NCM 211 NUTRITION AND DIET THERAPY (LECTURE)

Father Saturnino Urios University

Prepared by: REANNE MAE C. ABRERA SN
—————————————————————————————————————————————————————————————————————————————————————

CARDIOVASCULAR DISEASE

❖ It is a collective term referring to a group of diseases affecting the heart and blood
vessels.

HYPERTENSION (HPN/HTN)

❖ Sustained arterial blood pressure (BP) is equal or greater than 130/80.

❖ It is not a disease, but a symptom. Less than or increased cardiac output and increased
resistance of blood vessel walls to blood flow.
❖ It may occur at any age but most frequently in persons over 40 years old.
❖ Smoking and emotional stress may elevate blood pressure (BP).
❖ There are two (2) types of Hypertension (HPN/HTN):
1. Primary Hypertension → Idiopathic; more common type occurring in 85% to 90%
of all HPN cases.
2. Secondary Hypertension → due to a clearly defined cause.
 RISKS OF HYPERTENSION ROLES OF SELECTED DIETARY FACTORS IN HYPERTENSION

1. Formation of atheroma’s
2. Coronary Artery Disease
3. Cardiac failure
4. Aneurysm of the aorta
5. Acute vascular necrosis
6. Hemorrhagic stroke
7. Metabolic problems
❖ Sodium → Normally found in the ECF (blood plasma and interstitial fluid or extracellular
fluid) but may cross cell walls into ICF (water, electrolytes, protein or intracellular fluid)
causing edema and elevated blood pressure.
❖ Sodium → It lowers blood pressure.
❖ Magnesium → It reduces ICF (intracellular fluid) sodium which decreases blood pressure.
❖ Calcium → Some studies show that Ca (calcium) have beneficial effects on the blood
pressure.
❖ Cadmium → Implicated for hypertensives; found in shellfish, kidney meats, grain cereals,
vegetables, and packed fruit juices
❖ N-3 polyunsaturated fats (in fish oils) → It promotes synthesis of prostaglandins for Na
(sodium) and K (potassium) excretion.
❖ Alcohol → High intakes causes vasoconstriction which increases blood pressure.

DIETARY MANAGEMENT: HYPERTENSION (HPN/HTN)

