Student presentations resultsFinal exam 15 questions-short answer-point form covering whole term5 Q on diabetes and atherosclerosis10 Q on blood pressure, stroke, and kidney disease-10 points each- 3 hours-no choice on questions

PLEASE SEE EXAM REGULATIONSON: faculty.cbu.ca/ebarre

The

Lecture 11- 20 November 2012

Stroke

Outline of todays talk

I. Pathology  

 

II. Socioeconomic factors contributing to stroke 

III. Elementary nutritional approaches to be taken to avoid and treat these diseases including foods

available to those at risk 

 

IV. First Nations and other Cape Breton individuals at risk

 

V. How is nutritional assessment made for blood stroke? 

VI. How would one assess from a nutritional perspective the socioeconomics, pathology and success of

nutritional interventions relative to stroke?  

StrokeI. Pathology

three types of stroke

hemorrhagicthromboticembolic

all are cerebrovascular accidents

StrokeI. Pathology

three types of stroke-defined

hemorrhagic-blood vessel rupture

thrombotic-rupture of plaque and platelets aggregate

embolic-thrombus breaks off and moves down stream

StrokeI. PathologyWhat are the risk factors?

hypertension and all contributing factors to hypertension-explain

atherosclerosis and all contributing factors to atherosclerosis-explain

StrokeI. PathologyWhat are the risk factors?

Diabetes types I and II and all contributing factors to types I and II diabetes-explain

End stage renal disease and all contributing factors to end stage renal disease-explain

StrokeI. PathologyWhat are the risk factors?

Old age-how would this contribute to the pathology?

Smoking- how would this contribute to the pathology?

Socioeconomic factorsFood and hence nutritional choices depend on:

Personal preference-protective factors(preventative)-absence is a risk factor

consumption of fresh fruit

flavonoid consumption of greater than 4.7 cups green tea per day

fish consumption in white and black women and black men

Socioeconomic factors

Food and hence nutritional choices depend on:

Habitfattening foods bring on obesitywhich increases blood pressurewhich results in increased risk of all 3 types of types of stroke

Food and hence nutritional choices depend on:Ethnic heritage or tradition

fish consumers-Japanese, Inuitomega 3s EPA- effects of EPA

vitamin E consumption- sources of vitamin E-who might consume these- vegetable oils, nuts, seeds

Social interactionrelate social interaction to ethnic heritage or tradition

Food and hence nutritional choices depend on:

Availability of food

availability of omega 3s and vitamin E-who would have access to the omega 3s and vitamin E

Convenience of food

some convenience foods do not have omega 3s and vitamin E- list some of these foods

Food and hence nutritional choices depend on:

Economy of foodconsumption of fresh fruit

flavonoid consumption of greater than 4.7 cups green tea per day

fish consumption in white and black women and black men

Food and hence nutritional choices depend on:

Positive and negative associations

consumption of fresh fruit

flavonoid consumption of greater than 4.7 cups green tea per day

fish consumption in white and black women and black men

vitamin E

Food and hence nutritional choices depend on:

Emotional conflict

may induce eating

blood pressure elevated-what is the relation of hypertension to food and hence nutritional choices?

Food and hence nutritional choices depend on:

Values-how does this apply to:consumption of fresh fruit

flavonoid consumption of greater than 4.7 cups green tea per day

fish consumption in white and black women and black men

vitamin E

Food and hence nutritional choices depend on:

Body imagerelationship to food and hence nutritional choices- if one is too thin this will not lead to stroke- if one accepts a BMI of greater than 27 and the dietary habits that support such a BMI then one is at greater risk of stroke

Food and hence nutritional choices depend on:

Advertising-who is responsible for encouraging or not encouraging

consumption of fresh fruit

flavonoid consumption of greater than 4.7 cups green tea per day

fish consumption in white and black women and black men

vitamin E

BREAK

More on socioeconomic factors

Prestige-occupational-

lower the occupation the greater the risk of stroke-why?

low occupational fathers tend to have low or lower occupational kids

could be a number of generations before population stroke risk is reduced

More on socioeconomic factors

Prestige-occupational-

higher the occupation the less the risk of stroke-why?

high occupational fathers tend to have high or higher occupational kids

could be a number of generations before population stroke risk is increased among descendants of initial high

occupational fathers

More on socioeconomic factors

Prestige

-societal perceptions-dictate ability of people to change their social rankings

-education-eg university professors and astronauts have a lot of sophisticated

education and they are rated highly-however this is no guarantee that there is no risk of stroke

More on socioeconomic factors

Power-based on societal perceptions to some extent

Income-also based on societal perceptions of the importance of the job to society

More on socioeconomic factors

Wealth-based on education-lower classes tend to be less well educated and therefore less able to take advantage of the societal perceptions that improve one’s socioeconomic status including wealth

