HYPERLIPIDEMIA

• Excessive amounts of fats in the blood.

• Hyperlipidemia, hypertension (high blood pressure), and smoking are
major risk factors for the development of atherosclerosis.
MEDICAL NUTRITION THERAPY FOR HYPERLIPIDEMIA

• It involves reducing the quantity and types of fats and often calories in the diet.

• In overweight persons, weight loss alone will help reduce serum cholesterol levels.
• The American Heart Association categorizes blood cholesterol levels of 200 mg/dl

or less to be desirable, 200 to 239 mg/dl to be borderline high, and 240 mg/dl and

greater to be high.
In an effort to prevent heart disease, the American
Heart Association has developed guidelines in
which it is recommended that adult diets contain
• less than 200 mg of cholesterol per day
• and that fats provide no more than 20% to 35%
of calories,
• with a maximum of 7% from saturated fats and
trans fat,
• a maximum of 8% from polyunsaturated fats,
• and a maximum of 15% to 20% of
monounsaturated fats.
• Carbohydrates should make up 50% to 55%
of the calories and proteins from 12% to 20%
of them.
• In a fat-controlled diet, one must be particularly careful when using

animal foods.

• Studies indicate that water-soluble fiber, such as that found in oat bran,

legumes, and fruits, bind with cholesterol-containing substances and

prevent their reabsorption by the blood.

• It is thought that 20 to 25 grams of soluble fiber a day will effectively

reduce serum cholesterol by as much as 15%.

• This is a large amount of fiber and must be introduced gradually to the diet

along with increased fluids or the client will suffer from flatulence.

• Table 18-2 lists foods to limit on a low-cholesterol diet.

• If appropriate blood lipid levels cannot be attained within 3 to 6 months by

the use of a fat-restricted diet alone, the physician can prescribe a

cholesterol-lowering drug such as atorvastatin (Lipitor) or simvastatin

(Zocor).
• Food and/or drug interactions can occur with cholesterol-lowering drugs,

as well as with other cardiac drugs.

• For example, Zocor and Lipitor interact with grapefruit and its juice;

therefore total avoidance is necessary.

 MYOCARDIAL INFARCTION

• Myocardial infarction is caused

by the blockage of a coronary

artery supplying blood to the

heart.

• After the attack, the client is in

shock.
• This causes a fluid shift, and the • After several hours, the client

client may feel thirsty. The client may begin to eat.

should be given nothing by mouth • A liquid diet may be

(NPO), however, until the physician recommended for the first 24
evaluates the condition. hours.

• If the client remains nauseated after • Following that, a low-

the period of shock, IV infusions are cholesterol– low-sodium diet is
given to prevent dehydration. usually given, with the client
regulating the amount eaten.
• Foods should not be extremely hot or extremely cold. They should be easy
to chew and digest and contain little roughage so that the work of the
heart will be minimal.
• Both chewing and the increased activity of the gastrointestinal tract that
follow ingestion of high-fiber foods cause extra work for the heart.
• The percentage of energy nutrients will be based on the particular needs of
the client, but, in most cases, the types and amounts of fats will be limited.
• Sodium is usually limited to prevent fluid accumulation. Some physicians

will order a restriction on the amount of caffeine for the first few days after

an MI.

• The dual goal is to allow the heart to rest and its tissue to heal.
 HYPERTENSION

• When blood pressure is chronically high, the condition is called

hypertension (HTN).

• In 90% of hypertension cases, the cause is unknown, and the condition is

called essential, or primary, hypertension.

• The other 10% of the cases are called secondary hypertension because the

condition is caused by another problem.

• Some causes of secondary hypertension include kidney disease, problems

of the adrenal glands, and use of oral contraceptives.

• Hypertension contributes to heart attack, stroke, heart failure,

and kidney failure.

• The blood pressure categories are the following:

 MEDICAL MANAGEMENT

The three objectives for evaluating patients with hypertension are

to;
1. Identify the possible causes
2. Assess the presence or absence of target organ disease and
clinical CVD
3. Identify other CVD risk factors that help guide treatment.
The presence of risk factors and target organ damage determines
treatment priority.
Lifestyle modifications are definitive therapy for some and
adjunctive therapy for all persons with hypertension.
• A number of medications either raise blood pressure or
interfere with the effectiveness of antihypertensive drugs.
These include;
• Oral contraceptives
• Steroids, non-steroidal anti-inflammatory drugs (NSAID)
• Nasal decongestants and other cold remedies
• Appetite suppressants
• Cyclosporine,
• Tricyclic antidepressants, and
• Mono amineoxidase inhibitors
• Diuretics lower blood pressure in some patients by
promoting volume depletion and sodium loss.

• At high doses other water soluble nutrients are also lost and
may have to be supplemented.
• Thiazide diuretics increase urinary potassium excretion,
especially in the presence of a high salt intake, thus leading
to potassium loss and possible hypokalemia.
• Except in the case of a potassium sparing diuretic such as
spironolactone or triamterene, additional potassium usually
is required.
• Grapefruits and grapefruit juice can affect the action of
many of the calcium channel blockers and should not be
consume while taking the medication.
 MEDICAL NUTRITION THERAPY

• The appropriate course of nutrition therapy for managing hypertension should

be guided by data from a detailed nutrition assessment.
• Weight history;

• leisure-time physical activity;

• and assessment of intake of sodium, alcohol, fat type (e.g., MUFA versus
SFA),
• and other dietary patterns (e.g., intake of fruits, vegetables, and low-fat dairy
products) are essential components of the medical and diet history.
• Nutrition assessment should include evaluation of the individual in the

following specific domains to determine nutrition problems and diagnoses:

food and nutrient intake; knowledge, beliefs, and attitudes; behavior;

physical activity and function; and appropriate biochemical data.

