Post on 16-Jan-2015
description
transcript
The Role of Diet in CVD
Presented By:
Lisa Spott R.D
Clinical Nutrition – Cardiology
St. Mary’s General Hospital
A Professional Opinion
• Reliable source for health information
• Clarify media reports on various nutrition topics
• Help distinguish nutrition myth from nutrition fact
CLARITY
Workshop Goals
Answer your questions about nutrition and CVD management.
Provide useful tools and resources that can be used in the treatment of the CVD patient
Workshop Topics
Case #1 – Elevated Lipid Profile
Case #2 – Weight Loss
Case #3 – CHF
Points of interest:
• Homocysteine
• Omega-3 Fatty Acids
• DASH Diet
Where Do You Start?
Case Study • 55 year old male• PMHx: hypercholesterolemia• Family Hx: premature CVD• Ex-smoker• Exercises 30min 3x/wk• BP 115/79 mm hg• BMI - 29 • WC - 39in
Lab Values
Lab test Values
ATP III Reference Values
(primary prevention)
Total Cholesterol 7.44 < 5.2
LDL Cholesterol 4.32 <2.5
HDL Cholesterol 0.93 >1.0
Triglycerides 1.58 <1.7
Problem List
• Elevated TC
• Elevated LDL
• Low HDL
• Overweight
• Family History concerns
Diet Vs. Drugs
• Despite the wide spread use of statins and their effectiveness in reducing
cardiovascular disease, diet is still the preferred treatment option in primary prevention
The Portfolio DietDiet Components Dietary Change Approx. %
LDL
NCEP II <7% saturated fat
<200mg cholesterol/d10
Portfolio Diet:Soluble Fibre 20g/d 5
Vegetable protein 80g/d 5
Plant Sterols 2g/d 5
Almonds 30g/day 5
Cumulative Potential Effect 20-30
ATP III
Dietary Component Dietary Change Approx. %
LDL
Saturated Fatty Acids <7% kcal 8-10
Cholesterol <200mg/d 3-5
Weight Reduction Lose 10 pounds 5-8
Soluble Fibre 5-10g/d 3-5
Plant Sterols 2g/d 6-15
Cumulative Potential Effect 20-30
The Mediterranean Diet
Daily Activity
www.oldwayspt.org/
A Diet Prescription for Heart Disease
In 5 minutes or less…
Physician Nutrition Check List for Heart Health “The 5 F’s”
Fruits & Vegetables
Unsaturated Fats
Fish
Fibre
Food Portions
Fruits and Vegetables
• Current recommendations are to aim for 7-10 fruits and vegetable servings everyday
• Limit red meat to < 1 x per week• Choose a soft non-hydrogenated margarine• Choose low fat dairy products 1% M.F.or less for
milk, yogurt and cottage cheese, <20% M.F. for cheese
• Choose olive and canola oil for cooking• Snack on a ¼ cup of nuts daily
Unsaturated Fats
• Aim for 2-3 meals of fish per week• Salmon and trout are high in omega-3 fats
Fish
Fibre
• Recommendations for daily Fibre intake:
Men: 30-38 grams per day
Women: 21-27 grams per day
Soluble Fibre recommendation: 10-15grams per day• Sources include: psyllium, oatbran, oatmeal,
beans, lentils, some fruits and vegetables
• Eat frequently throughout the day so it is easier to control food portions
• Measure foods at home and become familiar with recommended portion sizes
Food Portions
In 5 minutes or less…
Fruits & Vegetables
Get a HANDle on Heart Healthy Nutrition
Fish
FibreFats
Food Portions
Get a HANDle on Food Portions
3 oz
¼ cup
1 cup&
½ cup
1 tsp
1 oz
Case Study # 2 -Weight Loss
• Patient returns to your office to review results of blood lipid profile
• In addition to elevated LDL-C patient has a BMI of 29.
Patient asks which “fad” diet you would recommend.
Discrediting Fad Diets
Diets Evidence of in
Coronary Disease
Weight LossShort term Long term
CompliancePotential
Worsening/
Side effects
VLFDOrnish
+ + + + + + + + + DM, Met
Syndrome
Low
Carb
Atkins
+/- + + + +/- + Gout, renal
disorders, hair loss, constipation,
bad breath
AHA + + + + + + + + None
Reported
DASH + + + + - - - None
Reported
Questions to ask when choosing a weight loss program…
1. Has a registered dietitian helped to design the program or is one available to talk with you?
2. Is the recommended weight loss more than 2 pounds per week?
3. Does the program provide at least 1200 Calories (5000 kilojoules) per day for women and 1500 Calories (6500 kilojoules) per day for men?
4. Does the program depend on special products, special foods, supplements or treatments?
Case Study #3– CHF
• Patient with know history of CHF comes to see you with complaints of increased ankle edema. The patient is on
maximum diuretic therapy, what else can you do for this patient to help her out of this potential crisis?
Nutrition Management of CHF
• Low Salt Diet:
2400mg sodium per day
• Fluid restriction:
1.5L fluid per day
Ask your CHF patient…
• Are you adding salt at the table or in cooking?
• Do you consume canned soups, vegetables or stews?
• Do you eat packaged frozen entrees?
• Do you eat processed cheese
and prepared meats?
• Do you eat out frequently?
Sodium and Food Labels
Using % Daily Value
% Daily Value How Much Sodium?
What does it mean?
< 5% <125mg sodium per serving
A low sodium food that can be enjoyed daily
5-10% 125-250mg sodium per serving
A food that can easily fit into a low sodium diet
11-20% 250-500mg sodium per serving
A food that can be carefully fit into a low sodium diet
>20% >500mg sodium per serving
A high sodium food that should not be consumed daily when following a low sodium diet
Fluid restriction
• Encourage the patient to track their fluid intake daily
•Remind patients that fluids include: Water, coffee, tea, milk, juice, pop, soup,
jello, nutrition supplements, alcohol, ice cream, thin fluids at room temperature
Additional Thoughts on CHFManagement…
• Multivitamin supplementation
• Thiamine supplementation
• Interpreting BMI in the CHF patient
Heart Failure Society of America
Education modules available online at
www.hfsa.org/pdf/module2.pdf
Should I be taking a vitamin B supplement?
Although two recent studies did show that the vitamins cut homocysteine levels, that did not translate into a reduction in the risk for heart attacks or strokes.
Lonn, E. et al. McMaster University. N Eng J of Med. 2006
Bonaa, K.H. et al. University or Tromso. N Eng J of Med.2006
I have heard a lot recently about Omega-3 fats…
• AHA recommends 2-3 meals of fish per week to meet omega-3 fatty acid requirements, 1000mg per day, for CVD prevention
Is an Omega-3 supplement a good idea?
• Omega-3 supplements are recommended for those who do not eat fish regularly
• Choosing a supplement:
1000mg capsule 400mg EPA
200mg DHA
600mg total
Take 1-2 times per day.
The DASH Diet• Dietary Approaches to Stop Hypertension
Grains and grain products 7-8 daily Fruits 4-5 dailyVegetables 4-5 dailyLow fat or fat free dairy 2-3 dailyMeats 2 or less dailyNuts,seeds and dry beans 4-5 x per weekFats and oils 2-3 dailySweets 5 per week
The DASH Eating Plan
Website Resource:
Download a copy of the DASH Eating Plan
www.nhlbi.nih.gov/health/public/heart/hbp/dash/
Community Services
• Referral to a private practice dietitian
• Meals on Wheels
• Cardiac Rehab
• Heart Function Clinic
• SMGH is considering a fee-for-service weightloss program…details to come