Medical Nutritional Therapy For Cardiovascular Diseases (CVD) Lecture 3 PDF

Dietetics 4th level Clinical Nutrition 2 Lecture 3 Medical Nutritional Therapy For Cardiovascular Diseases (CVD) Dr. Alzahraa Motawei Lecturer of Food Sciences & Nutrition Faculty of Agriculture...

Dietetics 4th level Clinical Nutrition 2 Lecture 3 Medical Nutritional Therapy For Cardiovascular Diseases (CVD) Dr. Alzahraa Motawei Lecturer of Food Sciences & Nutrition Faculty of Agriculture Mansoura University  Learning Objectives 1. Discuss the nutritional risk factors contributing to CVD risk 2. Define lifestyle risk factors contribute to CVD risk including: Dyslipidemia Hypertension Type 2 diabetes 3. Describe the nutritional approaches to reduce CVD risk Dr. Alzahraa Motawei clinical nutrition 2 2 CardioVascular Diseases Heart & Vascular Disease 30% of deaths globally (2005) Hypertension 46% deaths < 70 years Stroke 3.67 million Egyptians affected Myocardial infarction 1.10 million long term disability as a result Congestive Heart Failure Increased by 18.2% over last decade Peripheral arterial disease Dr. Alzahraa Motawei clinical nutrition 2 3 Cholesterol- Know the numbers! Dr. Alzahraa Motawei clinical nutrition 2 4 CVD Risk Factors Dr. Alzahraa Motawei clinical nutrition 2 5 1- Gender Heart Disease in Women Heart disease is the #1 killer of women 1 out of 3 women, killing approximately one woman every 80 seconds 90% of women have one or more risk factors for developing heart disease. 2 out of 3 women who die of heart disease have NO warning signs! A woman is more likely to die in the first year after a heart attack than a man is. Dr. Alzahraa Motawei clinical nutrition 2 6 Dr. Alzahraa Motawei clinical nutrition 2 7 Risk Factor: 2- Diabetes Coronary Artery Disease Mortality in patients with Diabetes The risk of coronary heart disease was > 6-fold that of those without diabetes! Dr. Alzahraa Motawei clinical nutrition 2 8 Risk Factor: 3- Smoking Smokers who have a heart Smoking: attack Causes plaque to are more likely to die and die form in blood vessels suddenly (within an hour) Reduces HDL Risk decreases after quitting (“good”) cholesterol 1/3 in 2 years Increases blood pressure Increases heart arrhythmias Dr. Alzahraa Motawei clinical nutrition 2 9 Risk Factor: 4- Obesity 34%of adults are overweight 34% are obese 6% are extremely obese ~30% increase in heart disease risk for each five-unit increase in body mass index (BMI) Dr. Alzahraa Motawei clinical nutrition 2 10 Benefits of Lowering Blood Pressure Dr. Alzahraa Motawei clinical nutrition 2 11 Dyslipidemia: lifestyle factors ↓ serum cholesterol - ↓ CHD ↓0.5mmol/L (about 10%) mean population serum cholesterol results in 12.6% ↓ coronary events Saturated fats & Trans fats: ↑Total - LDL cholesterol Small, potentially important CVD risk reduction with ↓ saturated fat Obesity: ↑Total - LDL cholesterol Exercise: ↑HDL cholesterol Dr. Alzahraa Motawei clinical nutrition 2 12 2- Hypertension Dr. Alzahraa Motawei clinical nutrition 2 13 Hypertension (>140/90mmHg) Men more likely to have hypertension than women (23.4% v 19.5%) Hypertension: 42.6% aged 65 years 5.5% aged 18-24 years Dr. Alzahraa Motawei clinical nutrition 2 14 Hypertension Dr. Alzahraa Motawei clinical nutrition 2 15  Stroke & Hypertension Strokes leading cause of long-term disability in Adults Strokes cause 9% all deaths Risk of stroke (& CHD) increases with BP Hypertension Most common chronic disease 1 in 4 males & 1 in 6 females (25-65yrs) Dr. Alzahraa Motawei clinical nutrition 2 16  Management of Hypertension Lifestyle modification Endorsed the recommendations of the Lifestyle : 1. Combine Dietary Approaches to Stop Hypertension (DASH) diet with reduced sodium intake < 2,400 mg of sodium (6 g salt) per day, noting that limiting intake to 1,500 mg (4g salt/d) can result in even greater reduction in BP 2. reducing sodium intake by 1,000 mg (2.5g salt)/day lowers blood pressure. 2- Physical activity. Moderate to vigorous physical activity for approximately 160 minutes per week (three to four sessions a week, lasting ~40 minutes per session). Weight loss. Dr. Alzahraa Motawei clinical nutrition 2 17 Nutrition management of CVD Dr. Alzahraa Motawei clinical nutrition 2 18 Nutrients associated with BP Sodium Potassium Calcium Magnesium Chloride Alcohol Vegetarian diet Fibre Fat (total) P:S ratio Fish oils Caffeine Variety of vitamins eg. Vit C ? Other dietary factors eg. Garlic ? Dr. Alzahraa Motawei clinical nutrition 2 19  Saturated Fats Solid at room temperature. Stearic acid: C18:O saturated fat mainly found in animal products Animal-based sources of saturated fats: Dairy foods – such as butter, cream, regular-fat milk and cheese Oleic acid:C18:1w9 Meat – such as fatty cuts of beef, processed meats mono unsaturated fat like salami, and chicken (especially chicken skin) Plant-derived saturated fats: Palm oil, Cooking margarine, Coconut, Coconut milk and cream Oleic acid:C18:2w6 Deep fried take away foods, Cakes, Biscuits, poly unsaturated fat Pastries and pies Dr. Alzahraa Motawei clinical nutrition 2 20  Trans fatty acids (TFA) Unsaturated fat that behaves like a saturated fat. Naturally occurring TFA: dairy products, beef, veal, lamb Artificial, synthetic, industrial or manufactured trans fats To Avoid trans fat Choose polyunsaturated and monounsaturated spreads unsaturated fatty acid and margarines molecule: trans limit deep-fried and baked foods: biscuits, pastries, pies) double bond between Avoid ”hydrogenated oils”. carbon atoms, which makes the molecule kinked. Dr. Alzahraa Motawei clinical nutrition 2 21  Salt in foods Low salt product