Transcript Fundamentals of Nutrition

Section 3
Medical Nutrition Therapy
Copyright © 2003 Delmar Learning, a Thomson Learning company
Chapter 18
Diet and Cardiovascular Disease
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Objectives
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Identify factors that contribute to heart
disease
Explain why cholesterol and saturated
fats are limited in some cardiovascular
conditions
Identify foods to avoid or limit in a
cholesterol-controlled diet
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Objectives
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Explain why sodium is limited in some
cardiovascular conditions
Identify foods that are limited or
prohibited in sodium-controlled diets
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Cardiovascular Disease
Affects heart and blood vessels.
Leading cause of death and permanent
disability in the United States.
Can be acute (sudden) or chronic.
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Cardiovascular Disease
Acute: myocardial infarction (MI, heart
attack)
Chronic: develops over time, loss of heart
function
Heart may or may not maintain circulation.
Heart may beat faster and enlarge to
compensate.
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Cardiovascular Disease
Congestive heart failure occurs when the
heart cannot maintain blood circulation to
all body tissues.
The heart muscle (myocardium), the
valves, the lining (endocardium), the outer
covering (pericardium), or the blood
vessels may be affected by heart disease.
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Arteriosclerosis and
Atherosclerosis
Arteriosclerosis: arteries become thick
and hard making the passage of blood
difficult and sometimes impossible.
Atherosclerosis: affects inner lining of
arteries where deposits of cholesterol, fats,
and other substances accumulate over
time, thickening and weakening artery
walls. Deposits are called plaque.
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Atherosclerosis
Plaque may cause a reduced blood flow
beyond the obstruction; ischemia occurs.
Ischemia may cause pain.
Angina pectoris: Chest pain; may radiate
down left arm.
If lumen of vessel narrows completely in a
coronary artery, a heart attack occurs.
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Atherosclerosis
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Atherosclerosis
Coronary artery bypass graft (CABG):
procedure to bypass circulation around a
clogged artery.
Cerebrovascular accident (CVA): blood
flow to brain is blocked or blood vessel
bursts (stroke).
Peripheral vascular disease: vessels in
extremities affected.
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Risk Factors
Major:
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Hyperlipidemia (elevated total
cholesterol; high LDL, low HDL)
Hypertension
Smoking
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Risk Factors
Contributory factors:
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Obesity
Diabetes mellitus
Male sex
Heredity
Personality type (ability to handle stress)
Age (risk increases with age)
Sedentary lifestyle
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Hyperlipidemia:
Medical Nutritional Therapy
Primary treatment for hyperlipidemia.
Involves reducing the quantity and types of
fats and often kcal in the diet.
American Heart Association guidelines:
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blood cholesterol 200 mg/dl or less is
desirable
200 to 239 mg/dl is borderline high
240 mg/dl and greater is high
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Hyperlipidemia:
Medical Nutritional Therapy
American Heart Association
recommendations for prevention:
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Adult diets contain less than 200 mg of
cholesterol per day
No more than 30% of kcal from fat;
maximum of 7% from saturated fats, 8%
from polyunsaturated fats, 15% from
monounsaturated fats
Proteins 12 to 20% of kcal, and
carbohydrates 50 to 55% of kcal
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Stop and Share
Your client has been given a very low fat
diet to follow. The client expresses to you
that it is almost impossible to follow this
diet.
What recommendations would you
suggest?
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Stop and Share
A diet very low in fat will seem unusual
and highly unpalatable.
It takes 2 to 3 months to adjust to a low-fat
diet.
Change should be made gradually if
physician allows.
Provide client with information about the
fat content of foods and methods to
prepare it.
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Stop and Share
Encourage client to select whole, fresh
foods and to prepare them without addition
of fat.
Lean meat should be selected and all visible
fat removed.
Use fat-free milk and fat-free skim cheeses.
Gradually introduce 25-35 grams of fiber.
Discuss challenges with a dietitian and the
M.D.
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Cholesterol-lowering Agents
If appropriate blood lipid levels cannot be
attained within 3 to 6 months by use of fatrestricted diet alone, the physician can
prescribe a cholesterol-lowering drug.
Example: simvastatin (Zocor)
Client teaching: Zocor interacts with
grapefruit and its juice; total avoidance is
necessary.
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Myocardial Infarction
Caused by blockage of a coronary artery
supplying blood to heart.
Heart tissue beyond blockage dies.
Causes: atherosclerosis, hypertension,
abnormal blood clotting, infection such as
that caused by rheumatic fever (damages
heart valves).
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Myocardial Infarction
After the attack, the client is in shock.
Fluid shift occurs, and client may be thirsty.
Client should be NPO (nothing by mouth).
IV fluids may be given.
After several hours, client may begin to eat.
Liquid diet usually recommended first 24
hours.
Then, a low-cholesterol, low-sodium diet.
