Nasjonal faglig retningslinje for forebygging av hjerte- og karsykdom 2017

Nasjonal faglig retningslinje for forebygging av hjerte- og karsykdom 2017
Nasjonal faglig retningslinje for forebygging av hjerte- og karsykdom 2017 bær anbefale å erstatte rødt kjøtt med plantekost
Nasjonal faglig retningslinje for forebygging av hjerte- og karsykdom, ved Helsedirektoratet, vil oppdateres i år

Retningslinjen anbefaler allerede å velge plantebaserte matvarer som inneholder umettet fett. Helsepersoenll for pkantebasert kosthold (HePla) mener at plantekost bør være førstevalget både som forebygging, primær og sekundær, og som en del i behandling av hjerte- og karsykdom. Derfor har HePla foreslått endringer til kapittel «Kartlegging av levevaner og råd om livsstilstiltak som forebygging av hjerte- og karsykdom»

Det er foreslått å endre «Hvitt kjøtt (kylling, kalkun), fisk og skalldyr i stedet for rødt kjøtt.
Begrenset inntak av salt, smør, sukker, mat og drikke med høyt sukkerinnhold, samt bearbeidede og fete kjøttvarer», slik det allerede står i utkastet, til

  • «Belgvekster som erter, bønner og linser, hvitt kjøtt (kylling, kalkun), fisk og skalldyr i stedet for rødt kjøtt.
  • Begrenset inntak av salt, smør, sukker, mat og drikke med høyt sukkerinnhold, samt så lite av bearbeidede og fete kjøttvarer som mulig.
  • Vegetariske retter som grønnsaksbaserte kjøtterstatninger, grønnsakskarbonader, retter med kikerter, bønner og linser flere ganger i uka istedenfor (rødt) kjøtt, samt saltfri nøttesmør som pålegg istedenfor kjøttpålegg.»

Begrunnelsen til å velge plantekost fremfor «vanlig» kost som forebygging av hjerte- og karsykdom:

1. Kosthold med lavt inntakt av kjøtt  (som middelhavskosthold) og vegetarisk kosthold reduserer risiko for å iskemisk hjertesykdom og for å dø av iskemisk sykdom, samt gir bedre vektkontroll. Bønner, erter og grønnsakskarbonader er en mye sunnere erstatning for rødt kjøtt enn kylling. Bønner og erter inneholder, i motsetning til kylling, mye fiber, ingen kolesterol eller mettet fett, mange helsefremmende plantestoffer og er ikke et risikoprodukt med tanke på resistente bakterier.

2. Vegetarmat blir mer populær blant befolkningen og matvarekjeder kommer med flere vegetartilbud, derfor er det lettere å følge råd om mer vegetarmat i dag ift tidligere.

De nyeste kunnskapsoppsummeringer om kosthold og hjerte- og karsykdom:

1. The Academy of Nutrition and Dietetics og deres standpunkt om vegetariske kostholdsmønstre, fra oktober 2016. URL: http://www.andjrnl.org/article/S2212-2672%2816%2931192-3/pdf

«Provided that adequate nutrition education is given, a therapeutic vegetarian diet performs as well as omnivorous diets in terms of adherence. 43 As with implementation of any diet, employing a variety of counseling strategies, including motivational interviewing, frequent sessions, cooking demonstrations, and incentives, can improve nutrition-related outcomes when using a vegetarian diet therapeutically.

CVD, Including Hyperlipidemia, Ischemic Heart Disease, and Hypertension

Vegetarian diets are associated with a reduction in the risk of CVD.15,53 Vegetarian diets improve several modifiable heart disease risk factors, including abdominal obesity,54 blood pressure,55 serum lipid profile,56 and blood glucose.42,57 They also decrease markers of inflammation such as C-reactive protein, reduce oxidative stress, and protect from atherosclerotic plaque formation.58 Consequently, vegetarians have reduced risk of developing and dying from ischemic heart disease.15,53,59 Vegan diets seem to be most beneficial in improving heart disease risk factors.55,57 The EPIC-Oxford study60 revealed that those who consumed a vegan diet ate the most fiber, the least total fat and saturated fat, and had the healthiest body weights and cholesterol levels compared with omnivores and other vegetarians. A meta-analysis of 11 randomized controlled trials found that those participants assigned to a vegetarian diet experienced a substantial reduction in total, lowdensity lipoprotein, and high-density lipoprotein cholesterol, which corresponded with an approximately 10% reduced risk of heart disease.56 The vegetarian diet was especially beneficial for healthy weight and overweight individuals, but less effective for obese individuals, underscoring the importance of early dietary intervention for long-term risk reduction.56

In the Adventist Health Study-2 of 73,308 Seventh-day Adventists, researchers found that vegetarians had a 13% and 19% decreased risk for developing CVD and ischemic heart disease, respectively, compared with nonvegetarians.15 A previous analysis from the EPIC study found that vegetarian groups had a 32% lower risk of hospitalization or death from heart disease.53

