chapter 9 CVD.pdf

Nutrition for Prevention and Treatment of Cardiovascular Disorders 1 8/25/2024  objectives  Identify risk factors of coronary heart disease.  Identification of fatty acids and food sources.  Lifestyle modification to...

Nutrition for Prevention and Treatment of Cardiovascular Disorders 1 8/25/2024  objectives  Identify risk factors of coronary heart disease.  Identification of fatty acids and food sources.  Lifestyle modification to manage hypertension.  Medical nutrition therapy for the client with metabolic syndrome.  Nutritional related issues of client with heart failure. 2 8/25/2024   Cardiovascular disease is the number one killer in the United States. It includes all diseases associated with the heart and blood vessels.  Atherosclerosis, a main cause of CVD, is a degenerative disease leading to narrow, clogged, and hardened arteries.  two causes of atherosclerosis: blood cholesterol and the immune system.  Cholesterol is a type of lipid necessary for the synthesis of steroid hormones, vitamin D, and bile acids and for cell membrane structure. 3 8/25/2024  Deaths from Cardiovascular Diseases in the United States © Cengage Learning 2017 Copyright © 2017 Cengage Learning. All Rights Reserved.   Coronary heart disease is also known as coronary artery disease. It occurs because of narrow blood vessels that supply the heart.  elevated total and LDL cholesterol with an increased risk of coronary heart disease.  Studies reveal that for every 1% decrease in LDL cholesterol, risk of CVD is reduced by 1%. 5 8/25/2024  Identify risk factors for CVD. 1. Elevated LDL cholesterol, low HDL cholesterol, high triglycerides 2. Diabetes mellitus. 3. Hypertension. 4. Family history of premature CHD. 5. Current cigarette smokers ✓ Dietary intervention can be useful in addressing elevated LDL cholesterol, 6 8/25/2024  Impact of Cigarette Smoking on Health  Cigarette smoke contains harmful chemicals, including nicotine, that damage endothelial cells, leading to atherosclerotic plaque formation.  Smoking promotes increased blood clotting, raising the risk of cardiovascular events.  Smoking raises LDL cholesterol levels and decreases HDL cholesterol levels, accelerating atherosclerosis progression.  Vasoconstriction caused by smoking narrows arteries, increasing the risk of heart attacks and strokes  Passive smoking inflicts similar harmful effects on cardiovascular health as active smoking. 7 8/25/2024  ❑ Major Risk Factors for CHD (not modifiable)  Increasing age  Male gender  Family history of premature heart disease ❑ Major Risk Factors for CHD (modifiable)  High blood LDL cholesterol  Low blood HDL cholesterol  High blood pressure (hypertension)  Diabetes  Obesity (especially abdominal obesity)  Physical inactivity  Cigarette smoking  An “atherogenic” diet (high in saturated fats and low in vegetables, fruits, and whole grains) 8 8/25/2024  Clearance of LDL cholesterol from the blood. 1. Phytosterols are plant sterols and stanols 2. Viscous fibers ( soluble fiber ). 3. Soy protein 4. High-protein diets 9 8/25/2024  Clearance of LDL cholesterol from the blood. 1- Phytosterols are plant sterols and stanols Plant sterols are substances that are similar to cholesterol but are made in plants It is believed that they inhibit cholesterol absorption in the intestine and increase cholesterol synthesis by the liver, leading to greater clearance of LDL cholesterol from the blood.  Clinical trials reveal that intake of 1 to 3 g/day of plant sterols is safe.  plant sterols are found in fruits, wheat germ, whole grains, beans, sunflower seeds 10 8/25/2024  Cont….clearance 2- Viscous fibers, also known as soluble fibers, can reduce LDL cholesterol.  Fibers (such as psyllium) that have been shown to lower LDL cholesterol.  Food sources containing these fibers include oats, barley, fruits (apples, citrus fruits), legumes, and flaxseed.  It is hypothesized that these fibers help reduce LDL cholesterol by binding to bile acids to increase cholesterol excretion. 