1. Cardiovascular System KNH 411

2. Hypertension Nutrition Therapy DASH – Dietary Approaches to Stop Hypertension *Decrease sodium, saturated fat, alcohol (w: one or less/day, m: two or less/day b/c may be taking multiple medications that could interact) 24-hr. recall Increase calcium, potassium, fiber ^daily products, ^fruits/veggies Lifestyle modifications Smoking, exercise (to increase HDLs) Weight loss BP, lipid profile come down to normal

4. Hypertension Nutrition Therapy Sodium restriction controversial “salt sensitive” or “salt resistance” Limit processed & cured foods, no added salt during preparation and cooking Limit to 2400 mg/day

7. Hypertension Nutrition Therapy DASH-Dietary Approaches to Stopping Hypertension Decrease Sodium, saturated fat, alcohol Increase calcium, potassium, fiber Lifestyle Changes

10. Atherosclerosis Etiology - risk factors cont. Physical inactivity Atherogenic diet (“western diet”)—high in fat and low in fiber Diabetes mellitus Impaired fasting glucose/ metabolic syndrome Cigarette smoke

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15. Atherosclerosis Nutrition Therapy Therapeutic Lifestyle Changes (TLC) developed as component of ATP-III Modifications in fat, cholesterol Rich in fruits, vegetables, grains, fiber Limit sodium to 2400 mg Include stanol esters (2 g/day)

16. © 2007 Thomson - Wadsworth

17. 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 Limit dietary cholesterol < 200 mg daily Lowering LDL cholesterol

19. Atherosclerosis Nutrition Therapy - Other Increase sources of soluble fiber Ridding body of cholesterol and free radicals Anti-inflammatory benefit **CVD disease related to soluble fiber Insoluble fiber is indigestible and helps with regulating poop! Increase intake of plant sterols Weight loss – BMI 18.5-24.9 Regular physical activity-tailored

20. Atherosclerosis Nutrition Therapy Prescription Assessment of dietary fat intake, saturated fat intake MEDFICTS assessment tool—most detailed Food frequency chart Evaluates cholesterol control (weekly consumption + serving size=score/rates risk of patients Dietary CAGE questions More simple than MEFFICTS Quick assessment of what patients are eating, seeing if there needs to be any scaling back—not exactly assessing what patient is taking in; great starting point with patients REAP (rapid eating assessment plan) Middle of CAGE and MEDFICTS Looks more specifically at each type food group, and then can see if they’re meeting all food requirements (ex: fruit servings) Target weight calculated Prioritize nutrition problems Multiple planned visits with R.D.

22. Ischemic Heart Disease Nutrition Therapy Post MI Decrease oral intake Medication prescription Clear liquids, no caffeine Don’t want to alter heart function Careful with excessive fluids Progress to soft, more frequent meals Individualized – use TLC recommendations

23. Heart Failure Nutrition Therapy Intervention Control signs and symptoms Managing getting patient enough calories for body to function until they can get a heart transplant (different than other 2 discussed) Promote overall nutritional status rehabilitation Sodium and fluid restriction Fluid balance is a huge concern when heart failure is severe 2000 mg Na (this is very restricted) Fluid 1 mL/kcal or 35 mL/kg Correction of deficiencies Increase nutrient density (no coffee or water because wasteful cc’s) Enhance oral intake (high calorie, high protein, small portions so system isn’t texed)

25. Heart Failure Nutrition Therapy Assess drug-nutrient interactions Losses of water-soluble vitamins Might want to recommend a multivitamin Supplementation may be warranted Consider arginine, carnitine and taurine in dietary regimen Aid is tissue repair and needed when body is in stressed state