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Transcript
The
Lecture 9- 29 October 2013
Blood pressure-really it is
elevated blood pressure or
hypertension that is the focus
of our discussion today
Outline of todays talk
I.
Pathology
II.
Socioeconomic factors contributing to the disease
III. Elementary nutritional approaches to be taken to
avoid and treat these diseases including foods
available to those at risk
IV.
First Nations and other Cape Breton individuals at
risk
V.
How is nutritional assessment made for blood
pressure?
VI.
How would one assess from a nutritional perspective
the socioeconomics, pathology and success of
nutritional interventions relative to blood pressure?
Blood pressure
I. Pathology
Volume and viscosity of blood in a given
volume of arterial lumen plus arterial
pressure inwards gives blood pressure
Blood pressure-systolic
-diastolic
>140 mm Hg systolic or > 90 mm Hg
diastolic represents hypertension in
otherwise healthy persons
Blood pressure
I. Pathology
So there are really two main factors in
blood pressure
volume and viscosity of water pushing
outward
pressure of artery pushing inward
Blood pressure
I. Pathology
Decrease blood pressure:
If one can reduce water volume by
reducing blood sodium, heart rate,
stroke volume and hence cardiac
output OR
Decrease blood viscosity by reducing salt
in blood serum and cholesterol, transand saturated fats in the blood cells
Blood pressure
I. Pathology
or decrease blood pressure via:
reduction in pressure of artery by
relaxing the artery (vasodilation) and
hence reduce vasoconstriction
Socioeconomic factors
Food and hence nutritional choices depend on:
Personal preference
what foods should be avoided
what foods should be encouraged
Habit
fattening foods bring on obesity
which increases blood pressure
Food and hence nutritional choices depend on:
Ethnic heritage or tradition
which groups would avoid the offending
foods?
Social interaction
teenagers and younger children
gathering at fast food establishments
eat fattening and atherosclerosis
producing foods and eat these foods
in greater quantities due to
repeated gatherings at these
establishments
Food and hence nutritional choices depend on:
Availability of food
if only offending foods available this can
be concern
food borne pathogens(H. pylori and
cytomegalovirus) may be an issue
here- how?
Convenience of food
convenience foods are frequently
cholesterol, trans fat, saturated fat and
salt laden- what is the issue here?
Food and hence nutritional choices depend on:
Economy of food
bag of potato chips, bag of frozen fries
Positive and negative association
-child may have associations of fast foods
with pleasant experiences
-negative- examples?
Food and hence nutritional choices depend on:
Emotional conflict
elevates blood pressure on its own- this
may be coupled with lack of judgment
and eating blood pressure elevating
foods
Values
-restrictions on prepared beef, pork may
lower incidence of hypertension
-contrast this point to values that allow
prepared beef, pork
Food and hence nutritional choices depend on:
Body image
if blood pressure elevating foods are
believed to be fattening such foods may
be avoided
Advertising
fast food companies selling blood
pressure elevating foods spend lots
of money to promote via ease and price,
the use of such foods
BREAK
More on socioeconomic factors
Prestige
-occupational-not necessarily an impact on
risk or presence of hypertension in terms of
diet but there is a relation between the lower
the occupation of one’s father and oneself and
both elevated diastolic and systolic blood
pressure
More on socioeconomic factors
Prestige
-societal perceptions- may have an impact on
risk or presence of hypertension
-education- not necessarily an impact on risk
or presence of hypertension
More on socioeconomic factors
Power-may have an impact on risk or presence of
hypertension
Income-may have an impact on risk or presence of
hypertension
More on socioeconomic factors
Wealth-may have an impact on risk or presence of
hypertension
Education-may have an impact on risk or presence
of hypertension
More on socioeconomic factors
Social stratification
-ancestry-groups with certain dietary habits
-gender-males
-race-blacks
-ethnicity-see ancestry
-mobility-see convenience of foods
-mental and physical activitymental-comfort foods
physical activity-blood pressure lowered
by chronic aerobic activity
More on socioeconomic factors
Class
-uppers
-lower uppers
-upper middles
-average middles
-working class
-lower class
How might each of these classes have an impact
risk or presence of hypertension ?
