nutrition for cardiovascular diseases 2012

7/27/2019 Nutrition for Cardiovascular Diseases 2012

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Nutrition forCardiovascular Diseases


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Outline

I. Nutritional requirements

II. Essential Hypertension

III. Myocardial Infarction

IV. Case


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ANATOMI & FISIOLOGI

JANTUNG

Otot jantung termasuk otot

bergaris

Mempunyai miofibril

Otot jantung saling berhubungansatu sama lain /sinsisium

Sifatsinsisium apabila satu sel otot

jantung terangsang, potensial aksi

akan menyebar dari satu sel ke sel

lain

Sinsisium


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Cardiovascular Diseases

It is a general term for any disease of the heart

(cardio) and blood vessels (vascular)

When the blood flowing through the heart and tothe body is obstructed or when something goes

wrong with the specialized cells that promote

contraction of the heart, or when the blood itself

that supplies nutrients to the heart is blocked, thena disease condition develops.


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Diseases:

Myocardial Infarction

HypertensionCongestive Heart Failure

Atherosclerosis

Coronary artery disease


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In the Philippines, diseases of the heartand of the vascular system are classified

as second and third causes of death.


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Manifestations Dyspnea on exertion Weakness

Pain in the chest

Severe failure marked dilation of the

heart with enlargementof the liver

Impaired circulation tothe kidneys and tissues-edema develops

Edema fluid collectsfirst in theextremities, withincreasing failure in

the abdominal andchest cavities.


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Cardiovascular: Major risk

Factors

1. Hypertension2. Cigarette smoking

3. Obesity (BMI >= 30kg/m2)

4. Physical Inactivity

5. Dyslipidemia6. Diabetes Mellitus

7. Microalbuminuria or estimated GFR


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Energy Requirements

Mild degree ofweight loss even of

normal wt.

1000-1500 caloriediet-obese patient in

bed

This leads to

slowing of the heartrate, a drop in blood

pressure and

improved cardiac

efficiency


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Sodium requirements

A sodium-restricteddiet is indicated

when there is

retention of fluid and

sodium.

Sodium restriction-

500mg satisfactory

in CHF Moderately

restricted sodium-

1000mg, once

edema disappeared


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Sodium-Restricted Diet

Sodium-restricted diets are used for theprevention, control and elimination of edema

in many pathologic conditions, and

occasionally for the alleviation of

hypertension.

Sodium-restricted diets should be

prescribed in terms of milligrams of sodium


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Mild Sodium Restriction Moderate Sodium

Restriction

Strict Sodium Restriction

(2400mg or 1 tsp cruderock salt/day)

1200mg or tsp cruderock salt/day

600mg or tsp crude rocksalt/day

Salt may be used in

cooking, but no salty

foods are permitted; no

salt is used at the table

No salt in cooking

Permits slightly higher

protein level if neededMay include measured

amount of salt or salted

bread and butter

No salt is used in cooking

Careful selection of foods inmeasured amounts

This level is used as a

maintenance diet incadiac and renal

diseases

This level may be used for

Congestive heart failure,occasionally in renal diseases

with edema, cirrhosis of the

liver.

Levels of Sodium Restriction


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Fluid Requirements

Restriction of fluid is not required so

long as the sodium is restricted.

Water is retained only when there issufficient sodium to maintain

physiologic concentrations


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Food requirements

Abdominal distention must be avoided

Omit vegetable of the cabbage family,

onions,legumes, turnips, melon and

sweet potato. Constipation must be avoided

Use fruits and vegetables, prune juice,

and a sufficient food intake


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HYPERTENSION

BP= CardiacOutput X

PeripheralResistance

BLOOD VOLUME

Sodium

Mineralocorticoids

CARDIAC FACTORS

Heart rate

Stroke Volume

HUMORAL FACTORS

Constrictors Dilators

Angiotensin II ProstaglandinsCatecholamines Kinins

Thromboxane NO

endothelin

Neural Factors

Constrictors Dilators

-adrenergic B-adrenergic

LOCAL FACTORS

Autoregulation


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Classification of HypertensionBp

classification

Systolic BP

(mmHg)

Diastolic BP

(mmHg)

Lifestyle

Modification

Initial Drug

therapy

Normal 100 yes 2 drug

combination

for most


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Treatment

Goals of therapy:Ultimate goal: reduction of cardiovascular

and renal mortality and morbidity

Achieve SBP goal

Treating SBP and DBP to targets that are


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The Mediterranean diet

The Mediterraneandiet is recognized as

capable of reducing

the risk of

cardiovasculardisease and cancer.


