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MEDICAL NUTRITION THERAPY OF CARDIOVASCULAR DISEASES
CARDIOVASCULAR DISEASES
Cardiovascular diseases or CVD is a general term used for diseases of the heart or blood vessels
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The build of fatty deposits in the arteries
increases the potential risk of blood clot formation
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Atherosclerosis- narrowing of small blood vessels responsible for the oxygenation of
blood muscles, by the accumulation of plaque
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Coronary Heart Disease – including angina, heart attack and heart failure
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Strokes and Transient Ischemic Attack
(TIA) – blood supply to the brain is topped,
causing brain damage and eventually death
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The exact causes of cardiovascular diseases are still
being studies but there are certain risk factors that increase the chances of developing anyone of
these conditions
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However the most significant factor that can put pone at risk for CVD is diet
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DIETARY MANAGEMENT OF CARDIOVASCULAR DISEASE
Cardiovascular diseases are the leading cause of death around the globe
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In some cases, such as in children, even
medical management can be limited
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The main focus in the dietary management of CVD is to decrease the intake of
unhealthy fats, such as saturated fats, and increase the intake of fruits, vegetables and healthy
fats
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Lipids that
contain cholesterol include Low Density Lipoproteins (LDL) and High Density Lipoproteins
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(HDL)
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Therefore, the first
step in dietary management of CVD is to lower the intake of foods that can contribute in elevated
LDL in the body
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These include the
Mediterranean diet, vegan diet and DASH diet
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Mediterranean diet:
There is no specific definition of the Mediterranean diet
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The Mediterranean diet or the ‘Med
Diet’ varies by country and region but in general, it's high in vegetables, fruits, legumes,
nuts, beans, cereals, grains, fish, and unsaturated fats
such as olive oil
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The main emphasis in this diet is
on the intake of polyunsaturated fats such as omega-3
fatty acids, whereas saturated and trans-saturated acids
are restricted
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Lean meat is
taken more as compared to red meat and processed
foods, sugar beverages are totally avoided
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By following this diet, the intake of saturated fats,
responsible for increasing LDL levels in body, as well
as sodium and simple sugars are reduced
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Research suggest that vegan diet has benefits when it comes to controlling the risk of
CVD
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Since vegan diet excludes all foods from animal
sources, the intake of processed foods and saturated fatty
acids is extremely minimal
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However, if
this diet is not followed under the supervision of a
registered dietitian or nutritionist, it can lead to
deficiencies of various nutrients such as calcium, vitamin
D and protein etc
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DASH diet:
DASH stands for Dietary Approaches to Stop
Hypertension
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The DASH
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eating plan requires no special foods and instead provides daily and weekly nutritional
goals
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This diet
also includes limiting foods that are high in saturated fat, such as fatty meats, full-fat
dairy products, and tropical oils such as coconut, palm kernel, and palm oils as well as
sugar-sweetened beverages and sweets
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These are:
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Saturated fat intake
should be lowered, which can be achieved by lowering the intake of animal based
proteins such as red meat or high fat dairy products
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Increasing fiber intake:
Every diet suggested to patients with CVD puts a heavy emphasis on the intake of fruits,
vegetables, whole grains and legumes
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This is either
because fiber binds bile acids lowering serum cholesterol or gut bacteria ferment fiber,
producing acetate, propionate and butyrate inhibiting the synthesis of cholesterol
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Hence they aid in lowering
LDL and in preventing the risk of CVD
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These include:
Eat a variety of fruit and vegetable servings every day
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Examples include spinach, carrots,
peaches, and berries
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Include whole-grain foods that have lots
of fiber and nutrients
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Eat foods low in saturated and trans-fatty acid
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DASH DIET
DASH stands for Dietary Approaches to Stop Hypertension
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This diet includes foods that are rich in
potassium, calcium and magnesium
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The diet limits
foods that are high in sodium, saturated fat and added sugars
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Studies have shown that
the DASH diet can lower blood pressure in as little as two weeks
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High blood pressure and high LDL cholesterol levels are two major
risk factors for heart disease and stroke
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Lowers metabolic syndrome risk: Some studies note that the DASH diet reduces your
risk of metabolic syndrome by up to 81%
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Some
studies demonstrate that it can improve insulin resistance as well
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Recommended Servings In DASH Diet:
The recommended servings from each food group for a
2,000-calorie-a-day DASH diet:
Grains: 6 to 8 servings a day
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Fruits: 4 to 5 servings a day
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Lean meats, poultry and fish: six 1-ounce
servings or fewer a day
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Fats and oils: 2 to 3 servings a day
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Diet Plan
Breakfast
Whole Wheat Bread
(2 Slices)
Boiled Egg
(1)
Banana
(1 Medium)
Fresh Grape Juice
(1/2 Cup)
Snack
Apple
(1 medium)
Lunch
Ceaser Salad-1 cup

