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clinical nutrition > chapter 21 book notes > Flashcards

chapter 21 book notes Flashcards

1
Q

Cardiovascular disease is responsible for what % of deaths in the U.S.?

A

-31%

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2
Q

Most common form of CVD?

A

-Coronary heart disease (42%)

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3
Q

Coronary heart disease is usually caused by…

A

-atherosclerosis in the coronary arteries that supple blood to the heart muscle.

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4
Q

If atherosclerosis restricts blood flow in these arteries, the
resulting deprivation of oxygen and nutrients can destroy heart tissue
and cause a ??

A

-myocardial infarction—a heart attack.

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5
Q

When the blood supply to brain tissue is blocked, a
?? occurs

A

-stroke

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6
Q

In atherosclerosis, the artery walls become progressively thickened due to an accumulation of

A

-plaque
- accumulation of fatty deposits, fibrous connective tissue, and smooth muscle cells,

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7
Q

The first lesions tend to occur in regions where the arteries…

A

-branch or bend due to the disturbed blood flow in those areas

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8
Q

The subtle damage elicits an ?? response, attracting immune cells and increasing the permeability of the artery wall

A

-inflammatory

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9
Q

what will slip under the artery’s thin layer of endothelial cells, become oxidized by
local enzymes, and accumulate?

A

-Low-density lipoproteins (LDL)

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10
Q

Atherosclerosis begins to develop as
early as ?? or ?? and typically progresses over
several decades before symptoms develop

A

-childhood
-adolescence

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11
Q

As atherosclerosis worsens, it may eventually ?? the lumen
of an artery and interfere with blood flow

A

-narrow

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12
Q

thrombosis:

A
  • the formation or presence of a blood clot in blood vessels
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13
Q

A blood clot (??? ) may
enlarge in time and ultimately obstruct blood flow.

A

-thrombus

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14
Q

A portion of a clot can also break free (?? ) and travel through the
circulatory system until it lodges in a narrowed artery and shuts off blood flow to
the surrounding tissue leading to (??)

A

-embolus
-embolism (can lead to tissue death)

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15
Q

ischemia:

A

-most common complication of atherosclerosis
-inadequate blood supply within a tissue due to obstructed blood flow.

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16
Q

Atherosclerosis can affect almost any ?? or ?? in the body and, accordingly, is a major cause of ?? or ?? .

A

-organ or tissue
-disability or death

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17
Q

angina pectoris:

A

-ischemia in the heart muscle
-results in discomfort or dull chest pain
-The pain often radiates to the left shoulder, arms, neck, back, or jaw

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18
Q

peripheral artery disease:

A

-impaired blood flow in the arteries of the legs;
-may cause pain and weakness in the legs and feet, especially during exercise.

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19
Q

Atherosclerosis is the most common cause of an ?? —the abnormal dilation of a blood vessel.

A

-aneurysm

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20
Q

Plaque can ?? the blood vessel wall, and eventually the pressure of
blood flow can cause the ?? region to stretch and balloon outward

A

-weaken
-damaged

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21
Q

Aneurysms can rupture and lead to massive bleeding and ?? , particularly when a large vessel such as the ?? is affected.

A

-death
-aorta

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22
Q

In the arteries of the brain, an aneurysm may lead to
bleeding within the brain, ?? , or a ??.

A

-coma
-stroke

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23
Q

The factors that initiate atherosclerosis either cause direct damage to the artery wall or allow lipid materials to ?? its surface

A

-
-penetrate

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24
Q

Factors that generally worsen atherosclerosis or lead to complications are those that cause plaque ?? or blood ??

A

-rupture
-coagulation

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25
Q

The development of advanced atherosclerosis is a long-term process that involves:

A

-recurrent plaque rupture, thrombosis, and healing

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26
Q

Turbulent blood flow: WHERE does it occur? and what can it cause?

