Nutrition in Cardio-Vascular Diseases

NUTRITION in CARDIO-
VASCULAR DISEASES
PREPARED BY
CHARLEMAGNE TAN, RND
FACULTY OF NUTRITION AND CULINARY DEPARTMENT
OUR LADY OF FATIMA UNIVERSITY
OBJECTIVES SETTING FOR NCP
• FOR EVERY PROBLEM OR NEED, THERE MUST
BE A CORRESPONDING OBJECTIVE.
• OBJECTIVES must be:
Specific and pt-centered
Time-bound
Realistic
Measurable
GUIDE FOR IDENTIFYING HIGH RISK PT
Signs of Underlying Disease
Malnutrition on Low Nutritional Increased Planned Actions
Admission Intake Nutritional
Demands
• Wt loss 5-10% • Bowel disease • Burns • Operation
(last 2-3 months) • Chronic pain • Sepsis • Repeated tests,
• Serum Albumin, • Pancreatitis • Multi-trauma X-rays
<3.5 g/dl • Old Age • Peritonitis • Cytostatic drug
• Anorexia • Depression • Cancer therapy
• Frequent • AIDS • AIDS • Expected
diarrhea, • Malabsorption hospital stay >2
vomiting weeks
• Chewing or
swallowing
problems
•Edema and/or
skin lesions
DIETARY INSTRUCTION / PT COUSELLING
- the process of providing individualized
professional guidance to assist a person in
adjusting his daily food consumption to meet
his health needs. The process involves
interviewing, counseling and consulting.
 planned interventions for pt
 regardless of setting,
in-pt or out-pt
 important aspect of
total nutritional care
OBJECTIVES OF DIET COUNSELING
• To help the pt understand and follow the
physician’s diet prescription in terms of the
kind and amounts of food prepared in specific
ways.
• To advise the pt on lifestyle changes needed to
support medical and nutritional management,
particularly of chronic ailments.
• To motivate the pt to make necessary
modifications in diet and lifestyle
STEPS IN DIET COUNSELING
1. INTERVIEW
• Basic parts of an interview are:
Opening: introduce self, establish rapport
Body: obtain desired info; give info as needed
Closing: may include setting date for next
session
• Types of questions asked in an interview:
 primary or secondary
 open or closed
 neutral or leading
• Nutrition Interview Guidelines
 Introduction
 developing a relationship
 defining roles
 determining the pt’s health need or problem
and related personal goals
 redefining objectives in light of pt’s goals
Pt profile
 gathering physical data: age, ht, wt [present and
past hx], experience with disease or wt problem
• The Pt’s Food Habits
Nutrition hx
 determining present food intake
 learning about place and time of eating
 referring to check-list of various food groups and
some individuals foods
 determining who prepares the food and how
 Physical exercise and rxn: activities associated with
the pt’s food habits
 Food rxns: pt’s likes, dislikes, intolerances, allergies
2. COUNSELING
TEACHING PLAN FOR INDIVIDUAL OR GROUP INSTRUCTION
Preparation
 research the subject and make a careful study
 make out teaching plan, w/c includes:
- Aim (rel. to pt’s needs, procedure, realistic)
- Approach (secure attn and interest, stimulation)
- Answers (involvement, organization, exploration)
- Application (summary of key pts., plan of action)
- Assignment (add. Info, feedback hearing)
 prepare and check out all aids and equipment ahead of
time
2. COUNSELING
TEACHING PLAN FOR INDIVIDUAL OR GROUP INSTRUCTION
Presentation
 for group instruction, arrange in advance for the room, chairs,
speaker’s desk, displays, materials and equipment necessary
 carry out the teaching plan
- Timing (begin & end on time, place materials for balance &
interest)
- Group Involvement (maintain relaxed and permissive
atmosphere)
 Purpose fulfilled??
 evaluate class results in light of its objective
 plan follow-up activity
2. COUNSELING
INDIVIDUAL DIET COUNSELING
• Choosing the diet
• Explaining the reasons for the diet
• Planning a daily food pattern with pt
• Reviewing the diet and answering questions
3. CONSULTING
- involves discussing proposals and plans for the
pt’s nutritional care with the health care team
and with the pt himself.
DOCUMENTATION
For: monitoring, evaluation and revision of the
nutritional care plan and action.
• Purposes of Medical Records
to document the medical care of the pt
to facilitate communication among all
members of the health care team and assist in
the coordination of their activities.
to serve as basis for evaluating the hospital’s
health care delivery and the quality of its care
monitoring program for hospital accreditation
DOCUMENTATION
• Types of Medical Records
Source-oriented: the chart is organized according to the
category of the personnel writing in the records. [Dr.’s notes,
nurse’s notes, AHP’s notes]
Problem-oriented medical record (POMR): an integrated
recording system focusing on the pt’s probs & profile, plan for
care and for pt education, assessment of progress and records.
Advantages of POMR:
 the ability to express each problem in its own observational
terms
 a pt profile that contains descriptions of the pt’s life situation
 integration of data recorded by diverse discipline
 deliberate attn to plans for education of the pt
 ideas for further applications or adaptations
DOCUMENTATION
• Types of Information that Need to be
Documented
 Four specific information areas
 Data base: c/c, present illness, PE and LAB,
NUT info.
 Problem list: any condition the pt presents
that requires the health team to obtain more
info.
 Initial care plan
 Progress notes: S-O-A-P{obtain more info,
treat & educate}
DOCUMENTATION
Information specifically recorded by dietitians
 confirmation of diet order
 summary of diet hx
 nutritional care therapy
 nutritional care discharge plan
 dietetic consultations
Other Formats for Progress Notes
 PIE – (prob, intervention, evaluation)
 PES – (prob, etiology, signs and symptoms)
What to evaluate
 The objectives: are they realistic?
 The interventions: are they appropriate for the problems
identified?
 The implementation: quality of health care, quality of
communication among members of the health care team
NUTRITION IN CARDIOVASCULAR DISORDERS
• The Cardiovascular System
Heart
Blood vessels
Blood
• Risk Factors for CVD

