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CNS Exam 2024 > Medical Nutrition Therapy: CVD > Flashcards

Medical Nutrition Therapy: CVD Flashcards

1
Q

Obesity diagnosis summary

A

BMI above 30, Body fat %above 30% for women and 25% for men

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2
Q

Obesity assessment

A

intra-abdominal adipose tissue, independent of BMI, correlates strongly with increased risk of CVD, stroke, dyslipidemia, hypertension and Type II diabetes in men and women

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3
Q

Criteria for Metabolic syndrome

A

Abdominal obesity: Men waist >40 inches, Women waist >35 inches; Pre-Hypertension: BP>1/85 mmHg; Glucose intolerance FBG>110 mg/dL; High Triglycerides >150 mg/dL; Low HDL-C Men <40 mg/dL, Women <50 mg/dL

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4
Q

Morbidity associated with increased Risk from Obesity

A

Cardiovascular system, dermatology, endocrinology and reproduction, Gi System, Neurology, Oncology, Psychiatry, Respiratory, Rheumatology and orthopedics, Urology and nephrology

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5
Q

Key points from pizzorno: obesity

A

-Reduction of excess calorie intake -minimize carbohydrates
-caloric intake <1500
-minimize processed foods
-cease lifestyle of physical inactivity
- GGT>25…convert to organic foods
-NAC to increase glutathione
-optimize brain serotonin- 5HTP
-enhance satiety and decrease appetite-viscous soluble fiber
-increase cellular sensitivity to insulin-chromium
-inhibit conversion of carbs to adipose and inhibit appetite- Hydroxycitrate (HCA)
-Increase thermogenesis-Medium chain triglycerides (MCT) from coconut oil

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6
Q

Obesity treatment goals

A

-weight reduction (lower BP, serum glucose, LDL-C and triglyceride levels)
-Lifestyle modifications
-Increased physcial activity
1. CDC recommends 30 min. per day, 5 days week
2. IOM recommends 1 hour per day for adults
-Diets
1. REcommendation of 45-65 % of calories come from carbs, 20-35 % fat, rest protein
2. Replace saturated fats with MUFAs
3. High fiber foods
4. Calorie reduction
5. DASH diet

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7
Q

Obesity: Pharmacotherapy Options:

A

-Xenical(Orlistat)- Activity occurs in the small intestine and promotes weight loss by inhibiting gastric and pancreatic lipases, partially blocking hydrolysis of triglycerides.
-Qsymia (topamate and phentermine) suppresses appetite and promotes satiety.
-Belviq-selective agonist of the serotonin 2C receptor

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8
Q

MNT Cardiovascular Disease (CVD)

A

-Electrical activity of the heart dependent on CA ++, Mg ++ and K+ ions for normal cardiac electrical and contraction activity.
-Blood fluid and volume dependent on NA+, K+ and free water homeostasis.
-Excessive salt retention associated with ascites, edeme, and anasarca, excessive depletion can reduce effective intravascular volume.
-Symptomatic inappropriate anti-diuretic hormone secretion (SIADH) can cause hyponatremia
-Food/drug interactions to monitor: coumadin, digoxin, calcium channel blockers, beta blockers, diuretics, ACE inhibitors, peripheral vasodilators, central and peripheral alpha-blocking agent/amiodarone or other antiarrhythmic medications.

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9
Q

Atherosclerosis (CVD)

A

-the buildup of fats, cholesterol and other substances in and on the artery walls. This buildup is called plaque. The plaque can cause arteries to narrow, blocking blood flow.
-Pathogenesis in a group of disorders collectively termed CVD.

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10
Q

disorders termed CVD

A

-Heart disease
-coronary artery disease (CAD)
-myocardial, pulmonary, or cerebral infarction

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11
Q

Major risk factor of CVD

A

-smoking- 70% greater risk of death than non smokers
-elevated cholesterol
-High BP
-Diabetes
-Physical inactivity
-Other: insulin resistance, low thyroid function, low antioxidant status, elevated c-reactive protein, low levels EFAs, increased platelet aggregation, low level MG and K, Type A personality

