NUTRITION ANALYSIS AND ASSESSMENT

Seminar 8 – Nutritional Assessment in Disease Prevention

Nazia SadatRD, LDN, MS, MPH

Introduction

The prominent role of diet and nutrition in many leading causes of death for North Americans – gives nutrition an important role in disease prevention

We will discussing 3 major chronic diseases states: Coronary Heart Disease Osteoporosis Diabetes

Nutritional Assessment in Chronic Disease

• Relationship between nutrition and overall status and the prevention of chronic disease has been well documented

• Physiological changes--85% of older adults have one or more nutrition-related problem

• Most common: • obesity, diabetes, cardiovascular disease,

hypertension, arthritis, osteoporosis and malnutrition

• Conditions that require specific vitamins and minerals include: • decrease in immune function, increased gastric pH,

and increase in oxidative stress

CORONARY HEART DISEASE

Coronary Heart Disease

Coronary Heart Disease/Coronary Artery Disease Collectively known as CVD Occurs when coronary arteries supplying the

heart with oxygen and nutrients becomes narrowed and inelastic because of arthrosclerosis Artherosclerosis - is the condition in which an

artery wall thickens as the result of a build-up of fatty materials such as cholesterol.

Cardiovascular Disease

• CVD affects more than 13 million American• #1 cause of deaths in the US• Males and Females

• Claimed 616,067 lives in 2007

• Any 1 of the 50 different disease affecting the heart and blood vessels• CHD• Stroke• Peripheral vascular disease

Risk Factors of CHD

• Excess weight for height• BMI >25

• Abdominal fat (android obesity)• Low HDL• <40 mg

• Hypertension• >140/90 mm Hg

• Lipid profile• High total cholesterol, Low HDL, High LDL

• Diabetes• Physical activity• Cigarette Smoking• Family history• Gender • Age: Men >45 years Women >55 years

Question

Which Cholesterol is better, LDL or HDL?

TOTAL CHOLESTEROL

Less than 200 mg/dL Desirable

200-239 mg/dL Borderline High

240 mg/dL and above High

LDL CHOLESTEROL

Less than 100 mg/dL Optimal

100-129 mg/dL Near Optimal

130-159 mg/dL Borderline High

160-189 mg/dL High

190 mg/dL and above Very High

HDL CHOLESTEROL

More than 60 mg/dL More is better

CHD

Because cholesterol, triglycerides, and other lipids are fat soluble, they are transported in the blood by lipoproteins.

Strong causal relationship between elevated LDL and mortality from CHD As LDL increases, risk of CHD rises as well

The National Cholesterol Education Program (NCEP) has set desirable levels of total cholesterol in adults at <200mg/dL

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

How is CHD Diagnosed?

Diagnosis of CHD is 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

Addressing High Cholesterol

Two ways of addressing high cholesterol levels Population based approach Patient based approach

Population based approach Emphasizes dietary and lifestyle changes

for people to lower cholesterol levels in the entire population

Patient based approach Identification and treatment of

individuals with elevated cholesterol levels by physicians

Dietary Factors and Cholesterol

Factors that can influence cholesterol and lipoprotein levels Saturated fats

Raise LDL cholesterol Unsaturated Fats

Polyunsaturated Fats Lower LDL and HDL

Monounsaturated Fats Lower LDL Maintain HDL cholesterol

Therapeutic Lifestyle Changes Diet • <200 mg of cholesterol per day• Limit sodium to <2400 mg per day• 25%-35% of daily calories from total fat• <7% saturated fat from total calories• PUFA upto 10% of total calories• MUFA upto 20% of total calories• Carbohydrates: 50-60% of total calories• Protein: 15% of total calories• Regular Exercise

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 ETOH consumption Inadequate potassium intake

Metabolic Syndrome

Abdominal Obesity Waist

circumference Men: >40 inches Women: >35 inches

Triglycerides >150 mg/dL

HDL cholesterol <40 mg/dL

Fasting Plasma glucose >110 mg/dL

Blood Pressure Systolic: >130 mm

Hg Diastolic: >85 mm Hg

Defined as “a person has multiple metabolic risk factors such as abdominal obesity, hypertension, insulin resistance and elevated triglycerides.

DIABETES

Diabetes

• According to the National Diabetes Information Clearing House• 23.6 million people have diabetes• 7.8% of the population have diabetes

• Risk factors for diabetes• Age >45 years• Overweight (BMI >25)• Family history• Physical inactivity• History of gestational diabetes• Hypertension (>140/90 mm Hg in adults)• PCOS• HDL <35mg/dL

Types of Diabetes

• 5 Types • Type 1: develops when the body’s immune system

destroys pancreatic beta cells, the only cells in the body that make the hormone insulin that regulates blood glucose.

• Type 2: In adults, type 2 diabetes accounts for about 90% to 95% of all diagnosed cases of diabetes. • It usually begins as insulin resistance, a disorder in which the cells

do not use insulin properly• As the need for insulin rises, the pancreas gradually loses its

ability to produce it.

• Gestational Diabetes: glucose intolerance in pregnant women

• Impaired fasting glucose: stage between normal glucose and diabetes• >100 mg/dL but <126 mg/dL

• Prediabetes: >140 mg/dL but <200 mg/dL

Nutritional Assessment of Diabetes

• Normal Blood glucose levels:• 80 – 110 mg/dL

• Nutritional assessment:• Body weight assessment• Height, Weight, BMI

• Waist Circumference• Men: >40 inches• Women: >35 inches

• blood pressure• >140/90 mm Hg

• HbA1c• Looks at blood glucose levels over a period of 3

months• <7% is good glucose control

Diabetes (continued)

• Nutritional recommendations: • Carbohydrates• Amount is more important than the source

• Protein• 15%-20% of total calories

• Fat• <7% saturated fat• <300 mg cholesterol

• Alcohol• 1 drink for women• 2 drink for men

Question?

What are the 3 most common signs of diabetes?

OSTEOPOROSIS

Osteoporosis

• Often called the “silent epidemic”• 1 in 9 or 10.29% or 28 million people in USA have

osteoporosis• 1 in 3 women over 50 will experience osteoporotic

fractures, as will 1 in 5 men • Characterized by a decrease in bone mass and

deterioration of bone tissues, without external evidence

• Visible Signs:• Deformity of the spine – widow’s hump

• Primary Osteoporosis: not related to another disease• Secondary Osteoporosis: related to another disease

– hyperthyrodism, amenorrhea

Risk Factors for Osteoporosis

Major Risk Factors Low bone mineral

density History of fractures Female >65 years of age Caucasian Menopausal women

Minor Risk Factors Impaired vision Dementia Alcoholism Physical inactivity Body weight

<127#

Bone Mineral Density

Between 20-25 years is when we achieve peak bone mass

Once peak bone mass is reached It declines at a rate of 0.3%-0.5% per year

• What can we do?• Get adequate amounts of calcium and Vit D

THROUGHOUT life• Weight-bearing exercise• Supplementation of Vit D and calcium to those with

a strong family history• Talk to a health care professional about bone

health

Question?

How many mg of calcium do 19-50 year olds need per

day?

Recommended Calcium Age Recommended

calcium intake (milligrams a day)

1–3 years 500

4–8 years 800

9–18 years 1,300

19–50 years 1,000

Older than 50 years 1,200

Any Questions?

Reminder

Quiz 8 Everything in this unit – lecture notes, readings

Project Discuss your clients risk of Coronary Heart

Disease Compare your clients current diet to the Nutrient

Composition of the Therapeutic Lifestyle Change diet

Use the MEDFICTS dietary assessment questionnaire (appendix E)