Transcript Diet - ISpatula

Nutrition & Cardiovascular
Disorders
Cardiovascular diseases
Hypertension
Ischemic heart disease
• Angina pectoris
• Myocardial infarction
Athrosclerosis
Artery walls become progressively thickened
due to accumulation of plaque
Occurs due to minimal but chronic injuries that
damage the inner arterial wall
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Consequences
• Lumen narrows
• Plaque can rupture,
forming a clot
(thrombus)
• Thrombus can break
free & shut off blood
flow (embolism)
• Ischemia occurs within
the tissue
– Coronary arteries
(angina pectoris & heart
attack)
– Brain (stroke)
• Aneurysm (sac-like
distention of blood
vessel wall)
Coronary Heart Disease
• Most common type
• Leading cause of death
in U.S.
• Evaluating Risk
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Smoking
High LDL
High blood pressure
Diabetes
Obesity
Inactivity
• Non-modifiable risk
factors
– Age
– Male gender
– Family history
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Lifestyle Changes for CHD
• Cholesterol-lowering diet
(<200 mg)
• Weight reduction
• Regular physical activity
• Decrease saturated fat
<7% total kcalories
• Decrease total fat 25-35%
of kcalories
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Decrease trans fat
Increase soluble fiber
Plant sterols & stanols
Eat soy products
Increase fish & omega-3
fatty acids
Vitamin Supplementation
• No conclusive research results have been
obtained for vitamins being preventative for
CVD
• Study is underway for increasing:
– Folate, vitamin B6 & B12 to decrease
homocysteine levels
– Vitamin C and E for antioxidant effects
Myocardial Infarction:
• Diet: For 24 to 48 hours the patient is only given
parenteral dextrose and no food is given by mouth, but
sips of cool water are given.
• After that low fat liquid diet (500 to 800 calories and
1000- 1500 ml fluid diet) is given in very small feeds
for 2 to 3 days.
• The patient -progresses to a soft diet (about 1000-1200
calories), which may help establish circulation needed
for digestion and absorption of food.
• The diet is given in five or six easily digestible
meals. The fat content of the diet is less than 30
per cent of total calories, with less than 300mg
cholesterol and less than 10 per cent calories
from saturated fat.
• The sodium is restricted to less than 1000 mg
for a congestive heart failure patient, while it
may be mild for less serious condition. Gas
producing foods as per patient’s perception are
avoided.
• In edema cases fluid is restricted
Congestive Heart Failure
• Heart’s inability to
pump adequate blood
• Fluids build up in
veins & tissues
• Consequences
– Fluid accumulation in liver,
abdomen, & lower extremities
– Chest pain; swelling legs,
ankles, feet; SOB
• Heart enlarges
– Impaired liver & kidneys
• 75% are 65 or older
– Heart failure
– Cardiac cachexia
Congestive Heart Failure:
• Diet: The workload of heart must be
reduced. The dietary progression is similar to
that given for myocardial infarction.
• In addition severe sodium restriction (500 –
1000 mg) and fluid restriction may be
advisable.
Medical Management
Sodium & fluid restrictions
Diuretics
Small, frequent meals
Vaccinations for influenza & pneumonia
Adequate fiber
Avoid alcohol
Liquid supplements, tube feedings, parenteral
support
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Hypertension
• Affects 1/3 of adults in
U.S.
• Factors influencing BP
– Cardiac output
– Peripheral resistance
– Secretion of hormones by
kidneys
• Desirable BP
– < 120/80
• Prehypertension
– 120-139/80-89
• Hypertension
– > 140/90
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Contributing Factors
• Aging
• Genetics
– More prevalent in
African Americans
• Obesity
– Alters kidney function &
promotes fluid retention
• Salt sensitivity
– 30-50% of cases
• Alcohol
• Diet
– Fruits, vegetables, nuts,
low-fat milk can lower BP
– Potassium, calcium, &
magnesium can lower BP
Treatment of Hypertension
• Weight reduction
• Low-sodium diet
• Diet rich in potassium,
calcium, & magnesium
• Regular physical activity
• Moderate alcohol
• DASH Diet - Limits:
– Red meats
– Sweets
– Sugar-containing
beverages
– Saturated fat to <7%
– Cholesterol to 150 mg/day
• Drug therapy
Diet Therapy
Hypertension may be often due to obesity
dietary changes which result in weight loss will
lead to reduction in blood pressure.
 The second possibility is excessive sodium
intake, which draws more water into circulation,
thus increasing blood volume, leading to
increased blood pressure.
In patients, whose only problem is mild hypertension, diet therapy
without use of drugs is used to achieve control. This includes:
(a)Moderate sodium restriction ( 1000-1500 mg/day): No salt in
cooking or at the table.
(b) Adequate potassium intake: Plant foods are rich sources of
potassium, especially fruits and vegetables.
(c) Regular exercise tailored to the individual is a must – walking 5
kilometres daily has been found to be an ideal way to keep fit.
(d) Stress management: is a very important aspect of therapy. It
involves regular planning of one’s activities allowing realistic
scheduling of work, relaxation, physical activity, mealtimes.
Sources of Sodium in the Diet
Most plant foods are low in sodium.
Animal foods – meat, fish and poultry are
naturally high in sodium.
• Eggs are especially high in sodium (most of
sodium is in the egg white).
Food Preparation for Sodium Restricted Diet
It takes about 3 months to get used to a sodium
restricted diet. By that time the taste preference for
salt decreases.
Use of spices, herbs, flavor extracts helps to
improve acceptance of salt less recipe. These
include lemon juice, pepper, green pepper, onion,
garlic etc., which may be used in vegetables, stews
and salads.
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Summary of American Heart Association Dietary
Guidelines
To Achieve An Overall Healthy Eating Pattern
Choose an overall balanced diet with foods from all major food
groups, emphasizing fruits, vegetables and grains.
Consume a variety of fruits, vegetables and grain products.
•At least 5 daily servings of fruits and vegetables.
•At least 6 daily servings of grain products, including whole grains.
Include fat-free and low-fat dairy products, fish, legumes, poultry
and lean meats.
•Eat at least two servings of fish per week.
To Achieve A Healthy Body Weight
Avoid excess intake of calories.
Maintain a level of physical activity that achieves
fitness and balances energy expenditure with
caloric intake; for weight reduction, expenditure
should exceed intake.
Limit foods that are high in calories and/or low in
nutritional quality, including those with a high
amount of added sugar.
To Achieve A Desirable Cholesterol Level
 Limit foods with a high content of saturated fat and cholesterol.
Substitute with grains and unsaturated fat from vegetables, fish,
legumes and nuts.
 Limit cholesterol to 300 milligrams (mg) a day for the general
population, and 200 mg a day for those with heart disease or its
risk factors.
 Limit trans fatty acids. Trans fatty acids are found in foods
containing partially hydrogenated vegetable oils such as
packaged cookies, crackers and other baked goods;
commercially prepared fried foods and some margarines
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Sodium vs. Potassium
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Potassium
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