Download Heart Disease Diet - Medical Nutrition Therapy Manual

Helen Diodore
KNH 413 MNT Diet
April 19, 2012
Medical Nutrition Therapy Diet-Congestive Heart Failure
1. Purpose
a. Nutrition Indicators
In patients who are at risk for, or diagnosed with CHF, nutrition indicators to monitor include:
● Blood lipids
● Weight/BMI
● Cigarette smoking
● Lipoproteins
● Hypertension BP>140/90 mm HG
● Cholesterol
○ Low HDL <40 mg
● Triglycerides.
● Fluid levels
● Hemoglobin A1C (should be less than 7%)
● Family Hx
● Men > 45 years, Women > 55 years
● CO-Q10
● L-Lysine, L-Carnitine, L-Taurine
● B-Complex Vitamins
● Vitamin C, E, Selenium
● Essential Fatty Acids (EFA’s)
Heart disease is often associated with nutritional deficiency of EFA’s, CO-Q10, amino acids, and
other vitamins. Body weight, B-blockers, and thiazide drugs, glucose tolerance, physical activity
level, exogenous steroids, and diabetes and thyroid diseases may affect cholesterol levels and
should be monitored by the dietitian in at risk patients.and Fluid retention or edema may also
be present. Saturated fatty acids, trans-fatty acids, and excessive poly-unsaturated fatty acid
(omega-6) intakes, and specifically SFA intakes are correlated to disease progression and should
be monitored in CHF.
b. Criteria to Assign the Diet
Those with metabolic syndrome, risk factors for CVD, family history of CHF, previous MI, and
diagnosis of CHF. High cholesterol levels have shown a direct correlation with an increased risk
of CHF, and lifestyle changes or drug therapy should be implemented depending on the stage of
CHF. In particular elevated LDL cholesterol levels and decreased HDL levels are problematic
and are grounds for intervention.
c. Rationale for Diet
Sodium and fluid are the primary concerns for heart failure patients because of edema and fluid
build up. CHF patients have a decreased ability to handle plasma volume, so water retention
raising BP weakens the heart muscle, increasing the risk of failure. Excess fluid intake may
increase a CHF patient’s body weight, and which may be confused with fluid retention due to
heart failure. The AHA recommends fluid be restricted to less than 2 liters (68 oz)per day. 60 oz
allows 8 oz of flex room for fluids ingested from food that the patient may not account for in
their diet.
2. Population
a. Overview
CHF failure results from cardiovascular disease and the resulting damage to the heart organ that
eventually leads to failure of some area of the heart. Primary causes are ischemic heart disease,
hypertension, and dilated cardiomyopathy. Heart disease is characterized by either right side
failure or left side failure. The difference is that right sided failure is characterized with
symptoms that result from systemic backup of the circulatory system, or failure of the left
ventricle to accept blood, and left sided failure occurs when the left ventricle loses the ability to
pump blood or to relax between beats. The general symptoms of heart failure are dyspnea,
fatigue, weakness, exercise intolerance, and poor adaptation to cold temperatures.
b. Disease Process
Typical pathophysiology of CHF begins with an injury to the heart or with left ventricle
hypertrophy that impairs overall function of the heart. The renin-angiotensin-aldosterone system
causes changes in BP to compensate for the heart damage, furthering damage. After MI cardiac
remodeling causes structural changes to the heart, resulting in a dilated left ventricular chamber.
Cardiac remodeling will occur before symptoms appear and progress even throughout treatment.
The progression of heart failure is mediated by neuro-hormanal systems, and patients typically
have elevated blood and tissue levels of norepinephrine, angiotensin II, aldosterone, endothelin,
vasoprestandem, and cytokines. Hypertension can lead to left ventricular hypertrophy impairing
contractibility, which decreases cardiac output and ejection fraction.
c. Biochemical and Nutrient Needs
B Vitamins are typically an issue with CHF patients, especially those who are prescribed to
diuretics to manage edema. Supplementation with a B-Complex vitamin is recommended.
