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Nutrition therapy for:
Hypertension
Atherosclerosis
Ischemic heart disease
Heart failure
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Hypertension
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Nutritional treatment
Nutrition Lifestyle
therapy modification
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Nutrition diagnosis
Common nutrition diagnoses for individuals with HT:
Excessive energy intake
Overweight/obesity
Physical inactivity
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Nutrition intervention
Nutrition therapy guided by:
The patients hypertension history
Other medical risk factors
Current medical treatment
Readiness for behavior change
Nutrition education
A Cochrane data analysis of 23 clinical trials
confirmed that nutrition education:
fiber, fruit, & vegetable intake
total dietary fat intake
blood pressure, LDL-c, & total serum cholesterol
Brunner EJ,Th orogood M, Rees K, Hewitt G. Dietary advice for reducing
cardiovascular risk. Cochrane Database Syst Rev. 2005 Oct 19;(4):CD002128.
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DASH
DASH study (1990s): n=459; SBP <160 mmHg, DBP 80-95
mmHg; 27% HT; 50%; 60% African-American.
3 eating plans:
= what many Americans consume;
= what Americans consume but higher in fruits & vegetables
DASH eating plan
All: 3000 mg of sodium daily
None of the plans was vegetarian or used specialty foods
Results: both F & V & DASH reduced BP
DASH had greatest effect, esp. for high BP
BP reductions came fastwithin 2 weeks
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Grains 6 68 10 11 12 13
Vegetables 34 45 56 6
Fruits 4 45 56 6
Fats, oils 2 23 3 4
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Weight loss
Weight reduction is a standard component of nutrition
therapy for HT
Weight loss >5 kg or even <10% SBP & DBP
Waist circumference is an independent predictor of HT
risk
A normal BMI or overweight, waist circumference should
be measured
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Sodium
Sodium modifications incidence HT 17%.
BP control through sodium restriction incidence of
cardiovascular disease, renal disease, and stroke
DASH Sodium (n=412), SBP 120159 mmHg & DBP
8095 mmHg, 41% HT, 57% , 57% African-Americans
2 eating plans: DASH or typical Americans
Followed for a month, sodium levels:
a higher intake = 3,300 mg/d (the level consumed by many
Americans)
an intermediate intake = 2,400 mg/d
a lower intake = 1,500 mg/d
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Sodium recommendation
<2300 mg of sodium 6 g of NaCl each day
Teach the client strategies for limiting intake to 2300
mg/day (100 mEq) and provide information
Only small amounts of sodium occur naturally in food
Limiting the intake of highly processed foods
Avoiding those foods that are cured using salt
Omitting salt during the cooking and preparation
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Alcohol
>2 drinks/day for (& one drink/day for ) risk HT
a dose-dependent relationship.
1 drink 12 oz of beer or 5 oz of wine (1 oz = 28 g)
Possible mechanism:
Imbalance of the CNS
Impairment of the baroreceptors
Increase of sympathetic activity
Stimulation of the renin-angiotensin-aldosterone system
Increase in cortisol levels
Increase of intracellular calcium levels
vascular reactivity
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Calcium
Increases in 1,25-dihydroxyvitamin D, which increases
vascular smooth muscle intracellular calcium, thereby
increasing peripheral vascular resistance and blood
pressure
Dietary calcium reduces blood pressure in large part via
suppression of 1,25-dihydroxyvitamin D, thereby
normalizing intracellular calcium.
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Fiber
Little is known about the potential mechanisms
through which dietary fiber might lower BP.
Dietary fiber reduces GI of foods, thereby attenuating
insulin response, enhance insulin sensitivity and
improve vascular endothelial function.
Soluble fiber improves mineral absorption in the GIT
Each gram increase in dietary fiber, the concentration
of blood LDL-c was lowered by about 2 mg/dL
Streppel MT, Arends LR, van 't Veer P, Grobbee DE, Geleijnse JM. Dietary
fiber and blood pressure: a meta-analysis of randomized placebo-
controlled trials. Arch Intern Med. 2005 Jan 24;165(2):150-6.
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Physical activity
According to the JNC 7, physical activity of 30
minutes per day BP by 49 mm Hg.
physical activity improves his or her
cardiorespiratory fitness, the relative workload
on the heart for all forms of activity
physical activity weight management
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Atherosclerosis
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Nutrition therapy
Nutrition therapy affects atherosclerosis by interfering
with plaque formation and/or by inhibiting the
inflammatory response that causes the physiological
changes within the blood vessels
The clinician should focus on the cumulative effect of the
entire diet as well as other lifestyle factors when planning
dietary changes
Nutrition assessment nutrition diagnosis nutrition
intervention:
TLC, weight loss, physical activity
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TLC
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Nutrition intervention
The immediate period post-MI
Oral intake << (due to pain, anxiety, fatigue, & shortness of breath
Soft diet
Patient stabilizes
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Heart failure
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Nutrition therapy
50% of patients with heart failure are malnourished
Sodium & fluid restriction is crucial to control acute
symptoms & may assist with reducing the overall work of
the heart
But at the same time, individuals with heart failure have
difficulty eating and many experience a syndrome of
malnutrition called cardiac cachexia, is a form of
malnutrition, characterized by extreme skeletal muscle
wasting, fatigue, & anorexia
The etiology is not completely understood
multifactorial metabolic and hormonal abnormalities
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Wolfram Doehner, Stefan D Anker. Cardiac cachexia in early literature: a review of research
prior to Medline. International Journal of Cardiology, 85, (1), September 2002, Pages 7-14
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Physiologic
Contributors
to Malnutrition
and Cachexia in
Heart Failure
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Nutrition intervention
Nutrition counseling
Focuses on the control of signs & symptoms;
the promotion of overall nutritional
rehabilitation.
Sodium and fluid restriction
Correction of nutrient deficiencies
Nutrition education for increasing nutrient
density & making food choices that enhance
oral intake.
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Sodium
A 2,000 mg sodium diet
Sodium intake evaluate the patients actual oral food &
beverage
<2,000 mg sodium Anorexia, fatigue, & shortness of
breath lead to such poor oral intake
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Fluid
Typically 1 mL/kcal or 35 mL/kg
HF 1500 2000 mL/day
Adjustments (+) based on renal and cardiac
status in order to prevent volume overload.
Weighing the patient daily to monitor fluid
status
Fluid restriction difficult to tolerate
nutrition education
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Y-J Xu, AS Arneja, PS Tappia, NS Dhalla. The potential health benefits of taurine in
cardiovascular disease. Exp Clin Cardiol 2008;13(2):57-65.
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Y-J Xu, AS Arneja, PS Tappia, NS Dhalla. The potential health benefits of taurine in
cardiovascular disease. Exp Clin Cardiol 2008;13(2):57-65.
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References
Mahan LK, Escott-Stump S. Krauses Food, Nutrition, & Diet
Therapy 11ed. Saunders, USA 2004
Nelms MN, Sucher K, Lacey K, Roth SL. Nutrition Therapy
and Pathophysiology, 2nd ed. Wadsworth, Cengage Learning,
USA, 2011.
Width M, Reinhard T. The Clinical Dietitians Essential Pocket
Guide. Lippincott Williams & Wilkins, 2009.
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