* Non-modifiable * Modifiable
1. Age 1. High BP
2. Genes 2. High LDL
3. Family History 3. Low HDL
4. DM
5. Obesity
6. Inactivity
• Statistics about Mortality
10 Leading Causes of Death in the Philippines (2004)
1. Heart Diseases
2. Vascular System Diseases
3. Malignant Neoplasm
4. Accidents
5. Pneumonia
6. Tuberculosis, all forms
7. Ill-defined and known cause of mortality
8. Chronic lower respiratory diseases
9. Diabetis mellitus
10. Certain condition originating in the perinatal period
-- HYPERTENSION (HPN) --
• DEFINITION & CHARACTERISTICS
an arterial BP >/= 140/90 mmHg
not a disease but a symptom: due to ↑
cardiac output & ↑ resistance of blood vessel
walls to blood flow
may occur at any age but most frequently in
persons over 40 y.o.
smoking & emotional stress may elevate BP
Classification of Blood Pressure for Adults
CATEGORY SYSTOLIC DIASTOLIC
(mm Hg) (mm Hg)
Normal < 130 < 85
High Normal 130 – 139 85 – 89
HPN Stage 1 (mild) 140 – 159 90 – 99
HPN Stage 2 (moderate) 160 – 179 100 – 109
HPN Stage 3 (severe) 180 – 209 110 – 119
HPN Stage 4 (very severe) >/= 210 >/= 120
• TYPES OF HPNs
Primary or Essential HPN: etiology, unknown;
more common type; occurring in 85-90% of
all HPN cases; can be treated
Secondary HPN: due to a clearly defined
cause which should be treated. These
include:
 kidney diseases  endocrine disturbances
 tumors  coarctation of the aorta
 toxemia  collagen disease
• RISKS OF HPN
-- with increasing BP, there is increasing risk of:
formation of atheromas
coronary artery disease
cardiac failure secondary to increased work of the hearth &
relative or absolute coronary insufficiency
aneurysm of the aorta  when HPN coexists
acute vascular necrosis with hyperlipedemia,
hemorrhagic stroke hyperisulism, glucose
metabolic problems intolerance & obesity, the
a) glocose intolerance condition is known as
b)hypercholesterolemia metabolic syndrome or
c) hyperisulism SYNDROME X
• DX OF SYNDROME X (clinical assessment)
HPN >/= 130/85 mm Hg
Low HDL <40mg/dL (men)
<50mg/dL (women)
Waist line > 102cm (>40in) men
>88cm (>35in) women
Tryglyceride >/=150mg/dL
FBS >/=110mg/dL
High LDL >100mg/dL
• Rx Algorithm for HPN
Step 1, non-drug therapy for mild HPN
 wt reduction, if overwt or obese
 smoking cessation
 regular physical exercise
 moderation of alcohol intake, if drinker
 dietary modification
Step 2, drug or pharmacological therapy for
persistent HPN (DONE BY THE PHYSISCIANS)
 diuretics  vasodilators  beta blockers
• Role of Selected Dietary Factors in HPN
Na: if ok, extracellular fluid control [edemas]
P: helps lower BP in individuals with LSP
Mg: reduces intracellular Na, ergo ↓ BP
Ca: (debatable status)
Cd: High conc. of renal Cd is present in HPN pts
Omega-3 PUF (in fish oils): promotes synthesis of prostaglandin
Alcohol:
High intake (>3 drinks/day) = vasoconstriciton
Moderate intake >>
MEN: (2 drinks/day) (40g absolute alc.) = beneficial
WOMEN: (1 drink/day) (20g absolute alc.) = beneficial
• Dietary Management
DIETARY FACTOR / RATIONALE
MODIFICATION
1. Calorie level, depends - Weight loss of 5-6% in over-
on weight status or weight/obese cn lower BP
weight goal - Excess Na may increase: a) cardiac
2. Na, restricted** output; b) peripheral resistance to
blood flow
3. Fluids and roughage - Prevent constipation which hinders
absorption of anti-hypertensive
drugs
**LEVELS OF SODIUM RESTRICTION & INDICATION FOR USE:

• 500 mg (severe) – when there is cardiac involvement, ascites
• 1000 mg (moderate) – when there is CHF, toxemia of pregnancy
• 2000-3000 mg (mild) – maintenance diet in cardiac & renal
disease
THE DASH EATING PLAN
(LOWERING CALORIES)
• To increase fruits –
Eat a medium apple instead of 4 shortbread cookies. (80
kcal less)
Eat ¼ c dried apricots instead of a 2-ounce bag of pork rinds.
( 200+ kcal less)
• To increase vegetables –
Have a hamburger that’s 3 ounces of meat instead of 6
ounces. Add ½ c serving of carrots and ½ c serving of
spinach. (200+ kcal less)
Instead of 5 ounces of chicken, have a stir-fry with 2 ounces
of chicken and 1 ½ c of raw veggies. Use a small amount of
veg. oil. (50 kcal less)
(LOWERING CALORIES)
• To increase lowfat or fat free dairy products –
Have a ½ cup serving of lowfat frozen yogurt instead of 1 1/2 –
ounce milk chocolate bar. (110 kcal less)
• And don’t forget these calorie saving tips –
1. Use lowfat or fat free condiments.
2. Use half as much veg. oil, soft or liquid margarine, or salad
dressing, or choose fat free versions.
3. Eat smaller portions – cut back gradually.
4. Chooses lowfat or fat free dairy products to reduce total fat intake.
5. Check the food labels to compare fat content in packaged foods-
items marked lowfat or ffat free are not always lower in calories
than their regular versions.
(LOWERING CALORIES)
• And don’t forget these calorie saving tips –
6. Limit foods with lots of added sugar, such as
pies, flavoured yogurts, candy bars, ice cream,
sherbet, regular soft drinks and fruit drinks.
7. Eat fruits canned in their own juice.
8. Add fruit to plain yogurt.
9. Snack on fruit, vegetable sticks, unbuttered
popcorn, or bread sticks.
10. Drink water or club soda.
DASH STUDY
EFFECTS OF DIET ON BP
Dietary Approaches to Stop Hypertension
• 459 adults with mild HPN randomized for 8
weeks to:
• Control diet or High fruit/vegetable diet or
• DASH combination diet (H Fr./Veg., L sat. fat
& chole., H Ca, H K)
• Sodium intake and body weight remained
constant.
DASH-SODIUM SUMMARY
• The DASH diet combined with Na reduction was more effective in
lowering BP than either dietary intervention alone.
• DASH Dietary Pattern Per 2000 kcal
-- CORONARY HEART DISEASE (CHD) --
• Definitions
 Atherosclerosis – the gradual thickening of
the walls of the arteries due to the formation
of plaques which consist of cholesterol,
triglycerides, phospholipids and Ca.
 When the coronary artery is involved, it is
called CHD or Atherosclerotic heart disease
(AHD) or Coronary artery
 disease (CAD)
• PATHOLOGIC EVENTS & RISK FACTORS IN CHD
PATHOLOGIC EVENTS PHYSIO RISK UNCONTROL- DIETARY RISK
FACTORS LABLE FACTORS
FACTORS
1. Injury to • HPN AGE - High Na
coronary arteries - High alcohol
SEX - Low n-3 PUFA
- obesity
• Lipid oxidation HEREDITY - High SFA
- High pro-
oxidants
(Fe, Cu)
-Low anti-oxidants
(B-carotene, vit
• Inflammation C&E, Se)
- Low n-3 PUFA
FACTORS
2. Fibrous plaque • LDL cholesterol AGE - High SFA
formation - High cholesterol
SEX - High trans PUFA
- Low n-6 PUFA
HEREDITY - Low cis PUFA
- Low dietary fiber
• Lipoprotein (a) - High trans fat FA
- Low n-3 PUFA
• Insulin resistance - Low dietary fiber
- High central
body fat (wais-to-
hip ratio)
FACTORS
3. Thrombosis • Platelet AGE - Low n-3 PUFA
and heart attack aggregation - low alcohol
SEX
• Fibrinogen - Low n-3 PUFA
HEREDITY - Low alcohol
• Arrhythmia - Low n-3 PUFA