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Myocardial Infarction
Foods should not be extremely hot or cold.
Food that is easy to chew and digest
prescribed.
Percentage of energy nutrients will be
based on particular needs of the client.
Sodium limited to prevent fluid overload.
Restriction on caffeine the first few days
after an MI.
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Congestive Heart Failure
Injury to the heart muscle occurs from
atherosclerosis, high BP, rheumatic fever.
When damage is extreme and the heart
cannot provide adequate circulation, the
amount of oxygen taken in is insufficient
for body needs.
Shortness of breath is common and chest
pain can occur on exertion.
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Congestive Heart Failure
Tissues retain fluid that would normally be
carried off by the blood.
Sodium builds up, and more fluid is
retained, resulting in edema.
Heart beats faster and enlarges to
compensate.
Death can occur in severe cases.
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Congestive Heart Failure
Body tissues do not receive sufficient
amounts of nutrients.
Edema may mask the problems of
malnutrition and underweight.
Fluid restriction may be ordered.
Diuretics aid in the excretion of water and
sodium, and a sodium-restricted diet
typically prescribed.
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Congestive Heart Failure
Diuretics can cause excessive loss of
potassium.
Blood potassium levels should be carefully
watched to prevent hypokalemia which
can upset the heartbeat.
Fruits, especially oranges, bananas, and
prunes are excellent sources of potassium.
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Hypertension
Chronically high blood pressure.
Essential, or primary hypertension: 90%
of cases; cause is unknown.
Secondary hypertension: 10% of cases;
caused by another condition.
Causes of secondary hypertension include
kidney disease, problems of the adrenal
glands, use of oral contraceptives.
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Hypertension
Blood pressure commonly measured is that
of the artery in the upper arm.
Sphygmomanometer is used to measure it.
Systolic pressure: top number taken as the
heart contracts.
Diastolic pressure: taken when the heart is
resting.
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Hypertension
Measured in millimeters of mercury (mm
Hg).
Hypertension can be diagnosed when, on
several occasions, the systolic pressure is
140 mm Hg or more and the diastolic
pressure is 90 mm Hg or more.
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Hypertension
Contributes to heart attack, stroke, heart
failure, and kidney failure.
“Silent disease” because sufferers can be
asymptomatic.
Frequency increases with age and is more
prevalent among African Americans.
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Hypertension
Heredity and obesity are predisposing
factors in hypertension.
Smoking and stress also contribute to
hypertension.
Weight loss usually lowers blood pressure
and, consequently, clients are often placed
on weight-reduction diets.
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Hypertension
Sodium and fluid collect in body tissue,
causing edema, extra pressure is placed on
the blood vessels.
Sodium-restricted diet, often accompanied
by diuretics, can be prescribed to alleviate
this condition.
Increasing fruits and vegetables to 6 to 10
servings per day helps to lower blood
pressure.
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Dietary Treatment
Weight loss
Sodium-restricted diet
Diuretics
When diuretics are prescribed together
with a sodium-restricted diet, the client
may lose potassium via the urine and, thus,
be advised to increase the amount of
potassium-rich foods in the diet.
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Sodium-Restricted Diets
Regular diet in which the amount of
sodium is limited.
Used to alleviate edema and hypertension.
Food and Nutrition Board recommends
daily intake of sodium be limited to no
more than 2,400 mg (2.4 g).
Board itself set a safe minimum at 500
mg/day for adults.
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Sodium-Restricted Diets
Impossible to have a diet totally free of
sodium.
Meats, fish, poultry, dairy products, and
eggs all contain substantial amounts of
sodium naturally.
Cereals, vegetables, fruits, and fats contain
small amounts of sodium naturally.
Water contains varying amounts of
sodium.
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Sodium-Restricted Diets
Many products contain sodium; check
labels.
Some over-the-counter medicines
contain sodium.
Physician’s permission should be
obtained before using any medication
or salt substitute.
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Adjustment to Sodium Restriction
Most people are accustomed to salt in their
food and transition to sodium-restricted
diet may be difficult.
It will help the client if the reduction in
sodium can be gradual.
Remind the client of the numerous herbs,
spices, and flavorings allowed.
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Considerations for the Health
Care Professional
Most of the cardiac clients will be told
they must reduce the fats, sodium, and
sometimes, the amount of kcal in their
diets.
Help the cardiac client want to learn how
to help himself or herself via nutrition.
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Conclusion
Cardiovascular disease represents the
leading cause of death in the United States.
May be acute, as in myocardial infarction,
or chronic, as in hypertension and
atherosclerosis.
Hypertension may be a symptom of
another disease.
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Conclusion
Cholesterol is associated with
atherosclerosis and a low-cholesterol diet
or a fat-restricted diet might be prescribed.
The health care professional can encourage
the client to maintain a healthy weight,
exercise, limit salt and fat intake, and
avoid smoking to reduce the risk of heart
disease.
Chapter 18
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