A

-occurs at the origins, branch points, and bent sections of arteries
-it can cause physical damage to endothelial tissue

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27
Q

Hypertension (high blood pressure) intensifies the damaging effects of blood flow on arteries, and is associated with ?? and ?? of the artery wall

A

-thickening and degeneration

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28
Q

very-low-density lipoproteins
(VLDL):

A

-lipoproteins that transport triglycerides from the liver to other tissues
-BAD

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29
Q

When LDL levels are high, they are actively taken up and
retained in susceptible regions in the artery wall, contributing to ?? development

A

-plaque

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30
Q

Elevated levels of very-low-density lipoproteins (VLDL) can also promote atherosclerosis, either by being retained within artery walls or by influencing the production of other ?? lipoproteins

A

-atherogenic
-able to initiate or promote atherosclerosis

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31
Q

high-density lipoproteins (HDL):

A

-lipoproteins that help to remove cholesterol from the bloodstream by
transporting it to the liver for reuse or disposal.
-GOOD

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32
Q

HDL contain proteins that inhibit…(3)

A

-inflammation, LDL oxidation, and plaque accumulation

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33
Q

Low HDL levels can contribute to the development of ?? as well.

A

-atherosclerosis

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34
Q

LDL vary in ?? and ??, and these LDL subtypes have differing effects on heart disease risk

A

-size and density

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35
Q

What kind of size and density of LDL promotes atherosclerosis more easily?

A

-smallest most dense LDL
-because they can slip into the walls easily

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36
Q

Furthermore, people who have small,
dense LDL frequently have elevated ?? and low ?? levels

A

-VLDL
-HDL

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37
Q

This lipoprotein profile is especially prevalent in individuals with ?? syndrome and type ?? diabetes

A

-metabolic
-2

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38
Q

lipoprotein(a):

A

-variant form of LDL
-has been found to speed the progression of atherosclerosis and raise the risk of various types of CVD

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39
Q

Lipoprotein(a) levels are primarily ?? determined and are influenced
to only a minor degree by ?? and ?? factors.

A

-genetically
-dietary and lifestyle

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40
Q

Compounds in cigarette smoke (including ?? ) are toxic to
endothelial cells and contribute to arterial injury and the development of…

A

-nicotine
-atherosclerosis

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41
Q

Chronic hyperglycemia leads to the accumulation of ???, which promotes ?? and ???

A

-advanced glycation end products (AGEs)
-inflammation and oxidative stress

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42
Q

As a person ages, arterial cells tend to ?? , and risk factors for
??? accumulate.

A

-degenerate
-CVD

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43
Q

The risk of atherosclerosis increases significantly with each additional ?? of adult life, although the incidence of obstructive artery disease occurs
?? to ?? years later in women than in men.

A

-decade
-7 to 10

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44
Q

After menopause, women’s risk increases, in part, because the decline in ?? has unfavorable effects on lipoprotein levels and endothelial function

A

-estrogen

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45
Q

homocysteine:

A

-amino acid produced during conversion of methionine to cysteine.
-elevated levels promote inflammation, endothelial dysfunction, and thrombosis
-associated with aging and more prevalent in men.

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46
Q

In angina pectoris and heart attacks, pain or discomfort most often occurs
in the ?? region and may be perceived as a feeling of ?? , constriction, or ?? ;

A

-chest
-heaviness
-squezzing

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47
Q

In angina pectoris, the symptoms are often triggered by ?? and subside with ??

A

-exertion
-rest

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48
Q

in a heart attack, the pain may be severe, last longer, and occur without ??

A

-exertion

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49
Q

?? are more likely than men to have a heart condition
(or even a heart attack) that is ?? by chest pain or acute symptoms.

A

-Women
-unaccompanied

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50
Q

The American Heart Association (AHA) and American College of
Cardiology (ACC) recommend a review of CHD risk factors every ?? to ?? years in individuals who are older than ?? years of age

A

-4 to 6
-20

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51
Q

A typical lipoprotein profile (blood lipid profile) includes measures of:

A

-total cholesterol
-LDL cholesterol
-HDL cholesterol
-blood triglycerides (VLDL)

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52
Q

What ratios can clinicians use to help assess CHD risk?

A

-total cholesterol:HDL
-LDL cholesterol:HDL cholesterol

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53
Q

In some individuals (especially those with high blood triglycerides), the ?? cholesterol level may be a more appropriate indicator of heart disease risk than the ?? level;

A

-non-HDL
-LDL

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54
Q

How to calculate non-HDL cholesterol level

A

-subtract the HDL value from the total cholesterol value

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55
Q

What else is regularly included in risk assessment?

