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Chapter 18

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Chapter 18

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  1. Chapter 18 Diet and Cardiovascular Disease

  2. Objectives • Identify factors that contribute to heart disease • Explain why cholesterol and saturated fats limited in some cardiovascular conditions • Identify foods to avoid or limit in cholesterol-controlled diet (continues)

  3. Objectives • Explain why sodium limited in some cardiovascular conditions • Identify foods limited or prohibited in sodium-controlled diets

  4. Cardiovascular Disease (CVD) • Affects heart and blood vessels • Leading cause of death and permanent disability in U.S. • Metabolic syndrome puts client at risk for CVD and type 2 diabetes

  5. Metabolic Syndrome • Risk factors in adults and children: • Abdominal obesity • Hyperlipidemia • High blood pressure • Insulin resistance • Elevated, highly sensitive C-reactive protein (CRP) in blood

  6. CVD • Acute • Myocardial infarction (MI) • Also known as heart attack • Chronic • Develops over time • Loss of heart function (continues)

  7. CVD • Heart may beat faster and enlarge to maintain circulation in compensated heart disease • Inability to compensate leads to congestive heart failure (CHF)

  8. Arteriosclerosis and Atherosclerosis • Arteriosclerosis • Arteries harden • Making passage of blood difficult • Sometimes impossible • Atherosclerosis • Thickening and weakening of artery walls by cholesterol and fatty deposits • Plaque

  9. Atherosclerosis • Plaque may cause reduced blood flow beyond obstruction and ischemia • Ischemia may cause pain • Angina pectoris • Chest pain • May radiate down left arm (continues)

  10. Atherosclerosis • If lumen narrows completely in coronary artery, heart attack occurs • Coronary artery bypass graft (CABG) • Procedure to bypass circulation around clogged artery (continues)

  11. Atherosclerosis • Cerebrovascular accident (CVA) or stroke • Blood flow to brain blocked or blood vessel bursts • Peripheral vascular disease (PVD) • Affects vessels in extremities

  12. Risk Factors for Atherosclerosis • Major: • Hyperlipidemia • Elevated total cholesterol, high LDL, or low HDL • Hypertension • Smoking (continues)

  13. Risk Factors for Atherosclerosis • Contributory factors: • Obesity • Diabetes mellitus • Male sex • Heredity • Personality type • Age • Sedentary lifestyle

  14. Medical Nutrition Therapy for Hyperlipidemia • Reduce quantity and types of fats in diet • And often calories • American Heart Association guidelines for blood cholesterol: • Desirable • 200 mg per dL or less (continues)

  15. Medical Nutrition Therapy for Hyperlipidemia • American Heart Association guidelines for blood cholesterol: • Borderline high • 200 to 239 mg per dL • High • 240 mg per dL or more (continues)

  16. Medical Nutrition Therapy for Hyperlipidemia • American Heart Association recommends: • Adult diets with less than 200 mg of cholesterol per day • No more than 20 to 35 percent of calories from fat • Maximum of 7 percent from saturated fats and trans fats • Maximum of 8 percent from polyunsaturated fats • Maximum of 15 to 20 percent from monounsaturated fats • Have proteins provide 12 to 20 percent of total calories • Have carbohydrates provide 50 to 55 percent of total calories

  17. Stop and Share • Consider the following scenario: • Your client has been given a very low-fat diet to follow. He expresses to you that it is almost impossible to follow this diet. What recommendations would you suggest? (continues)

  18. Stop and Share • Diet very low in fat seems unusual and highly unpalatable • Realize it takes two to three months to adjust to low-fat diet • Make change gradually if physician allows • Provide client with information about fat content of foods and food preparation methods (continues)

  19. Stop and Share • Encourage client to select whole, fresh foods • Prepare them without adding fat • Select lean meat • Remove all visible fat • Use fat-free milk and fat-free skim cheeses • Gradually introduce 25 to 35 g of fiber per day • Discuss challenges with dietitian and physician

