CardiovascularDisease

Kelli Williams, PhD, RDAmy Gannon, MS, RD

Risk Factors for CVD

Non-Modifiable Age

Gender

Heredity

Modifiable Diet

Weight Abdominal obesity

Physical Activity

Inflammatory Disease

such as Diabetes & Rheumatoid

Arthritis

Elevated Homocysteine

Levels

Viral & BacterialInfections

Toxins from Cigarettes andOther Tobacco

Products

HTN

High LDL

Risk Factors forPlaque formation

Homocysteine Amino acid that results from methionine metabolism

High levels are a marker for CVD

Effects of Homocysteine Leads to arterial damage by increasing clotting and

inflammation

Some evidence shows homocysteine can be reduced through: Folic acid Vitamin B12 Pyridoxine

Atherosclerosis and Diet

Atherosclerosis Disturbs blood flow

Relationship to dietary fat and lifestyle

Cholesterol

Food Cholesterol vs. Blood Cholesterol Soft, waxy substance found in the blood and in

your body’s cells. Forms cell membranes, hormone, Vitamin D Produced by the liver of all animals Not an essential nutrient

Liver produces sufficient amount that is needed by the body

Animal Foods Only

LDL versus HDL Cholesterol LDL (Low Density Lipoprotein) “Bad” cholesterol

Dietary Factors

HDL (High Density Lipoprotein) “Good” cholesterol

Dietary & Lifestyle Factors

Optimal Blood Lipids LDL: Optimal is <100mg/dL

<130 if heart disease risk is low

HDL: Optimal is >60mg/dL >40 for men >50 for women

Triglycerides: <150mg/dL (optimal)

Triglycerides Three forms:

Food fat, body fat and blood fat

Forms of fatty acids in food: Saturated, Mono-, Poly: Omega-3 & -6

Major source of energy (9 kcal/gram)

Risk Factors for High Blood Triglycerides Diabetes Dietary Influences

Fatty Acids Various forms of lipids

Even numbered carbon chain Differ in number of

carbons (2-24) Differ in number of

double bonds Differ in degree of

saturation

Monounsaturated Fatty Acids Monounsaturated Fatty

Acids

Metabolic Impact

Comprised of carbon chain with one double bond

Sources: Olive oil Canola oil Peanut oil Avacado

Olive Oil Extra Virgin olive oil

(EVOO)

Virgin olive oil

Olive Oil

PUFAs- Essential Fatty Acids Omega-3 Linolenic Acid (ALA) EPA (eicosapentaenoic acid)

DHA (docosahexaenoic acid)

Food sources

Marine oil supplement (fish oil)

Metabolic impact

Omega-6 Linoleic Acid ARA (arachidonic acid)

Food sources

Metabolic Impact

Saturated Fatty Acids Saturated Fat Carbon chain fully

hydrogenated

Solid to semi-solid at room temperature

Metabolic Impact

Sources: Animal fats (solid)

Tropical oils (semi-solid)

Trans- Fatty Acids Trans Fat Hydrogenation

Sources

Dietary Intake

Metabolic Impact

Conjugated- Linoleic Acid (CLA) Naturally occurring trans-fat

Nutrition Facts Panel

Dietary Fats

How to Choose Dietary FatsMost Heart Healthy Olive oil Canola oil Peanut oil Non-hydrogenated

margarines Cooking spray Liquid vegetable oil

Least Heart Healthy Shortening Bacon Fat Lard Coconut oil Butter Tallow

Therapeutic Lifestyle Changes for CAD

Total Fat < 30% of kcals ~66 grams/ day for a 2000 kcal diet

Saturated fat < 10% of kcals w/ normal lipids < 7% of kcals w/ elevated lipids

Dietary Cholesterol < 300 mg w/ normal lipids < 200 mg/ w/ elevated lipids

Trans Fat

Therapeutic Lifestyle Changes for CAD

Omega-3 fatty acids Supplements vs. Food

Soluble Fiber Sources

Alcohol Red Wine

Added Sugar

Hypertension “Normal” BP

< 120/80

Borderline HTN 120/80 to 139/89

HTN 140/90

Traditional Therapy Reduce Na

2400 mg/day 1500 mg/day

1 tsp Na = 2400 mg Salt sensitive HTN:

African American Obese Middle-aged and older Diabetes Chronic kidney disease Existing HTN

DASH Diet Dietary Approaches to Stop Hypertension

Based on a 2000 Kcal diet Grains (Whole) - 7-8 servings per day Vegetables - 4-5 servings per day Fruits - 4-5 servings per day Low-Fat Dairy - 2-3 servings per day Meats/Poultry/Fish - 2 servings per day Nuts, seeds - 4-5 per week

& legumes Fats and Oils - 2-3 servings per day Sweets - < 5 per week

DASH Diet Nutrient Role in the DASH Diet: Sodium Recommended intake

Calcium

Potassium

Magnesium

DASH Diet BP Reductions: 12 point reduction in SBP When consuming fruits, vegetables and low fat dairy

Immediate and sustainable

Comparable to monotherapy (ACE inhibitor or Ca channel blocker)

High risk population more responsive

Heart Failure In heart failure, the heart can not adequately

pump blood to tissues to meet metabolic needs.

Symptoms: fatigue shortness of breath fluid retention

Diseases of the heart lead to HF

Nutrition Goals

Initial goal of nutrition therapy for HF is managing symptoms of fluid retention, shortness of breath, and fatigue.

Long-term goal is to reduce workload of heart, providing a longer and better quality of life.

Nutrition Prescription

Adequate Energy to Meet Needs 2 grams Sodium/ Day or Less Fluid Restriction, Typically 1,500 mL /Day Limit Alcohol to 1 Drink/ Day Adjust Texture and Timing of Foods to Allow

Adequate Energy Intake Without Discomfort

American Dietetic Association. www.nutritioncaremanual.org

Food & Feeding Issues Loss of Appetite D/T Early Sensation of

Satiety SOB Interferes with Adequate Nutrient

Intake Low-Sodium Foods Unfamiliar and

Unpalatable Patient may Seek High-Fluid Foods to

Compensate for Restriction

Desired Nutrition Related Outcomes

Distinguish High and Low Sources of Sodium

Use Nutrition Labels to Limit Sodium Adapt Recipes to Reduce Sodium Manage Sodium Intake on Special

Occasions

Desired NutritionOutcomes Continued Use Herbs to Replace Salt in Diet Explain Rationale for Sodium/

Fluid Restriction Weigh Daily to Monitor Fluid

ManagementNeily JB, Toto KH, Gardner EB, Rame JE, Yancy CW, Sheffield MA, Dries DL, DraznerMH. Potential contributing factors to noncompliance with dietary sodium restriction in patientswith heart failure. Am Heart J. 2002;143:29-33.

Kuehneman T, Saulsbury D, Splett P, Chapman DB. Demonstrating the impact of nutrition intervention in a heart failure program. J Am Diet Assoc. 2002;102:1790-1794.