Clinical Nutrition
Academic year 2023-2024
Lecture No.2: Heart disease
Clinical Nutrition2
Lecturer
Dr.
Heba Emad El din Amin Abdalla
Assistant Professor: Food Science Department , Faculty of
Agriculture Mansoura University,Egypt.
[email protected] Your heart pumps blood, oxygen and other nutrients to every cell in your body.
Heart disease
• Heart diseases include:
Blood vessel disease, such as coronary artery
disease, Cardiovascular, Atherosclerotic
cardiovascular disease (ASCVD) , (arrhythmias)
Irregular heartbeats , (congenital heart defect) Heart
problems you're born with .
• Cardiovascular disease (CVD) is a group of
interrelated diseases that include atherosclerosis,
hypertension, dyslipidemia,ischemic heart disease,
peripheral vascular disease, and heart failure (HF).
Types of heart disease
Atherosclerosis
Blood vessels are composed of three layers. The outer layer is mainly connective
tissue that gives structure to the vessels. The middle layer is smooth muscle that contracts
and dilates to control blood flow and blood pressure. The inner lining is a thin layer of
endothelial cells that in a healthy state, the release of bioactive substances that maintain
vascular homeostasis. One such substance is nitric oxide (NO). Atherosclerosis is the
underlying cause of many forms of CVD.
Dyslipidemia
refers to a blood lipid profile that increases the risk of developing
atherosclerosis. Three important biochemical measurements in ASCVD include
lipoproteins, total cholesterol, and triglycerides. Cholesterol is delivered into cell walls by
low-density lipoprotein (LDL). and high-density lipoproteins (HDL) consist of varying
amounts of triglyceride, cholesterol, phospholipid, and protein. role of lipoprotein
includes transporting lipid to cells for energy, storage, or use as substrate for synthesis
of other compounds such as prostaglandins, thromboxanes, and leukotrienes .The typical
dyslipidemic condition is one in which LDL levels are elevated (hyperlipidemia) and HDL
levels are low.
HYPERTENSION
• Hypertension is persistently high arterial blood pressure,
the force exerted per unit area on the walls of arteries .
• Adult blood pressure is considered normal at 120/80 mm
Hg.
• Until now, people with those chronic conditions have
been prescribed medication when their blood pressure
exceeded 130/80.
• Hypertension is a major contributing factor to
atherosclerosis, stroke, renal failure,
NB: people with high blood pressure should follow a healthy diet and lifestyle along with
medication management.
Heart failure (HF)
HF patients have elevated levels of
norepinephrine, angiotensin II, aldosterone,
endothelin, and vasopressin; all of these are
neurohormonal factors that increase the
hemodynamic stress on the ventricle by causing
sodium retention and peripheral vasoconstriction.
• The clinical outcome of impaired arterial function arising from
atherosclerosis depends on the location of the impairment. In the
coronary arteries atherosclerosis can cause angina (chest pain), MI,
and sudden death.
• Triglyceride measurements are now considered along with glucose
intolerance, hypertension, low HDL cholesterol, and high LDL
cholesterol as part of the metabolic syndrome.
NB: an inverse correlation between HDL levels and risk of cardiovascular events
Risk factor
1.Cigarette smoking
2. Cholesterol level, blood pressure .
3. Obesity . Carrying excess adipose tissue greatly affects the heart through
the many risk factors that are often present: hypertension, glucose intolerance,
inflammatory markers (IL-6, TNF-a, CRP), obstructive sleep apnea, pro thrombotic
state, endothelial dysfunction, and dyslipidemia
4.Diabetes is a disease that is an independent risk
factor
5. High blood pressure found to increase the risk of
stroke.
6. Menopause .
7. Psychosocial factors found to affect heart disease.
risk factors for HF were hypertension, diabetes, ASCVD, and left ventricular hypertrophy (LVH)
(enlargement of the left ventricle of the heart). Antecedent hypertension is present in about
three fourths of HF patients.
8. Progression from hypertension to heart
failure described.
9. Genetic Research Study begins to identify
genes underlying cardio-vascular diseases
10.Physical inactivity: retarding atherogenesis,
increasing vascularity of the myocardium,
increasing fibrinolysis, increasing HDL cholesterol,
improving glucose tolerance and insulin sensitivity,
aiding in weight management, and reducing blood
pressure..
