07 Dietary Management of CVD.pdf

Dietary Management of Cardiovascular Diseases (CVD)  Cardiovascular Diseases (CVD) Definition: Cardiovascular disease (CVD) is an umbrella term for diseases that affect the heart and blood vessels, such as – coronary heart disease (CHD), – stroke, – heart failu...

Dietary Management of Cardiovascular Diseases (CVD)  Cardiovascular Diseases (CVD) Definition: Cardiovascular disease (CVD) is an umbrella term for diseases that affect the heart and blood vessels, such as – coronary heart disease (CHD), – stroke, – heart failure (HF), – hypertension, and – arterial diseases. Atherosclerotic CVD is caused by atherosclerosis, a progressive narrowing and hardening of blood vessels.  Hypertension Definition: Sustained elevated blood pressure greater than or equal to 140/90 mmHg Hypertension is one of the most important modifiable risk factors for heart disease, stroke, kidney disease, & peripheral arterial disease (PAD). Hypertension is associated with shorter overall life expectancy Hypertension is the result of environmental factors (obesity, physical inactivity, sodium intake, and alcohol intake), genetic factors, and interactions among these factors  Dietary Management of Hypertension Nutrition therapy has the potential to Lower blood pressure and prevent hypertension in people who are normotensive or pre-hypertensive. Eliminate the need for medication in people with mild hypertension. Diet is the initial treatment before drug therapy is introduced. Lower blood pressure and reduce the dose of medication needed in people who have hypertension and are treated with medication. Dietary Management of Hypertension 1) Follow “The DASH Diet” (Dietary Approaches to Stop Hypertension) which is diet:- a) Rich in fruit, vegetables, low-fat dairy products, and whole grains; b) Moderate in poultry, fish, and nuts; and c) Low in fat, red meat, and added sugar 2) The DASH eating plan is rich in potassium, magnesium, calcium, and fiber and low in total fat, saturated fat, and cholesterol. Dietary Management of Hypertension 3. Following this diet lowers both systolic and diastolic blood pressures as well as low- density lipoprotein (LDL) cholesterol. 4. Reductions in blood pressure were similar in men and women and similar in magnitude to the effects seen with drug monotherapy for mild hypertension. 5. The decrease in blood pressure occurred without lowering sodium intake and without lowering calories to produce weight loss. Dietary Management of Hypertension  Dietary Management of Hypertension Limit sodium intake to 1,500 mg/day. Lowering sodium with either the control diet or DASH diet lowers blood pressure; the lower the sodium intake, the lower the blood pressure. At each sodium level, blood pressure was lower on the DASH diet than on the control diet. The greatest reduction in blood pressure occurred at 1500 mg of sodium. Approximately 77% of the sodium in a typical American diet comes from processed foods with high levels of “hidden” sodium  Tips to lower sodium intake General Guidelines. Eliminate processed and prepared foods and beverages high in sodium; use fresh, frozen, and canned low-sodium products. Do not use salt in cooking or at the table. Read Nutrition Facts labels; most foods eaten should provide less than 300 mg sodium per serving.  Tips to lower sodium intake Patient teaching. Reducing sodium intake will help the body rid itself of excess fluid and help lower high blood pressure. Sodium appears in the diet in the form of salt and, to some degree, in almost all foods and beverages.  Tips to lower sodium intake Patient teaching. Approximately 77% of the sodium in a typical American diet comes from processed foods. Sodium-containing compounds are used extensively as preservatives (sodium propionate, sodium sulfite, and sodium benzoate), leavening agents (sodium bicarbonate, baking soda, and baking powder), and flavor enhancers (e.g., salt, monosodium glutamate [MSG]) are found in foods that may not taste salty.  Tips to lower sodium intake Patient teaching. Salt substitutes replace sodium with potassium or other minerals. “Low-sodium” salt substitutes are not sodium free and may contain half as much sodium as regular table salt. The preference for salty taste eventually will decrease. When an occasional food containing more than 300 mg/serving is eaten, balance it out with low-sodium foods the rest of the day.  Tips to lower sodium intake Patient teaching. Try to make low-sodium choices while eating out Enhance sodium-free flavour; such as herbs, spices, lemon juice, and vinegar.  Dietary Management of Hypertension Increase potassium intake to 4700 mg/day. As potassium intake increases, blood pressure decreases in hypertensive and non-hypertensive people  Dietary Management of Hypertension Weight loss. The greater the weight loss, the greater is the reduction in blood pressure in both hypertensive and non-hypertensive people  Atherosclerosis Definition: The formation of plaque along the smooth inner walls of arteries, which results in progressive narrowing and diminished blood flow to the tissue they supply. Plaque: deposits of fatty material, cholesterol, calcium, and other blood components that are covered with connective tissue and embedded in the artery wall.  