❖ Calories → it depends on the weight’s status or weight goal

❖ Sodium → Restricted (250mg, 500mg, 1g, 2g, 4g, and etc.)
❖ Fluids and Roughage → prevents constipation which hinders absorption of
antihypertensive drugs
❖ The DASH Diet → dietary approach to stop hypertension
➢ Effective with 14 days of initiation
➢ High quantities of fruits, vegetables, low-fat dairy products, whole grains, poultry,
fish, and nuts
 ❖ Alcohol → avoid high intake; the excessive levels can cause hypertriglyceridemia,
CORONARY HEART DISEASE (CHD)
elevated LDL, arrhythmia, cardiac enlargement, and heart failure
❖ It is a disease involving the network of blood vessels surrounding and serving the heart.
❖ Calories → sufficient to maintain/achieve DBW
❖ It is manifested in clinical end points of myocardial infarction and sudden deaths.
THERAPEUTIC LIFESTYLE CHANGES DIET (TLC)
❖ Pathological events leading to coronary heart disease (CHD):
1. Injury to coronary arteries ❖ It is one of the several heart-healthy diets that can lower cholesterol and help lower the
2. Fibrous plaque formation (Arteriosclerosis) risk of heart disease or stroke.
3. Thrombosis and heart attack ❖ Eating less fat and changing the types of fats to eat.
❖ Eating fewer foods that have cholesterol.
DIETARY MANAGEMENT: CORONARY HEART DISEASE (CHD)
❖ Maintain desirable body weight.
❖ Total Fat → not more than 30% of TER (total energy requirement)
❖ Manage stress.
❖ SFA (saturated fatty acids) → Approximately 10% of TER (total energy requirement) or
❖ Small frequent feedings are indicated.
10% of TER; reduces plasma LDL (low density lipoproteins)
❖ Adequate dietary fiber and fluid intake.
❖ PUFA (polyunsaturated faty acids) → Approximately 10% of TER (total energy
❖ Initially, full liquid diet is done to promote rest and danger in aspiration.
requirement); reduce plasma LDL;
❖ Caffeine intake is reduced (less than 3 cups per day) to prevent potential arrhythmias.
➢ N-6 PUFA (e.g. linoleic acid) promotes prostaglanding synthesis which promotes
❖ Sodium is restricted.
arterial dilatation and heart muscle contractility;
❖ Fluid intake is individualized depending on the fluid status of the patient.
➢ N-3 PUFA of O3 FA reduces blood pressure, inflammation, platelet aggregation,
❖ Low in saturated fats or cholesterol.
fibrinogen, and severity of arrhythmia
❖ Small frequent feedings to reduce cardiac workload.
❖ MUFA (monounsaturated fatty acids) → as effective as PUFA but DOES NOT LOWER
❖ Adequate calcium, potassium, and magnesium is needed.
HDL, less susceptible to oxidation, less thrombogenic potential, does not raise serum TGC
ANGINA AND PRE-INFARCTION ANGINA
(triglycerides)
❖ Cholesterol → not more than 200mg/day; reduce LDL ❖ Pain is caused by demand on the heart when inadequately supplied with blood.
❖ Sodium → moderate intake ❖ It is a type of temporary chest pain, pressure, or discomfort.
❖ Carbohydrates → depends on severity of hyperlipoproteinemias ❖ There is a presence of a narrowed artery which causes ischemia as the heart muscle is
not receiving enough oxygen.
❖ Pain is precipitated by exertion. ❖ Sub-acute Phase
❖ The etiology of angina is atherosclerosis. ➢ 1000kcal to 1200kcal (20% CHON, 45% CHO, 35% FAT) in order to meet REE
(resting energy expenditure??)
DIETARY MANAGEMENT: ANGINA AND PRE-INFARCTION ANGINA
➢ 300mg to control blood cholesterol
❖ Small Meals → To reduce cardiac workload
➢ Soft, low fiber, free of gastric irritants to avoid indigestion and flatus
❖ Avoidance of Gas-Forming Foods → Prevent abdominal distention which may add
➢ Coffee and tea in moderation to avoid stimulation
pressure to the heart
➢ Sodium restriction to prevent or correct edema
❖ Low Calorie for the Obese → To attain DBW (desired body weight)
➢ Small, frequeny feeding to reduce possibility of postprandial dyspnea or pain
❖ Low Cholesterol, Total Fat → To lower cholesterol and TGC (triglycerides) in the serum
■ Postprandial means after eating dinner or lunch, or usually a meal
❖ Alcohol → in moderation; may induce arrhythmias and in large amounts, depresses
❖ Rehabilitative Phase
cardiac function
➢ Calories are adjusted to maintain optimal weight so as to avoid obesity which
ACUTE MYOCARDIAL INFARCTION increases cardiac workload
➢ Fat-controlled diet to control blodo lipid levels so as to lessen the risk for another
❖ It is also known as coronary occlusion or thrombosis.
infarction
❖ It is the destruction of a position of the myocardium due to an interruption of blood
➢ Avoidance of excessive roughage, gas forming and spice foods for easy digestion
supply resulting to formation of localized necrotic areas.
and preventing distention
❖ The etiology can be atherosclerosis.
➢ Limit stimulants
DIETARY MANAGEMENT: ACUTE MYOCARDIAL INFARCTION
➢ Sodium restriction when necessary in case of edema
❖ Acute Phase
CONGESTIVE HEART FAILURE
➢ 500kcal to 800kcal in order to avoid gagging and aspiration of solid foods
❖ It is a disorder of the cardiovascular system caused by the failure of the heart as a pump.
➢ No extreme in temperature to prevent possible precipitation of arrhythmias
❖ The characteristics are:
➢ No coffee or tea as it may stimulate and increase heart rate
1. Weakening of the heart muscles leads to increased blood supply to the body.
➢ Parenteral Feeding → for those unwilling to consume a liquid diet
2. Pooling of blood in the venous system which leads to increased venous pressure
➢ Restriction of Na (sodium) in order to prevent or correct edema.
resulting to edema.
 3. RAAS (renin, angiotensin, aldosterone system) is active and responsible for
regulating blood pressure (BP).
4. Low renal blood flow causes Na (sodium) retention which results in edema.
5. Release of vasopressin causes water absorption.
6. Dyspnea, anorexia, nausea and vomiting.

DIETARY MANAGEMENT: CONGESTIVE HEART FAILURE

❖ Low Calorie → reduce weight; decrease workload of the heart

❖ Moderate Protein → maintenance of N (nitrogen) balance
❖ Sodium Restriction → 500mg initially, 1000mg later to control edema
❖ Small Frequent Feeding → decrease circulatory and cardiac workload
❖ Fluid as desired

CARDIAC CACHEXIA

❖ A syndrome of malnutrition that occurs in up to half of patients with moderate to severe

heart failure.
DIETARY MANAGEMENT: CARDIAC CACHEXIA
❖ Cachexia, also known as wasting syndrome, is loss of weight, muscle atrophy, fatigue,
weakness, and significant loss of appetite in someone who is not actively trying to lose ❖ Sodium Restriction → approximately 2400mg/day

weight. It is a common complication of congestive heart failure (CHF) or due to other ❖ Fluid Restriction → 500 - 2000ml/day, typically only during hospitalization

cardiac diseases.