1. Student presentations results Final exam 15 questions-short answer-point form covering whole term 5 Q on diabetes and atherosclerosis 10 Q on blood pressure, stroke, and kidney disease-10 points each- 3 hours- no choice on questions PLEASE SEE EXAM REGULATIONS ON: faculty.cbu.ca/ebarre

2. The Lecture 11- 20 November 2012 Stroke

3. Outline of todays talk I.Pathology II.Socioeconomic factors contributing to stroke III. Elementary nutritional approaches to be taken to avoid and treat these diseases including foods available to those at risk IV.First Nations and other Cape Breton individuals at risk V.How is nutritional assessment made for blood stroke? VI. How would one assess from a nutritional perspective the socioeconomics, pathology and success of nutritional interventions relative to stroke?

4. Stroke I.Pathology three types of stroke hemorrhagic thrombotic embolic all are cerebrovascular accidents

5. Stroke I.Pathology three types of stroke-defined hemorrhagic-blood vessel rupture thrombotic-rupture of plaque and platelets aggregate embolic-thrombus breaks off and moves down stream

6. Stroke I.Pathology What are the risk factors? hypertension and all contributing factors to hypertension-explain atherosclerosis and all contributing factors to atherosclerosis-explain

7. Stroke I.Pathology What are the risk factors? Diabetes types I and II and all contributing factors to types I and II diabetes-explain End stage renal disease and all contributing factors to end stage renal disease-explain

8. Stroke I.Pathology What are the risk factors? Old age-how would this contribute to the pathology? Smoking- how would this contribute to the pathology?

9. Socioeconomic factors Food and hence nutritional choices depend on: Personal preference-protective factors(preventative)-absence is a risk factor consumption of fresh fruit flavonoid consumption of greater than 4.7 cups green tea per day fish consumption in white and black women and black men

10. Socioeconomic factors Food and hence nutritional choices depend on: Habit fattening foods bring on obesity which increases blood pressure which results in increased risk of all 3 types of types of stroke

11. Food and hence nutritional choices depend on: Ethnic heritage or tradition fish consumers-Japanese, Inuit omega 3s EPA- effects of EPA vitamin E consumption- sources of vitamin E-who might consume these- vegetable oils, nuts, seeds Social interaction relate social interaction to ethnic heritage or tradition

12. Food and hence nutritional choices depend on: Availability of food availability of omega 3s and vitamin E- who would have access to the omega 3s and vitamin E Convenience of food some convenience foods do not have omega 3s and vitamin E- list some of these foods

13. Food and hence nutritional choices depend on: Economy of food consumption of fresh fruit flavonoid consumption of greater than 4.7 cups green tea per day fish consumption in white and black women and black men

14. Food and hence nutritional choices depend on: Positive and negative associations consumption of fresh fruit flavonoid consumption of greater than 4.7 cups green tea per day fish consumption in white and black women and black men vitamin E

15. Food and hence nutritional choices depend on: Emotional conflict may induce eating blood pressure elevated-what is the relation of hypertension to food and hence nutritional choices?

16. Food and hence nutritional choices depend on: Values-how does this apply to: consumption of fresh fruit flavonoid consumption of greater than 4.7 cups green tea per day fish consumption in white and black women and black men vitamin E

17. Food and hence nutritional choices depend on: Body image relationship to food and hence nutritional choices- if one is too thin this will not lead to stroke- if one accepts a BMI of greater than 27 and the dietary habits that support such a BMI then one is at greater risk of stroke

18. Food and hence nutritional choices depend on: Advertising-who is responsible for encouraging or not encouraging consumption of fresh fruit flavonoid consumption of greater than 4.7 cups green tea per day fish consumption in white and black women and black men vitamin E

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21. More on socioeconomic factors Prestige -occupational- lower the occupation the greater the risk of stroke-why? low occupational fathers tend to have low or lower occupational kids could be a number of generations before population stroke risk is reduced

22. More on socioeconomic factors Prestige -occupational- higher the occupation the less the risk of stroke-why? high occupational fathers tend to have high or higher occupational kids could be a number of generations before population stroke risk is increased among descendants of initial high occupational fathers

23. More on socioeconomic factors Prestige -societal perceptions-dictate ability of people to change their social rankings -education-eg university professors and astronauts have a lot of sophisticated education and they are rated highly-however this is no guarantee that there is no risk of stroke

24. More on socioeconomic factors Power-based on societal perceptions to some extent Income-also based on societal perceptions of the importance of the job to society

