed diet and nutrition for over 50s health check
The individuals with 50 years and above from South Wales region were selected for conduct of the study. The outcome of study
is shown in below table.
Foods & drinks
A medium serving of
Average intake over the past month (tick one box for each row)
Never or less
than
once a month
1-3 per
month
Once a
week
2-4
per
week
5-6
per
week
Once a
day
2-3
per
day
4+
per
day
Fresh, frozen or tinned fruit E.g., banana, apple,
peaches, pomegranate
√
Coffee, Tea (green/black), Cocoa/energy drinks √
Frequency of roasted butter √
Alcohol Consumption √
Meat consumption √
Fish consumption √
Cereals and Pulses √
Fried rice and wheat
Boiled ground nuts √ √
Fried egg and analogues √
Oatmeal, oat bran, Barley √
Soya Foods √
Baked beans, black beans √
Butter, Ghee, Lard √
Cabbage √
Boiled/fried legumes √
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