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12
Q

CVD assessment

A

-Lab tests
-total cholesterol (should be <200 mg/dL)
-LDL (<130 mg/dL)
-HDL (>40 mg/dL men; >50 mg/dL women)
-Risk factor ratios: Ratio of TC to DHL-C below 4.2, ratio of LDL-C to HDL-C is above 2.5
-Triglycerides (should be <150 mg/dL)
-C-reactive protein
-lipoprotein (a)
-Fibrinogen
-Homocysteine
-Ferritin (iron binding protein)
-lipid peroxides
-exercise stress test
-electrocardiography
-echocardiography

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13
Q

CVD Minimize obstacles

A

-reduce dietary stress- choose mediterranean, ornish, DART or Lyon diet
-weight management
-aerobic exercise
-eliminate smoking
-anger and aggression management
-Vitamin D
-Thyroid therapy

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14
Q

CVD Tailored

A

-Enhance antioxidant status: vit. C, Vit. E, CoQ10, colorful fruits and vegetables, red wine
-Ensure Omega 3 EFA sufficiency: Fish oil, Flaxseed oil
-Support integrity of microvasculature: Grapeseed extract, Pine bark extract.
-Hyperlipidemia: Niacin, Garlic
-Diabetic Hypertriglyceridemia: pantethine
-Hyperhomocysteinemia: vitamin B6, B12, Folic Acid, Vitamin C
-Previous MI or Stroke: Gingko biloba

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15
Q

CVD (general)

A

-Group of interrelated diseases that include atherosclerosis, hypertension, ischemic heart disease, peripheral vascular disease, heart failure.
-1-3 americans have one or more type of CVD
-#1 killer in the US
-Life time risk: 2 in 3 in American men, 1 in 2 for women

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16
Q

CVD Major risk factors, Modifiable risk factors

A

1 Major risk factors:
-Hypertension
-Age >45 years men, >55 years woman
-Diabetes Mellitus
-Estimated glomular filtration rate <60 ml/mn
-microalbuminuria
-Family history of premature CVD in men <55 years and women <65

17
Q

CVD modified risk factors

A

-lipoprotein profile
-LDL-C elevated
-Total Triglycerides elevated
-Elevated TMAO (Trimethylamine N-oxide
-HDL- C low
-Inflammatory Markers

18
Q

CVD Inflammatory markers

A

-Genetic markers: angiotensin !! receptor type-1 polymorphism
-oxidized LDL-C
-Adhesion molecules
-selectins
-free fatty acids
-cytokins
-interleukin 1, interleukin 6
-tumor necrosis factor-alpha
-acute phase reactants
-fibrinogen
-creactive protein
-serum amyloid A
-white blood cell count
-Erthrocyte sedimentation rate
-TMAO

19
Q

Pathophysiology and care management algorithm for atherosclerosis

A

-smoking, obesity, hypertension, elevated LDL-cholesterol
-Genes, high saturated fat, cholesterol diet, elevated serum triglycerides, inactivity, diabetes, stress
-decreased HDL-cholesterol, ageing, hyperhomocysteinemia, endothelial dysfunction

20
Q

Atherosclerosis (clinical findings, nutrition assessment, medical management, nutrition management)

A

CF: Elevated LDL cholesterol, elevated serum triglycerides, elevated c-reactive protein, low HDL-cholesterol
NA: BMI evaluation, waist circumference, waist to hip ratio (WHR), Dietary assessment (SFA< trans fatty acids, fiber, sodium, alcohol, sugar, phytonutrients)
MM: Lifestyle change, HMG CoA reducatse inhibitors (statins), Triglyceride lowering medication, blood pressure lowering medication, medication for glucose management, percutaneous coronary intervention (PCI) Balloon, stent, antiplatelet therapy
NM: DASH dietary pattern, mediterranean diet pattern, weight reduction, increase dietary fiber to 25-30 g/day or more, add fruits and vegetables, CoQ10 for those on statin drugs.

