Post on 23-Jan-2018
Indonesia’s health and nutrition status:
Omega-3s for cardiovascular health
Dr Fiastuti Witjaksono
Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital
Overall health status in Indonesia
3
Hypertension / high blood pressure Diabetes mellitus Heart Disease Stroke Osteoporosis
0.6 0.70.26
0.8 0.90.39
1.71.3
0.64
3.9
2.11.67
5.5
2.83.3
4.8
3.6
4.61
3.5 3.2
6.7
0
1
2
3
4
5
6
7
8
Diabetes Cor. Heart Disease Stroke
15-24 25-34 35-44 45-54 55-64 65-74 75+
Top 5 health concerns in Indonesia
% of prevalence
Source: Riskesdas 2013
High blood pressure and arthritis are the two major issues in Indonesia
The higher occurrence of these disabilities in elderly may be caused by age or lifestyle
Nutritional prevention can reduce risk factors and fight degenerative disabilities
4
Cardiovascular diseases are the top cause of death by non-communicable diseases in Indonesia
Source: World Health Organization – Non-Communicable Diseases (NCD) Country Profiles - Indonesia, 2014
Source: http://www.thejakartapost.com/news/2014/04/07/world-health-day-heart-disease-still-number-one-killer.html
What is Cardiovascular diseaseDefinition:
A general term that describes a disease of the heart or blood vessels
Types of CVD
• Coronary heart disease
The flow of oxygen-rich blood to the heart is blocked or reduced by a build-up of
fatty material in the coronary arteries
• Stroke
A serious medical condition that occurs when the blood supply to part of the brain is cut off
• Peripheral arterial disease
A blockage in the arteries to your limbs (usually legs).
• Aortic disease
The wall of the aorta becomes weakened and bulges outwards
Years of life lost (YLLs) quantify premature mortality by weighting younger deaths more than older deaths
Institute for Health Metrics and Evaluation. GBD Profile: Indonesia
Indonesia’s Nutritional Profile
Rajwinder K. Harikaa Ans Eilandera Marjan Alssemaa Saskia J.M. Osendarpc Peter L. Zock. Intake of Fatty Acids in General Populations Worldwide Does Not Meet Dietary Recommendations to Prevent Coronary Heart Disease: A Systematic Review of Data from 40 Countries
Mean intake of SFA (intake in descending order) and PUFA in 40 countries
Consumption of total fat and saturated fat
Hardinsyah, Analisis komsumsi lemak, gula dan garam penduduk Indonesia, Gizi Indon 2011
• Pedoman Umum Gizi Seimbang (PUGS) Indonesia recommend to consume fat less than 25 % of total calories (2000 kal-56 g)
• Consumption of saturated fat of WHO recommendation is less than 10%
Cardiovascular diseases risk factors
• Obesity
• Diabetes Mellitus
• High blood pressure
• Hyper- triglyceride
Proportion of obese women (BMI>25) Age >18 years in Indonesia
Indonesia Basic Health Survey (Riskesdas), 2013
Proportion of obese men (BMI>25) Age >18 years in Indonesia
Indonesia Basic Health Survey (Riskesdas), 2013
Proportion of abnormal cholesterol according gender and age >15 years in 2013
Men Women Urban Rural Indonesia
Indonesia Basic Health Survey (Riskesdas), 2013
Indonesia Basic Health Survey (Riskesdas), 2013
Proportion of abnormal fasting glucose according to gender
Prevalence of High Blood Pressure based on measurement
Indonesia Basic Health Survey (Riskesdas), 2013
The Role of Omega-3 in Cardiovascular Diseases
What are Omega-3s: Structure of n-3 PUFA
Calder PC. Marine omega-3 fatty acids and inflammatory processes: effects, mechanism, and clinical relevance. Biochimica et Biophysica Acta, 2015: 1851:469-484.
Omega-6 Omega-3 Essential Fatty Acids
The conversion of short chain to long-chain omega-3s is limited.
Route of omega-3s from food to tissue
20
[Schuchardt et al., 2013]
Food Sources of Long-Chain n-3 PUFA
Mozaffarian and Wu. Omega 3 Fatty Acids and Cardiovascular Disease. J Am Coll Cardiol 2011;58:2047–67
Physiological Effects of n-3 PUFA That Might Influence CVD Risk
Mozaffarian and Wu. Omega 3 Fatty Acids and Cardiovascular Disease. J Am Coll Cardiol 2011;58:2047–67
Clinical Studies on Omega-3s and Heart Health
RCTs of n-3 PUFA and Clinical Cardiovascular Events
Mozaffarian and Wu. Omega 3 Fatty Acids and Cardiovascular Disease. J Am Coll Cardiol 2011;58:2047–67
The strengthen of ‘Mozaffarian and Wu’ study1. Randomized clinical trial2. Comparing omega-3 and placebo3. Large sample4. Decrease cardiovascular diseases by omega-3
Efficacy of Omega-3 Polyunsaturated Fatty Acids Administration Through Dietary Counseling
Rizos EC, Ntzani EE, Bika E, Kostapanos MS, Elisaf MS. Association Between Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease Events. A Systematic Review and Meta-analysis. JAMA, September 12, 2012; 308
Efficacy of Omega-3 Polyunsaturated Fatty Acid Supplements Across Different Outcomes
Rizos EC, Ntzani EE, Bika E, Kostapanos MS, Elisaf MS. Association Between Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease Events. A Systematic Review and Meta-analysis. JAMA, September 12, 2012; 308
Dose-Response Effects of n-3 PUFA Consumption on Fasting Plasma Triglycerides in RCTs
Mozaffarian and Wu. Omega 3 Fatty Acids and Cardiovascular Disease. J Am Coll Cardiol 2011;58:2047–67
Summary: How omega-3s benefit your heart • Lowering of triglycerides
• Reduces resting heart rate
• Reduces systolic and diastolic blood pressure
• Antithrombotic effect
• Improved flow-mediated arterial dilatation (endothelial function)
• Improved cardiac filling and myocardial efficiency
• Enhancing insulin sensitivity
• Anti inflammatory effect
• Anti-arrhythmic effect
Mozaffarian and Wu. Omega 3 Fatty Acids and Cardiovascular Disease. J Am Coll Cardiol 2011;58:2047–67
Leading Medical Organizations recommend fish intake or EPA/DHA supplements
Regular fish consumption (1-2 servings per week) is protective against coronary heart disease and ischaemic stroke and is recommended. The serving should provide an equivalent of 200-500 mg of eicosapentaenoic and docosahexaenoic acid.
500 mg/day EPA/DHA for adults for cardiovascular health
2 servings of fatty fish per week – for general health
1000 mg/day of EPA/DHA – patients with coronary heart disease
2-4g/day of EPA/DHA – patients with high triglycerides
General population: At least 2-3 servings of fatty fish
Post MI: 1 g/day