Vegetarians enjoy a lower risk of heart disease by regularly consuming a variety of vegetables, fruit, whole grains, legumes, and nuts. Low-fat vegan and vegetarian diets, combined with other lifestyle factors, including not smoking and weight reduction, have been shown to reverse atherosclerosis. 61

Risk factors for coronary heart disease, such as total and lowdensity lipoprotein cholesterol levels, body weight, and body fat, improve within a short time on a vegetarian diet, even without the use of cholesterol-lowering drugs.61

Compared with nonvegetarians, vegetarians have a lower prevalence of hypertension. Results of the EPICOxford study showed vegans have the lowest systolic and diastolic blood pressure levels and the lowest rate of hypertension of all diet groups (vegans, vegetarians, fish eaters, and meat eaters).62 Data from the Adventist Health Study-2 confirmed that vegans have the lowest blood pressure Levels and the least hypertension of all vegetarians, and significantly less than the meat eaters.55 A meta-analysis comparing blood pressure from more
than 21,000 people around the world found that those who follow a vegetarian diet have systolic blood pressure about 7 mm Hg lower and diastolic blood pressure 5 mm Hg lower than study participants who consume an omnivorous diet.63»

2. Middelhavslignende kosthold, med lite (rødt) kjøtt, reduserer risiko for HKS. 

The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice, Piepoli et al, 2016 European Guidelines on cardiovascular disease prevention in clinical practice, European Heart Journal. Advance Access published June 8, 2016  URL: http://eurheartj.oxfordjournals.org/content/early/2016/06/08/eurheartj.ehw106

«Dietary patterns

Studying the impact of a total dietary pattern theoretically shows the full preventive potential of diet since it yields a combined estimate of the impact of several favourable dietary habits. The Mediterranean diet comprises many of the nutrients and foods that have been discussed previously: high intake of fruits, vegetables, legumes, wholegrain products, fish and unsaturated fatty acids (especially olive oil); moderate consumption of alcohol (mostly wine, preferably consumed with meals) and low consumption of (red) meat, dairy products and saturated fatty acids. A meta-analysis of prospective cohort studies has demonstrated that greater adherence to a Mediterranean diet is associated with a 10% reduction in CV incidence or mortality [pooled RR 0.90 (95% CI 0.87, 0.93)] and an 8% reduction in all-cause mortality [pooled RR 0.92 (95% CI 0.90, 0.94)].336 An RCT in high-risk individuals suggested that following a Mediterranean diet over a 5 year period, compared with a control diet, was related to a 29% lower risk of CVD [RR 0.71 (95% CI 0.56, 0.90)].337»

3. Vegetarisk kosthold kan redusere risiko for livsstilssykdommer som diabetes og hjerte- og karsykdommer med 20 – 25%, samt gir bedre vektkontroll, viser en metaanalyse og oversikt.

Harland, J., Garton, L. An update of the evidence relating to plant-based diets and cardiovascular disease, type 2 diabetes and overweight.
Nutrition Bulletin 41-4-1467-3010  http://dx.doi.org/10.1111/nbu.12235

«Recent findings from meta-analyses, European cohorts and randomised controlled trials (RCTs) evaluating the relationship between plant-based dietary regimes (i.e. those with an emphasis on plant foods, such as vegetarian, vegan, Mediterranean or combination diets), and the incidence of, or risk factors for, cardiovascular disease (CVD), type 2 diabetes (T2D) and obesity are considered in this review.

Evidence from meta-analyses of epidemiological studies indicates that those following plant-based dietary regimes have around 20–25% lower risk of developing CVD and a similar reduced risk of developing T2D.

Evidence from RCTs indicates that those following plant-based dietary regimes have lower total cholesterol, low-density lipoprotein-cholesterol and blood pressure, and modest reductions in inflammatory and endothelial markers. Higher intake of plant foods has been associated with lower incidence of obesity, lower BMI and smaller waist circumference. For weight loss, it seems that following a plant-based dietary regime results in weight loss comparable to that achieved on conventional reduced calorie diets, but with better overall weight management.

The totality of evidence indicates there are benefits for cardiovascular health, risk of developing T2D and weight management from following a plant-based dietary regime. From a nutritional perspective, plant-based diets tend to be lower in saturated fatty acids, higher in unsaturated fatty acids and fibre, and lower in energy density than typical ‘Western’ diets. These qualities may be at the core of the health benefits reported and/or it may be simply a greater proportion of plant foods in the diet that is beneficial in its own right.»

4. Semi-vegetarisk kosthold er gunstig ved metabolsk syndrom.

Derbyshire Emma J. Flexitarian Diets and Health: A Review of the Evidence-Based Literature. Frontiers in Nutrition.  2017 DOI=10.3389/fnut.2016.00055 http://journal.frontiersin.org/article/10.3389/fnut.2016.00055/full

«The trend of flexitarianism does not appear to be subsiding. This review provides a first line of evidence that FDs may have emerging health benefits in relation to weight loss, metabolic health, and diabetes prevention. While most flexitarians presently seem to be female, there is a clear need to communicate the potential health benefits of these diets to males. As not everyone and in particular men might not want to exclude meat altogether, FDs offer a path that includes their dietary preferences yet could improve public health outcomes.»

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