21
Q

CVD lifestyle recommendations based on risk factors

A

elevated LDL-C: decrease saturated fat, increase soluble fiber, weight loss, avoid trans fat
Low HDL-C: increase exercise, weight loss
Diabetes and insulin resistance: weight loss, decrease BP, decrease carbs, increase exercise
Elevated triglycerides: increase fish oils, weight loss, decrease alcohol, decrease carbs
Obesity (BMI>30): Weight loss, increase exercise, decrease portion size
Hypertension: Decrease sodium, increase fruits and veg, decrease alcohol, weight loss, increase exercise
Metabolic syndrome: weight loss, increase exercise, custom recommendations for macro intake

22
Q

CVD medical nutrition

A
  1. Reduce saturated fats
    -major contributors: fatty meat and poultry, dairy products, bread/processed snack foods, desserts/sweets
    2.Substitutions of dietary sources of PUFAs (omega 3 and omega 6) lowers LDL-C and reduces risk for CHD
    - long chain omega 3 decrease serum triglycerides, platelet aggregation, and inflammation
    -1 g/day of EPA/DHA can reduce death from cardiac event
    -Best sources fatty fish
  2. Diet high in MUFA (olive oil) show improvement in risk factors
23
Q

MNT Hypertension Key points

A

-Hypertension often is affection by high sodium intake and may be ameliorated by dietary sodium restriction and supplemental potassium, calcium, and magnesium.
-Appropriate dietary modification should account for concurrent cardiovascular, renal and endocrine conditions.

24
Q

Hypertension ranges

A

Prehypertension: 120-139/80-89 mmHg
Stage 1: 140-159/90 to 99 mm Hg
Stage 2: 160 + /100 + mmHg

25
Q

Hypertension Lifestyle and dietary factors

A
  1. Lifestyle: coffee, alcohol, lack of exercise, stress, smoking
  2. Dietary: obesity, high Na/K ratio, low fiber/high sugar diet, high saturated fat and low EFAs, low ca, Mg and vitamin C
  3. Elevated lead-chelation program to reduce levels
26
Q

Hypertension Natural Interventions

A

-Antihypertension diets: High K+ diet rich in fiber, increase celery, garlic, onions; reduce animal fats and increase olive and flaxseed oils
-Mild hypertension: High potency vitamin-mineral, vitamin C, magnesium, potassium, calcium, folic acid and B6, Fresh garlic, flaxseed oil or fish oil
-Moderate hypertension: All measures above, Anti-ACE peptides from bonito, CoQ10, Arginine, Hawthorn extract (crataegus) or olive leaf or hibiscus, mistletoe

27
Q

Hypertension Key Points

A

-normal adult BP 120/80
-Adults aged 60 or older should be treated with medication if BP exceeds 150/90
- In the US 1 in 3 has high BP, 90-95% have essential hypertension
-Known lifestyle factors include poor diet, smoking, physical inactivity, stress and obesity
-Genetics play a role (renal, neuroendocrine)
-Hypertension derived from another disease, usually endocrine, termed secondary hypertension.

28
Q

Renin Angiotensin cascade

A
29
Q

Major regulators of BP

A

-sympathetic nervous system for short term control
-Kidney for long term control

30
Q

Recommendations for HTN

A

-Energy intake: for each Kg of weight lost, reductions in SBP and DBP are approximately 1 mm Hg are expected
-DASH diet
-Salt restriction <2300 mg per day, further improvement at <1500 mg per day except for patients with heart failure
-Diet rich in potassium, calcium, magnesium
-Intake of fish oils>2 g day
-Alcohol, men limit to two drinks (2 oz, 80 proog whiskey, 10 oz wine, 24 oz beer, women to one drink)
-Exercise moderate to vigorous 3-4 x week, 40 min sessions

31
Q

MNT Dyslipidemia

A

Abnormally high levels of lipids (fats) in the blood. Usually with no symptoms but can lead to cardiovascular diseases.

32
Q

Dyslipidemia

A

-Core treatment : nutritional modifications
-restricted intake of dietary fats, simple sugar cholesterol, alcohol, and total calories, increased dietary fiber
-exercise programs

33
Q

Dyslipidemia recommendation for statins

A

-clinical diagnosis of ASCVD
-elevations of LDL-C>190 mg/dL
-diabetes, aged 40-75 years with LDL-C 70-189 mg/dL
-Without ASCVD or diabetes with LDL-C 70-189 mg.dL, estimated 10 year risk of > or = 7.5 %

34
Q

Recommended diet for Dyslipidemia

A

-saturated fat below 5-6% of calories, avoid trans fat
-Dietary cholesterol intake below 200 mg/day
-increase of viscous (soluble) fiber to 10-25 g/day
-intake of 2 g/day of plant sterols/stanols
-weight management and increased physical activity

CNS Exam 2024 (32 decks)

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