Transcript Fat-Controlled, Mineral-Modified Diets for Cardiovascular Diseases Chapter 22 Nutrition & Diet Therapy (7th Edition)

Fat-Controlled, Mineral-Modified
Diets for Cardiovascular
Diseases
Chapter 22
Nutrition & Diet Therapy (7th Edition)
Cardiovascular Disease
• General term describing diseases of
the heart & blood vessels
• Global issue
– Accounts for approximately 37% of
deaths in U.S. & 29% worldwide
– Leading cause of death in Europe
– More women die from CVD than men
every year
Nutrition & Diet Therapy (7th Edition)
Nutrition & Diet Therapy (7th Edition)
I. Atherosclerosis
• Accumulation of fatty
deposits, smooth muscle
cells & fibrous connective
tissue—forming plaque, on
the inner walls of the
arteries
• Leads to progressive
thickening of arterial walls
• Eventually narrows lumen
of artery, interfering with
blood flow
• Affects almost any organ
or tissue in the body—
resulting in many
consequences
Nutrition & Diet Therapy (7th Edition)
Atherosclerosis
• Consequences
– Thrombosis: formation of blood clot within the artery;
enlarges over time, causing obstruction in blood flow
– Embolus: a portion of blood clot that breaks free &
travels through circulatory system; eventually lodges in
smaller vessel & interrupts blood flow, causing sudden
tissue death
– Ischemia: lack of blood supply within tissues, due to
obstruction of blood flow through arteries; major
complication caused by atherosclerosis
– Aneurysm: abnormal enlargement or bulging of blood
vessel wall; vessel weakens & is prone to rupture,
causing massive bleeding & death
Nutrition & Diet Therapy (7th Edition)
Atherosclerosis
• Causes
– Begins to develop as early as childhood &
adolescence; progresses before onset of
symptoms
– Inflammation & infection
– Hypertension
– Smoking
– Elevated LDL & VLDL
– Diabetes mellitus
– Aging
Nutrition & Diet Therapy (7th Edition)
II. Coronary Heart Disease
• Most common type of cardiovascular disease;
leading cause of death in U.S.
• Usually caused by atherosclerosis in large &
medium-sized arteries that supply heart muscle
with oxygen & nutrients
• Evaluating risk
– Prevention usually begins by reducing risk
– Classic risk factors
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Smoking
High LDL cholesterol
High blood pressure
Diabetes
– CHD risk assessment-lipid profile at 20 yrs & every 5 yrs
Nutrition & Diet Therapy (7th Edition)
Nutrition & Diet Therapy (7th Edition)
Nutrition & Diet Therapy (7th Edition)
Coronary Heart Disease
• Therapeutic Lifestyle Changes (TLC) for lowering
CHD risk (p. 607-611)
– Approach to risk reduction promoted by National
Cholesterol Education Program
• Cholesterol-lowering diet
• Weight reduction
• Regular physical activity
– Substantial progress may be seen after 6 weeks if
followed carefully
– Individuals with high risk of CHD should try to lower LDL
cholesterol with at least 3-month trial of TLC before
starting drug therapy
– When high LDL levels persist despite adherence to a TLC
program, drug therapy may be only effective treatment
Nutrition & Diet Therapy (7th Edition)
Coronary Heart Disease
• Dietary strategies
• Lifestyle choices
– Increase physical activity to
– Reduce saturated fat in
at least 30 minutes of
diet; control overall fat &
moderate intensity most
cholesterol
days of week (4/7d.)