Education- lower classes tend to be less well educated and therefore less able to take advantage of the societal perceptions that improve one’s socioeconomic status including the benefits arising from that education

More on socioeconomic factors

Social stratification

-ancestry-socioeconomic childhood-gender-fish consumption in white and black

women and black men-race- fish consumption in white and black

women and black men-ethnicity-those consuming omega 3s and

vitamin E

More on socioeconomic factors

Social stratification-mobility-effect on depression and food

choices

-mental and physical activity-mental patients-may be marginalised by society-what impact does this have onthe risk of stroke?

physical activity

More on socioeconomic factors

Social stratification

physical activity-stroke risk lowered by chronic aerobic activity-caution with elevated blood pressure- blood pressure increases during aerobic exercise

- benefit with exercise comes after blood pressure is lowered in rest and during exercise- this is a training effect

More on socioeconomic factors

Class-uppers-lower uppers-upper middles-average middles-working class-lower class

How might each of these classes have an impact risk or presence of stroke?

More on socioeconomic factors

Global economy-globalisation- impact on:

consumption of fresh fruit

flavonoid consumption of greater than 4.7 cups green tea per day

fish consumption in white and black women and black men

Government-nutrition policies affect risk of stroke-how?

More on socioeconomic factors

Business-promotion of globalisation-why would business promote globalisation?

Psychology-susceptibility to business tactics such as?- impact on the risk of stroke?

History-one’s habits and childhood socioeconomic status

Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk

Planning a healthy diet 

To do this bear in mind AdequacyBalanceEnergy controlNutrient densityModerationVariety

Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk

Prevention-eat foods in accordance with low salt (if salt-sensitive) and eat in accordance with keeping

blood plasma lipids and lipoproteins to target levels specified to prevent atherosclerosis, hypertension, type II diabetes and end stage renal disease

Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk?Prevention

increase fruits and vegetables and low fat foods(DASH diet)-contain antioxidants and other blood pressure lowering chemicals

DASH-Dietary approaches to stop hypertension

Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk

Post-onset-eat foods in accordance with low salt (if salt-sensitive) and eat in accordance with keeping

blood plasma lipids and lipoproteins to target levels specified to prevent atherosclerosis, hypertension, type II diabetes and end stage renal disease

--antioxidant vitamins and minerals

BREAK

IV. First nations and other Cape Breton individuals at risk.

Aboriginals

Retired

Unemployed

Genetics

Others?

How is nutritional assessment made for stroke-prevention and cure?Nutrient intake analysis

salt intakedietary lipids

-saturated fat-trans-fatty acids-cholesterol

-other dietary components adjusted in accordance with recommendations made in lectures on atherosclerosis, types I and II diabetes and blood pressure

How is nutritional assessment made for stroke- prevention and cure?

Daily food record/Diary

what are potential problems with this approach regarding stroke?

How is nutritional assessment made for stroke-prevention and cure?

Retrospective data

-24 hour recall

-food frequency questionnaire

both 24 hour recall and are used to cross check one another-how would this apply to stroke

How is nutritional assessment made for hypertension--prevention and cure?

Anthropometry-focus on overweight andobesity

skin foldsunderwater weighingbioimpedancewaist circumferenceBMI

How is nutritional assessment made for hypertension--prevention and cure?

Nutrition focussed physical exam:

• body weight and height• direct blood pressure determination• anthropometric measures

waist circumferenceBMI

How is nutritional assessment made for stroke-prevention and cure?

Skin testing-not applicable

How is nutritional assessment made for stroke-prevention and cure?

Biochemical analysisblood lipids-which raise bp and

promote risk of

aneurysm/thrombosis/embolism

blood lipoproteins-which raise bp and promote risk of

aneurysm/thrombosis/embolism

How is nutritional assessment made for stroke--prevention and cure?

Biochemical analysis blood sodium-raises bp and

promotes risk of aneurysm/thrombosis/embolism

blood potassium-lowers bp and reduces risk of aneurysm/thrombosis/embolism

How is nutritional assessment made for stroke--prevention and cure?

Biochemical analysis blood calcium-lowers bp and risk of

aneurysm/thrombosis/embolism

blood magnesium-lowers bp and risk of aneurysm/thrombosis/embolism

How is nutritional assessment made for stroke--prevention and cure?

CLASSIFYING MALNUTRITION

obesity is the main issue here

thin individuals are much less at risk than obese persons

VI. GROUP DISCUSSION-HOW WOULD ONE ASSESS FROM NUTRITIONAL PERSPECTIVE THE SOCIOECONOMICS, PATHOLOGY AND SUCCESS OF NUTRITIONAL INTERVENTIONS RELATIVE TO STROKE ?