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Clinical Nutrition > Nutritional care in coronary artery disease and hypertension > Flashcards

Nutritional care in coronary artery disease and hypertension Flashcards

1
Q
  • lipids are soluble in ____ but not soluble in ___
  • they include? (types of lipids)
A
  • organic solvents (benzene, ether) but not in water.
  • triglycerides (fats and oils), sterols (cholesterol), phospholipids (lecithin).
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2
Q

what is triglyceride composed of?

A

1 glycerol + 3 fatty acids

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3
Q

fatty acids may be?
they vary in?

A
  • saturated fatty acids or unsaturated fatty acids (presence of double bond; can be mono or polyunsaturated)
  • length of their hydrocarbon chain and degree of unsaturation
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4
Q

saturated fatty acids:
- at room temperature
- shelf life
- oxygen
- where is it found

A
  • solid
  • longer
  • doesnt react with atmospheric oxygen
  • fat in animal products (red meat, full fat milk, butter, pork, bacon, etc); cooconut oil and palm oil.
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5
Q

monounsaturated fatty acids:
- bond?
- where is it found
- how does it affect HDL and LDL

A
  • second bond is vulnerable - easily oxidized at room temperature
  • plant oils - peanut oil, olive, canola, etc
  • dec ldl inc hdl
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6
Q

polyunsaturated FAs

A

multiple double bonds
liquid at room temp
found mainly in vegetable oils

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7
Q

how do the length and saturation of fatty acids affect?

A
  • affect triglycerides’ physical characteristics (solid vs liquid) and storage properties (stability & shelf life).
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8
Q

vegetable and fish oils:
- what type of fat
- how at room temp
- stability

A
  • polyunsaturated fatty acids
  • liquid at room temp
  • not very stable => becomes rancid via oxidation process: double bonds are unstable and react with atmospheric oxygen
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9
Q

animal fats:
- what type of fat
- room temp how is it
- stability

A
  • saturated
  • solid
  • stable
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10
Q

where is visible fat found?
where is invisible fat found?

A
  • butter, oil, mayonaise, fat trimmed from meat
  • milk, cheese, pastries, fried food, fat in the marbling of meat
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11
Q

how do saturated FAs affect LDL? receptors?
sources?

A

increase LDL => dec receptor synthesis and activity
animal products: beef, chicken, pork, dairy

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12
Q

why do fried oils increase LDL cholesterol in the blood?

A

due to oxidization of the fat => inc aldehydes => inc LDL

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13
Q

MUFAS:
how do they affect the cholesterol
sources

A

increase HDL levels (if MUFAS >15%)
decrease LDL & triglycerides
sources: oleic acids = olive, canola oil, avocados, almonds, peanuts

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14
Q

how does PUFA affect cholesterol?
sources?

A

decrease LDL and HDL levels
in vegetable seeds and fish

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15
Q

PUFAS: classified into? which is further classified into?

A

omega 3: alph linolenic acid –> docosahexaenoic acid and eicosapentaenoic acid
omega 6: arachidonic acid

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16
Q

we aim to reach a ratio of omega 6 : omega 3 of how much?

A

4:1 (still not official in the guidelines)

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17
Q

how are trans fatty acids made?

A

hydrogenation (adding hydrogens to fatty acids double bonds) = fat becomes > saturated, more solid, and more stable (can last longer before becoming rancid).

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18
Q

advantages of trans fats

A
  • alters texture of food
  • makes the oil more stable and more resistant to oxidation = longer shelf life
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19
Q

disadvantages of trans fats

A
  • makes PUFAs more saturated = less healthy
  • dec HDL, inc LDL
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20
Q

what are phospholipids?
example
naturally occurring where?
composed of?

A
  • important constituents of cell membranes and emulsifiers
  • lecithin
  • peanuts, egg yolk, liver, soybeans
  • 1 glycerol + 2 Fatty acids (hydrophobic end) + phosphate group (hydrophilic end)
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21
Q

what are sterols?
examples

A
  • compounds with multiple ring structure
    1. cholesterol
    2. sex hormones (testosterone & estrogen)
    3. bile
    4. vitamin D
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22
Q

cholesterol:
- why is it important
- where is it synthesized
- do we need extra from diet?
- how much cholesterol does the liver make every day
- dietary cholesterol and hdl/ldl

A
  • starting material for all the above cpds (bile, vitamin D, sex hormones)
    its also an imp structural component of the brain & nerve cells.
  • liver of humans (endogenous) but can be obtained from exterior source (exogenous)
  • no; Our body makes enough cholesterol: no need to get extra cholesterol through the diet.
  • 800 mg - 1500 mg /day
  • raises total cholesterol and LDL but to a lesser extent than saturated fatty acids
23
Q

foods rich in cholesterol?

A
  • eggs
  • red meat
  • shellfish
  • liver
  • dairy products
  • egg yolk
24
Q

how is cholesterol in the blood transported?

A
  • in 2 forms: LDL which transports cholesterol from liver to tissues = linked to heart diseases
  • HDL: transports cholesterol from tissues to liver = protective effect
25
Q

factors that inc HDL?
factors that inc LDL?

A
  • weight loss (if obese), exercise, estrogen, mod alcohol intake
  • smoking, sedentary lifestyle, obesity, saturated and trans fat intake.
26
Q

wht do cardiovascular diseases include

A
  • CHD
  • atherosclerosis
  • htn
  • ischemic heart disease
  • pvd
  • hf
27
Q

what are the 3 major risk factors for CVD?