Atherosclerosis Cause: Elevated levels of LDL cholesterol promote atherosclerosis, particularly if the LDLs are oxidized or glycated. Because high-density lipoprotein (HDL) cholesterol helps prevent oxidation of LDL and removes cholesterol from circulation, low levels of HDL are a risk factor for atherosclerosis.  Atherosclerosis Levels of blood lipids: Total Cholesterol – Less than 200 mg/dL Desirable – 200–239 mg/dL Borderline high – 240 mg/dL High LDL Cholesterol – Less than 100 mg/dL Optimal (ideal) – 100–129 mg/dL Near optimal/above optimal – 130–159 mg/dL Borderline high – 160–189 mg/dL High – 190 mg/dL Very high HDL Cholesterol – < 40 mg/dL men Risk factor for heart disease and stroke – < 50 mg/dL women Risk factor for heart disease & stroke – > 60 mg/dL Provides some protection against heart disease  Atherosclerosis Levels of blood lipids: Metabolic Syndrome Definition: Metabolic syndrome (MetS) is a risk factor for CVD and type 2 diabetes. It consists of a cluster of metabolic abnormalities—namely, elevated triglycerides, low HDL cholesterol, high blood pressure, high fasting blood glucose levels, and central obesity  Metabolic Syndrome Diagnosis: Metabolic syndrome is confirmed by the presence of three of the following five risks: Abdominal obesity* Easured by calculating Waist to Hip ratio (WHR) – Men ≥ 0.90 – Women ≥ 0.85 Elevated triglycerides – ≥ 150 mg/dL, or taking medication for high TAG levels Low HDL – Men ≤ 40 mg/dL in men – Women ≤ 50 mg/dL in women – Or taking medication for low HDL  Metabolic Syndrome Diagnosis: Metabolic syndrome is confirmed by the presence of three of the following five risks: Elevated blood pressure – ≥ 130 mmHg systolic blood pressure – ≥ 85 mmHg diastolic blood pressure – Or drug treatment in a patient with a history of hypertension Elevated fasting glucose – ≥ 100 mg/dL or taking medication to control blood sugar level  Traditional Mediterranean Diet Another heart healthy food group approach is the traditional Mediterranean diet Like the DASH diet, it is characterized by a high intake of vegetables, fruits, whole grains, plant proteins (e.g., nuts and legumes), and fish. It includes a moderate intake of alcohol, normally with meals, and low intake of refined grains, sweets, and red meat (approximately twice per month) It is not a low-fat diet but is low in animal fat and therefore low in saturated fat and cholesterol. Olives and olive oil contribute to high monounsaturated fat content.  Traditional Mediterranean Diet Studies link a traditional Mediterranean diet with the following: A decreased risk of CHD, stroke, cancer, and total mortality Improvements in obesity and type 2 diabetes Improvements in Metabolic Syndrome components, including abdominal obesity, lipid levels, glucose metabolism, and blood pressure Traditional Mediterranean Diet  Heart Failure Definition: HF is a syndrome characterized by specific symptoms namely, shortness of breath, fatigue, & edema. Neuro-hormonal abnormalities and elevated levels of inflammatory markers and oxidative stress are involved in this systemic illness. CHD, hypertension, & diabetes are prevalent causes. Obesity, MetS, and previous heart attack increase the risk for HF.  Heart Failure Nutrition therapy: Sodium restriction is recommended in all patients with HF. A fluid restriction of less than 2 L/day for all patients with fluid retention that is difficult to control despite high doses of diuretic medication and sodium restriction. Appropriate nutrition therapy counselling if co-morbidities, such as diabetes, renal disease, or hyperlipidemia, are present.  Heart Failure Nutrition therapy: Protein fortification, because patients with HF have protein needs higher than normal (1.12 g/kg not the Recommended Dietary Allowance of 0.8 g/kg), even when they are not malnourished. Patients who are malnourished require more. Small, frequent meals to limit gastric distention and pressure on the heart. Soft, easy-to-chew foods for patient with fatigue. Nutritional supplements for additional protein and calories for patients with weight loss or muscle wasting (cardiac cachexia). Potassium and thiamine supplements, as needed, to compensate for losses in patients on diuretics.  Revision Questions Define Hypertension. Astherosclerosis. Metabolic syndrome. Heart Failure.  Revision Questions Compare between DASH diet & traditional Mediterranean diet.  Revision Questions Mention Tips to lower sodium intake. Causes of atherosclerosis. Criteria for diagnosis of metabolic syndrome.  Revision Questions Give an account on Dietary management of hypertension. Dietary management of heart failure. DASH diet Traditional Mediterranean diet.