nutrition of the cardiovascular system

7/30/2019 Nutrition of the Cardiovascular System

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NUTRITION of TheCARDIOVASCULER

SYSTEM

SYARIF HUSINBLOK 10


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INTRODUCTION

In United States; 37,3% cause of death, 1 inevery 2,7 deaths.

Atherosclerosis, ischemic heart disease andhypertension is a risk factor for all otherscardiovasculer disease.

Determined cardiovasculer disease: hereditary,environmental and lifestyle.

Lifestyle: Prevention and treatment ofcardiovasculer disase.


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A. HYPERTENSION

Goal treatment: 1. Reduction risk of cardiovascular and renal

disease.

2. Reduction BP to < 140/80 mmHg ( or to130/80 mmHg with diabetes and cronic renaldisease)

Plan treatment: weight reduction, physicalactivity, nutrition therapy, pharmacologicalintervention.


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NUTRITION THERAPY

Lifestyle modification and nutritiontherapy.

Increased physical activity Smoking cessation

Weight loss

Reduction of sodium and alcohol

Consume Calsium


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NUTRITION

INTERVENTIONS

Decrease sodium, saturated fat andalcohol.

Increase calsium, potassium and fiber :efectife lowering of BP.

Sodium restriction reduce incidenceCardiovascular Disease, Renal Diseaseand Stroke.


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INCREASED PHYSICAL

ACTIVITY

DASH : Recommended 30-60 min

of aerobic minimum four days per

week


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SMOKING CESSATION

To achieve success, the smoker

should also be able to identify his

or her reasons for quitting


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WEIGHT LOSS

Weight loss of greater than 5 kg reduced bothdiastolic and systolic.

An approximate 20 lb weight loss will result inlowered systolic.

Waist circumference: independent predictor of

hypertension risk. BMI > 35 risk factor.


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REDUCTION SODIUM

The Dietary Guidelines for Americansrecommend an intake of less than 2300 mg of

sodium, equivalent 6 g sodium chloride. Terapy hypertension:

Mild : 1,52,5 g Na (3,756,25 gNaCl)

Moderate : 0,5-1,5 g Na (1,25 - 3,75g NaCl)

Severe : < 0,5 g Na ( < 1,25 g NaCl)


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EFFECTS of LIFESTYLE MODIFICATION to

MANAGE HYPERTENSION

RECOMMENDATION

Weight reduction (BMI 18,5-

24,9).

Diet rich fruits, vegetables andlow fat.

Intake sodium 2,4 g ( 6 g

sodium chloride)

Aerobic (walking) 30 min/day.

AVERAGE SYSTOLICREDUCTION

520 mmHg/10 Kg

814 mm Hg

2 - 8 mmHg

49 mm Hg


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B. ATHEROSCLEROSIS

Thickening of the blood vesselwalls specifically caused by the

presence of plaque.


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RISK FACTORS

Family history

Age

Sex

Obesity

Dyslipidemia

Hypertension

Diabetes

Physical inactivity

Smoking


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ALTERABLE RISK FACTORS

Obesity

Dyslipidemia

Hypertension

Physical inactivity

Atherogenic diet Smoking


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OBESITY

Risk factor of atherosclerosis

Waist circumference : Men >102 cm

Women > 88 cm. Abdominal fat and insulin resistance

Hypothyroidism leading to obesity : risk of

atherosclerosis Poorly managed hypothyroidism : greaterprogression of coronary atherosclerosis


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Obesity Types


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Bagaimana kegemukan

terjadi ?

Pemasukan

Pengeluaran

Rasa LaparRasa Kenyang

Penyerapan zat gizi

Aktivitas 10%Thermogenesis 20%Metabolisme Basal

70%


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DAMPAK OBESITAS

OSTEOARTHRITIS

KANKER

PENYAKIT JANTUNG KORONER

DIABETES MELLITUS

PENYAKIT HEPATOBILIAR

HIPERLIPIDEMIA

HIPERTENSI

MASALAH PERNAFASAN


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Konsekuensi Obesitas

Faktor risiko kardiovaskuler

Penyakit saluran nafas

Penyakit Jantung

Penyakit Kandung empedu

Kelaianan hormonal

Kelebihan asam urat

dan gout

Stroke

Diabetes

Osteoarthritis

Kanker


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SETTING THE GOALS

Discuss patients unrealistic goals!