A

blood cholesterol concentration
smoking
htn

28
Q
  • major risk factors for cardiovascular disease
A
  • hypertension
  • age
  • diabetes
  • family history of premature cardiovascular disease
29
Q

modifiable risk factors of cardiovascular disease

A

inc LDL
inc TG
dec HDL
CRP
inflammatory markers

30
Q

lifestyle RF for cardiovascular disease

A
  • poor diet
  • physical inactivity
  • tobacco
  • stress
  • insufficient sleep
  • excessive alcohol
31
Q

related conditions

A

HTN
obesity
metabolic syndrome (hdl dec, tg inc, abdominal obesity)

32
Q

desirable range of:
- total cholesterol
- LDL
- HDL
- TG

A
  • < 200 mg/dl
  • < 130 mg/dl
  • > 40 mg/dl
  • < 150 mg/dl
33
Q

13 recommendations from the AHA for CVD risk reduction

A
  1. healthy body weight
  2. diet rich in fruits & vegetables
  3. inc fiber food
  4. 2 x /week of fish
  5. saturated fat <7% of total calories
  6. trans fat <1% of total calories
  7. total cholesterol intake < 300 mg/dl
  8. lean meats
  9. low fat dairy
  10. little - no salt in food
  11. moderate alcohol intake
  12. dec hydrogenated oil
  13. dec food with added sugar
34
Q

TLC diet:
- % of total fat
- % proteins
- CHO %
- saturated fat %
- trans fat %
- PUFA %
- MUFA %
- daily cholesterol intake
- physical acivity
- fiber
- sterols

A
  • 25 - 35%
  • 15%
  • 50 - 60% (whole grain, fruits, veggies)
  • < 7%
  • zero or as low as possible
  • up to 10%
  • up to 20%
  • < 200 mg/day
  • 200 kcal/day
  • 25 - 35 g (mostly soluble)
  • 2g/day
35
Q

how does increased intake of total fat increase the risk of CVD?

A

increased postprandial lipemia = increased debris or fragments of chylomicrons = increased risk of CVD

36
Q

if the diet is < 25% of fat how does that affect?

A

inc TG, dec HDL

37
Q

effect of fatty acids on TG and HDL

A
  • Fatty acids, regardless of their type, decrease TG when they replace carbohydrates.
38
Q

what fibers do we go for in CVD?

A

inc Intake levels of dietary fiber are
associated with dec prevalence of
CHD and stroke. In particular,
SOLUBLE FIBERS pectins , gums
and mucilages etc.) that dec LDL
cholesterol.

39
Q

how do soluble fibers decrease cholesterol?

A
  • the fiber binds bile acid = lowers serum cholesterol
  • bacteria in the colon ferment the fiber to produce acetate, propionate, butyrate = inhibit cholesterol synthesis
40
Q

where are stanols and sterols derived from

A

soybean or pine tree

41
Q

how do stanols and sterols help in cholesterol

A

decrease blood cholesterol by decreasing its absorption

42
Q

when stanols and sterols are made into margarines?

A

decrease cholesterol up to 20%

43
Q

when does oxidative stress occur?

A

when the free radical activity&raquo_space;» antioxidant defenses
this leads to inflammation => heart disease and cancer

44
Q

what are antioxidants?

A

compounds that protect other cpds from damaging reactions involving oxygen by themselves reacting with oxygen

45
Q

what has an antioxidant effect?

A

vitamins A, C, E

46
Q

what are phytochemicals?

A

Phytochemicals are compound in
plants that confer color, taste and
other characteristics.
*
Known to have an antioxidant
activity.
*
Some can mimic the body’s own
hormones ( i.e :
*
Catechins found in red grapes, red
wine, tea (especially green),
chocolate, and olive oil , have been
found to improve vascular
reactivity.
4. Antioxidants and their role
in disease prevention

47
Q

what is hypertension?

A

Hypertension is persistently high arterial blood pressure, the force exerted per unit area on the walls of arteries

48
Q

risk factors of hypertension

A
  1. smoking
  2. diabetes
  3. hypercholesterolemia
  4. obesity
  5. excessive alcohol
  6. MI
  7. impaired renal function
  8. cerebrovascular accident
  9. retinal hemorrhage
  10. black race
  11. male gender
49
Q

prevention of hypertension?

A
  1. limiting alcohol
  2. decreased dietary intake of Na
  3. as per DRI of Ca, Mg, K
  4. inc fruits and vegetables
  5. physical activity
  6. weight reduction if overweight
  7. dec fat dairy products
50
Q

food sources of na

A
  • salty snacks (chips, popcorn, etc)
  • cheese and bread rolls
  • soy sauce
  • pasta dishes
  • cured meats
  • processed soups, poultry, sandwich
  • pizz
  • meat mixtures
  • cold cuts
51
Q

lifestyle modifications to reduce BP

A
  1. weight reduction: maintaining a BMI of < 25
  2. DASH diet: low fat dairy, fruits, vegetables, reduced saturated fat intake
  3. aerobic physical activity for at least 30 mins per day most days of the week
  4. alcohol intake decreased: 2 drinks for men per day, 1 drink for women per day.
  5. Na restriction: < 6g of salt /day ; < 2300 mg of Na /day.
52
Q

DASH diet

A
  • 2 x the servings of fruits & vegetables
  • 1/2 the typical amounts of fats, oils, and salad dressing
  • limiting by 1/3 the amount of beef, pork, and ham
  • eating 1/4 the number of snacks and sweets
53
Q

how does a diet rich in K help?
examples of K+ rich food sources
Ca & Mg

A

lowers BP and blunts the effect of salt on BP in some individuals
leafy green vegetables, root vegetables, fruiits: oranges, beet greens, white beans, spinach, bananas, sweet potatoes
- may have BP benefits: low fat dairy, beans nuts

54
Q

what is moderate physical activity defined as

A

30 - 45 minutes of brisk walking on most days of the week

Clinical Nutrition (3 decks)

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