11.Stress activates a neurohormonal response
in the body that results in increased heart rate,
blood pressure, and cardiac.
12.High sodium intake ,Low potassium intake
Prevention and Management of Risk Factors
Life style modifications: remains the backbone of
CVD prevention and treatment
Calcium and Vitamin D and hypertensionHigher dairy Sodium:dietary sodium and potassium intake on
versus supplemental calcium is associated with lower
risk of hypertension. blood pressure and CVD outcomes, reduction of
Magnesium : Magnesium is a potent inhibitor of sodium intake to 1500 mg/day
vascular smooth-muscle contraction and may play a
role in blood pressure regulation as a vasodilator The DASH diet is used for preventing and controlling
Potassium :Supplemental doses of potassium in the
range of 1900 to 4700 mg/day lower blood pressure high blood pressure .
with a lower risk of stroke.
The MeD dietary patterns that have been studied were
Salt Restriction :1 tsp salt = 2400 mg sodium
Caffeine moderate in total fat (32% to 35%), relatively low in
Until now caffeine has been considered detrimental saturated fat (9% to 10%), high in polyunsaturated
to patients with HF because it contributes to
irregular heartbeats. fatty acids (especially omega-3), and high in fiber (27
to 37 g per day) with lower sodium intake
Exercise in preventing and treating CVD
• Weight Reduction It is estimated that at least 75% of the
incidence of hypertension is related directly to obesity Weight
gain during adult life is responsible for much of the rise in blood
pressure seen with aging.
• Sodium The lowest blood pressures were achieved by those
eating the 1500-mg sodium level in the DASH diet,the Dietary
Guidelines for Americans recommend an intake of less than
2300 mg of sodium, the equivalent of 6 g of salt, each day
• Physical Activity Less active persons are 30% to 50% more
likely to develop hypertension than their active counterparts
minimum of 40 minutes on 3 to 4 days per week
• Salt Restriction less than 2300 mg of sodium per day.
• Fats :Fish consumption and fish oils rich in omega-3 fatty acids
can lower elevated triglyceride levels and may prevent atrial
fibrillation in HF patients
Top Ten Categories of High- Sodium Foods
1. Smoked, processed, or cured meats and fish (e g., ham, bacon, corned beef, cold cuts, hot
dogs, sausage, chipped beef, pickled herring, anchovies, tuna, and sardines)
2. Tomato juices and tomato sauce, unless labeled otherwise
3. Meat extracts, meat sauces, MSG, and taco seasoning .
4. Salted snacks (potato chips, tortilla chips, pretzels, salted nuts, popcorn, and crackers).
5. Prepared salad dressings, condiments, ketchup, Worces-tershire sauce, barbecue sauce,
cocktail sauce, teriyaki sauce, soy sauce, salsa, pickles, olives, and sauerkraut .
6. Packaged mixes for sauces, gravy, and noodle, rice, or potato dishes; macaroni and cheese;
stuffing mix .
7. Cheeses (processed and cheese spreads)
8. Frozen entrees=appetizer and pot pies.
9. Canned soup.
10. Foods eaten away from home.
The Dietary Approaches to Stop Hypertension
Description of the DASH Eating Plan
The DASH eating plan calls for less sodium,
saturated fat and added sugar and more potassium,
calcium, magnesium, fiber and lean protein.
It s a lifestyle change and a dietary pattern
designed for disease prevention and improved
health.
• High fiber(25-35 g/day), lean protein.
The theory is these nutrients work together • Eating vegetables, fruits, and whole grains
synergistically to regulate blood pressure. • Including fat-free or low-fat dairy products, fish,
poultry, beans, nuts, and vegetable oils
Even if you’re already taking high blood pressure
• Limiting foods that are high in saturated fat, such
medications, following this eating plan as fatty meats, full-fat dairy products, and tropical
can enhance your success. oils such as coconut, palm kernel, and palm oils
• Limiting salty food (2300mg. daily)
• Limiting sugar-sweetened beverages and sweets
• IT 'S work:
Two DASH variations were studied in the OmniHeart (Optimal
Macronutrient Intake Trial for Heart Health) trial, one that replaced 10% of
total daily energy from carbohydrate with protein; the other that replaced the
same amount of carbohydrate with unsaturated fat. The former had showed
better results than the latter in lowering CVD risk.(diets rich in
potassium,magnesium and cacium )(lowering blood pressure).
