Transcript Chapter 18 - Delmar

Chapter 18
Diet and Cardiovascular Disease
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Objectives
• Identify factors that contribute to heart disease
• Explain why cholesterol and saturated fats
limited in some cardiovascular conditions
• Identify foods to avoid or limit in cholesterolcontrolled diet
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Objectives
• Explain why sodium limited in some
cardiovascular conditions
• Identify foods limited or prohibited in sodiumcontrolled diets
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Cardiovascular Disease (CVD)
• Affects heart and blood vessels
• Leading cause of death and permanent
disability in U.S.
• Metabolic syndrome puts client at risk for
CVD and type 2 diabetes
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Metabolic Syndrome
• Risk factors in adults and children:
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Abdominal obesity
Hyperlipidemia
High blood pressure
Insulin resistance
Elevated, highly sensitive C-reactive protein (CRP) in
blood
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CVD
• Acute
– Myocardial infarction (MI)
– Also known as heart attack
• Chronic
– Develops over time
– Loss of heart function
(continues)
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CVD
• Heart may beat faster and enlarge to maintain
circulation in compensated heart disease
• Inability to compensate leads to congestive
heart failure (CHF)
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Arteriosclerosis and Atherosclerosis
• Arteriosclerosis
– Arteries harden
• Making passage of blood difficult
– Sometimes impossible
• Atherosclerosis
– Thickening and weakening of artery walls by cholesterol
and fatty deposits
• Plaque
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Atherosclerosis
• Plaque may cause reduced blood flow beyond
obstruction and ischemia
• Ischemia may cause pain
• Angina pectoris
– Chest pain
– May radiate down left arm
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Atherosclerosis
• If lumen narrows completely in coronary
artery, heart attack occurs
• Coronary artery bypass graft (CABG)
– Procedure to bypass circulation around clogged artery
(continues)
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Atherosclerosis
• Cerebrovascular accident (CVA) or stroke
– Blood flow to brain blocked or blood vessel bursts
• Peripheral vascular disease (PVD)
– Affects vessels in extremities
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Risk Factors for Atherosclerosis
• Major:
– Hyperlipidemia
• Elevated total cholesterol, high LDL, or low HDL
– Hypertension
– Smoking
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Risk Factors for Atherosclerosis
• Contributory factors:
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Obesity
Diabetes mellitus
Male sex
Heredity
Personality type
Age
Sedentary lifestyle
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medical Nutrition Therapy for
Hyperlipidemia
• Reduce quantity and types of fats in diet
– And often calories
• American Heart Association guidelines for
blood cholesterol:
– Desirable
• 200 mg per dL or less
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medical Nutrition Therapy for
Hyperlipidemia
• American Heart Association guidelines for
blood cholesterol:
– Borderline high
• 200 to 239 mg per dL
– High
• 240 mg per dL or more
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Medical Nutrition Therapy for
Hyperlipidemia
• American Heart Association recommends:
– Adult diets with less than 200 mg of cholesterol per day
– No more than 20 to 35 percent of calories from fat
• Maximum of 7 percent from saturated fats and trans fats
• Maximum of 8 percent from polyunsaturated fats
• Maximum of 15 to 20 percent from monounsaturated fats
– Have proteins provide 12 to 20 percent of total calories
– Have carbohydrates provide 50 to 55 percent of total calories
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Stop and Share
• Consider the following scenario:
– Your client has been given a very low-fat diet to follow. He
expresses to you that it is almost impossible to follow this
diet. What recommendations would you suggest?
