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CHAPTER7· NUTRITION181 TABLE 7. 5 Recommended Int Children 1-3yr Boys and giri 19g/ B ys and gi 25g/d 9-13 yr Boy 31g/d Girls 26g/d 14-18 Bow 38g/d 6 g/d Adults 19-50 yr:Men 38g/d Women 25g/ Me 30g/d Women 21g/d Institute of Medicine: Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids Washington, DC: National Academy of Sciences, FATS Total fat intake should not exceed 20-30% of total calories, and saturated fats should contribute less than 10% of calories. Fats consumed should eschew trans-unsaturated fatty acids and emphasize polyunsaturated fatty acids and ds such as those found in fish d ble oils(canola, olive oil, and the fat in peanut butter). For meats, poultry dried beans, milk or milk products, the varieties should be selected that are low-fat or fat-free, with a limited intake of fats and oils high in saturated or trans-fatty acids. As discussed in Chapter 8, reducing fat intake is a basic principle of weight control, but overrestriction of dietary fat to less than 20% of caloric intake may compromise the overall quality of the diet. Patients should consume less than 300 mg/day of cholesterol Heart-Healthy Dietary Practices To help control blood pressure, the AHA recommends a diet that limits intake of sodium(see subsequent text) and alcohol (no more than two drinks per day for men and one drink per day for women)and maintenance of a daily pattern that emphasizes fruits, vegetables, and low-fat dairy products
182SECT|ON|· WHAT TO DO V|HTHE| NFORMAT|○N (see Table 7.6). Recommendations also emphasize the need for normal body weight and physical activity(see Chapters 6 and 8) To achieve and maintain a desirable blood cholesterol and lipoprotein profile, Patients should limit intake of saturated fatty acids, trans-unsaturated fatty acids, and cholesterol. Dietary factors that lower low-density lipoprotein (LDL) cholesterol and raise high-density lipoprotein(HDL) include intake of polyunsaturated fatty acids, monounsaturated fatty acids, soluble fiber, soy protein, and Omega-3 fatty acids(4-6). Nondietary measures to control serum lipids include the interrelated tasks of aerobic exercise and weight loss (see Chapters 6 and 8) TRIGLYCERIDES Factors that increase triglyceride levels include excess body weight, reduced physical activity; increased intake of sugar and refined carbohydrates, particularly in the setting of insulin resistance and glucose intolerance and increased alcohol intake. High triglycerides are often associated with low HDL cholesterol, obesity, diabetes, and high blood pressure(see Table 7.7) SODIUM AND POTASSIUM Sodium intake should be limited to less than 2, 300 mg(approximately one teaspoon of salt)/day. This can be accomplished by choosing and preparing foods with little salt and at the same time consuming potassium rich food such as fruits and vegetables. Table 7. 8 lists food rich in sodium The AHA recommends limiting sodium intake to approximately 5 g/day for those with or without hypertension. The reduction of salt intake is most effective in lowering blood pressure in older individuals and in those with hypertension, diabetes, or chronic kidney disease. The AHa recommends eating eight to ten servings of fruits and vegetables daily to increase potassium intake, which effectively reduces blood pressure in both normotensive and hypertensive individuals Specifically, the AHA recommends the use of the Dietary Approaches to Stop Hypertension(DASH)diet, which emphasizes fruits, vegetables and low-fat dairy products and no more than 1, 500 mg of sodium per day(see Table 7.9). It includes whole-grain products, fish, poultry, nuts, and reduced intake of red meat, sweets, and sugar containing beverages. The DASH diet contains higher amounts of magnesium, potassium, calcium, protein, and fiber as compared to the average American diet Owing to its relatively high content of potassium, phosphorus, and protein, the dash diet is not recommended for those individuals with chronic kidney disease, that estimated glomerular filtration rate lower than b0 mL/minute/1.73m2 Is, an The National Heart, Lung, and Blood Institute Health Information Center has produced an informative booklet entitled The DASh Eating plan The guide provides examples of the dash diet on a daily basis, information