1. Cardiovascular System
KNH 411

2. 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

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

4. 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)

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

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

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

10. 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

11. *****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

12. **Step 3 – lifestyle components

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

15. 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

16. © 2007 Thomson - Wadsworth

17. 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

19. Atherosclerosis Nutrition Therapy - Other
Increase sources of soluble fiber
Increase intake of plant sterols
Weight loss – BMI
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

20. 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

21. Simple guidelines

22. 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

23. 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

25. 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