- High SFA
• GOALS OF DIETARY MANAGEMENT
 To normalize blood lipid levels:
 Total cholesterol <200 mg/dL
 LDL-C <100 mg/dL
 HDL-C >40 mg/dL (men)
>50 mg/dL (women)
 Triglycerides <150 mg/dL
 Weight control, thru diet
modification and increase
physical activities
• RECOMMENDED DIETARY MODIFICATIONS
DIETARY FACTOR/MODIFICATION RATIONALE
1. Total fat not more than 30% TER -Avoid post-prandial hyperlipidimia
& its adverse effect on coagulation
- reduce plasma LDL
2. SFA – approx 7% of TER (NCEP III) - reduce plasma LDL
3. PUFA – approx 10% of TER -reduce plasma LDL
 n-6 PUFA (linoleic acid) - promote prostaglandin synthesis
 LC n-3 PUFA (omega 3 FA) - reduce BP
- reduce inflammation
- reduce Lp (a)
- reduce platelet aggregation
- reduce fibrinogen
4. MUFA – approx 10% of TER - as effective as PUFA
5. Cholesterol – not more than 200 - reduce plasma LDL
mg/day
6. Sodium – moderate intake -- control BP
• RECOMMENDED DIETARY MODIFICATIONS
DIETARY FACTOR/MODIFICATION RATIONALE
7. CHO – type and amounts depends
on lipd abnormality
8. Alcohol – avoid high intake - control BP
- reduce fibrinogen
- excessive intake can produce HTD,
high LDL, arrhythmia, cardiac
enlargement and heart failure
9. Calories – sufficient to maintain or - reduce insulin resistance
achieve DBW - reduce synthesis of cholesterol
- reduce risk of cholesterol gallstone
10. Viscous fibers (10-25 g/day) - maintain insulin sensitivity→↓risk
Plant etanols/sterols (2 g/day factors of hyperinsulinemia and
hyperglycemia
- ↑LDL→↑insulin, ↑proneness to
DM, ↑neurotransmitters which may
↑heart rate and BP→HPN
• ROLE OF SELECTED DIETARY FACTORS IN CV HEALTH
DIETARY FACTOS ROLES
1. Beta-carotene and anti-oxidant - reduce lipid oxidation w/c is an
nutrients, vit C & E important step in VLDL production
2. Vit B6 - necessary for endogenous
production of PUFA
3. Folic acid - improves blood flow
4. Nicotinic acid - large doses will reduce serum
cholesterol, B-Lp and triglycerides
5. Thiamin - necessary for normal heart muscle
function
6. Mg - prevents plaque formation
7. Ca - helps lower serum cholesterol and
triglycerides
8. Cr - may protect against plaque
-formation, lower LDL and raise HDL
9. Cu - may protect against atherosclerosis
• ROLE OF SELECTED DIETARY FACTORS IN CV HEALTH
DIETARY FACTOS ROLES
10. Fe - prevents high blood lipid levels
11. Va - protective effect is due to its role in
lipid metabolism
12. Zn - deficiency may lower blood
cholesterol but very high intake may
reduce HDL and thus increase the
risk of CHD
13. Trans-fatty acids (H-PUF) - increase blood cholesterol levels
14. Omega-3 FA, LC n-3 PUFAs, EPA, - protects CV health but excessive
DHA (deep-sea fish oils) amounts may increase risk of
hemorrhagic stroke
15. non-starch complex CHO - reduce blood cholesterol by binding
(soluble dietary fiber) cholesterol-containing bile salts
16. Phytochemicals in red wines and - protective effect is due to their
other plant foods antioxidant property
-- HYPERLIPIDEMIA --
• DEFINITION
- An elevation of plasma lipids including cholesterol,
cholesterol esters, phospholipids and triglycerides
- When defined in terms of class or classes of elevated
plasma lipoproteins, the term
hyperlipoproteinemia is used.
• CLASSES OF LIPOPROTEINS
 Chylomicrons
 Pre-β lipoprotiens (VLDL)
 β –lipoproteins (LDL)
 α-lipoproteins (HDL)
-- HYPERLIPIDEMIA --
DIETARY MANAGEMENT
TYPE I TYPE IIA TYPE IIB TYPE III TYPE IV TYPE V
LIPID ↑chlyom ↑ LDL ↑ LDL ↑ VLDL ↑ VLDL ↑ VLDL
ABNORM -icrons ↑C ↑ VLDL ↑TG,↑C norm. or ↑chlyom
ALITY ↑ TG & C ↑TG,↑C ↑TG,↑C -icrons
↑ TG & C
CHO NR NR 40% kcal 40% kcal 45% kcal 50% kcal
R -sweets R -sweets R -sweets R -sweets
FAT 25-35g ↑ PUF 40%kcal 40%kcal ↑ PUF 30%kcal
Type NR ↓ SF ↑ PUF ↑ PUF ↓ SF ↑ PUF
↓ SF ↓ SF ↓ SF
CHOLE NR <300 mg <300 mg <300 mg 300-500 300-500
mg mg
ALCOHOL Avoid Dr’s Disc Dr’s Disc Dr’s Disc Dr’s Disc Avoid
LEGEND: C or CHOLE – cholesterol TG – triglycerides