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Treatment: Dietary Management

Carbohydrate: Decreased since it is the most source of energy

Fat:

Decreased to 25% of the energy requirement; more of

the polyunsaturated fats

Sodium:

Decreased to reasonable level

Fruits and Vegetab le:

Increased to supply vitamins, minerals and fibers


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Congestive Heart Failure

Heart fails to maintain a satisfactory circulation ofthe bodys various metabolic needs

It results in reduced heart pumping efficiency of the

ventricles, with less blood circulating.

CHF can best be treated by a combination of diet,

rest, diuretics, digitalis, and oxygen therapy.

The diet for CHF is restricted in Sodium


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Dietary Management


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AHA UPDATED DIETAY

GUIDELINES

CHOOSE 5 SERVINGS OF FRUITS ANDVEGETABLES PER DAY

CHOOSE FATS WITH 2GRAMS OF SATURATED FATOR LESS-CANOLA OIL OR OLIVE OIL AND TUBMARGARINE

INCLUDE FAT FREE OR LOW FAT MILK PRODUCTS,

FISH, BEANS, SKINLESS CHICKEN AND LEANMEATS


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PRIMARY SOURCES OF


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PRIMARY SOURCES OF

OMEGA 3

FATTY FISH-SALMON, TUNA , SARDINESMACKERAL

FLAXSEEDS

WALNUTST

CANOLA AND SOYBEAN OILS

FISH OILS-COROMEGA

OMEGA 3 ENRICHED EGGS AND MILK


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ANTIOXIDANT VITAMIN


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ANTIOXIDANT-VITAMIN

RECOMMENDATIONS

MULTIVITAMIN+MINERALS B6, B12,AND FOLIC ACID

VITAMIN C

VITAMIN E

COENZYME Q10

SELENIUM


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EMERGING RISK FACTORS

HOMOCYSTEINE-AN AMINO ACID FORMED INTHE BREAKDOWN OF DIETARY PROTEIN-MAY

SIGNIFICANTLY INCREASE THE RISK OF

HEART DISEASE AND STROKE

BLOOD LEVELS OF HOMOCYSTEINE DAMAGEARTERIAL WALLS

PLATELET AGGREGATION

THROMBOSIS


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Degree


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Degree

OverweightBMI Mortality Risk

Non-Obese less than 27 RR = 1.0

Mild Obesity 27-30 RR = 1.3

Moderate

Obesity30-37 RR = 1.4-2.2

Severe Obesity 37-45 RR = 3-5

Morbid Obesity greater than 45 RR = 6-13


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2nd & 3rd Hospital Day:


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2nd & 3rd Hospital Day:

Low-Fat Liquid Diet

Low-Fat Liquid Diet:

500-800 kcal

1000-1500 mL of liquid

Small frequent feeding

Slender Now Thick

Shake, ToppFast Diet

Plan, Slim Fast,

Medifast, and Optifast


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How To Make Liquid Diet


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Given 1200 ml of liquid= 1200 ml/4 pack

= 300 ml/pack

Feeding Frequency

7 am, 10 am, 1 pm

4 pm, 7 pm, 10 pm,

Avoid extreme temp food

arrhythmia

No caffeine

Stimulate the heart

Blender Protein powder (1 scoops =

15+ g of protein

Orange juice (100 ml=45kcal)

Whole milk (milk powder 4tspn=170 kcal)

Water

Energy = scoops proteinpowder + 100 ml OJ + 1tspn milk powder +200 mlH2O

= 8 g (4kcal/g) + 45 kcal + 43 kcal= 32 + 45 + 43 = 119kcal/feeding

Total Kcal per day=119kcal/feeding X 6 feeding/day=714 kcal/day

Average adult: 46 to 56 g ofprotein a day


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This Sample Diet Provides the


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This Sample Diet Provides the

Following

Calories: 1940 kcal Protein 73 gm (15%)

Carbohydrates: 302 gm (63%) Fat: 53 gm (23%)

Sodium: 1500 mg Fiber: 24 gm


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Thank You


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Thank YouBefore After

nutrition for cardiovascular diseases 2012

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