– Increase carbohydrates
– Smoking cessation; limit
from whole grains,
exposure to any form of
legumes, fruits &
tobacco
vegetables
– Avoid foods with trans fatty • Weight reduction
acids
– May improve other risk
factors
– Select foods high in soluble
fiber
– General goal: prevent weight
gain, reduce body weight &
– Limit sodium intake to 2400
maintain lower body weight
mg per day
– Initial goal: lose no more
– Consume fish & omega-3
than 10% of original body
fatty acids on regular basis
weight
– Use alcohol in moderation
Nutrition & Diet Therapy (7th Edition)
Coronary Heart Disease
• Lifestyle changes for hypertriglyceridemia
– Elevated blood triglycerides
– Common in people with diabetes mellitus &
metabolic syndrome
– Can result in serious complications (fatty
deposits in liver & pancreatitis)
– Diet & lifestyle may contribute to mild
hypertriglyceridemia
– Genetic factors are usually responsible for severe
cases (“high” & “very high” levels)
Blood Triglycerides
Borderline high: 150-199 mg/dL
High: ≥200 mg/dL
Nutrition & Diet Therapy (7th Edition)
Coronary Heart Disease
Mild hypertriglyceridemia
– Dietary & lifestyle changes
can improve
– Contributing factors
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Overweight & obesity
Sedentary lifestyle
Cigarette smoking
Dietary factors (high intake of
alcohol & carbohydrate,
sucrose & fructose)
– Basic treatment
•
•
•
•
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Controlling body weight
Being physically active
Quitting smoking
Restricting alcohol
Avoiding high carbohydrate
intake
Nutrition & Diet Therapy (7th Edition)
Severe hypertriglyceridemia
– Medications usually
necessary
– Weight reduction &
physical activity
emphasized
– Very-low-fat diet (<15%
of kcalories from fat) in
extreme cases
Coronary Heart Disease
• Vitamin supplementation & CHD risk-studies are
inconclusive and therefore supplementation is not recommended at this
time
– B vitamin supplements & homocysteine
• Homocysteine is known risk factor for CHD—direct
causative relationship unknown
• Increased intakes of folate, vitamins B6 & B12 lower
homocysteine levels; direct effect of these vitamins on
reducing risk is not demonstrated in research studies
– Antioxidant vitamin supplements
• Some studies suggest relationship of antioxidant-rich diets
(like Vit. C and E) may protect against CHD; other suggest
possible harm
• Study results still inconclusive
Nutrition & Diet Therapy (7th Edition)
Coronary Heart Disease
• Drug therapies for CHD prevention
– Dietary & lifestyle changes may not be
fully effective in reducing LDL goals
– LDL-lowering drugs
• Statins: reduce cholesterol synthesis in liver
• Bile acid sequestrants: reduce cholesterol &
bile absorption in small intestine
• Niacin (nicotinic acid): reduces blood
triglycerides & increases HDL levels (when
taken in high amounts)
– Anticoagulants & aspirin
Nutrition & Diet Therapy (7th Edition)
Coronary Heart Disease
• Treatment for heart attack (MI)
– May result from blockage of one or more coronary arteries,
cutting off blood supply to heart muscle
– Medications
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Thrombolytic drugs: immediately after heart attack breaks clots
Anticoagulants, aspirin
Pain medications
Medications to regulate heart rhythm & reduce blood pressure
– Dietary management
• Low-sodium diet
• Low saturated fat & cholesterol
– Cardiac rehabilitation programs
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Exercise therapy
Smoking cessation
Stress management
Dietary instruction
Medication counseling
Nutrition & Diet Therapy (7th Edition)
III. Hypertension
• Affects almost 1/3 of adults in U.S.
– Especially prevalent among African Americans
– Estimated 37% of people with hypertension are unaware
of problem
• Primary risk factor for atherosclerosis & cardiovascular
diseases—increases risk for…
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–
–
–
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Cardiac arrhythmias (abnl muscle contractions…)
Congestive heart failure
Stroke
Kidney failure
Sudden death
• Reducing blood pressure can dramatically reduce
incidence of these diseases
Nutrition & Diet Therapy (7th Edition)
Blood Pressure
Measurement
Systolic BP:
• measurement of
pressure in arteries
during contraction of
heart muscle
Diastolic BP:
• measurement of
pressure in arteries
during resting or
relaxation of heart
muscle
Nutrition & Diet Therapy (7th Edition)
• Desirable BP
– Systolic <120 mmHg
– Diastolic <80 mmHg
• Prehypertension
– Systolic 120-139 mmHg
– Diastolic 80-89 mmHg
• Hypertension
