1. Cardiovascular System
KNH 411
Things to focus on: hypertension; DASH, arthrosclerosis (TLC), mm

2. Hypertension Nutrition Therapy
DASH – Dietary Approaches to Stop Hypertension
Decrease sodium, saturated fat, alcohol
Increase calcium, potassium, fiber
Lifestyle modifications
Weight loss
Low fat dairy products
Lifestyle: smoking and exercise
Weight loss: #1; once weight comes down BP comes down

3. Direct correlation between decrease in diastolic BP and weight reduction

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
The people who respond the best to lowering their salt are African Americans, senior citizens

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

8. Key numbers you want to remember for BMI
Serial measurements; use as one of your markers

9. Always have reference value to compare where they are and where they need to be
Lowering triglycerides: lower alcohol intake, weight reduction and saturated fat

10. Atherosclerosis Etiology - risk factors cont. Physical inactivity
Atherogenic diet
Diabetes mellitus
Impaired fasting glucose/ metabolic syndrome
Cigarette smoke
Think of TLC plan (Therapeutic lifestyle changes)
Usually physically inactive; with activity HDL will rise, LDL will go down’ lower BP, lower triglycerides
Atherogenic diet is the western diet; high in fat and low in fiber; 2:3 times more likely to have cardiovascular disease

11. ***
© 2007 Thomson - Wadsworth

12. Step 3* Different lifestyle components
smoking, age group, family history

13. Work on weight manaagement and inactivity
© 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 plan 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
Polyunsaturted: corn, sunflower seeds
Omega 3: fish
Limit dietart choelsterol: lowers LDL

18. Fiber that are soluble: legumes, oats; getting rid of the cholesterol; lowering the cholesterol
Fiber that is insoluble: can not get rid of cholesterol

19. Atherosclerosis Nutrition Therapy - Other
Increase sources of soluble fiber
Increase intake of plant sterols
Weight loss – BMI
Regular physical activity
Benecal, Take control (functional foods, added into the product after it has been produced)
BMI is in kilos per meter squared
Regular physical activity: what level can they obtain with their weight reduction plan and accessibility

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 evaluating your diet for cholesterol control; comes out with score with the highest risk and exc.; categorizing to see which client is at the highest risk
CAGE: simple quick assessment of what they are eating; Cheese, Animal Fats, Got it away from home; Eat (extra) high-fat commercial products; scale back on what they are doing
REAP: rapid eating assessment plan; looking at the different food stuff they are taking in and then assessing how much they are are having and what types
Depends on the client to see how in depth or how much they want to learn/ know

22. Ischemic Heart Disease
Nutrition Therapy
Post MI
Decrease oral intake medication
Clear liquids, no caffeine (don’t want to alter heart function)
Progress to soft, more frequent meals
Individualized – use TLC recommendations
Could be because of blockage or stroke; rebuild their strength; could have issue with swallowing or being active
Long term smokers or diabetics are the usual clients

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
Not talking about look at sodium, potassium; instead talking about calories to sustain nutrients until they get a transplant
Waiting for heart, monitor weight and calorie and fluid status
Fluid balance is a concern so put on a sodium restriction to pull off the fluid; watch watermelon, lettuce different foods are filled with water
Don’t just give coffee or water, give a nutrient or caloric dense drink

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
Recommend supplements
Milkshakes, instant breakfast