* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Heart Disease Diet - Medical Nutrition Therapy Manual
Survey
Document related concepts
Electrocardiography wikipedia , lookup
Cardiovascular disease wikipedia , lookup
Remote ischemic conditioning wikipedia , lookup
Saturated fat and cardiovascular disease wikipedia , lookup
Lutembacher's syndrome wikipedia , lookup
Cardiac contractility modulation wikipedia , lookup
Management of acute coronary syndrome wikipedia , lookup
Arrhythmogenic right ventricular dysplasia wikipedia , lookup
Heart failure wikipedia , lookup
Coronary artery disease wikipedia , lookup
Antihypertensive drug wikipedia , lookup
Dextro-Transposition of the great arteries wikipedia , lookup
Transcript
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. ● ● ● ● ● 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 ● ● ● 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 ● ● ● 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 ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● 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/