Medical Nutrition Therapy: CVD Flashcards
(34 cards)
Obesity diagnosis summary
BMI above 30, Body fat %above 30% for women and 25% for men
Obesity assessment
intra-abdominal adipose tissue, independent of BMI, correlates strongly with increased risk of CVD, stroke, dyslipidemia, hypertension and Type II diabetes in men and women
Criteria for Metabolic syndrome
Abdominal obesity: Men waist >40 inches, Women waist >35 inches; Pre-Hypertension: BP>1/85 mmHg; Glucose intolerance FBG>110 mg/dL; High Triglycerides >150 mg/dL; Low HDL-C Men <40 mg/dL, Women <50 mg/dL
Morbidity associated with increased Risk from Obesity
Cardiovascular system, dermatology, endocrinology and reproduction, Gi System, Neurology, Oncology, Psychiatry, Respiratory, Rheumatology and orthopedics, Urology and nephrology
Key points from pizzorno: obesity
-Reduction of excess calorie intake -minimize carbohydrates
-caloric intake <1500
-minimize processed foods
-cease lifestyle of physical inactivity
- GGT>25…convert to organic foods
-NAC to increase glutathione
-optimize brain serotonin- 5HTP
-enhance satiety and decrease appetite-viscous soluble fiber
-increase cellular sensitivity to insulin-chromium
-inhibit conversion of carbs to adipose and inhibit appetite- Hydroxycitrate (HCA)
-Increase thermogenesis-Medium chain triglycerides (MCT) from coconut oil
Obesity treatment goals
-weight reduction (lower BP, serum glucose, LDL-C and triglyceride levels)
-Lifestyle modifications
-Increased physcial activity
1. CDC recommends 30 min. per day, 5 days week
2. IOM recommends 1 hour per day for adults
-Diets
1. REcommendation of 45-65 % of calories come from carbs, 20-35 % fat, rest protein
2. Replace saturated fats with MUFAs
3. High fiber foods
4. Calorie reduction
5. DASH diet
Obesity: Pharmacotherapy Options:
-Xenical(Orlistat)- Activity occurs in the small intestine and promotes weight loss by inhibiting gastric and pancreatic lipases, partially blocking hydrolysis of triglycerides.
-Qsymia (topamate and phentermine) suppresses appetite and promotes satiety.
-Belviq-selective agonist of the serotonin 2C receptor
MNT Cardiovascular Disease (CVD)
-Electrical activity of the heart dependent on CA ++, Mg ++ and K+ ions for normal cardiac electrical and contraction activity.
-Blood fluid and volume dependent on NA+, K+ and free water homeostasis.
-Excessive salt retention associated with ascites, edeme, and anasarca, excessive depletion can reduce effective intravascular volume.
-Symptomatic inappropriate anti-diuretic hormone secretion (SIADH) can cause hyponatremia
-Food/drug interactions to monitor: coumadin, digoxin, calcium channel blockers, beta blockers, diuretics, ACE inhibitors, peripheral vasodilators, central and peripheral alpha-blocking agent/amiodarone or other antiarrhythmic medications.
Atherosclerosis (CVD)
-the buildup of fats, cholesterol and other substances in and on the artery walls. This buildup is called plaque. The plaque can cause arteries to narrow, blocking blood flow.
-Pathogenesis in a group of disorders collectively termed CVD.
disorders termed CVD
-Heart disease
-coronary artery disease (CAD)
-myocardial, pulmonary, or cerebral infarction
Major risk factor of CVD
-smoking- 70% greater risk of death than non smokers
-elevated cholesterol
-High BP
-Diabetes
-Physical inactivity
-Other: insulin resistance, low thyroid function, low antioxidant status, elevated c-reactive protein, low levels EFAs, increased platelet aggregation, low level MG and K, Type A personality
CVD assessment
-Lab tests
-total cholesterol (should be <200 mg/dL)
-LDL (<130 mg/dL)
-HDL (>40 mg/dL men; >50 mg/dL women)
-Risk factor ratios: Ratio of TC to DHL-C below 4.2, ratio of LDL-C to HDL-C is above 2.5
-Triglycerides (should be <150 mg/dL)
-C-reactive protein
-lipoprotein (a)
-Fibrinogen
-Homocysteine
-Ferritin (iron binding protein)
-lipid peroxides
-exercise stress test
-electrocardiography
-echocardiography
CVD Minimize obstacles
-reduce dietary stress- choose mediterranean, ornish, DART or Lyon diet
-weight management
-aerobic exercise
-eliminate smoking
-anger and aggression management
-Vitamin D
-Thyroid therapy
CVD Tailored
-Enhance antioxidant status: vit. C, Vit. E, CoQ10, colorful fruits and vegetables, red wine
-Ensure Omega 3 EFA sufficiency: Fish oil, Flaxseed oil
-Support integrity of microvasculature: Grapeseed extract, Pine bark extract.