(continues)
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Stop and Share
• Diet very low in fat seems unusual and highly
unpalatable
• Realize it takes two to three months to adjust
to low-fat diet
• Make change gradually if physician allows
• Provide client with information about fat
content of foods and food preparation methods
(continues)
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Stop and Share
• Encourage client to select whole, fresh foods
– Prepare them without adding fat
• Select lean meat
– Remove all visible fat
• Use fat-free milk and fat-free skim cheeses
• Gradually introduce 25 to 35 g of fiber per day
• Discuss challenges with dietitian and physician
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Cholesterol-Lowering Agents
• If blood lipid levels not corrected after three to
six months of fat-restricted diet alone,
cholesterol-lowering drug may be prescribed
• Food and/or drug interactions common
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
MI
• Caused by blockage of coronary artery
supplying blood to heart
• Heart tissue beyond blockage dies
• Causes:
– Atherosclerosis, hypertension, abnormal blood clotting,
infection (e.g., those caused by rheumatic fever)
(continues)
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MI
• Initial shock causes fluid shift
– Client may be thirsty
• Client should be nothing by mouth (NPO) with
IV fluids
• When diet resumed, liquid diet recommended
initially
– Then, low-cholesterol, low-sodium diet in controlled portions
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
MI
• To allow heart to rest and heal, prescribed
foods should be:
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Not extremely hot or cold
Easily chewed and digested
Low in fibers
Limited in sodium to prevent fluid overload
Restricted in caffeine for first few days
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CHF
• Decompensation or severe injury to heart
muscle
• Decreased circulation causes decreased
oxygenation of body and fluid build up
• Common to have shortness of breath, chest
pain on exertion, and edema
• Death can occur in severe cases
(continues)
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CHF
• Decreased nutrients to body tissues
• Edema may mask problems of malnutrition
and underweight
• Fluid restriction may be ordered
• Diuretics and sodium-restricted diet typically
prescribed
(continues)
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CHF
• Diuretics can cause excessive loss of potassium
– Blood levels should be monitored
• Hypokalemia can upset heartbeat
• Fruits excellent sources of potassium
– Especially oranges, bananas, and prunes
– But supplements may be given
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Hypertension
• Chronically high blood pressure
• Essential hypertension
– Also known as primary hypertension
– 90 percent of cases
– Cause unknown
(continues)
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Hypertension
• Secondary hypertension
– 10 percent of cases
– Caused by another condition
• E.g., kidney disease, problems of adrenal glands, use of oral
contraceptives
• Sphygmomanometer
– Measures hypertension
(continues)
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Hypertension
• Systolic pressure
– Top number
– Taken as heart contracts
• Diastolic pressure
– Bottom number
– Taken when heart rests
(continues)
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Hypertension
• Measured in millimeters of mercury (mmHg)
• Normal:
– Less than 120/80
• Prehypertension:
– 120 to 139/80 to 88
(continues)
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Hypertension
• Stage 1:
– 140 to 159/90 to 99
• Stage 2:
– 160/100
• Contributes to heart attack, stroke, heart
failure, and kidney failure
(continues)
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Hypertension
• “Silent disease”
– Sufferers can be asymptomatic
• Predisposing factors:
– Heredity, age, obesity and African-American race
• Contributing factors:
– Smoking and stress
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Dietary Treatment
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Weight-reduction diet
Sodium-restricted diet
Potassium-rich foods if diuretics used
Increased fruits and vegetables
– Six to 10 servings per day
– Helps lower blood pressure
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Sodium-Restricted Diets
• Regular diet with limited sodium
• Food and Nutrition Board recommends daily
intake of no more than 2,300 mg
– Safe minimum at 500 mg per day for adults
• African-Americans and people with
hypertension should limit sodium intake to
1,500 mg per day
(continues)
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Sodium-Restricted Diets
• Sodium-free diet impossible
• Most foods naturally contain sodium
– Processed foods often contain high amounts
• Other sources of sodium:
– Water contains varying amounts
– Some over-the-counter medicines contain some amounts
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Adjustment to Sodium Restriction
• Transition may be difficult
• Gradual reduction easier
• Remind client of numerous herbs, spices, and
flavorings allowed
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Considerations for the
Health Care Professional
• Most cardiac clients told to reduce fat, sodium,
and sometimes amount of calories in diets
• Help cardiac clients want to learn how to help
themselves via nutrition
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Conclusion
• CVD
– Leading cause of death in U.S.
• May be acute, as in MI, or chronic, as in
hypertension and atherosclerosis
• Hypertension may be symptom of another
disease
(continues)
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Conclusion
• Cholesterol associated with atherosclerosis
– Low-cholesterol or fat-restricted diet might be prescribed
• Health care professional can encourage client
to maintain healthy weight, exercise, limit salt
and fat intake, and avoid smoking to reduce
risk of heart disease
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.