– Systolic ≥140 mmHg
– Diastolic ≥90 mmHg
Hypertension
• Contributing factors
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–
–
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–
–
Aging
Genetics
Obesity (60% obese)
Salt sensitivity (30-50%)
Alcohol
Diet
DASH Eating
Plan-p. 616-618
“Dietary
Approaches to
Stop
Hypertension”
Nutrition & Diet Therapy (7th Edition)
• Treatment
– Lifestyle
modifications
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•
•
•
•
Weight reduction
DASH eating plan
Sodium restriction
Physical activity
Moderate alcohol
consumption
– Drug therapies
Nutrition & Diet Therapy (7th Edition)
IV. Congestive Heart Failure
• Consequences of CHF
• Characterized by
inability of heart to
pump adequate blood
– Results in buildup of
fluid in veins & tissues
– Can develop after
illness that impairs
heart’s ability to fill with
or eject blood
– Heart cannot cope with
usual workload
– Develops primarily in
elderly individuals
Nutrition & Diet Therapy (7th Edition)
– Fluid accumulation in liver,
abdomen & lower
extremities
– Fluid buildup in lungs,
causing shortness of
breath & limited tolerance
for activity
– Impaired function to other
organs, such as liver &
kidneys
– Reduced food intake
Cardiac Cachexia
Malnutrition caused by changes in
body chemistry & reduced appetite &
food intake; severe weight loss &
tissue wasting
Congestive Heart Failure
• Medical management
– Goals of treatment: to enhance the patient’s quality of
life & slow disease progression
– Treatment depends on nature & severity of illness
– Drug therapy
• Manage congestion & improve heart function
• Diuretics to reverse or prevent fluid retention
– Nutrition therapy
• Moderate sodium intake to 2000-3000 mg/day
• Severe cases of CHF may need stricter sodium restriction:
to 2000 mg/day or less
• Fluid restriction may be necessary
• Small, frequent meals or enteral supplements may be
better tolerated if eating difficulties exist
• Avoid alcohol
Nutrition & Diet Therapy (7th Edition)
V. Stroke (CVA)
• Third leading cause of death in U.S. (after heart
disease & cancer)
• Most strokes are consequence of atherosclerosis
or hypertension, or both
• Ischemic strokes (majority of incidence—about
88%) result from obstruction of blood flow to
brain tissue
• Hemorrhagic stroke results from bleeding in brain
tissue & resultant tissue damage
• Transient ischemic attacks (TIA): brief “strokes”
(lasting 2-30 minutes)
– Warning sign that more severe stroke may follow
– Usually treated with aspirin & other drugs that inhibit
blood clotting
Nutrition & Diet Therapy (7th Edition)
Stroke
• Stroke prevention
– Risk factors are similar to
CHD
– Lifestyle changes to reduce
risk
– Drug therapy
• Aspirin
• Antiplatelet drugs
• Anticoagulants
• Stroke management
– Specific symptoms depend
on area of brain affected
– Early diagnosis & treatment
necessary to preserve brain
tissue & minimize long-term
disability
– Early administration of
thrombolytic drugs
Nutrition & Diet Therapy (7th Edition)
• Nutritional goals
– Maintain nutrition status &
overall health, despite
disabilities
– Management of food
intake, depending on level
of disability & associated
problems with food intake
– Tube feedings may be
necessary until disabilities
are resolved & patient
regains eating/swallowing
& communication skills
Nutrition in Practice—
Metabolic Syndrome
• Metabolic syndrome
– Group of disorders that substantially increases
risk of development of cardiovascular disease
– Cluster of at least 3 of the following:
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•
•
•
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Hyperglycemia
Obesity
Elevated blood triglycerides
Reduced HDL cholesterol levels
Hypertension
– Causes
• Precise cause unknown
• Close relationship between abdominal obesity &
insulin resistance may be partly responsible
Nutrition & Diet Therapy (7th Edition)
Nutrition & Diet Therapy (7th Edition)
Nutrition in Practice—
Metabolic Syndrome
• Treatment
– Primarily treated with diet & lifestyle changes—goal is to
correct abnormalities that increase CVD risk
– Combination of weight loss & physical activity can
improve insulin resistance, blood pressure & blood lipid
levels
– Additional strategies depend on specific symptoms
– Dietary strategies
• Reduce intake of added sugars & refined grains
• Increase servings of whole grains & foods high in fiber
• Carbohydrate restriction may help reduce triglyceride levels
& improve hyperglycemia
• Low saturated fats, trans fats & cholesterol can help reduce
LDL levels
Nutrition & Diet Therapy (7th Edition)