Diet Related Diseases and CVD

Diet Related Diseases

• Medical Nutrition Therapy is a crucial aspect of managing diet-related diseases.

Diet and CVD

• Cardiovascular Disease (CVD) affects the heart and blood vessels.
• Myocardial infarction (MI), or heart attack, is caused by artery blockage.
• Atherosclerosis is a condition where arteries harden, restricting blood flow.
• Cholesterol, fats, and other substances accumulate in the arteries, forming plaque, which reduces the lumen size.
• Reduced blood flow restricts nutrient and oxygen supply, causing ischemia in surrounding tissues.
• Thrombus is a blood clot that forms within narrow arteries.

Risk Factors for Atherosclerosis

• Major Risk:
  • Hyperlipidemia: Elevated serum cholesterol levels.
    • Saturated fats increase cholesterol.
    • Monounsaturated fats reduce cholesterol.
    • LDL (low-density lipoprotein) carries cholesterol to cells (high levels contribute to atherosclerosis).
    • HDL (high-density lipoprotein) carries cholesterol from tissues to the liver (low levels contribute to atherosclerosis).
  • Hypertension: High blood pressure.
• Other Risks: Obesity, diabetes, male gender, heredity, personality (stress response), age, sedentary lifestyle.

MNT for Hyperlipidemia

• Reduce the quantity and types of fat and total calories in the diet.
• Weight loss reduces serum cholesterol levels.
• Serum Cholesterol Levels:
  • <200 mg/dL: Desirable level
  • 200–239 mg/dL: Borderline high
  • ≥240 mg/dL: High
• Recommended Dietary Intake:
  • <200 mg dietary cholesterol/day
  • No more than 30% of calories from fat (7% saturated, 8% polyunsaturated, 15% monounsaturated)
  • 50-55% of calories from carbohydrates
  • 12-20% of calories from protein

Low-fat Diet (Dietary Changes)

• Gradual lifestyle changes are essential for adhering to a low-fat diet.
• Patient education is crucial to understand fat content in food and methods for low-fat cooking.
• Limit foods high in cholesterol (animal products, organ meats).
• Limit saturated fats (animal products, coconut oil, palm oil).
• Increase water-soluble fiber (oats, legumes, fruits).
• 25-35% soluble fiber intake daily can reduce serum cholesterol by 15%.
• Consider supplemental fat-soluble vitamins if limiting caloric intake to 1200 or less.
• Drugs such as Lipitor or Zocor may be prescribed if diet is insufficient.

Hypertension

• Hypertension is chronically high blood pressure (systolic >140/diastolic >90 mmHg).
• Factors contributing to hypertension include heredity, obesity, smoking, stress, excessive salt intake.
• Therapy:
  • Weight loss
  • Sodium-restricted diet with diuretics
  • Limit sodium intake to <2400mg/day
  • Increase potassium-rich fruits and vegetables (6-10 servings)
  • Increase calcium and magnesium-rich foods
  • DASH diet (a therapeutic diet) limiting sodium, cholesterol, saturated fat, red meat, and sugary foods. Focuses on whole grains, fruits, vegetables, and low-fat dairy.

Diabetes Mellitus

• Diabetes mellitus is a group of serious and chronic disorders affecting carbohydrate metabolism.
• Key features:
  • Hyperglycemia (high blood sugar levels)
  • Causes major health problems (death, blindness, heart and kidney disease, amputations)
  • Involves the pancreas, insulin, and glucagon.

Diabetes Symptoms

• Abnormal Glucose Concentration:
  • Glycosuria: Glucose in the urine as the body attempts to excrete excess blood glucose.
  • Polyuria: Excessive urination due to fluid shift from cells to blood.
  • Polydipsia: Excessive thirst due to fluid loss through urination.
  • Polyphagia: Excessive hunger due to cells not receiving glucose.
• Fat Breakdown:
  • Ketonemia: Ketones in blood.
  • Ketonuria: Ketones in urine.
  • Acidosis: Reduced blood pH due to ketone buildup
• Other Symptoms:
  • Diabetic coma
  • Muscle waste, weight loss, weakness, fatigue.

Additional Diabetes Symptoms

• Vascular System: Atherosclerosis
• Retina: Retinal degeneration & retinopathy
• Nerve Damage: Neuropathy

Etiology of Diabetes

• Uncertain
• Potential factors include heredity and environmental influences.

Diabetes Classification

• Type I Diabetes Mellitus:
  • Acute onset (ages 1-40)
  • Pancreas produces little to no insulin
  • Requires insulin therapy
• Type II Diabetes Mellitus:
  • Gradual onset (after age 40)
  • Reduced insulin effectiveness
  • Managed primarily through diet and exercise
• Gestational Diabetes:
  • During pregnancy
  • May require insulin therapy

Normal Blood Glucose Control

• Normal blood glucose regulation involves a balance between insulin (which lowers blood glucose) and glucagon (which raises blood glucose).
• The pancreas plays a critical role in releasing these hormones.

Type I Diabetes

• Muscle cells cannot use glucose due to insufficient insulin.
• Glycogen and protein breakdown lead to ketoacidosis.
• Insufficient insulin in blood vessels

Type II Diabetes

• Insulin resistance develops in body cells
• The pancreas produces sufficient to adequate insulin, but body cells are resistant to taking up glucose from blood
• Glucose buildup in bloodstream.