25. More on socioeconomic factors Wealth-based on education-lower classes tend to be less well educated and therefore less able to take advantage of the societal perceptions that improve one’s socioeconomic status including wealth Education- lower classes tend to be less well educated and therefore less able to take advantage of the societal perceptions that improve one’s socioeconomic status including the benefits arising from that education

26. More on socioeconomic factors Social stratification -ancestry-socioeconomic childhood -gender-fish consumption in white and black women and black men -race- fish consumption in white and black women and black men -ethnicity-those consuming omega 3s and vitamin E

27. More on socioeconomic factors Social stratification -mobility-effect on depression and food choices -mental and physical activity- mental patients-may be marginalised by society-what impact does this have on the risk of stroke? physical activity

28. More on socioeconomic factors Social stratification physical activity-stroke risk lowered by chronic aerobic activity-caution with elevated blood pressure- blood pressure increases during aerobic exercise - benefit with exercise comes after blood pressure is lowered in rest and during exercise- this is a training effect

29. More on socioeconomic factors Class -uppers -lower uppers -upper middles -average middles -working class -lower class How might each of these classes have an impact risk or presence of stroke?

30. More on socioeconomic factors Global economy-globalisation- impact on: consumption of fresh fruit flavonoid consumption of greater than 4.7 cups green tea per day fish consumption in white and black women and black men Government-nutrition policies affect risk of stroke-how?

31. More on socioeconomic factors Business-promotion of globalisation-why would business promote globalisation? Psychology-susceptibility to business tactics such as?- impact on the risk of stroke? History-one’s habits and childhood socioeconomic status

32. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Planning a healthy diet To do this bear in mind Adequacy Balance Energy control Nutrient density Moderation Variety

33. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Prevention-eat foods in accordance with low salt (if salt-sensitive) and eat in accordance with keeping blood plasma lipids and lipoproteins to target levels specified to prevent atherosclerosis, hypertension, type II diabetes and end stage renal disease

34. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk? Prevention increase fruits and vegetables and low fat foods(DASH diet)-contain antioxidants and other blood pressure lowering chemicals DASH-Dietary approaches to stop hypertension

35. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Post-onset-eat foods in accordance with low salt (if salt-sensitive) and eat in accordance with keeping blood plasma lipids and lipoproteins to target levels specified to prevent atherosclerosis, hypertension, type II diabetes and end stage renal disease -- antioxidant vitamins and minerals

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37. IV. First nations and other Cape Breton individuals at risk. Aboriginals Retired Unemployed Genetics Others?

38. How is nutritional assessment made for stroke-prevention and cure? Nutrient intake analysis salt intake dietary lipids -saturated fat -trans-fatty acids -cholesterol -other dietary components adjusted in accordance with recommendations made in lectures on atherosclerosis, types I and II diabetes and blood pressure

39. How is nutritional assessment made for stroke- prevention and cure? Daily food record/Diary what are potential problems with this approach regarding stroke?

40. How is nutritional assessment made for stroke-prevention and cure? Retrospective data -24 hour recall -food frequency questionnaire both 24 hour recall and are used to cross check one another-how would this apply to stroke

41. How is nutritional assessment made for hypertension--prevention and cure? Anthropometry-focus on overweight and obesity skin folds underwater weighing bioimpedance waist circumference BMI

42. How is nutritional assessment made for hypertension--prevention and cure? Nutrition focussed physical exam: body weight and height direct blood pressure determination anthropometric measures waist circumference BMI

43. How is nutritional assessment made for stroke-prevention and cure? Skin testing-not applicable

44. How is nutritional assessment made for stroke-prevention and cure? Biochemical analysis blood lipids-which raise bp and promote risk of aneurysm/thrombosis/embolism blood lipoproteins-which raise bp and promote risk of aneurysm/thrombosis/embolism

45. How is nutritional assessment made for stroke--prevention and cure? Biochemical analysis blood sodium-raises bp and promotes risk of aneurysm/thrombosis/embolism blood potassium-lowers bp and reduces risk of aneurysm/thrombosis/embolism

46. How is nutritional assessment made for stroke--prevention and cure? Biochemical analysis blood calcium-lowers bp and risk of aneurysm/thrombosis/embolism blood magnesium-lowers bp and risk of aneurysm/thrombosis/embolism

47. How is nutritional assessment made for stroke--prevention and cure? CLASSIFYING MALNUTRITION obesity is the main issue here thin individuals are much less at risk than obese persons

48. VI. GROUP DISCUSSION-HOW WOULD ONE ASSESS FROM NUTRITIONAL PERSPECTIVE THE SOCIOECONOMICS, PATHOLOGY AND SUCCESS OF NUTRITIONAL INTERVENTIONS RELATIVE TO STROKE ?