Atherosclerosis Etiology - risk factors cont./ typical profile Physical inactivity Atherogenic diet- or the Western diet, high in fat and low in fiber Diabetes mellitus- highest risk of CAD, because they have metabolic syndrome Impaired fasting glucose/ metabolic syndrome Cigarette smoke- decreasing vascular system, CAD, stroke
Atherosclerosis Nutrition Therapy Therapeutic Lifestyle Changes (TLC) developed as component of ATP-III Modifications in fat, cholesterol- more advance than the DASH Rich in fruits, vegetables, grains, fiber Limit sodium to 2400 mg Include stanol esters- up to 2 grams per day
Atherosclerosis Nutrition Therapy - Fat Modifications Total fat 25-35% of calories Very-low-fat diets Saturated fat < 7% of calories Avoid trans fats Increase intake of monounsaturated fats & Polyunsaturated omega-6 fatty acids Increase intake of omega-3 essential fatty acids Cold water fish, hopefully three times per week Limit dietary cholesterol < 200 mg daily Trying to lower LDL levels with this
Atherosclerosis Nutrition Therapy - Other Increase sources of soluble fiber- legumes, oats, ridding of cholesterol, and free radicals, lowering cholesterol, helpful for HD, anti-inflammatory Increase intake of plant sterols Weight loss – BMI 18.5-24.9 Regular physical activity What level can they maintain or take? Work with doctor, trainer as well
Atherosclerosis Nutrition Therapy Prescription Assessment of dietary fat intake, saturated fat intake MEDFICTS assessment tool- food frequency chart to be used with individuals, comes out with a score that you can instruct on, which clients to see first Dietary CAGE questions- even simpler, quick assessment of what they are eating- cheese, animal fats, got it away form home, eat (extra) high-fat commercial products- assessment of saturated fats and cholesterol intake, just get them to cut back as a starting point REAP- rapid, eating, assessment, plan, in between CAGE and MEDFICTS plan Target weight calculated Prioritize nutrition problems Multiple planned visits with R.D.
Ischemic Heart Disease Nutrition Therapy Post MI Decrease oral intake Clear liquids, no caffeine! Progress to soft, more frequent meals Individualized – use TLC recommendations
Heart Failure Nutrition Therapy Intervention Control signs and symptoms Promote overall nutritional status rehabilitation Sodium and fluid restriction 2000 mg Na Fluid 1 mL/kcal or 35 mL/kg Correction of deficiencies Increase nutrient density- coffee, or water- give ensure not to waste calories Enhance oral intake-
Heart Failure Nutrition Therapy Assess drug-nutrient interactions Losses of water-soluble vitamins Supplementation may be warranted Consider arginine, carnitine and taurine in dietary regimen- all aid in tissue repair