Treatment of Diabetes Mellitus

• Control blood sugar levels (70-110 mg/dL for fasting).
• Provide optimal nutrition.
• Prevent complications of disease and related symptoms.
• Treatment usually begins when blood tests reveal hyperglycemia (excessive blood sugar).

Treatment of Diabetes Mellitus (Cont)

• Normal fasting blood glucose levels: 70-110 mg/dL
• HbA1c: indicator of blood sugar control over time
• Dietary measures for managing blood glucose levels.

Nutritional Management of Diabetes Mellitus

• Diet based on exchange system or carbohydrate counting.
  • Type 1 patients require a balanced plan accounting for insulin requirements
  • Type 2 patients management relies heavily on weight loss and exercise
• Carbohydrate Intake: 50–60% (40–50% complex; 10–20% simple)
• Fat Intake: 30% of total daily calories
• Protein Intake: 15–20% of total daily calories

Miscellaneous Concerns

• Fiber: 25-30 grams daily.
• Alternative sweeteners (i.e. sucralose and aspartame).
• Alcoholic beverages should be avoided.
• Exercise is important but can complicate diabetes management (Type I).
• Insulin therapy (exogenous and endogenous).
• Hypoglycemic episodes require immediate glucose intervention (oral glucose or IV dextrose).

Kidney Stones

• Nephrolithiasis: Stones in the kidneys.
• Symptoms:
  • Asymptomatic
  • Hematuria (blood in urine)
  • Infection
  • Obstruction
  • Intense pain during stone movement
• Causes: Metabolic imbalances, patient immobilisation
• Classification: Based on composition (calcium oxalate, uric acid, cystine, struvite).

Dietary Treatment of Renal Stones

• All types: Drink plenty of fluids, particularly water, and eat a balanced diet.
• Calcium Oxalate Stones:
  • Avoid excessive animal protein.
  • Avoid foods high in oxalate (beets, wheat bran, chocolate, tea, strawberries, spinach).
• Uric Acid Stones:
  • Limit purine-rich foods (meats, fish, poultry).
• Cystine Stones:
  • Increased fluids and alkaline-ash diet (limiting meat, poultry, cheese, grains, emphasizing fruits, vegetables, and milk).
• Struvite Stones:
  • Low-phosphorus diet (reducing milk and cola).

Cancer

• Etiology is often unknown, could be related to heredity, viruses (Epstein Barr, hepatitis B, herpes simplex II), environmental carcinogens, or emotional stress.

Food and Cancer

• Bad:
  • Nitrates in processed meats converting to nitrosamines (stomach/esophagus cancers).
  • High-fat diets
  • Excess calories
  • Smoking and alcohol
• Good:
  • Antioxidants (certain plant substances): protect cells against carcinogens
    • Vitamin C
    • Vitamin A and beta-carotene
    • Flavonoids, phenols, indoles, found in fruits and vegetables
  • High-fiber diets are associated with decreased colorectal cancer risk.

Effects of Cancer

• General Effects: Unexplained weight loss (due to increased metabolism and nutrient use by cancer cells); muscle loss (hypoalbumenia, low protein in blood); anemia; weakness, anorexia; altered senses of taste and smell due to nutrient deficiencies; early satiety due to decreased digestive secretions; delayed gastric emptying; and poor appetite.
  • Specific Effects: depend on tumor site. Untreated cancer → anorexia → malnutrition → cachexia → death

Cancer Treatment

• Medical Treatments Side Effects:
  • Surgical removal: Can affect organ function
    • (example: stomach removal affecting digestion).
  • Radiation: Can lead to altered taste and smell, dry mouth (xerostomia), difficulty swallowing, reduced ability of intestine to absorb nutrients, bowel obstruction and diarrhea.
  • Chemotherapy: Can result in reduction of small intestine absorptive cells ability to regenerate, hemorrhagic colitis; reduced appetite, vomiting, nausea, and diarrhea
• Combined therapy (chemo-radiation): Further aggravates medical treatment side effects.

Nutritional Care for Cancer Patients

• High metabolic rate: High-calorie, high-protein diets
• Sufficient calories and nutrients: Essential for survival.
• Specific nutritional requirements: 40–50 kcal/kg body weight (high protein); 1–1.2 g protein/kg body weight for well-nourished clients; 1.3-2 g protein/kg body weight if malnourished.
• Nutrient supplementation: Include multivitamins and minerals; use carbohydrates and fats to spare proteins needed for tissue building and immune function)
• Hydration: Ensure adequate intake to support kidney function.
• Anorexia: Common, manage by preparing familiar foods attractively, and offer soft foods.
• Add sugar to fruit juices to improve taste. Avoid nausea with cold food/covering.

This quiz explores the relationship between diet and diet-related diseases, particularly focusing on cardiovascular disease (CVD). Learn about major risk factors like hyperlipidemia, the impact of cholesterol, and how dietary choices can influence the development of conditions such as atherosclerosis. Test your knowledge on medical nutrition therapy essential for disease management.