NS 210: Seminar 8 Nutritional Assessment in Disease Prevention

Overview Nutritional assessment in disease prevention Coronary heart disease Osteoporosis

Coronary Heart Disease Coronary Heart Disease (CHD) –Leading cause of death in the US despite >26% decline in CHD death rates since 1988 –Associated with several risk factors Elevated blood cholesterol High blood pressure Cigarette smoking

Coronary Heart Disease (CHD) Risk Factors Risk factors for CHD –Positive risk factors Cigarette smoking Hypertension (blood pressure >140/90) Low HDL cholesterol <40 –Goals »Women >55 »Men > 45 Family history of premature CHD Age (men >45, women >55) –Negative Risk Factors HDL Cholesterol >60 –10-year risk:

Heart Attack Warning Signs Heart attack warning signs –Chest discomfort –Discomfort in other areas of the upper body Arm, back, neck, jaw –Shortens of breath –Other signs Cold sweat, nausea, lightheadedness

CHD Risk – Elevated Cholesterol CHD risk is directly related to serum levels of total cholesterol and LDL cholesterol CHD risk is inversely related to levels of high HDL cholesterol National Cholesterol Education Program (NCEP) desirable levels of total cholesterol in adults –<200mg/dL

Atherosclerosis

How is CHD Diagnosed? Doctors will diagnosis CHD based on: –Your medical and family history –Risk factors –Results of a physical exam and diagnostic test procedures EKG (Electrocardiogram) Stress Testing Echocardiography Chest X-Ray Blood tests Electron-Beam Computed Technology Coronary Angiography and Cardiac Catheterization

How is CHD Treated? Lifestyle Changes –Reduce high blood pressure –Reduce high cholesterol Follow a Heart Healthy Eating Plan Therapeutic Lifestyle Changes DASH Diet Increased Physical Activity Maintain a Healthy Weight Smoking Cessation Stress Reduction Medications Cardiac Rehab

Dietary Factors and Cholesterol Factors that can influence cholesterol and lipoprotein levels –Saturated Fats & Cholesterol Raise LDL cholesterol –Unsaturated Fats Polyunsaturated Fats –Lower LDL Monounsaturated Fats –Lower LDL –Maintain HDL cholesterol –Dietary Fiber –Sugar

CHD and Hypertension Hypertension is one of the most common risk factors for cardiovascular disease and renal disease –1 in 4 Americans has hypertension or is taking antihypertensive medications –Systolic >120mm HG and diastolic >80mmg HG increases risk for cardiovascular disease Most important risk factors for hypertension –Sodium intake –Excessive energy consumption –Physical inactivity –obesity –Alcohol consumption –Inadequate potassium intake

Nutrition Assessment in Disease Prevention: Osteoporosis Osteoporosis –Bone mineral content is decrease –Resulting in great susceptibility to fracture –Common fracture sites - pelvis vertebrae, hip, distal forearm, humorous Peak bone mass –Varies considerably among individuals because of Heredity Sex Race Environmental factors

Nutritional Assessment in Disease Prevention Osteoporosis –Cost In 2005 –Osteoporosis-related fractures were responsible for an estimated $19 billion in costs By 2025 –Experts predict that these costs will rise to approximately $25.3 billion

Risk Factors for Osteoporosis –Being female –Older age –Family history of osteoporosis or broken bones –Being small and thin –Certain race/ethnicities such as Caucasian, Asian, or Hispanic/Latino although African Americans are also at risk –History of broken bones –Low sex hormones –Diet –Inactive lifestyle –Smoking –Alcohol abuse –Certain medications –Certain diseases and conditions

Prevention

Bone Densitometry Bone densitometry –The measurement of bone mineral content –Important in early detection and treatment of osteoporosis and monitoring progression and response to treatment –Dual-energy X-Ray Absorptiometry (DEXA) is the most widely used technology for determining bone mineral density Quantitative Ultra-songoraphy (QUS) –Identify those persons likely to benefit from DEXA testing

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