• Following are the components of the current recommendations for

managing elevated blood pressure.

 ENERGY INTAKE

• A modest caloric reduction is associated with a significant lowering of SBP

and DBP, and LDL cholesterol levels.

• Hypocaloric diets that include a low-sodium DASH dietary pattern have

produced more significant blood pressure reductions than low-calorie diets

emphasizing only lowfat foods.

• Another benefit of weight loss on blood pressure is the synergistic effect

with drug therapy.

• Weight loss should be an adjunct to drug therapy because it may decrease

the dose or number of drugs necessary to control blood pressure.

 DASH DIET

• Successful adoption of this diet requires many behavioral changes: eating

twice the average number of daily servings of fruits, vegetables, and dairy

products; limiting by one third the usual intake of beef, pork, and ham;

eating half the typical amounts of fats, oils, and salad dressings; and eating

one quarter the number of snacks and sweets.

• Lactose-intolerant persons may need to incorporate lactase enzyme or use

other strategies to replace milk.

• Assessing patients’ readiness to change and engaging patients in problem

solving, decision making, and goal setting are behavioral strategies that

may improve adherence.

• The high number of fruits and vegetables consumed on the DASH diet is a
marked change from typical patterns of Americans.
• To achieve the 8 to 10 servings, two to three fruits and vegetables should
be consumed at each meal.
• Importantly, because the DASH diet is high in fiber, gradual increases in
fruit, vegetables, and whole-grain foods should be made over time.
• Eight to 10 cups of fluids daily should be encouraged.
• Slow changes can reduce potential short-term gastrointestinal disturbances
associated with a high-fiber diet, such as bloating and diarrhea.
 SALT RESTRICTION

The Dietary Guidelines for Americans recommend that young adults consume
less than 2300 mg of sodium per day.
Mild Sodium Restriction (3 to 5 Grams Daily)
• This is a regular diet that omits only salty foods and the use of salt at the
table.
• Salt may be used lightly in cooking; for example, use half the amount stated
in the recipe.
• This diet is used frequently after discharge from the hospital, when edema is
under control.
• Moderate Sodium Restriction (1000 Milligrams Daily)

• This diet is used both in the hospital and at home. In addition to avoiding

the foods indicated for the 3- to 5-gram sodium diet, the diet has the

following restrictions:

1. No more than 2 c milk per day.

2. No more than 5 oz meat per day. One egg may be substituted for 1 oz

meat.
3. No salt in cooking.

4. Bread and butter beyond three servings daily should be unsalted.

5. No commercial mixes or regular canned vegetables.

• Strict Sodium Restriction (500 Milligrams Daily)
• This diet is used primarily for hospitalized patients, though it may
be followed at home.
• The restrictions, however, result in low patient compliance except in
a hospital setting.
• In addition to the restrictions indicated for 3- to 5-gram and 1000-
mg sodium diets, two other restrictions are required to lower the
dietary sodium to 500 mg:
1. No bread and butter that has salt added
2. No vegetables that are naturally high in sodium content
• Severe Sodium Restriction (250 Milligrams Daily)
• The substitution of low-sodium milk for regular milk in the 500-mg
sodium diet will lower the dietary sodium content to 250 mg.
• The Exchange Lists for Meal Planning, issued by the American Dietetic
Association and the American Diabetic Association (see Appendix F), may
be modified for the various levels of sodium restriction.
• This booklet is a helpful tool for diet planning, particularly when a caloric
or fat modification is also necessary.
• Some drinking water is high in sodium, especially if water softeners are

used.

• Patients on low-sodium diets should ascertain their drinking water’s

sodium content and, if necessary, use distilled water.

• Many drugs, both prescription and over-the-counter, contain high levels of

sodium. Patients need to be made aware of these.

 POTASSIUM-CALCIUM-MAGNESIUM

• Consuming a diet rich in potassium may lower blood pressure and blunt
the effects of salt on blood pressure in some individuals (Appel et al,
2006).
• The recommended intake of potassium for adults is 4.7 g/day (IOM, 2004).
• Potassium rich fruits and vegetables include leafy green vegetables, fruits,
and root vegetables. Examples of such foods include oranges, beet greens,
white beans, spinach, bananas, and sweet potatoes.
• Although meat, milk, and cereal products contain potassium, the potassium
from these sources is not as well absorbed as that from fruits and
vegetables (USDA, 2010).
• Increased intakes of calcium and magnesium may have blood pressure
benefits, although there are not enough data to support a specific
recommendation for increasing levels of intake (AND, 2009).
• Rather, recommendations suggest meeting the AI intake for calcium and
the recommended dietary allowance for magnesium from food sources
rather than supplements.
• The DASH diet plan encourages foods that would be good sources of both
nutrients, including low-fat dairy products, dark green leafy vegetables,
beans, and nuts.
 LIPIDS

• Current recommendations for lipid composition of the diet are

recommended to help control weight and decrease the risk of CVD.

• Omega-3 fatty acids are not highlighted in blood pressure treatment

guidelines (AND, 2009), although intakes of fish oils exceeding 2 g/day

may have blood pressure benefits.

 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