Heart diseases are the third leading cause of death in Hong Kong and account for approximately 13 percent of overall fatalities. In the city, 11 people died of coronary heart disease per day on average in 2013. Danica Yau, Medical Affairs Specialist at Wyeth Nutrition Hong Kong, with a focus on paediatric nutrition, obesity and diabetes, provides an easy-to-understand guide to a heart-healthy diet
By Channy Lee
biz.hk: What are some of the most common heart issues?
Yau: Heart diseases refer to a spectrum of conditions involving the heart and blood vessels, being largely categorized by the part of circulatory system where the problem arises and different causes behind.
The most common heart disease in Hong Kong is coronary heart disease, which occurs when blood flow to the heart muscle is limited due to a blood clot. This is often a result of the buildup of cholesterol layer inside coronary arteries, and it can lead to a heart attack. Other common heart problems include hypertensive, chronic rheumatic and congenital heart diseases.
biz.hk: How prevalent are these diseases in Hong Kong? Are there any risk factors especially pertinent to the Hong Kong or Asian population?
Yau: Heart diseases are the third leading cause of death in Hong Kong, accounting for approximately 13 percent of deaths. In 2013, 11 people died of coronary heart disease per day on average. Although the rate is considerably lower than that of Western countries, it is still important to note risk factors that make the population of Hong Kong more prone to heart diseases.
Diabetes is more common in Hong Kong compared to the world average, and diabetic patients are about two times more likely to develop coronary heart disease. Severe air pollution in Hong Kong and China increases the risk as there is growing evidence that exposure to particulate matter (an air pollutant) contributes to prevalence of heart diseases. Chronic stress that is especially prevalent in a fast-paced city like Hong Kong is also associated with an increased risk.
biz.hk: What is the significance of healthy eating in reducing the risk of heart diseases?
Yau: Healthy and balanced nutrition is a key focus of disease prevention as such approaches are also recommended by authorities. Diet is an important modifiable factor as it not only helps reduce the risk of heart diseases, but also reduces the chances of comorbidities such as obesity, high blood pressure and abnormal blood lipids. But diet alone may not suffice. A healthy lifestyle involving physical activities with abstinence from smoking and alcohol is concurrently needed to support heart health.
biz.hk: What is a healthy diet for the heart?
Yau: The broad principle of a heart healthy diet encompasses the following:
- A range of fruits and vegetables (≥ 5 servings/day)
- Skim or low-fat dairy products, or alternative calcium supplemented foods and drinks (1-2 glasses/day)
- Lean meat and fish (5-8 taels/day)
- More nuts and legumes
- More wholegrains
- Vegetable oils (limit cooking oil to 2 teaspoon max per person in each meal)
- Red meat
- Foods high in saturated fat and trans fat (eg cakes, biscuits)
- Foods high in salt (e.g. processed meat like bacon, sausages and spam)
- Sweets and sugar-sweetened beverage
Following the above dietary pattern will reduce the intake of sodium and sugar, while consuming more fiber and achieving an optimal fatty acid intake profile. Emphasis should also be placed on portion control and corresponding calories for weight management.
biz.hk: How do dietary fats play into a heart healthy diet?
Yau: Fat is a macronutrient and is a fuel and energy source for the body, while also aiding in the absorption of fat-soluble vitamins such as vitamin E. Very importantly, dietary fat plays a role in body cholesterol levels. Cholesterol is the waxy substance that occurs naturally in the body but forms plaque that narrows or even blocks arteries when there is an excessive amount.
Fats are categorized by their structure and properties, each impacting heart health in different ways (see above table). One fact about dietary fats that needs particular attention is, eating large amounts of food containing saturated and trans fats is a more relevant dietary cause of high blood cholesterol level than consuming cholesterol- containing foods.
biz.hk: Is there an aspect of culinary culture or eating habits that needs to be further promoted?
