Cardiovascular System KNH 411

Hypertension Nutrition Therapy DASH – Dietary Approaches to Stop Hypertension Decrease sodium, saturated fat, alcohol Increase calcium, potassium, fiber Lifestyle modifications Weight loss 3 Main Categories: 1. Hypertension 2. Atherosclerosis 3. Ischemic heart/CAD Alcohol: 1 or less per day for women 2 or less per day for men Increased consumption of dairy products (calcium, potassium), increased consumption of fruits and vegetables/whole grains (fiber) Lifestyle modifications – exercise, etc. Weight Loss – weight reduction plan

Decrease in BMI and decrease in diastolic BP = direct correlation to BP

Hypertension Nutrition Therapy Sodium restriction controversial “salt sensitive” or “salt resistance” Limit processed & cured foods, no added salt during preparation and cooking Limit to 2400 mg/day African Americans, older adults, and people with diabetes best respond to a low-sodium diet (small component)

Hypertension Nutrition Therapy DASH-Dietary Approaches to Stopping Hypertension Decrease Sodium, saturated fat, alcohol Increase calcium, potassium, fiber Lifestyle Changes

Use as a marker; serial measurements (numerous BMI measurements, numerous dietary recalls)

To lower TG: 1. Exercise/weight reduction 2. Reduction of saturated fat intake 3. Reduction of alcohol consumption

Atherosclerosis Etiology - risk factors cont. Physical inactivity Atherogenic diet Diabetes mellitus Impaired fasting glucose/ metabolic syndrome Cigarette smoke TLC plan (Therapeutic Lifestyle Change) #1 concern when talking about CAD and stroke Individual usually physically inactive  with exercise, increase to decrease platelet aggregation, increase HDL levels High in fat, low in fiber is the “athero” diet Diabetics have metabolic syndrome (impaired fasting glucose) making them more susceptible to CAD

*****Important Abdominal Obesity (anthropometrics) TG level HDL levels Blood pressure Fasting Glucose (70 – 110 is normal); but for these individuals, greater than 100 creates risk © 2007 Thomson - Wadsworth

**Step 3 – lifestyle components

**Step 6 is how we will take action (treating each of these components through diet) © 2007 Thomson - Wadsworth

Atherosclerosis Nutrition Therapy Therapeutic Lifestyle Changes (TLC) developed as component of ATP-III Modifications in fat, cholesterol Rich in fruits, vegetables, grains, fiber Limit sodium to 2400 mg Include stanol esters Similar to DASH, but more advanced

© 2007 Thomson - Wadsworth

Atherosclerosis Nutrition Therapy - Fat Modifications Total fat 25-35% of calories Very-low-fat diets Saturated fat < 7% of calories Avoid trans fats Increase intake of monounsaturated fats & Polyunsaturated omega-6 fatty acids Increase intake of omega-3 essential fatty acids Limit dietary cholesterol < 200 mg daily Safflower oil (omega-6) Coldwater fish are high in omega-3 fatty acids (3x a week) <200 mg of cholesterol is key component to lowering LDL levels

Atherosclerosis Nutrition Therapy - Other Increase sources of soluble fiber Increase intake of plant sterols Weight loss – BMI 18.5-24.9 Regular physical activity Soluble fiber – ridding ourselves of cholesterol and free radicals as well Absorption is beneficial For CVD Insoluble fiber helps strengthen GI tract (diverticulosis and other diseases) Benicol (plant sterols) – added to food after produced Calculate BMI in kg/m2 for client Regular physical activity depends on RD, physical therapist and client… what can they do

Atherosclerosis Nutrition Therapy Prescription Assessment of dietary fat intake, saturated fat intake MEDFICTS assessment tool Dietary CAGE questions REAP Target weight calculated Prioritize nutrition problems Multiple planned visits with R.D. MEDFICTS – food frequency chart (document on Niihka) Exchange of evaluating diet for cholesterol control Cardiac Rehab – this would be important for determining risk CAGE plan – simple, quick assessment of what client is eating Rapid Eating Assessment Plan – REAP (rapidly assessing where client is going/how often consumption) Where they fall on risk scale

Simple guidelines

Ischemic Heart Disease Nutrition Therapy Post MI Decrease oral intake Clear liquids, no caffeine Progress to soft, more frequent meals Individualized – use TLC recommendations Heart damage – stroke, blockage, etc. Probably most common in long term smokers and diabetics Blood flow that has been interrupted (can come in form of atherosclerosis or perforation of lining of the arteries); progressive or long term ischemic heart disease can lead to artificial heart/heart transplant

Heart Failure Nutrition Therapy Intervention Control signs and symptoms Promote overall nutritional status rehabilitation Sodium and fluid restriction 2000 mg Na Fluid 1 mL/kcal or 35 mL/kg Correction of deficiencies Increase nutrient density Enhance oral intake ICU patients Getting enough calories to sustain life until able to get transplant is main concern Hard time breathing, eating, etc. Monitor weight, calorie intake, fluid status Heart failure – watch fluids (fluid/sodium restriction, diuretic drugs to pull off fluid) 2,000 calorie diet = 2,000 cc fluid 1 cup = 250 cc Monitor watermelon/fruits with excess fluids (iceberg lettuce 80% water) Multiple small feedings, high calorie/high protein

Heart Failure Nutrition Therapy Assess drug-nutrient interactions Losses of water-soluble vitamins Supplementation may be warranted Consider arginine, carnitine and taurine in dietary regimen Argining, carnitine, taurine aid in tissue repair and are needed in increased levels during stress