NUTRITION ANALYSIS AND ASSESSMENT Seminar 8 – Nutritional Assessment in Disease Prevention Nazia...
-
Upload
harold-jenkins -
Category
Documents
-
view
227 -
download
0
Transcript of NUTRITION ANALYSIS AND ASSESSMENT Seminar 8 – Nutritional Assessment in Disease Prevention Nazia...
NUTRITION ANALYSIS AND ASSESSMENT
Seminar 8 – Nutritional Assessment in Disease Prevention
Nazia SadatRD, LDN, MS, MPH
Introduction
The prominent role of diet and nutrition in many leading causes of death for North Americans – gives nutrition an important role in disease prevention
We will discussing 3 major chronic diseases states: Coronary Heart Disease Osteoporosis Diabetes
Nutritional Assessment in Chronic Disease
• Relationship between nutrition and overall status and the prevention of chronic disease has been well documented
• Physiological changes--85% of older adults have one or more nutrition-related problem
• Most common: • obesity, diabetes, cardiovascular disease,
hypertension, arthritis, osteoporosis and malnutrition
• Conditions that require specific vitamins and minerals include: • decrease in immune function, increased gastric pH,
and increase in oxidative stress
CORONARY HEART DISEASE
Coronary Heart Disease
Coronary Heart Disease/Coronary Artery Disease Collectively known as CVD Occurs when coronary arteries supplying the
heart with oxygen and nutrients becomes narrowed and inelastic because of arthrosclerosis Artherosclerosis - is the condition in which an
artery wall thickens as the result of a build-up of fatty materials such as cholesterol.
Cardiovascular Disease
• CVD affects more than 13 million American• #1 cause of deaths in the US• Males and Females
• Claimed 616,067 lives in 2007
• Any 1 of the 50 different disease affecting the heart and blood vessels• CHD• Stroke• Peripheral vascular disease
Risk Factors of CHD
• Excess weight for height• BMI >25
• Abdominal fat (android obesity)• Low HDL• <40 mg
• Hypertension• >140/90 mm Hg
• Lipid profile• High total cholesterol, Low HDL, High LDL
• Diabetes• Physical activity• Cigarette Smoking• Family history• Gender • Age: Men >45 years Women >55 years
Question
Which Cholesterol is better, LDL or HDL?
TOTAL CHOLESTEROL
Less than 200 mg/dL Desirable
200-239 mg/dL Borderline High
240 mg/dL and above High
LDL CHOLESTEROL
Less than 100 mg/dL Optimal
100-129 mg/dL Near Optimal
130-159 mg/dL Borderline High
160-189 mg/dL High
190 mg/dL and above Very High
HDL CHOLESTEROL
More than 60 mg/dL More is better
CHD
Because cholesterol, triglycerides, and other lipids are fat soluble, they are transported in the blood by lipoproteins.
Strong causal relationship between elevated LDL and mortality from CHD As LDL increases, risk of CHD rises as well
The National Cholesterol Education Program (NCEP) has set desirable levels of total cholesterol in adults at <200mg/dL
Heart Attack Warning Signs
Heart Attack Warning Signs Chest discomfort Discomfort in other areas of the upper body
Arm, back, neck, jaw Shortens of breath Other signs
Cold sweat, nausea, lightheadedness
How is CHD Diagnosed?
Diagnosis of CHD is based on: Your medical and family history Risk factors Results of a physical exam and diagnostic
test procedures EKG (Electrocardiogram) Stress Testing Echocardiography Chest X-Ray Blood tests Electron-Beam Computed Technology Coronary Angiography and Cardiac
Catheterization
How is CHD Treated? Lifestyle Changes
Reduce high blood pressure Reduce high cholesterol
Follow a Heart Healthy Eating Plan Therapeutic Lifestyle Changes DASH Diet Increased Physical Activity Maintain a Healthy Weight Smoking Cessation Stress Reduction Medications Cardiac Rehab
Addressing High Cholesterol
Two ways of addressing high cholesterol levels Population based approach Patient based approach
Population based approach Emphasizes dietary and lifestyle changes
for people to lower cholesterol levels in the entire population
Patient based approach Identification and treatment of
individuals with elevated cholesterol levels by physicians
Dietary Factors and Cholesterol
Factors that can influence cholesterol and lipoprotein levels Saturated fats
Raise LDL cholesterol Unsaturated Fats
Polyunsaturated Fats Lower LDL and HDL
Monounsaturated Fats Lower LDL Maintain HDL cholesterol
Therapeutic Lifestyle Changes Diet • <200 mg of cholesterol per day• Limit sodium to <2400 mg per day• 25%-35% of daily calories from total fat• <7% saturated fat from total calories• PUFA upto 10% of total calories• MUFA upto 20% of total calories• Carbohydrates: 50-60% of total calories• Protein: 15% of total calories• Regular Exercise
CHD and Hypertension
Hypertension is one of the most common risk factors for cardiovascular disease and renal disease 1 in 4 Americans has hypertension or is taking
antihypertensive medications Systolic >120mm HG and diastolic >80mmg HG
increases risk for cardiovascular disease Most important risk factors for hypertension
Sodium intake Excessive energy consumption Physical inactivity ETOH consumption Inadequate potassium intake
Metabolic Syndrome
Abdominal Obesity Waist
circumference Men: >40 inches Women: >35 inches
Triglycerides >150 mg/dL
HDL cholesterol <40 mg/dL
Fasting Plasma glucose >110 mg/dL
Blood Pressure Systolic: >130 mm
Hg Diastolic: >85 mm Hg
Defined as “a person has multiple metabolic risk factors such as abdominal obesity, hypertension, insulin resistance and elevated triglycerides.