More on socioeconomic factors
Global economy-bringing fast foods to the world
-obesity is becoming an issue even in the
third world
Government
-government can both help and hurt in
the fight against hypertension-how?
More on socioeconomic factors
Business-advertising, development of fast,
convenient foods and marketing them to
individuals facing the fast life profile
Psychology-comfort foods
-business uses behaviour modification
techniques to obtain business today
“you deserve a break today”
History-movement toward fast paced society and
the historical factors that have lead to that fast
pace-such factors would be?
Elementary nutritional biochemistry of
nutritional approaches that use foods
available to those at risk
Planning a healthy diet
To do this bear in mind
Adequacy
Balance
Energy control
Nutrient density
Moderation
Variety
Elementary nutritional biochemistry of
nutritional approaches that use foods
available to those at risk
Prevention-eat foods in accordance with
low salt (if salt-sensitive) and eat in
accordance with keeping blood plasma
lipids and lipoproteins to target levels
specified in the lectures on
atherosclerosis
Elementary nutritional biochemistry of
nutritional approaches that use foods
available to those at risk?
prevention-increase fruits and vegetables
and low fat foods(DASH diet)
DASH-Dietary approaches to stop
hypertension
Elementary nutritional biochemistry of
nutritional approaches that use foods
available to those at risk
Post-onset-eat foods in accordance with
low salt (if salt-sensitive) and eat in
accordance with modifying blood plasma
lipids and lipoproteins to target levels
specified in the lectures on
atherosclerosis
antioxidant vitamins and minerals
Elementary nutritional biochemistry of
nutritional approaches that use foods
available to those at risk?
post onset-increase fruits and vegetables
and low fat foods(DASH diet)
DASH-Dietary approaches to stop
hypertension
Elementary nutritional biochemistry of
nutritional approaches that use foods
available to those at risk
Prevention-obesity, salt, dietary components
detailed in the lectures on atherosclerosis to
achieve a healthy blood lipid and lipoprotein
profile
Post-onset-obesity, salt, dietary components
detailed in the lectures on atherosclerosis to
achieve a healthy blood lipid and lipoprotein
profile
BREAK
IV. First nations and other Cape Breton
individuals at risk.
Aboriginals
Retired
Unemployed
Genetics
Others?
How is nutritional assessment made for blood
pressure-prevention and cure?
Nutrient intake analysis
salt intake
dietary lipids
-saturated fat
-trans-fatty acids
-cholesterol
-other dietary components adjusted
in accordance with
recommendations made in lecture
on atherosclerosis
How is nutritional assessment made for
hypertension- prevention and cure?
Daily food record/Diary
what are potential problems with
this approach?
How is nutritional assessment made for
hypertension-prevention and cure?
Retrospective data
-24 hour recall
-food frequency questionnaire
both 24 hour recall and are used to
cross check one another-how?
How is nutritional assessment made for
hypertension--prevention and cure?
Anthropometry-focus on overweight and
obesity
skin folds
underwater weighing
bioimpedance
waist circumference
weight, height
BMI
How is nutritional assessment made for
hypertension--prevention and cure?
Nutrition focussed physical exam:
body weight and height, waist
circumference
direct blood pressure determination
headaches
dizziness
palpitations
easy fatigability
blurred vision
How is nutritional assessment made for
hypertension--prevention and cure?
Skin testing-not applicable
How is nutritional assessment made for
hypertension--prevention and cure?
Biochemical analysis
blood lipids-which raise bp
blood lipoproteins-which
raise bp
blood sodium-raises bp
blood potassium-lowers bp
blood calcium-lowers bp
blood magnesium-lowers bp
How is nutritional assessment made for
hypertension--prevention and cure?
CLASSIFYING MALNUTRITION
obesity is the main issue here
thin individuals are much less at risk than
obese persons
VI. GROUP DISCUSSION-HOW WOULD
ONE ASSESS FROM NUTRITIONAL
PERSPECTIVE THE SOCIOECONOMICS,
PATHOLOGY AND SUCCESS OF
NUTRITIONAL INTERVENTIONS
RELATIVE TO HYPERTENSION ?