MUFAs, resveratrol, and moderate alcohol intakes have all been associated with decreased risk
of MI in CHF patients. Plant sterols, fiber, soy protein, calcium supplementation, Vitamin E and
other antioxidants have all been shown to have positive impacts on heart health.
3. General Guidelines
a. Nutrition Rx
A 2 g sodium and 60 fl oz diet is the recommendation for patients with CHF to limit blood
sodium levels and fluid retention. A TLC Lifestyle Change would be most beneficial for CHF
patients. In addition to 2 grams of sodium and no more than 60 oz of fluid per day, the
macronutrient and fiber goals are broken down in the chart below.
b. Adequacy of Nutrition Rx
It is recommended by the Academy of Nutrition and Dietetics as well as the American Heart
Association, and numerous other reputable authorities that a diet restricting sodium and fluids
is best for CHF patients.
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c. Goals
Keep a food journal
Record daily sodium intakes in mg (<2,000 mg/day)
Record daily fluid intakes
Stop smoking if necessary
Participate in appropriate daily physical activity
d. Does it Meet DRI
The sodium restriction of 2g per day is .5 greater than the DRI of 1.5 for adults. Most Americans
consume much more sodium than the DRI however, so 2g may seem like a very small amount
when compared with the usual intakes. The 60 oz of fluid recommended is 4 fl oz less than the
DRI of 8 glasses of water a day. The 64 oz DRI is a minimum, whereas 64 oz for a CHF patient is
the absolute max, and may even be too much for certain patients.
4. Education Material
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a. Nutrition Therapy
Provide nutrition education pamphlet on a low-sodium diet with menu ideas, and ideas
for fluid restriction.
Provide older patients with hard copy of papers to use as a food journal, and direct
younger patients to a virtual food diary like fitday.com.
Give patient links or handouts of informational websites, blogs and AHA
recommendation charts.
b. Ideas for Compliance
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Develop a personalized meal plan
Work with family/friends to encourage adherence to the diet
Counsel/educate the patients family and friends on the patient’s MNT
5. Sample Menu
a. Foods Recommended
● Fresh produce
● Lean meat and fish
● Low fat dairy
● Soy milk
● Soy protein
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b. Foods to Avoid
Packaged processed foods in general
Canned soup
Baked goods
Processed meats
Cheese
Soy sauce
MSG
Baking powder/Baking soda
Whole fat dairy
Eggs
Fatty meat & poultry (w/skins)
Butter
Lard
Fried foods
Margarine
Bread with high sodium
c. Example of a meal plan
● Breakfast
Oatmeal with soymilk, blueberries, strawberries
● Lunch
Apple
Low Sodium Bread
Low Sodium Black Bean Burger w/ lettuce, tomato, red pepper hummus
● Dinner
Steamed shrimp in olive oil, no salt spices
Salad w/ carrots, diced almonds, tomatoes, reduced salt cheese & dressing
6. Websites
a. Organizations with Websites
American Heart Association (AHA):
http://www.heart.org/HEARTORG/
Mayo Clinic:
http://www.mayoclinic.com/
b. Government Websites
University of Maryland Medical Center:
http://www.umm.edu/patiented/articles/what_symptoms_of_congestive_heart_failure_0000
13_3.htm
U.S Department of Health and Human Services-Agency for Healthcare Research and Quality:
http://qualitymeasures.ahrq.gov/content.aspx?id=26564
7. References
a. Journal articles references
(2011). Heart Failure (HF) Protein Needs in Heart Failure
Patients Retrieved from
http://www.adaevidencelibrary.com/template.cfm?template=guide_summary&key=2184
&auth=1
b. Web references
(2010, January 04). Slideshare-present yourself. (2010). [0]. Retrieved from
http://www.slideshare.net/noelmd/medical-nutrition-in-cardiovascular-diseases
Fisher, D. (n.d.). Livestrong. Retrieved from
http://www.livestrong.com/article/346670-medical-nutrition-therapy-for-heart-failuretransp
lants/