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TUJUAN PENATALAKSANAAN

BERAT BADAN

Menurunkan berat badan

Mempertahankan berat badan

Mencegah peningkatan kembali BB

Mengurangi asupan lemak

Mengkonsumsi makanan yang beragam

Menurunkan tekanan darah

Mengurangi pengobatan penyakit DM

Meningkatkan aktivitas fisik


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PENATALAKSANAAN

OBESITAS

Menetapkan target penurunan BB

Pengaturan diet

Pengaturan aktivitas fisik

Mengubah pola hidup/perilaku

Peran keluarga/teman Terapi intensif


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Hindari Makanan Tinggi Kalori !!
http://www.animationfactory.com/free/animals/pigs_variant_page_pig_eating.html


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Healthy Food
http://www.animationfactory.com/free/creatures/vegieguys_variant_page_cool_carrot.html


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Sumber energi

Pembentukan dinding sel

Pembentukan hormon

Bermanfaat dalamjumlah tepatBerbahaya jika berlebih

MANFAAT KOLESTEROL

Dapat melekat pada dinding

pembuluh darah

sehingga terjadi Aterosklerosis

yang dapat mengakibatkan

PJK/Stroke

BAHAYA KOLESTEROL

BERLEBIH


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EXOGEN

ENDOGEN

DarimanaDatangnyaKolesterol ?


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Hubungan

Lemak

PJK - Stroke

E

R

AT

L E M A K :Cholesterol

Trigliserida

Cholesterol-HDL

Cholesterol-LDL


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TARGET PENURUNAN

BERAT BADAN

PENURUNAN 2,55 Kg

KECEPATAN 0,52 Kg/Bulan


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PENGATURAN DIET

DIET SEIMBANG

OBESITAS SEDANG RENDAH KALORIDAN PENGURANGAN ASUPAN KALORI30%

OBESITAS BERAT KALORI SANGATRENDAH


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PENGATURAN DIET

MENURUNKAN BERAT BADAN DANTETAP SEHAT.

DIET SEIMBANG KARBOHIDRAT 50-60%,LEMAK JENUH


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CONTOH DIET

1. DIET KALORI BILA BERAT BADAN LEBIH

- ASUPAN KALORI 25-50% KEBUTUHAN ENERGI

- MENU GIZI SEIMBANG

- PERLU AKTIVITAS DAN OLAHRAGA


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CONTOH DIET2. DIET RENDAH KOLESTEROL DAN LEMAK TERBATAS

- BATASI MINYAK KELAPA, LEMAK HEWAN,MENTEGA

- BATASI LIMPA DAN JEROAN LAINNYA

- BATASI KUNING TELUR

- TAHU, TEMPE DAN KACANG-KACANGAN

LEBIH SERING- BATASI GULA DAN MAKANAN MANISAN

- SAYURAN DAN BUAH LEBIH SERING


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JUMLAH LEMAK

< 30 % TOTAL KALORI

< 10% ASAM LEMAK JENUH

20% ASAM LEMAK TAK JENUH(CONTOH OMEGA 3 DAN 6)


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PERTIMBANGAN BM LEMAK

DAGING : TIDAK LEBIH 150 gram

POTONGAN DAGING TANPA LEMAK

AYAM TANPA KULIT < JEROAN

< UDANG

> BERBAGAI JENIS IKAN (>OMEGA 3)

> LEMAK NABATI


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PERTIMBANGAN LAIN

BAHAN OLAHAN SUSU DAN KEJU(KECUALI SUSU SKIM)

TELUR (BATASI KUNING TELUR 3XSEMINGGU)

>> BUAHAN DAN SAYURAN

SEREAL DAN ROTI SEBAGAIPENGGANTI DAGING DALAM DIET

MINYAK 6-8 SENDOK TEH/HARI


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CONTOH DIET3. DIET SERAT

- SERAT KASAR: BUAH, SAYURAN,

MAKANAN LAUT- SERAT MAKANAN: BERAS,

KENTANG, SINGKONG, KACANG IJO

DIANJURKAN 20-30 GRAM PERHARI


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PENCEGAHAN OBESITAS LIBATKAN KELUARGA