DIABETES
Diabetes
• According to the National Diabetes Information Clearing House• 23.6 million people have diabetes• 7.8% of the population have diabetes
• Risk factors for diabetes• Age >45 years• Overweight (BMI >25)• Family history• Physical inactivity• History of gestational diabetes• Hypertension (>140/90 mm Hg in adults)• PCOS• HDL <35mg/dL
Types of Diabetes
• 5 Types • Type 1: develops when the body’s immune system
destroys pancreatic beta cells, the only cells in the body that make the hormone insulin that regulates blood glucose.
• Type 2: In adults, type 2 diabetes accounts for about 90% to 95% of all diagnosed cases of diabetes. • It usually begins as insulin resistance, a disorder in which the cells
do not use insulin properly• As the need for insulin rises, the pancreas gradually loses its
ability to produce it.
• Gestational Diabetes: glucose intolerance in pregnant women
• Impaired fasting glucose: stage between normal glucose and diabetes• >100 mg/dL but <126 mg/dL
• Prediabetes: >140 mg/dL but <200 mg/dL
Nutritional Assessment of Diabetes
• Normal Blood glucose levels:• 80 – 110 mg/dL
• Nutritional assessment:• Body weight assessment• Height, Weight, BMI
• Waist Circumference• Men: >40 inches• Women: >35 inches
• blood pressure• >140/90 mm Hg
• HbA1c• Looks at blood glucose levels over a period of 3
months• <7% is good glucose control
Diabetes (continued)
• Nutritional recommendations: • Carbohydrates• Amount is more important than the source
• Protein• 15%-20% of total calories
• Fat• <7% saturated fat• <300 mg cholesterol
• Alcohol• 1 drink for women• 2 drink for men
Question?
What are the 3 most common signs of diabetes?
OSTEOPOROSIS
Osteoporosis
• Often called the “silent epidemic”• 1 in 9 or 10.29% or 28 million people in USA have
osteoporosis• 1 in 3 women over 50 will experience osteoporotic
fractures, as will 1 in 5 men • Characterized by a decrease in bone mass and
deterioration of bone tissues, without external evidence
• Visible Signs:• Deformity of the spine – widow’s hump
• Primary Osteoporosis: not related to another disease• Secondary Osteoporosis: related to another disease
– hyperthyrodism, amenorrhea
Risk Factors for Osteoporosis
Major Risk Factors Low bone mineral
density History of fractures Female >65 years of age Caucasian Menopausal women
Minor Risk Factors Impaired vision Dementia Alcoholism Physical inactivity Body weight
<127#
Bone Mineral Density
Between 20-25 years is when we achieve peak bone mass
Once peak bone mass is reached It declines at a rate of 0.3%-0.5% per year
• What can we do?• Get adequate amounts of calcium and Vit D
THROUGHOUT life• Weight-bearing exercise• Supplementation of Vit D and calcium to those with
a strong family history• Talk to a health care professional about bone
health
Question?
How many mg of calcium do 19-50 year olds need per
day?
Recommended Calcium Age Recommended
calcium intake (milligrams a day)
1–3 years 500
4–8 years 800
9–18 years 1,300
19–50 years 1,000
Older than 50 years 1,200
Any Questions?
Reminder
Quiz 8 Everything in this unit – lecture notes, readings
Project Discuss your clients risk of Coronary Heart
Disease Compare your clients current diet to the Nutrient
Composition of the Therapeutic Lifestyle Change diet
Use the MEDFICTS dietary assessment questionnaire (appendix E)