11 8/25/2024  Cont….clearance 3- Soy protein: Research initially suggested that a large amount of soy protein in the diet reduces LDL cholesterol and raises HDL (good).  soybeans and some products made from soy may reduce the risk of CVD in other ways and be beneficial to health.  Ex: soy milk, soy protein powder  Soy contains all nine essential amino acids 12 8/25/2024  Cont….clearance 4- The effect of high-protein diets on CVD is debated.  Such diets may be high in saturated fat and lead to elevated LDL cholesterol.  but may cause faster weight loss in some individuals.  Fish is probably the best source of protein. Evidence suggests that eating moderate amounts of fish (twice a week)  may improve by :  reducing Triglyceride, Blood pressure, the risk for stroke, and elevating HDL levels 13 8/25/2024  fatty acids and CVD  Dietary fat has the potential to both raise and lower LDL and HDL cholesterol based on the type and amount of fatty acid.  The three main types of fat found in food are: saturated fatty acids. monounsaturated fatty acids. polyunsaturated fatty acids.  Their physical and chemical properties and their effects on cholesterol differ. 14 8/25/2024   Effects on Cholesterol  High saturated fatty acids increase LDL cholesterol.  High polyunsaturated fatty acids decrease LDL cholesterol.  MUFA decrease or do not change LDL cholesterol.  Trans fats increase LDL cholesterol.  High saturated, polyunsaturated, or monounsaturated fatty acids: little or no HDL cholesterol effect  Trans fats decrease HDL cholesterol. 15 8/25/2024  Types of fatty acid Effects Source High saturated fatty acids increase LDL cholesterol. Animal fat. High polyunsaturated fatty acids decrease LDL cholesterol Vegetable oil MUFA decrease or do not change LDL Olive oil cholesterol. Trans fats increase LDL cholesterol margarine, fried foods, decrease HDL cholesterol. and baked goods such as crackers, biscuits, and pies. High saturated, polyunsaturated, or little or no HDL cholesterol effect monounsaturated fatty acids 16 8/25/2024   n-3 polyunsaturated fatty acids play a role in prevention of CVD.  The possible mechanisms of action include reducing triglycerides, inflammation, and platelet adhesion; inhibiting plaque formation; decreasing arrhythmias, and decreasing blood pressure.  Many organizations have made recommendations for consuming fish.  Alpha linolenic acid (ALA) is a plant-derived omega-3 fatty acid.  It is found in flaxseed oil, and in canola, soy, perilla, and walnut oils. 17 8/25/2024   n-3 polyunsaturated fatty acids play a role in prevention of CVD.  The possible mechanisms of action include reducing triglycerides, inflammation, and platelet adhesion; inhibiting plaque formation; decreasing arrhythmias, and decreasing blood pressure.  Many organizations have made recommendations for consuming fish 18 8/25/2024 19 8/25/2024  National Cholesterol Education Program’s  The National Cholesterol Education program issues guidelines to detect, evaluate, and treat hypercholesterolemia.  Dietary manipulation is considered to be the key to managing high levels of LDL cholesterol. 20 8/25/2024  Therapeutic Lifestyle Changes for Lowering CHD Risk (TLC)  People who have CHD or multiple risk factors for CHD are often advised to make dietary and lifestyle changes before considering drug treatment. An approach to risk reduction promoted by the National Cholesterol Education Program, known as Therapeutic Lifestyle Changes (TLC) 21 8/25/2024 22 8/25/2024   Reducing elevated LDL cholesterol is the first goal for primary and secondary prevention of CHD.  Primary prevention refers to delaying or preventing onset.  Secondary prevention refers to preventing recurrent coronary events or death.  A client’s LDL cholesterol goal and appropriate therapy should be individually assessed based on the client’s risk status.  Raising HDL via medication has not been identified as a goal, but it is recommended that nondrug therapies that raise HDL be employed. 