Imrovements in fasting blood sugars, insulin resistance , inflammatory
markers and HDL Cholesterol levels.
Decrease in triglycerides and LDL-Cholesterol levels.
How much sodium in salt?
• 1/4teaspon=600mg sodium.
• 1/2teaspon=1200mg sodium.
• 3/4teaspon=1800mg sodium.
• 1teaspon=2400mg sodium.
• 1tsp baking soda =1000mg sodium.
All salts are made with sodium choloride. (Are natural salts better than table salt?)
Lean proteins
• A serving size 3-4
• For poultry ,choose breast meat without skin.
• For beef without visible marbling(fat in the muscle), steak.
• Fresh fish
• Instead of animal protein choosing vegetable protein food
:beans,lentils,tofu,nuts,seeds and peanut butter.
Fats
• The DASH diets included about 27% of
calories from fats.
• Lower fat –non-fat dairy , limit foods that are Unsaturated
Come from plant
saturated fat (fat meat- full fat dairy products) sources
Include mono-
unsaturated –
omega3
Saturated fats:
Comes from
animal sources
,coconut and
palm oil.
Fiber
• A diet full of whole grain ,fruits , vegetables ,nuts
,seeds and legumes with naturally be high in fiber.
• Higher fiber intake, especially soluble fiber ,has been
linked with :
THE DASH eating plan
lowering high blood encourages at least 30
Lowering total cholesterol grams of fiber daily
Assisting with loss
Improving blood sugar control and insulin resistance.
Improved bowel health and lower risk of colon cancers
Calcium
• Aim for about 1250 mg daily per the DASH guidelines.
• Getting enough calcium:
Helps blood vessels and decrease blood volume.
Helps our body maintain a good sodium balance.
Helps with excreting excess sodium in urine.
NB:No enough can cause calcium to be pulled out of our bones to help meet our needs.
High calcium food sources
Dairy sources Non-dairy sources
• Low fat yogurt • Sardine
• Spinach
• Milk
• Tofu
• Cheddar cheese • Kale
• Feta cheese • Soybeans
• Cottage cheese • Broccoli
• Almonds
• Sesamme seed
• figs
Practical tips
• Using frozen fruits and vegetables more economical
• Choose snakes like fruit ,raw veggies ,yogurt and nuts.
• Add legumes to salad.
• Choose a whole grain toast ,high fiber cereal .
• Balance snacks and meals with protein and something with fiber to
help feel full.
Vegan Diet
There is ongoing
research to suggest only this
type of very restricted diet can
actually reverse ASCVD.
The Mediterranean Diet(MeD)
• The MeD dietary patterns that have been studied were
moderate in total fat (32% to 35%), relatively low in saturated
fat (9% to 10%), high in polyunsaturated fatty acids (especially
omega-3), and high in fiber (27 to 37 g per day).
• Advise adults who would benefit from LDL-C lowering to
Consume a dietary pattern that emphasizes intake of
vegetables, fruits, and whole grains; includes low-fat dairy
products, poultry, fish, legumes, nontropical vegetable oils and
nuts; and limits intake of sweets, sugar-sweetened beverages
and red meats.
• Aim for a dietary pattern that achieves 5% to 6% of calories
from saturated fat. ,Lower sodium intake
Case study
Tom is a 55-year-old single man with hypertension (blood pressure 145/92),
high low-density lipoprotein cholesterol (241), and low high- density lipoprotein
cholesterol (38) and a CRP of 4mg/L. He has a strong family history of heart disease.
He reports that he often eats in his car, so he frequents fast-food restaurants. He
works long hours and, other than gardening on the weekends, he does not
exercise. He is 5'10" and 220 lb. His breakfast is usually a cheese-egg biscuit, bacon,
and coffee without milk or cream Lunch is often a bean and cheese burrito and ice
cream. His favorite dinner is fried chicken, mashed potatoes with gravy, and pie.