A

-blood pressure and body weight

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56
Q

Atherosclerosis can be evaluated using the coronary artery calcium score, which is…

A

-a value obtained from a compound tomography (CT) scan that analyzes the calcium content of plaque in the coronary arteries

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57
Q

What protein can also identify patients at risk for CHD, and is also a marker of inflammation?

A

-C-reactive protein

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58
Q

ankle-brachial index:

A

-a ratio of blood pressure measurements taken at the ankles and the upper arms,
-helps determine the presence or severity of peripheral artery disease.

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59
Q

Once a person’s level of risk has been identified, much of the treatment focuses on lowering ?? cholesterol

A

-LDL

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60
Q

Elevated LDL levels are directly related to the development of ?? , and clinical studies have confirmed that ?? treatments can successfully reduce the rates of cardiovascular events.

A

-atherosclerosis
-LDL-lowering

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61
Q

low HDL levels are usually associated with other CHD risk
factors, such as ?? , ?? , ?? , and ?? resistance.

A

-obesity
-smoking
-inactivity
-insulin

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62
Q

Although having adequate HDL is beneficial, high HDL levels do not necessarily confer additional ?? and in some cases may be associated with ?? outcomes.

A

-benefits
-adverse

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63
Q

The main features of lifestyle management of CHD is to include a

A

-healthy dietary pattern,
-regular physical activity,
-nonsmoking status,
-healthy body weight

64
Q

For individuals with elevated LDL, current guidelines suggest
limiting saturated fat intake to less than ?? percent of the total kcalories consumed

A

-7%

65
Q

The average saturated fat intake in the United States is
about ?? percent of the energy intake

A

-12%

66
Q

main sources of saturated fat in the United States
include

A

-cheese,
-hamburgers,
-meat
-poultry dishes,
-various types of desserts.

67
Q

more effective ways of reducing saturated fat.

A

-choosing fat free or low fat dairy products
-selecting lean meat or fish
-avoiding certain types of desserts

68
Q

The effect on blood triglycerides can be minimized by limiting ?? sugars and including ??-rich foods

A

-added
-fiber

69
Q

most polyunsaturated fat in the diet consists of omega-?? fatty acids such as linoleic acid, omega-?? fatty acids may also have beneficial effects on heart disease risk,

A

-6
-3

70
Q

Individuals with elevated blood triglycerides may benefit from
achieving a fat intake at the upper end of this range (?? to ?? percent) so that their
?? intakes are not excessive

A

-30 to 35
-carbohydrates

71
Q

Fat intakes higher than ?? percent of kcalories
are discouraged because they may promote weight gain in some people

A

-35

72
Q

Trans fats can both raise ?? levels and reduce ?? levels

A

-LDL
-HDL

73
Q

diets high in trans fats promote:

A

-inflammation and endothelial dysfunction and are associated with increases in CVD events and CVD deaths.

74
Q

The influence of dietary cholesterol on CHD risk is somewhat ??

A

-unclear

75
Q

guidelines recommend cholesterol intakes of less than ?? milligrams per day for high-risk individuals.

A

-200

76
Q

Cholesterol intakes of women and men in the United States average about
?? and ?? milligrams per day, respectively

A

-259 and 358

77
Q

Major cholesterol sources in the U.S. diet include:

A

-meat and poultry dishes,
-eggs,
-full-fat dairy products,
-grain products made with cholesterol-rich ingredients.

78
Q

The effect of eggs on CHD risk is controversial, as eggs supply much more cholesterol than other commonly eaten foods (about ??? milligrams per large egg).

A

-210

79
Q

Soluble, viscous fibers can reduce LDL cholesterol levels by inhibiting
?? and ?? absorption in the small intestine and reducing cholesterol synthesis in the liver.

A

-choloesterol
-bile

80
Q

Good sources of soluble fibers include

A

-oats, barley, legumes, and some fruits and vegetables.