23 8/25/2024 Nutrition therapy for hypertriglyceridemia  Control body weight  Become physically active  Restrict alcohol  Limit intakes of refined carbohydrates  Eliminate alcoholic beverage consumption  Fish oil supplements Sometimes recommended 24 8/25/2024  Hypertension Primary risk factor for atherosclerosis and cardiovascular diseases Primary cause of stroke and kidney failure Affects about one-third of U.S. adults – An estimated 17% of people with hypertension are unaware that they have it Risk factors for hypertension Aging, genetic factors, obesity, salt sensitivity, alcohol, and dietary factors 25 8/25/2024  Hypertension  Hypertension is systolic blood pressure (SBP) > 140 mm Hg or diastolic blood pressure (DBP) > 90 mm Hg.  It is most prevalent in African Americans and older adults. All the above factors increase the risk factor for CVD. 26 8/25/2024  Lifestyle factors and HBP Lifestyle factors contributing to the development or worsening of high blood pressure include: 1. Obesity (There is a linear relationship between excess body weight and the severity of hypertension. Weight loss of 10 to 20 lbs. is associated with reductions in SBP and DBP). 2. Lack of physical activity (Regular aerobic physical activity for 30 minutes daily can reduce blood pressure and assist in restoring and maintaining an appropriate weight). 3. Alcohol abuse. 4. smoking. 5. High Na diet (A diet low in sodium and rich in fruits, vegetables, and low-fat dairy products has been shown to reduce blood pressure. Reducing sodium levels can reduce blood pressure in clients with and without hypertension) 27 8/25/2024  Hypertension  Treatment of hypertension 1) Weight reduction ✓ Blood pressure reduced by ~1 mm Hg per kg weight loss ✓ Most beneficial for blood pressure control during periods when weight is decreasing 2) Dietary approaches to stop hypertension( DASH) ✓ More fiber, potassium, magnesium, and calcium than the typical American diet ✓ Limits red meat, sweets, sugar-containing beverages, saturated fat, cholesterol ✓ More effective when accompanied by sodium restriction 3) Regular Physical Activity 28 8/25/2024 29 8/25/2024  Benefits of Regular Physical Activity ✓ Regular aerobic activity can effectively reverse multiple risk factors for coronary heart disease (CHD). ✓ Key health improvements linked to aerobic activity include: Lowered triglyceride levels Increased high-density lipoprotein (HDL) cholesterol Reduced blood pressure Promotion of weight loss Enhanced insulin sensitivity Strengthening of the heart muscle Increased size and tone of coronary arteries  Types of Aerobic Activities Aerobic activities that engage large muscle groups provide the most significant health benefits. Examples of effective aerobic activities include: Brisk walking Running Swimming Cycling Stair-stepping 30 8/25/2024  Physical Activity and Coronary Heart Disease (CHD)  Active individuals exhibit CHD rates approximately 50% lower than those who are least active.  The American Heart Association advises adults to engage in at least 30 minutes of moderate-intensity physical activity most days of the week.  For weight loss or maintenance, a target of 60 minutes of physical activity is recommended daily.  Caution for Individuals with Heart Disease Vigorous physical activity increases the risk of heart attack; therefore, Sedentary adults should gradually increase their physical activity levels to avoid health risks. 31 8/25/2024  Metabolic syndrome  Definition: Metabolic syndrome is a cluster of abnormalities characterized by abdominal obesity, insulin resistance, dyslipidemia, and elevated blood pressure.  It increases the risk of both type 2 diabetes mellitus and CVD.  Waist circumference is an essential parameter for establishing this diagnosis.  The overall goal with clients with metabolic syndrome is to reduce risk of CVD. The focus should be on risk factors of CVD. 32 8/25/2024  Metabolic syndrome These criteria defined metabolic syndrome as present when 3 of these 5 components are present: 1. Elevated waist circumference (≥88 cm for women and ≥102 cm for men) 2. Blood pressure over 130/85 mmHg 3. Elevated triglycerides (≥150 mg/dL) 4. Low HDL cholesterol (