-Hyperlipidemia: Niacin, Garlic
-Diabetic Hypertriglyceridemia: pantethine
-Hyperhomocysteinemia: vitamin B6, B12, Folic Acid, Vitamin C
-Previous MI or Stroke: Gingko biloba
CVD (general)
-Group of interrelated diseases that include atherosclerosis, hypertension, ischemic heart disease, peripheral vascular disease, heart failure.
-1-3 americans have one or more type of CVD
-#1 killer in the US
-Life time risk: 2 in 3 in American men, 1 in 2 for women
CVD Major risk factors, Modifiable risk factors
1 Major risk factors:
-Hypertension
-Age >45 years men, >55 years woman
-Diabetes Mellitus
-Estimated glomular filtration rate <60 ml/mn
-microalbuminuria
-Family history of premature CVD in men <55 years and women <65
CVD modified risk factors
-lipoprotein profile
-LDL-C elevated
-Total Triglycerides elevated
-Elevated TMAO (Trimethylamine N-oxide
-HDL- C low
-Inflammatory Markers
CVD Inflammatory markers
-Genetic markers: angiotensin !! receptor type-1 polymorphism
-oxidized LDL-C
-Adhesion molecules
-selectins
-free fatty acids
-cytokins
-interleukin 1, interleukin 6
-tumor necrosis factor-alpha
-acute phase reactants
-fibrinogen
-creactive protein
-serum amyloid A
-white blood cell count
-Erthrocyte sedimentation rate
-TMAO
Pathophysiology and care management algorithm for atherosclerosis
-smoking, obesity, hypertension, elevated LDL-cholesterol
-Genes, high saturated fat, cholesterol diet, elevated serum triglycerides, inactivity, diabetes, stress
-decreased HDL-cholesterol, ageing, hyperhomocysteinemia, endothelial dysfunction
Atherosclerosis (clinical findings, nutrition assessment, medical management, nutrition management)
CF: Elevated LDL cholesterol, elevated serum triglycerides, elevated c-reactive protein, low HDL-cholesterol
NA: BMI evaluation, waist circumference, waist to hip ratio (WHR), Dietary assessment (SFA< trans fatty acids, fiber, sodium, alcohol, sugar, phytonutrients)
MM: Lifestyle change, HMG CoA reducatse inhibitors (statins), Triglyceride lowering medication, blood pressure lowering medication, medication for glucose management, percutaneous coronary intervention (PCI) Balloon, stent, antiplatelet therapy
NM: DASH dietary pattern, mediterranean diet pattern, weight reduction, increase dietary fiber to 25-30 g/day or more, add fruits and vegetables, CoQ10 for those on statin drugs.
CVD lifestyle recommendations based on risk factors
elevated LDL-C: decrease saturated fat, increase soluble fiber, weight loss, avoid trans fat
Low HDL-C: increase exercise, weight loss
Diabetes and insulin resistance: weight loss, decrease BP, decrease carbs, increase exercise
Elevated triglycerides: increase fish oils, weight loss, decrease alcohol, decrease carbs
Obesity (BMI>30): Weight loss, increase exercise, decrease portion size
Hypertension: Decrease sodium, increase fruits and veg, decrease alcohol, weight loss, increase exercise
Metabolic syndrome: weight loss, increase exercise, custom recommendations for macro intake
CVD medical nutrition
- Reduce saturated fats
-major contributors: fatty meat and poultry, dairy products, bread/processed snack foods, desserts/sweets
2.Substitutions of dietary sources of PUFAs (omega 3 and omega 6) lowers LDL-C and reduces risk for CHD
- long chain omega 3 decrease serum triglycerides, platelet aggregation, and inflammation
-1 g/day of EPA/DHA can reduce death from cardiac event
-Best sources fatty fish - Diet high in MUFA (olive oil) show improvement in risk factors
MNT Hypertension Key points
-Hypertension often is affection by high sodium intake and may be ameliorated by dietary sodium restriction and supplemental potassium, calcium, and magnesium.
-Appropriate dietary modification should account for concurrent cardiovascular, renal and endocrine conditions.
Hypertension ranges
Prehypertension: 120-139/80-89 mmHg
Stage 1: 140-159/90 to 99 mm Hg
Stage 2: 160 + /100 + mmHg
