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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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The first step is to minimize or eliminate the use of table salt and high-sodium foods
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Lack of cooking skills or adequate cooking facilities is another obstacle because
it leads patients to eat premade foods that tend to be high in salt
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In addition, food labels,
although informative, may be hard for many patients or their caregivers to comprehend
Caffeine
Until now caffeine has been considered detrimental to patients with HF because it contributes to
irregular heartbeats
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The antioxidant effects of
coffee and tea may be beneficial
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Cachectic HF patients have lower bone mineral density and lower calcium levels
than HF patients without cachexia
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Fats
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Fish consumption and fish oils rich in omega-3 fatty acids can lower elevated triglyceride levels
and may prevent atrial fibrillation in HF patients
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Some evidence suggests that high saturated fat feeding in mild to moderate HF preserves
contractile function and prevents the switch from fatty acid to glucose metabolism, thus serving a
cardio protective role
Folate
Vitamin B6 and Vitamin B12 High dietary intakes of folate and vitamin B6 have been associated
with reduced risk of mortality from HF and stroke in some populations
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Magnesium
Magnesium deficiency is common in patients with HF as a result of poor dietary intake and the
use of diuretics, including furosemide
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Magnesium deficiency aggravates changes in electrolyte concentration by
causing a positive sodium and negative potassium balance
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Poor dietary intake of magnesium has been associated with elevated CRP, a product of
inflammation
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Thiamin
Patients with HF are at risk for thiamin deficiency because of poor food intake; use of loop
diuretics, which increases excretion; and advanced age
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Therefore, thiamin deficiency can
cause decreased energy and weaker heart contractions
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Thiamin supplementation (e
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, 100 mg/day) can improve left
ventricular ejection fraction (fraction of blood pumped out of the
ventricles with each heartbeat) and symptoms
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As a steroid
hormone, vitamin D regulates gene expression and inversely regulates
renin secretion
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Life Style Recommendations

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The energy needs of patients with HF depend on their current dry weight, activity restrictions, and
the severity of the HF
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However, the nutrition status of the obese patient must be assessed to ensure that the patient is not
malnourished
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Another study found lower calorie needs when compared
with healthy controls
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Standard nutritional assessment should be
employed with careful monitoring

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