LEC 11: Lifestyle Interventions for Cardiometabolic Health

What is metabolic syndrome?

3 out of 5 of:
A waist circumference > 40 inches in men & 35 inches in women
Serum triglycerides level of 150 mg/dL or greater
Reduced high-density lipoprotein cholesterol, < 40 mg/dL in men or 50 mg/dL in women
Elevated fasting glucose of l00 mg/dL or greater
Blood pressure values of systolic 130 mm Hg or higher or diastolic 85 mm Hg or higher

What is required for metabolic health?

Achieve healthy waist circumference
Keep triglycerides in healthy range
Keep HDL in healthy range (high)
Keep blood glucose in healthy range (low)
Keep blood pressure in healthy range
Maintain a healthy weight/waist circumference via a good energy balance (energy intake [food] vs. energy expenditure [physical activity]) and maintain healthy blood sugar & lipid profiles & blood pressure via good nutrition practices & exercise, i.e., LIFESTYLE INTERVENTIONS

How much energy do we need?

Dependent on sex, age group, activity levels

What is energy balance?

Energy Intake vs. Energy Expenditure

What is positive energy balance?

Energy Intake > Energy Expenditure

What is negative energy balance?

Energy Expenditure > Energy Intake

What is resting energy expenditure?

65-70% total energy expenditure (TEE)
Energy required for normal bodily functions

How much of total energy expenditure is PA?

20-30% TEE
Higher in athletes

What is the thermic effect of food?

10-15% TEE
Energy cost of digestion, absorption, metabolism and storage of food in body

What are the MET equivalents?

1 MET = 1kcal/kg/hr
Rest: 1 MET
Sedentary: ≤ 1.5 METs
Light-intensity PA: 1.6 – 2.9 METs
Moderate-intensity PA: 3.0 – 5.9 METs
Vigorous-intensity PA: ≥ 6.0 METs

What are the Canadian 24-Hour Movement Guidelines?

What should energy intake be to maintain weight?

Energy Intake = Energy Expenditure

What should energy intake be to gain weight?

Energy Intake 500 kcal > Energy Expenditure

What should energy intake be to lose weight?

Energy Expenditure 500 kcal > Energy Intake

How much of your diet should be carbohydrates?

(1 g = 4 kcal)
45-65%
8-10 g/kg for endurance athlete
5-6 g/kg for strength athlete

How much of your diet should be protein?

(1 g = 4 kcal)
10-35%
0.8-2.2 g/kg – 1.6 g/kg the sweet spot?

How much of your diet should be fat?

(1 g = 9 kcal)
20-35%

How does sodium relate to chronic disease?

Sodium is an essential nutrient
Higher sodium intake is associated with higher blood pressure
Sodium is present throughout the food supply, but by far the main contributors to dietary sodium intake are processed foods
58% of all Canadians and 72% of children between the ages of 4 and 13 years consumed sodium above the recommended limits

How do free sugars relate to chronic disease?

Free sugars are monosaccharides and disaccharides added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates
Free sugars do not include the naturally occurring sources of sugars found in intact or cut fruit and vegetables, and (unsweetened) milk
Intake of foods or beverages with added sugars has been associated with an increased risk of weight gain, overweight and obesity, and type 2 diabetes

How do saturated fats relate to chronic disease?

Found in animal-based foods, such as cream, butter, cheeses, and fatty meats as well as some vegetable oils such as coconut and palm kernel oil, and in coconut milk
One in two Canadians consume saturated fat above the recommended limit
Lower intakes of foods that contain mostly saturated fat, through replacement with foods that contain mostly unsaturated fat, helps lower cardiovascular risk factors such as LDL-cholesterol

What are the dietary guidelines for sodium, free sugars, and saturated fats?

Sodium <2,300 mg/day
Free sugars <10% total energy intake
Saturated fat <10% total energy intake

How does insulin resistance relate to sleep?

