1. NS 210: Seminar 8 Nutritional Assessment in Disease Prevention Leslie Young MS RD LDN

2. Overview The prominent role of diet and nutritional status ins several leading causes of death for North Americans give nutritional assessment an important role to play in disease prevention Risk factors of Coronary Heart Disease –Leading cause of death for North Americans –Are related to diet –Elevated serum total and LDL cholesterol –Hypertension –Diabetes

3. Coronary Heart Disease Coronary Heart Disease (CHD) –Leading cause of death in the US despite >26% decline in CHD death rates since 1988 –Associated with several risk factors Elevated blood cholesterol High blood pressure Cigarette smoking

4. Coronary Heart Disease (CHD) Risk Factors Risk factors for CHD –Positive risk factors Cigarette smoking Hypertension (blood pressure >140/90) Low HDL cholesterol <40 –Goals »Women >55 »Men > 45 Family history of premature CHD Age (men >45 yo, women >55 yo) –Negative Risk Factors HDL Cholesterol >60

5. Heart Attack Warning Signs Heart attack warning signs –Chest discomfort –Discomfort in other areas of the upper body Arm, back, neck, jaw –Shortens of breath –Other signs Cold sweat, nausea, lightheadedness

6. CHD Risk – Elevated Cholesterol CHD risk is directly related to serum levels of total cholesterol and LDL cholesterol CHD risk is inversely related to levels of high HDL cholesterol National Cholesterol Education Program (NCEP) desirable levels of total cholesterol in adults –<200mg/dL

7. Atherosclerosis

8. How is CHD Diagnosed? Dr. will diagnosis CHD based on: –Your medical and family history –Risk factors –Results of a physical exam and diagnostic test procedures EKG (Electrocardiogram) Stress Testing Echocardiography Chest X-Ray Blood tests Electron-Beam Computed Technology Coronary Angiography and Cardiac Catheterization

9. How is CHD Treated? Lifestyle Changes –Reduce high blood pressure –Reduce high cholesterol Follow a Heart Healthy Eating Plan Therapeutic Lifestyle Changes DASH Diet Increased Physical Activity Maintain a Healthy Weight Smoking Cessation Stress Reduction Medications Cardiac Rehab

10. Addressing High Cholesterol Two ways of addressing high cholesterol levels –Population based approach –Patient based approach Population based approach –Emphasizes dietary and lifestyle changes for people to lower cholesterol levels in the entire population Patient based approach –Identification and treatment of individuals with elevated cholesterol levels by physicians

11. Dietary Factors and Cholesterol Factors that can influence cholesterol and lipoprotein levels –Saturated fats Raise LDL cholesterol –Unsaturated Fats Polyunsaturated Fats –Lower LDL and HDL Monounsaturated Fats –Lower LDL –Maintain HDL cholesterol

12. CHD and Hypertension Hypertension is one of the most common risk factors for cardiovascular disease and renal disease –1 in 4 Americans has hypertension or is taking antihypertensive medications –Systolic >120mm HG and diastolic >80mmg HG increases risk for cardiovascular disease Most important risk factors for hypertension –Sodium intake –Excessive energy consumption –Physical inactivity –ETOH consumption –Inadequate potassium intake

13. Nutrition Assessment in Disease Prevention: Osteoporosis Osteoporosis –Bone mineral content is decrease –Resulting in great susceptibility to fracture –Common fracture sites - pelvis vertebrae, hip, distal forearm, humorous Peak bone mass –Varies considerably among individuals because of Heredity Sex Race Environmental factors

14. Nutritional Assessment in Disease Prevention Osteoporosis –Cost In 2005 –Osteoporosis-related fractures were responsible for an estimated $19 billion in costs By 2025 –Experts predict that these costs will rise to approximately $25.3 billion http://www.nof.org/osteoporosis/diseasefacts.htm#gender

15. Prevention http://www.girlshealth.gov/bones/

16. Bone Densitometry Bone densitometry –The measurement of bone mineral content –Important in early detection and treatment of osteoporosis and monitoring progression and response to treatment –Dual-energy X-Ray Absorptiometry (DXA) is the most widely used technology for determining bone mineral density Quantitative Ultrasongoraphy (QUS) –Identify those persons likely to benefit from DXA testing

17. Questions