1. Cardiovascular System KNH 411

2. Hypertension Nutrition Therapy DASH – Dietary Approaches to Stop Hypertension Decrease sodium, saturated fat, alcohol Increase calcium, potassium, fiber Lifestyle modifications- smoking, exercise (increase HDL) Weight loss (everything comes back to normal) Increase Ca, K, and Fiber Decreased alcohol

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 Hardest to change

10. 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

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15. 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

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 Cold water fish, hopefully three times per week Limit dietary cholesterol < 200 mg daily Trying to lower LDL levels with this

19. 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

20. 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.

22. Ischemic Heart Disease Nutrition Therapy Post MI Decrease oral intake Clear liquids, no caffeine! Progress to soft, more frequent meals Individualized – use TLC recommendations

23. 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-

25. 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