Snack

Strawberry smoothie 1 cup

Dinner
Chicken Gravy -2 oz
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However, in general, individual dietary components have been the predominant focus
because foods are consumed typically in combinations rather than individually and because of the
possibility of synergist relationships between nutrients, there has been increasing attention to
dietary patterns and their relationship to health outcomes such as CVD
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The Mediterranean 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 omega3), and high in fiber (27 to 37 g per day)
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Two DASH variations were studied, one that
replaced 10% of total daily energy from carbohydrate with protein; the other that replaced the same
amount of carbohydrate with unsaturated fat
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Vegan Diet
A vegan diet is a strict vegetarian diet that includes no dietary sources from animal origins
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Lifestyle Recommendations
Weight Loss
More than 78 million adults in the United States were obese in 2009 to 2010, and obesity raises
the risk of hypertension, dyslipidemia, type 2 diabetes, ASCVD, and stroke
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Physical Inactivity
Physical inactivity and a low level of fitness are independent risk factors for ASCVD
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With the high prevalence of obesity, physical activity
is a high priority
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Their recommendation based
on the evidence is for three to four sessions of aerobic
exercise per week for an average of 40 minutes
duration
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The stress hormone angiotensin II is released after stimulation
of the sympathetic nervous system (SNS); exogenous infusion of angiotensin II accelerates the
formation of plaque
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Foods to Eat and Avoid
Saturated Fatty Acids
The recommendation for decreasing LDL cholesterol is 5% to 6%
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Saturated fat is generally found
in animal proteins
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Trans Fatty Acids
Trans fatty acids (stereoisomers of the naturally occurring cis-linoleic acid) are produced in the
hydrogenation process used in the food industry to increase shelf life of foods and to make
margarines, made from oil, firmer
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This was based on the mounting evidence that Trans fats contributed

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to ASCVD and was associated with increased LDL cholesterol levels
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Monounsaturated Fatty Acids
Substituting oleic acid for carbohydrate has almost no appreciable effect on blood lipids
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Oleic acid as part
of the Mediterranean diet has been shown to have anti-inflammatory effects
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Large amounts of LA decrease
HDL serum cholesterol levels
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Replacing
PUFAs for carbohydrate in the diet results in a decline in serum LDL cholesterol
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Overall,
eliminating SFAs is twice as effective in lowering serum cholesterol levels as increasing PUFAs
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The
recommendation for the general population is to increase fish consumption specifically of fish high
in omega-3 fatty acids (salmon, tuna, mackerel, and sardines)
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Omega-3 fatty acids lower triglyceride levels by inhibiting VLDL and Apo B-100 synthesis,
thereby decreasing postprandial lipemia
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The US Dietary Guidelines also eliminate the
recommendation to restrict cholesterol
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Fiber
High intake levels of dietary fiber are associated with significantly lower prevalence of ASCVD
and stroke
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This combination
of foods provides a combination of soluble and insoluble fiber
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Foods with concentrated amounts of antioxidants are found in phytochemicals known
as catechins and have been found to improve vascular reactivity
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HYPERTENSION
Dietary Recommendations
DASH Diet
The DASH diet is used for preventing and controlling high blood pressure
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Salt Restriction
In addition to advice to select minimally processed foods, dietary
counseling should include instruction on reading food labels for
sodium content, avoidance of discretionary salt in cooking or meal
preparation and use of alternative flavorings to satisfy individual taste
Because most dietary salt comes from processed foods and eating
out, changes in food preparation and processing can help patients
reach the sodium goal
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The recommended intake of potassium for adults is 4
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Potassium rich fruits and vegetables include leafy green vegetables, fruits, and root
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vegetables
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Lipids
Current recommendations for lipid composition of the diet are recommended to help control
weight and decrease the risk of CVD
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Lifestyle Recommendations
Exercise
Moderate to-vigorous aerobic activity such as brisk walking done at least three to four times per
week, lasting on average 40 minutes per session, is recommended as an adjunct therapy in
hypertension management
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For substantial health benefits, the dietary guidelines recommends at least 2 hours and 30
minutes a week of moderate-intensity physical activity as well as muscle-strengthening activities
that include all major muscle groups on 2 or more days
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Because exercise is associated strongly with success in weightreduction and weight-maintenance programs, any increase in activity level should be encouraged
for those trying to lose weight
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HEART FAILURE
Dietary recommendations
The total diet must be addressed in patients with HF because underlying risk factors are often
present; dietary changes to modify these risk factors are an important component of MNT
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For persons with hypertension, the DASH diet is recommended
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Salt Restriction
Patient compliance with sodium restriction of 2 g/day has been shown to be poor

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