81
Q

The soluble fiber in psyllium seed husks, frequently used to treat ?? ,
is effective for lowering cholesterol levels when used as a dietary supplement

A

-constipation

82
Q

About ?? grams of plant sterols daily (provided by 2 to 2½ tablespoons of sterol-enriched margarines) can lower LDL cholesterol by ?? to ? percenT

A

-2
-5 to 10%

83
Q

These plant compounds are added to various food products, such
as ?? and ?? juice, or supplied in dietary supplements

A

-margarine
-orange

84
Q

Omega 3 fatty acids … and … may benefit people at risk of CHD by suppressing…

A

-EPA AND DHA
-inflammation, lowering blood triglycerides levels, and reducing blood clotting, and stabilizing heart rhythm

85
Q

The American Heart Association recommends consuming ?? to ??
servings of seafood per week, with an emphasis on fatty fish

A

-one to two

86
Q

The effects of fish oil supplementation on CVD outcomes are ?? , as clinical
studies have had mixed results.

A

-unclear

87
Q

?? to ?? consumption of alcohol—from beer, wine, or liquor—has
favorable effects on atherosclerosis, HDL levels, blood-clotting activity, insulin resistance, and overall CHD risk

A

-light to moderate

88
Q

Consumption should be limited to ?? drink daily for women
and ?? for men,

A

-one
-two

89
Q

Excessive dietary ?? may raise blood pressure, whereas ?? can help to lower blood pressure

A

-sodium
-potassium

90
Q

Current guidelines recommend at least ?? minutes of moderate-intensity activity per week or ?? minutes of vigorous-intensity activity per week, or an equivalent combination

A

-150
-75

91
Q

Activities that use ?? muscle groups provide the greatest benefits;
such activities include

A

-large
-brisk walking, swimming, cycling, and cross-country skiing.

92
Q

Note that vigorous activity increases the risk of a ?? or sudden ?? in individuals with diagnosed heart disease, so sedentary adults may be advised to increase their activity levels ?? .

A

-heart attack
-death
-gradually

93
Q

What is a major risk factor for CHD and other types of cardiovascular disease?

A

-cigarette smoking

94
Q

Obesity(MAINLY CENTRAL OBESITY) also strains the heart and blood vessels because cardiac output is greater, resulting in a greater ?? for the ?? ventricle, which pumps blood to the major ??

A

-workload
-left
-arteries

95
Q

The goal of a typical weight-reduction program is a loss of ?? to ?? percent of a person’s initial body weight over the ensuing ?? months, followed by additional periods of weight loss until an acceptable weight is reached.

A

-5 to 10%
-6

96
Q

In some individuals, high LDL levels may persist despite adjustments in health behaviors, and ?? therapy may be the only effective treatment

A

-drug

97
Q

Patients are often interested in the potential benefits of using certain types of dietary supplements for reducing CHD risk, particularly ?? vitamin and ?? supplements.
ARE THEY EFFECTIVE?

A

-B
-antioxidants
-effectiveness has not been confirmed

98
Q

What vitamins can help lower homocysteine levels but clinical trails have not demonstrated that supplementation with these vitamins can reduce the incidence of CVD outcomes in those at risk?

A

-folate
VB6
-VB12

99
Q

Hence, ?? vitamin supplements are not currently recommended for patients at risk for CHD.

A

-B

100
Q

Most studies that have tested supplementation with single antioxidants (such as vitamins ?/ or ??) or combinations of antioxidants have produced weak or inconsistent results, and several studies suggested possible ?? .

A

-C or E
-harm
-use of antioxidants supplements is not recommended for heart disease prevention

101
Q

hypertriglyceridemia:
It affects about what % of the adults in the U.S.?

A

-elevated blood triglyceride levels
-22%

102
Q

hypertriglyceridemia is common in people with what disease?

A

-diabetes mellitus, obesity, and metabolic syndrome

103
Q

Elevated blood triglycerides may
coexist with elevated ?? cholesterol or occur separately

A

-LDL

104
Q

Whereas mild or moderate hypertriglyceridemia is often associated with increased CHD risk, more serious cases (blood triglycerides above ?? mg/dL) can cause additional complications, including ?? deposits in the skin and soft tissues and ??

A

-500
-fatty
-acute pancreatitis

105
Q

?? and ?? changes can
improve most cases of mild hypertriglyceridemia

A

-dietary and lifestyle

106
Q

Extreme elevations in blood triglycerides are usually
caused by ?? mutations that upset lipoprotein metabolism

A

-genetic

107
Q

medications are usually necessary for lowering blood triglyceride levels
above about ?? milligrams per deciliter.

