1. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 18 Diet and Cardiovascular Disease

2. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Objectives Explain why sodium limited in some cardiovascular conditions Identify foods limited or prohibited in sodium- controlled diets

4. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. CVD Acute –Myocardial infarction (MI) –Also known as heart attack Chronic –Develops over time –Loss of heart function (continues)

7. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. CVD Heart may beat faster and enlarge to maintain circulation in compensated heart disease Inability to compensate leads to congestive heart failure (CHF)

8. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Atherosclerosis Cerebrovascular accident (CVA) or stroke –Blood flow to brain blocked or blood vessel bursts Peripheral vascular disease (PVD) –Affects vessels in extremities

12. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Risk Factors for Atherosclerosis Major: –Hyperlipidemia Elevated total cholesterol, high LDL, or low HDL –Hypertension –Smoking (continues)

13. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Risk Factors for Atherosclerosis Contributory factors: –Obesity –Diabetes mellitus –Male sex –Heredity –Personality type –Age –Sedentary lifestyle

14. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Hypertension Chronically high blood pressure Essential hypertension –Also known as primary hypertension –90 percent of cases –Cause unknown (continues)

28. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Hypertension Systolic pressure –Top number –Taken as heart contracts Diastolic pressure –Bottom number –Taken when heart rests (continues)

30. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Hypertension Measured in millimeters of mercury (mmHg) Normal: –Less than 120/80 Prehypertension: –120 to 139/80 to 88 (continues)

31. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Hypertension “Silent disease” –Sufferers can be asymptomatic Predisposing factors: –Heredity, age, obesity and African-American race Contributing factors: –Smoking and stress

33. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Adjustment to Sodium Restriction Transition may be difficult Gradual reduction easier Remind client of numerous herbs, spices, and flavorings allowed

37. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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