Exposure to acute sleep restriction induces the presence of insulin resistance
Poor sleep, in the form of short sleep, long sleep, insomnia, and sleep-disordered breathing are all associated with an ↑ propensity to insulin resistance & risk of developing diabetes mellitus
There are multiple mechanistic pathways by which impaired sleep can increase DM risk

How do hormones regulate sleep?

Several hormones have a circadian rhythm and are altered by poor quality sleep, irregular sleep schedules and intrinsic sleep disorders
Cortisol rises in the early part of the day and is important for dealing with somatic stresses
Growth hormone is primarily secreted during deep sleep – impaired sleep or limited deep sleep has the potential to impact growth and muscle repair
Sleep disorders can lead to central suppression of testosterone
Fragmented sleep results in an alternation in the normal balance of ghrelin & leptin, which promote hunger & satiety, respectively
When these hormones are unbalanced, an individual often has ↑ hunger & appetite and an impaired sense of satiety, ↑ the risk of obesity & DM

What is the relationship between sleep duration and CV events?

Relationship between sleep duration and CV events, as well as sleep and overall mortality is J-shaped
Both short sleep(

What is good sleep hygiene?

Duration
7-9 hours
<7 h is associated with adverse health outcomes, impaired immunity, impaired performance, increased errors, and greater risk of accidents

9 h is also associated with health risk, although it might be appropriate for young adults or people who are ill
Consistent sleep schedule
Helps maintain the body's internal clocks
↓ daytime sleepiness
Allows people to fall asleep and wake up more easily
Helps optimize mental health, endocrine system, & reproductive system

How does exercise affect sleep hygiene?

A 30 min session of moderate aerobic exercise can help boost sleep quality (↑ the amount of deep sleep as well as sleep duration) in that night

How does napping affect sleep hygiene?

Most sleep experts believe that a single consolidated period of sleep for 7-9 h each day during darkness on a regular schedule is optimal
Research is emerging that napping can provide health benefits such as relaxation, ↓ fatigue, & improved mood & alertness
A 20-30 min nap in the early afternoon is often most appropriate
Longer naps may lead to grogginess or disorientation upon awakening if an individual enters deep sleep
For younger individuals, a mid-day nap has been shown to be beneficial while for older populations, excessive napping may be linked with negative outcomes

How does light exposure affect sleep hygiene?

Light exposure sends an alerting signal to the brain through diminished secretion of melatonin
↓ both ambient light exposure & light from electronic devices promotes earlier sleep onset & improves sleep quality
Even low levels of light from electronic devices can delay sleep & impair alertness the next morning
Approaches to ↓ light exposure late in the day include:
Avoiding screens
Darkened room
Blue light blocking glasses
The effectiveness of blue light filters is not conclusive & stimulation from screens may still affect sleep
Wearing a sleeping mask

How does caffeine affect sleep hygiene?

85% of the US population drinks at least one caffeinated beverage a day
Coffee & other caffeine containing sources, typically used to increase alertness and decrease fatigue, have negative sleep consequences
Caffeine promotes wakefulness by blocking adenosine receptors in the brain, preventing adenosine from performing its sedative effects
Caffeine intake is associated with:
Prolonged sleep onset latency
↓ sleep duration
↓ sleep efficiency
Worse perceived sleep quality
The half-life of caffeine is 6-7 h – avoiding caffeine beyond mid-day can help ↑ the likelihood of achieving sleep when desired

How does alcohol affect sleep hygiene?

Alcohol is a sedative, which is associated with decreased sleep latency
However, it can disrupt sleep architecture, often resulting in awakening during the 2nd half of the night
Alcohol increases stage 3 sleep and delays and decreases REM sleep, decreasing overall sleep quality and resulting in shorter sleep duration

How does eating before sleeping affect sleep hygiene?

Avoid eating within 2 h of one's desired bedtime if possible
Late time eating is associated with later bedtime, shorter sleep duration, and weight gain
This may be because late time eating often involves less healthy foods
Negative outcomes of late time eating have not been consistently shown when the food choice is nutrient-dense, low energy, and/or composed of single macronutrients
Avoiding large mixed meals and unhealthy foods before sleeping can help improve sleep quality and prevent weight gai