A

-500

108
Q

Clinical trials suggest that a daily intake of ?? to ?? grams of EPA and DHA (combined) may reduce elevated triglyceride levels by 30 to 50 percent

A

-2 to 4

109
Q

drugs most often prescribed for lowering
LDL levels:
the names and how they work:

A

-statins (such as Lipitor and Crestor),
-reduce cholesterol synthesis in the liver

110
Q

Drugs less effective than statins but help reduce LDL levels:
-the names and how the work:

A

-bile acid sequestrants (Colestid and Questran)
-interfere with bile acid reabsorption in the small intestine

111
Q

Fibrates( Lopid and Tricor)=
nicotinic acid=

A

-lower triglycerides and increase HDL
–nicotinic acid can reduce LDL and lipoprotein(a) levels

112
Q

In addition to lipid-lowering medications, some people may require drugs that suppress blood clotting and reduce blood pressure such as:

A

-aspirin and anticoagulants

113
Q

What is the name of the vasodilator that can be given to alleviate angina as needed?

A

-nitroglycerian

114
Q

The damage to heart muscle may result in ?? or even
heart ?? .

A

-cardiac arrhythmias
-heart failure

115
Q

cardiac arrhythmias:

A

-abnormal heart rhythms

116
Q

Drug therapies given immediately after a heart
attack may include

A
  • thrombolytic drugs (sometimes called clot-busting drugs),
    -aspirin,
    -anticoagulants,
    -painkillers,
    -medications that regulate heart rhythm and reduce blood pressure.
117
Q

After a heart attack, patients are not given ?? or ??, expect for sips of ?? or ?? liquids until condition stabilizes.

A

-food or beverages
-water or clear liquids

118
Q

Once able to eat, they are offered a heart-healthy diet, limited
to ?? milligrams of sodium per day, in small portions or as
tolerated

A

-2000

119
Q

Stroke is the ?? most common cause of death in the United States and a leading cause of
long-term disability in adults

A

-5th

120
Q

ischemic strokes:

A

-strokes caused by the obstruction of blood flow to brain tissue.
-87% of strokes

121
Q

hemorrhagic strokes:

A

-strokes caused by bleeding within the brain, which destroys or compresses brain tissue
-13% of strokes

122
Q

Hemorrhagic strokes are generally more ?? : more than ?? percent of
cases result in death within 30 days.

A

-deadly
-33%

123
Q

transient ischemic attacks (TIAs):

A

-brief ischemic strokes that cause short-term neurological symptoms (confusion, numbness, difficulty speaking).
-warning sign that a more severe stroke may follow

124
Q

Medications that suppress ??? reduce the risk of ischemic stroke, especially in people
who have suffered a first stroke or a TIA

A

-blood clotting

125
Q

Drugs typically prescribed to treat strokes:

A

-antiplatelet drugs (aspirin(
-anticoagulants (warfarin, coumadin)

126
Q

Ideally, ?? (clot-busting) drugs should be used within ?? hours following an ischemic stroke to restore blood flow and prevent further brain damage

A

-thrombolytic
-4½

127
Q

initial assessment after stroke should determine the nature of the patient’s ?? difficulty (if any) and the adjustments required for appropriate food intake.

A

-self-feeding

128
Q

??? is a frequent complication and is associated with a poorer prognosis.

A

-Dysphagia (difficulty swallowing)

129
Q

Hypertension is also a primary cause of ?? and ?? failure, and reducing blood pressure can dramatically reduce the incidence of these diseases

A

-stroke and kidney

130
Q

Hypertension affects about ?? percent of adults in the United States
-Prevalence is especially high in ?? Americans, who develop hypertension earlier
in life and sustain higher average blood pressures throughout their lives than
other ethnic groups.

A

-47%
-African

131
Q

What does blood pressure depend on?

A

-cardiac output & peripheral resistance)

132
Q

When either cardiac output or peripheral resistance
increases, ?? rises.

A

-blood pressure

133
Q

How is cardiac output raised?