MONITOR BB & TB

BIASAKAN MAKAN PAGI

MAKANAN TINGGI LEMAK & GULA (-)

BIASAKAN MAKAN BUAH & SAYUR

HINDARI SNACK MENINGKAT KAN KALORI

HINDARI FAST FOODS DALAM KULKAS

TINGKATKAN AKTIFITAS FISIK & KURANGI NONTON TV

BIASAKAN POLA MAKAN SEIMBANG


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TERAPI OBESITAS

DIET

MAKAN TERATUR (GIZI SEIMBANG)

KURANGI MAKAN (SUMBER KALORI)

KURANGI MINYAK, LEMAK & SANTAN

KURANGI GULA

BANYAK BUAH & SAYUR (SERAT) HINDARI ALKOHOL


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Pada PenampilanMeningkatkan rasa percaya diriLebih ekonomis dan lincah

Meningkatkan kepuasan diri

Pada EstetikaMenjadi MACAN

Pada Status Kesehatan

Dengan turun BB 5-10% saja (dari BB awal)dapat mengurangi risiko beberapa penyakit yang

terkait dengan kegemukan (DM, jantung koroner,

hipertensi, stroke dll)

Efek Penurunan Berat Badan


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INCREASING PHYSICAL

ACTIVITY

Lowering blood pressure and

triglycerides. Increasing HDL

Improving endothelial fucntion

Decreasing platelet aggregation

E r i


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Exercise:Motivasi Keluarga dalam Berolahraga

GAT A A T TAS


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PENGATURAN AKTIVITAS

FISIK Jenis : Jogging, jalan, sepeda, renang

Frekuensi: 3-5 kali seminggu

Intensitas: Nadi 110-140 x/meni

Waktu : 30-60 menit

Makan & minum secukupnya

Diawali dengan pemanasan dan diakhiri denganpendinginan


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ATHEROGENIC DIET

Westernized diet : high saturated

fat and low fiber.

Palembang diet ?


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SMOKERS

Higher levels of serum cholesterol, triglyceridesand LDL cholesterol.

Lower HDL cholesterol

Endothelial dysfucntion, inflammation andmodification of lipids

Nitric oxide : endothelial relaxasion.

Inflammatory : increased leukocyte count andproinflammatory cytokines


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ATP III GUIDELINES

STEP 1Determine lipoprotein levels (lipoprotein profile)

STEP 2Identify presence of clinical atherosclerotic disease thatconfers high risk for coronary heart disease (CHD)events (CHD risk equivalent):

Clinical CHD

Symptomatic carotid artery diseasePeripheral arterial disease

Abdominal aortic aneursym


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ATP III next

STEP 3

Determine presence of major risk factors (otherthan LDL): Major risk factors (Exclusive ofLDL Cholesterol) that Modify LDL Goals.

Cigarette smoking.

Hypertension (BP140/90 mmHg or on

antihypertensive medication).

Low HDL choselterol (


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ATP III next

STEP 3

Family history of premature CHD (CHD in malefirst degree relative


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ATP III next

STEP 4

If 2 + risk factors (other than LDL) are presentwithout CHD or CHD risk equivalent, asses 10

year (short term) CHD risk.

Three levels of 10-year risk:

> 20% --- CHD risk equivalent

1020%

< 10%


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ATP III next

STEP 5

Determine risk category

Establish LDL goal of therapyDetermine need for Therapeutic

Lifestyle Changes (TLC)

Determine level for drug consideration

QUIDELINE THERAPY


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QUIDELINE THERAPY

Risk category

CHD orCHD RiskEquivalent

(10-yearrisk>20%)

LDL goal

< 100 mg/dl

LDL+TLC

100mg/dl

LDL+Drug

130/mg/dl

(100-129mg/dl

+drug)

2 + Risk

factors(10-year risk20%)

< 130 mg/dl 130 mg/dl 10-year risk

10-20%:130mg/dl

10-year risk


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QUIDELINE THERAPY

Risk category

0-1 Risk

Factor

LDL goal

< 160 mg/dl

LDL + TLC

160 mg/dl

LDL+Drug

190mg/dl

(160-189mg/dl: LDLloweringdrug


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ATP III next

STEP 6

Initiate therapeutic lifestyle changes (TLC) ifabove goal

TLC diet :