Yau: Eating out being a prominent part of Hong Kong’s culture, it is important to know how to choose healthier alternatives while doing so. This includes simple choices such as adding a side of vegetables, removing the skin from chicken wings, choosing fish over steak, limiting sodium rich sauces such as oyster sauce, asking for less rice for calories and portion control, and opting for coffee or tea without sugar.
When grocery shopping, the nutritional content of food products may not always be evident, and there is a likelihood that they can be easily misunderstood due to common misperceptions. By paying closer attention to nutrition labels on food packaging to compare nutrient levels, we can be a step closer to a healthy heart.
biz.hk: Any food myths that must be busted?
Yau: It is a myth that eggs, particularly the yolk, should be avoided for health reasons of the heart. Fat found in eggs is mostly unsaturated – the healthy fats – and cholesterol found in eggs (220 mg per egg on average) is limited in amount to affect our blood cholesterol level.
The Australian Heart Foundation recommends up to 6 eggs each week as part of a healthy balanced diet without increasing the risk of heart diseases. In addition, the Hong Kong government advises to avoid consuming other high cholesterol foods on an egg-day to prevent exceeding the daily upper-limit cholesterol intake of 300 mg.
Another widespread myth is that there is no limit to consumption of good fats – the notion that it can be consumed as much as one wants. While it is true that the good fats may help support heart health, one needs to keep in mind that fat is the most calorie dense macronutrient with 9 kcal per gram, while carbohydrates and protein both contain 4 kcal per gram.
The reference values for daily energy intake are 2350-2400 kcal and 1850-1900 kcal for adult men and women, respectively, and a diet with fat as 15-30 percent of total energy intake is recommended.
Lastly, it is a myth that vitamin supplements can aid in preventing heart diseases. Some people have turned to vitamin supplements with the notion that vitamins with antioxidant properties are beneficial for heart health. However, the American Heart Association, based on available scientific data, concluded in 2004 that the use of vitamin supplements is not justified, and a dietary pattern with wholesome foods is recommended instead. The latest recommendation made by the Association states vitamin supplements may only be considered if intake from a normal diet is deficient, with the advice of healthcare professionals.
biz.hk: Who should be most concerned about eating right for the heart?
Yau: Men of advancing age and those with a family history of heart diseases are at higher risk and hence it is an aspect of their health requiring more attention. However, with the current trend of heart-related problems, it is recommended – and always best – to establish a healthy eating pattern from a young age. If not, we need to start now. A healthy diet for the heart is also aligned with overall health: appropriate body weight, less prone to diabetes, cancers and other non-communicable diseases. So everyone can benefit from it in different ways.
biz.hk: What are some other lifestyle factors to consider for a synergetic effect in prevention?
Yau: There are several tips to preventing heart diseases in everyday life. It is important to exercise regularly, at least 30 minutes every day to maintain cardiovascular fitness. With that, a healthy weight should be maintained. Using Body Mass Index (BMI) as a measure, BMI of 18.5-22.9 and waist circumference of less than 90 cm and less than 80 cm for men and women, respectively, are considered healthy.
Secondly, smoking should be avoided. Tobacco in every form and exposure to second-hand smoke are harmful. Overall, learning to recognize and manage stress in healthy ways will contribute to the prevention of heart diseases, as some individuals tend to over-eat, smoke and consume alcohol when under stress.
More importantly, any individual experiencing heart disease symptoms should seek medical attention from healthcare providers. Dietary information about maintaining a healthy heart only serves as a reference for the general public.
Danica Yau is a medical affairs specialist at Wyeth Nutrition Hong Kong. She is an Accredited Practising Dietitian (Dietitians Association of Australia) and Accredited Dietitian (Hong Kong Dietitians Association), with an interest in paediatric nutrition, obesity and diabetes. She graduated from the University of Sydney with a Bachelor of Science (Honors) degree in Nutrition and has recently completed a Master of Science degree in Endocrinology, Diabetes and Metabolism at the Chinese University of Hong Kong.