A

-either the heart rate or the blood volume increase

134
Q

Peripheral resistance is affected mainly by the diameters of the:

A

-arterioles and blood viscosity

135
Q

Blood pressure is therefore influenced by the ??
system, which regulates heart muscle contractions and arteriole diameters, and ??
signals, which may cause fluid retention or blood vessel constriction

A

-nervous
-hormonal

136
Q

The ?? also play a role in regulating blood pressure by controlling the secretion of the hormones involved in vasoconstriction and retention of sodium and water

A

-kidneys

137
Q

primary hypertension:

A

-hypertension with an unknown cause;
-also known as essential hypertension
-accounts for 90 to 95% of cases

138
Q

secondary hypertension:

A

-hypertension that results from a physiological abnormality.
-such as abnormality in an organ or hormone involved in blood pressure regulation

139
Q

For example, conditions characterized by the narrowing of ?? arteries often result in the increased production of proteins and hormones that stimulate ?? retention and ?? , thereby raising blood pressure.

A

-renal
-water
-vasoconstriction

140
Q

Risk factors of hypertension:

A

-aging: 77% of people 65 years or older have hypertension
-genetic factors
-obesity
-salt sensitivity
-alcohol (more than 3 drinks daily)
-dietary factors

141
Q

For many people with stage 1 hypertension, changes in ?? and ?? alone may lower blood pressure to a normal level.

A

-diet and lifestyle

142
Q

Clinical studies suggest that systolic blood pressure
can be decreased by about ?? mm Hg for each kilogram of weight loss and that the
blood pressure reduction may be sustained for several years

A

-1

143
Q

DASH diet

A

-popular diet for reducing hypertension
-limit red meats, sweets, sugar containing beverages, saturated fat(7%), and cholesterol(150mg)

144
Q

During the eight-week study period when subjects with hypertension consumed the DASH diet, their systolic blood pressures fell by ?? mm Hg
more than the blood pressures of subjects who remained on the standard American
control diet

A

-11.4

145
Q

DASH eating plan is most effective when accompanied with low sodium intake of..

A

-1500mg per day

146
Q

Drug therapy for hypertension:

A

-combo of medications such as
-diuretics (lowers bp by reducing blood volume)
-ACE inhibitors
-angiotensin receptor blockers

147
Q

heart failure:

A

-a condition characterized by the heart’s inability to pump adequate blood to the body’s cells, resulting in fluid accumulation in the tissues;
-also called congestive heart failure.
-consequence of CHD and hypertension

148
Q

Heart failure develops mainly in older adults and is the leading cause of ?? in
individuals over 65 years of age

A

-hospitalization

149
Q

Left-sided heart failure

A

-left side of heart normally receives blood from lungs and pumps it to peripheral tissues
-weakened left heart allows fluid to build up in lungs (pulmonary edema)
-results in shortness of breath, limited oxygen activity, and in severe cases respiratory failure

150
Q

The inadequate blood flow to tissues can result in ?? dysfunction. In addition, fluid
accumulation within the lungs increases fluid pressure in the ?? side of the heart,
potentially damaging heart tissue and leading to right-sided heart failure

A

-organ
-right

151
Q

right-sided heart failure

A

-right side of heart receives blood from peripheral tissues and pumps blood to the lungs
-impaired pumping can lead to fluid backup into abdomen and peripheral tissues causing ascites, liver and spleen enlargement, impaired liver and gastrointestinal function, and swelling in legs, ankles and feet.

152
Q

Heart failure often affects a person’s ?? intake and level of ??

A

-food
-physical activity

153
Q

End-stage heart failure is often accompanied by ?? which is??

A

-cardiac cachexia
-severe malnutrition that develops in patients with heart failure
-“weight loss and tissue wasting”

154
Q

Cardiac cachexia may develop due to increased
levels of:

A

-pro-inflammatory cytokines (promote catabolism)
-elevated metabolic rate
-reduced food intake
-malabsorption

155
Q

The medications prescribed for heart failure
include:(5)

A

-diuretics,
- ACE inhibitors,
-angiotensin-receptor blockers,
-beta blockers, vasodilators,
-digitalis

156
Q

No known therapies can ?? cardiac cachexia, and the prognosis is poor

A

-reverse

157
Q

Individuals at risk of wasting should be advised to obtain enough energy to maintain an appropriate body weight and consume at least ?? grams of protein per kilogram of body weight per day:

A

1.1

clinical nutrition (26 decks)

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