Saturated fat < 7% of cal, cholesterol < 200 mg/day

Consider increased viscous (soluble) fiber (10-15

g/day) and plant stanols/ sterols (2 g/day) astherapeutic options to enhance LDL lowering

Weight management

Increased physical activity


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ATP III next

STEP 7Consider adding drug therapy if LDLexceeds levels shown in step 5 table :

Consider drug simultaneously with TLCfor CHD and CHD equivalents

Consider adding drug to TLC after 3months for other risk categories

ATP III next


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ATP III next

STEP 8

Identify metabolic syndrome and treat, if present, after 3 monthsTLCClinical Identification of the Metabolic SyndromeAny 3 of therisk factors defined

Treatment of the metabolic syndrome

a. Treat underlying causes (overweight/obesity and physicalinactivity)

Intensify weight managementIncrease physical activity

b. Treat lipid and non-lipid factors if they persist despite theselifestyle therapies:

Treat hypertensionUse aspirin for CHD patients to reduce prothrombotic state

Treat elevated triglycerides and/or low HDL (as shown in step 9

below)

ATP III next


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ATP III next STEP 9

Treat elevated triglycerides

ATP III Classification of serum Triglycerides< 150 Normal150-199 Borderline high200-499 High

500 Very highTreatment of elevated triglycerides (150mg/dl)Primary aim of therapy is to reach LDL goalIntensify weight managementIncrease physical activityIf triglycerides are200 mg/dl after, LDL goal is reached, setsecondary goal for non-LDL cholesterol (total-HDL)30 mg/dlhigher than LDL goalComparison of LDL cholesterol and non-HDL cholesterol goals

for three risk categories

Step 9 next


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Step 9 next

Risk category

CHD and CHDRisk

Equivalent(10-years risk forCHD >20%)

LDL goal (mg/dl)

< 100

Non HDL Goal

(mg/dl)


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STEP 9 next

If triglycerides 200-499 mg/dl after LDL goal is reached,

consider adding drug if needed to reach non-HDL goal:

Intensify therapy with LDL - lowering drug, or

Add nicotinic acid or fibrate to further lower VLDL

If triglycerides 500 mg/dl, first lower triglycerides toprevent pancreatitis :

Very- low- fat diet (15% of calories from fat)

Weight management and physical activity Fibrate or nicotinic acid

When triglycerides < 500 mg/dl, turn to LDLlowering therapy


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STEP 9 next

Treatment of low HDL cholesterol (


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C. ISCHEMIC HEART DISEASE

Nurition Implications

Immediate medical care after MI

strives to reduce pain, stabilize cardiacfunction and when appropriate, beginthe rehabilitation post MI. Nutrition

therapy after MI will be consistent

with these medical goal.


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IHD next

Nutrition interventions Many institutions treatment protocols limit

initial oral intake to clear liquids with out

caffeine in order to prevent arrytmias and todecrease risk of vomiting or aspiration.

Oral diets usually progress from liquids to soft,

easily chewed foods with smaller, more frequentmeals.

Therapy lifestyle.


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D. HEART FAILURE

Nutrition implications

Nutritional care during CHF is difficult.

Nutritional therapy that restricts bothsodium and fluid is crucial to control acute

symptoms and may assist with reducing

with the overall work of the heart. Difficulty eating and cardiac cachexia.


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CACHEXIA in HF

Cachexua in HF include myocardial nutrientdeficiencies of:

L-carnitine

Coenzyme Q10

Creatine

Thiamine Taurine


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Nurition interventions

Restrictions sodium and fluid.

Correction of nutrient deficiencies.

Nutrition education for increasing nutrientdensity and making food choice that enhanceoral intake.

Sodium 2000 mg (Standard initialrecommendation).

Fluid requirement 1 ml/kcal or 35 ml/Kg BB.


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E. STROKE and ANEURYSM

Enteral nutrition support will be

necessary if an oral diet cannot meet

nutritional needs. Evidence support early initiation of

nutritional support to prevent

complications, reduce hospital stay andpromote rehabilition.


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nutrition of the cardiovascular system

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