Dr’s Disc - physician’s discretion R – restricted NR – not restricted
-- ANGINA & PREINFARCTION ANGINA --
• CHARACTERISTICS
- Pain caused by demand on the heart when
inadequately supplied with blood.
- Pain precipitated by exertion, emotion and
stress
• ETIOLOGY
 atherosclerosis
-- ANGINA & PREINFARCTION ANGINA --
• DIETARY MANAGEMENT
DIETARY MODIFICATIONS / FACTOR RATIONALE
1. Dietary
 Small meals - so as not to overtax the heart
 Avoid gas-forming foods - to prevent abdominal distention
which may add pressure to the heart
 Low calorie for the obese - to attain DBW
 Low cholesterol, total fat - to lower cholesterol and
triglycerides in the serum
 Low SFA - to correct Lp disorder
 Alcohol in moderation - alcohol can induce arrhythmias and
in large amounts may depress
cardiac function
2. Avoidance of smoking

Nutrition in Cardio-Vascular Diseases

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Nutrition in Cardio-Vascular Diseases

Uploaded by

Copyright:

Available Formats

NUTRITION in CARDIO-

• Risk Factors for CVD

**LEVELS OF SODIUM RESTRICTION & INDICATION FOR USE:

• Arrhythmia - Low n-3 PUFA

LEGEND: C or CHOLE – cholesterol TG – triglycerides

You might also like