  20. Cholesterol-Lowering Agents • If blood lipid levels not corrected after three to six months of fat-restricted diet alone, cholesterol-lowering drug may be prescribed • Food and/or drug interactions common

  21. MI • Caused by blockage of coronary artery supplying blood to heart • Heart tissue beyond blockage dies • Causes: • Atherosclerosis, hypertension, abnormal blood clotting, infection (e.g., those caused by rheumatic fever) (continues)

  22. MI • Initial shock causes fluid shift • Client may be thirsty • Client should be nothing by mouth (NPO) with IV fluids • When diet resumed, liquid diet recommended initially • Then, low-cholesterol, low-sodium diet in controlled portions (continues)

  23. MI • To allow heart to rest and heal, prescribed foods should be: • Not extremely hot or cold • Easily chewed and digested • Low in fibers • Limited in sodium to prevent fluid overload • Restricted in caffeine for first few days

  24. CHF • Decompensation or severe injury to heart muscle • Decreased circulation causes decreased oxygenation of body and fluid build up • Common to have shortness of breath, chest pain on exertion, and edema • Death can occur in severe cases (continues)

  25. CHF • Decreased nutrients to body tissues • Edema may mask problems of malnutrition and underweight • Fluid restriction may be ordered • Diuretics and sodium-restricted diet typically prescribed (continues)

  26. CHF • Diuretics can cause excessive loss of potassium • Blood levels should be monitored • Hypokalemia can upset heartbeat • Fruits excellent sources of potassium • Especially oranges, bananas, and prunes • But supplements may be given

  27. Hypertension • Chronically high blood pressure • Essential hypertension • Also known as primary hypertension • 90 percent of cases • Cause unknown (continues)

  28. Hypertension • Secondary hypertension • 10 percent of cases • Caused by another condition • E.g., kidney disease, problems of adrenal glands, use of oral contraceptives • Sphygmomanometer • Measures hypertension (continues)

  29. Hypertension • Systolic pressure • Top number • Taken as heart contracts • Diastolic pressure • Bottom number • Taken when heart rests (continues)

  30. Hypertension • Measured in millimeters of mercury (mmHg) • Normal: • Less than 120/80 • Prehypertension: • 120 to 139/80 to 88 (continues)

  31. Hypertension • Stage 1: • 140 to 159/90 to 99 • Stage 2: • 160/100 • Contributes to heart attack, stroke, heart failure, and kidney failure (continues)

  32. Hypertension • “Silent disease” • Sufferers can be asymptomatic • Predisposing factors: • Heredity, age, obesity and African-American race • Contributing factors: • Smoking and stress

  33. Dietary Treatment • Weight-reduction diet • Sodium-restricted diet • Potassium-rich foods if diuretics used • Increased fruits and vegetables • Six to 10 servings per day • Helps lower blood pressure

  34. Sodium-Restricted Diets • Regular diet with limited sodium • Food and Nutrition Board recommends daily intake of no more than 2,300 mg • Safe minimum at 500 mg per day for adults • African-Americans and people with hypertension should limit sodium intake to 1,500 mg per day (continues)

  35. Sodium-Restricted Diets • Sodium-free diet impossible • Most foods naturally contain sodium • Processed foods often contain high amounts • Other sources of sodium: • Water contains varying amounts • Some over-the-counter medicines contain some amounts

  36. Adjustment to Sodium Restriction • Transition may be difficult • Gradual reduction easier • Remind client of numerous herbs, spices, and flavorings allowed

  37. Considerations for the Health Care Professional • Most cardiac clients told to reduce fat, sodium, and sometimes amount of calories in diets • Help cardiac clients want to learn how to help themselves via nutrition

  38. Conclusion • CVD • Leading cause of death in U.S. • May be acute, as in MI, or chronic, as in hypertension and atherosclerosis • Hypertension may be symptom of another disease (continues)

  39. Conclusion • Cholesterol associated with atherosclerosis • Low-cholesterol or fat-restricted diet might be prescribed • Health care professional can encourage client to maintain healthy weight, exercise, limit salt and fat intake, and avoid smoking to reduce risk of heart disease